Introduction to Telehealth and Using Telehealth to Improve Access in Health Centers

1
Introduction to Telehealth and Using Telehealth
to Improve Access in Health Centers
BPHC ALL-GRANTEE MEETING Gaylord National Resort
Convention Center National Harbor,
Maryland June 24, 2008

• Dena S. Puskin, Sc.D.
• U.S. Department of Health and Human Services
• Health Resources and Services Administration
• Office of Health Information Technology
• Office for the Advancement of Telehealth

2
Telehealth vs. Telemedicine
Telehealth
Regional Health Inform. Sharing
Telemedicine
Health Professions Education
Consumer Education
Administration
Public Health
Evaluation Research
Homeland Security
3
Educational and Administrative Uses

• Continuing education
• Patient education
• Administrative meetings

Providers can receive continuing education
without the need to travel.
4
Real-Time Telemedicine
Patient in rural ER gets benefit of local care
plus remote consultation with specialists.
Remote doctor examines a patients inner ear from
a remote location.
5
Store-and-Forward

• Primary care provider takes a still image and
  sends it to a consulting physician who later
  reviews it
• No real time interaction between patient
  consultant
• Commonly used for dermatology, radiology

Clinician reviews scan which was forwarded for
consultation.
6
Public Health
work
Telecommunications Informatics Infrastructure
National Health Information Infrastructure And Tel
ehealth
7
Inland Northwest Telepharmacy System
8
Disease Management
9
Informatics
10
Some telemedicine facts

• Almost 50 different medical subspecialties have
  successfully used telemedicine.
• There are approximately 200 active telemedicine
  networks in the United States, excluding purely
  radiology networks.
• Of these, estimates are that about half are
  actively providing patient care services on a
  daily basis.

11
Positive Trends

• Better Off-The-Shelf Equipment
• Lower Cost Equipment
• Wireless Technology
• Expanding Bandwidth Telecommunications Access
  to the Home
• High Patient/Family Acceptance

12
Key Challenges

• Reimbursement/Start-up Costs
• Re-engineering Practice/Clinical Acceptance
• Low Volume gt High Per Visit Cost
• Evaluation Measuring Cost- effectiveness
• Financial Sustainability
• Infrastructure
• Licensure/Credentialing

13

Office for the Advancement of Telehealth (OAT)
Grant Awards

• Awarded over 250 million in grants since 1989
• Competitive and Congressionally-
• mandated projects
• FY2006/2007 148 programs in 43 States and
  District of Columbia

14
Telehealth 3-Year Grants (FY 2006)

• Telehealth Resource Center Grant Program
• 6 awards
• Telehealth Network Grant Program (including home
  health)
• 16 awards
• Licensure Portability Grant Program
• 2 awards

15
Telehealth Network Grants

• To demonstrate how telehealth technologies can be
  used through telehealth networks to
• expand access to, coordinate, and improve
  quality of health services
• improve and expand the training of health care
  providers and
• expand and improve the quality of health
  information available to health care providers,
  and to patients and their families
• Eligibility Open to urban and rural networks,
  but limited funding resulted in only rural
  networks funded.

16
Telehealth Grants Allow Grantees to. . .

• Purchase/lease equipment (up to 40 of grant)
• Pay for organizational development and
  operations
• Conduct internal evaluations on
  cost- effectiveness of services
• Provide clinical services, develop distance
  education programs, mentor/precept at a
  distance
• Promote collaboration in the region to improve
  the quality of and access to health services

17
Telehealth Network Grants University of
Arkansas for Medical Sciences, AR Northern Sierra
Rural Health Network, CA Ware County Board of
Health, GA The Queen's Medical Center, HI Public
Hospital Cooperative SE Idaho Inc., ID Illinois
Department of Human Services, IL University of
Kansas Medical Center Research Institute,
KS Eastern Maine Healthcare Systems,
ME Tri-County Hospital, MN Citizen's Memorial
Hospital District, MO St. Patrick Hospital
Health Foundation, MT Duke University,
NC Children's Hospital Medical Center of Akron,
OH Home Nursing Agency Visiting Nurse
Association, PA University of Washington,
WA Marshfield Clinic Research Foundation, WI
18
FY 2006 Telehealth Resource Center
Grantees/States Covered

