Title: Introduction to Telehealth and Using Telehealth to Improve Access in Health Centers
1Introduction 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
2Telehealth vs. Telemedicine
Telehealth
Regional Health Inform. Sharing
Telemedicine
Health Professions Education
Consumer Education
Administration
Public Health
Evaluation Research
Homeland Security
3Educational and Administrative Uses
- Continuing education
- Patient education
- Administrative meetings
Providers can receive continuing education
without the need to travel.
4Real-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.
5Store-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.
6Public Health
work
Telecommunications Informatics Infrastructure
National Health Information Infrastructure And Tel
ehealth
7Inland Northwest Telepharmacy System
8Disease Management
9Informatics
10Some 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.
11Positive Trends
- Better Off-The-Shelf Equipment
- Lower Cost Equipment
- Wireless Technology
- Expanding Bandwidth Telecommunications Access
to the Home - High Patient/Family Acceptance
12Key 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
-
13Office 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
14Telehealth 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
15Telehealth 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.
16Telehealth 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
18FY 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
19Licensure 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
20Licensure 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.
21Lessons 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
22Lessons 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!
23Lessons Learned (continued)
- SUSTAINABILITY
- Reimbursement
- Design multiple uses
- Establish measures of success early and
measurement tools - Develop protocols
- Training and TA
- Strategic/financial Planning
24Federal 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
25Technical Assistance/Information http//www.HRSA.g
ov/telehealth Grants Information http//www.grant
s.gov Coming Soon HRSA HIT/Telehealth Portal
26Other Resources
- American Telemedicine Association
- http//www.atmeda.org
27Computer of the Future1954
28(No Transcript)
29CONTACT US
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_at_hrsa.gov