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

1. BPHC ALL-GRANTEE MEETING Gaylord National Resort & Convention Center National Harbor, Maryland June 24, 2008 Introduction to Telehealth and Using Telehealth to Improve Access in Health Centers 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 Telehealth vs. Telemedicine 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 patient’s 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. Patient Long Term Care Pt-MD Messaging Live Telehealth Urgent Care HomeCare Hospitals Office Visit Care Delivery Systems Electronic Health Records Public Health work Telecommunications Informatics Infrastructure National Health Information Infrastructure And Telehealth

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 > 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. 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. Telehealth Network Grants

16. 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 Telehealth Grants Allow Grantees to. . .

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. Driver’s 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 President’s 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.gov/telehealth Grants Information http://www.grants.gov Coming Soon HRSA HIT/Telehealth Portal

26. Other Resources • American Telemedicine Association http://www.atmeda.org

27. Computer of the Future1954

29. Dena Puskin, Sc.D. 5600 Fishers Lane Room 7C-22 Rockville, MD 20857 Phone: (301) 443-3682 Fax: (301) 443-1330 Fax E-Mail: dpuskin@hrsa.gov CONTACT US