• California Telemedicine and eHealth Center
  California
• Northeast Telehealth Resource Center (Medical
  Center at Lubec) Maine, Vermont, New Hampshire,
  Massachusetts
• Midwest Alliance for Telehealth and Technologies
  Resources (Marquette Hospital) Michigan, Kansas
• Northwest Regional Telehealth Resource Center
  (St. Vincent Foundation) Alaska, Hawaii, Idaho,
  Montana, Oregon, Utah, Washington State, Wyoming
• Great Plains Telehealth Resource and Assistance
  Center (Avera Rural Health Institute) North
  Dakota, South Dakota, Nebraska, Minnesota
• Center for Telehealth and E-Health Law National
  Center

19
Licensure Portability Grants

• National Council of State Boards of Nursing Grant
• The primary objective of this grant is to
  assist states in adoption of the Nurse Licensure
  Compact (NLC)
• What is the NLC?
• A mutual recognition licensure model based on the
  U.S. Drivers License Compact
• Allows both RN and LP/VN nurses to hold one
  license to practice in their home state while
  being permitted to practice in other
  participating NLC states, both physically and
  electronically
• First Year Contracts to states to
• develop strategies to overcome barrier to
  implementation
• assessment of the costs and benefits of such
  strategies
• Nurse Summit to increase knowledge about the NLC
  among states
• Assist states in defraying costs of criminal
  background check (CBC) for licensees a major
  barrier to adoption in some states
• Development of standardized financial impact
  tools to evaluate the cost of implementing the
  NLC and CBCs

20
Licensure Portability Grants

• Federation of State Medical Boards of the United
  States, Inc. Grant
• Primary objective of grant is to create
  demonstrations of different models that reduce
  licensure barriers to telehealth for physicians
  practicing across state lines.
• Implements two proposals developed by medical
  boards in the northeastern (Maine,
  Massachusetts, Vermont, Connecticut, Rhode
  Island and New Hampshire) and western
  regions (North Dakota, Kansas, Colorado,
  Minnesota, Iowa, Idaho, Oregon, and Wyoming) to
  share licensure information across
  jurisdictions.
• Promote the adoption of common license
  application form in up to 10 states.
• Develop and implement an interstate qualified
  physician endorsement/mutual recognition
  agreement process in four states.

21
Lessons Learned from Our Grantees in10 Minutes

• PREPLANNING PHASE
• Match technology to needs/demand
• K.I.S.S. and stay flexible
• Empower referring sites
• Talk with those who have gone before
• Conduct Careful vendor analysis

22
Lessons Learned (continued)

• START-UP PHASE
• Champion(s)
• Clinician acceptance
• Staffing Site coordinators/ Technical and vendor
  support
• Clinical encounter should resemble in-person
  clinical appointment
• Market, market, market!
• Focus on customer service!

23
Lessons Learned (continued)

• SUSTAINABILITY
• Reimbursement
• Design multiple uses
• Establish measures of success early and
  measurement tools
• Develop protocols
• Training and TA
• Strategic/financial Planning

24
Federal HIT/Telehealth Funding

• 169 M. for HIT in the 2007 Presidents Budget
• HIT legislative activities is anticipated in
  2007
• HRSA Federal Collaboratives around HIT
• AHRQ
• CMS
• NIH
• IHS
• Agencies implementing HIT into operations
• FDA
• IHS
• CDC
• DoD
• VA

25
Technical Assistance/Information http//www.HRSA.g
ov/telehealth Grants Information http//www.grant
s.gov Coming Soon HRSA HIT/Telehealth Portal
26
Other Resources

• American Telemedicine Association
• http//www.atmeda.org

27
Computer of the Future1954
28
(No Transcript)
29
CONTACT US
Dena Puskin, Sc.D. 5600 Fishers Lane Room
7C-22 Rockville, MD 20857 Phone (301)
443-3682 Fax [phone] Fax E-Mail
dpuskin_at_hrsa.gov