telemedicine provider, began their partnership. The local delivering hospital had no maternal fetal physician specialist but
did have OB hospitalists that introduced the two organizations. Lack of MFM resources, revenue opportunities, improved access, decreased expense to patients and technology
mindsets drove them to achieve remarkable results together.
Methods: To accomplish the goal, the partners overcame
barriers of telemedicine adoption, clinical workflow disruption, technology integration and patient acceptance. Strategies included:
Telemedicine adoption:
“Live” demos of similar MFM telemed programs
Joint ROI development
Education sessions
Disruptive clinical workflow:
Training an onsite, dedicated telehealth coordinator
Development of Clinical Collaborative Agreement
MFM patient appointment “blocks” (if non-urgent)
New/Legacy Technology Integration:
Legacy ultrasound use
T1 line installation
WT supplied telemed cart under “Rent Back”
Agreement
EMR integration from referral to consult results
Patient Engagement:
Joint marketing collateral and a “Trial” mentality
Results: The program was “live” within 60 days of agreement
execution and has existed for 15 months (as of 3/31/16). A
total of 1656 MFM telemedicine encounters (store-andforward, hybrid and “live scanning”) have been completed.
Benefits include: continuity of care, high patient satisfaction,
decreased costs for patients, market differentiation, faster
MFM access and increased revenue.
Conclusion: Through commitment to mutual goals, keeping
patient care foremost, and problem solving together, the two
organizations were able to create a sustainable, high quality
and unique service using telehealth technologies.
19. Adoption of Telerehabilitation by
Older Adults: the Validation of a
Survey Instrument
Robert W. Nithman, PT, DPT, GSC, COS-C
Midwestern University
Background: The practice of telerehab can refer to any remote assessment, monitoring, or intervention performed by a
licensed occupational therapist, physical therapist, or speechlanguage pathologist. While telehealth may be a welcome
option for some individuals, little is known about the attitudes
and beliefs of older adults with regard to receiving telecom-
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munications-aided healthcare services and whether or not
those attitudes and beliefs will be influenced by a telerehab
experience. Older adults, as end users, may not be receptive
to the use of real-time telehealth delivery systems. No surveys specific to telerehabilitation are found in the literature.
Methods: Appraisal of the literature revealed seven constructs that will depict an older adult's attitude toward using a
system and their behavioral intention to use a system. Evidenced-based constructs are as follows: performance expectancy/perceived usefulness, effort expectancy, social influence, facilitating conditions, perceived security, computer
anxiety, and physicians' opinion. A panel of healthcare providers and technology experts that included one communitydwelling older adult were then assembled to assist with survey construction and content validation. Results: The expert
panel completed two reviews of this survey tool; content validity indices are being calculated based upon final panelist
responses for each item: essential, useful but not essential,
not necessary.
Conclusions: This 7-point Likert scale survey tool is methodologically superior to other telehealth surveys found in the
literature. Survey construction is evidence-based and the first
of its kind to measure prospective telerehabilitation use in
older adults.
20. Diagnosis of Acute Abdomen by e-Visit:
A Physician-guided Exam for
Suspected Diverticulitis
Rachel Nordstrom, BS1,2, Justin Fazio, BS, MS1,2,
Priya Radhakrishnan, MD, FACP2
1
Creighton University School of Medicine,
2
St. Joseph’s Hospital & Medical Center
Background: Traditionally, telemedicine provides the opportunity to bring subspecialists to underserved and rural areas,
provide "e-visits" for urgent care, and more recently, to improve compliance in patients with chronic disease. The application of telemedicine to the diagnosis and treatment of
acute abdomen presentations has been limited. In this report,
we describe the use of telemedicine for physician assessment
of a patient presenting with diverticulitis.
Methods: 48-year-old female with a past medical history of
hypothyroidism presented to the physician by e-visit with one
day of acute right lower quadrant pain. The pain worsened
with deep breathing. She denied nausea or vomiting or any
changes in her bowel movements. On review of systems, she
denied fever, chills, weakness, weight loss, visual changes,
chest pain, edema, shortness of breath, dyspnea on exertion,
diarrhea, heartburn, blood in stool, dysuria, hematuria, frequency, nocturia, and abnormal vaginal bleeding. T 36/HR 60/
RR 12/ BP 114/73. On guided physical exam, patient had ten-