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  • Good summary - Telehealth 2010
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  • 1. Telehealth The Future Is Here Virginia Telehealth Summit March 17, 2010 Dena S. Puskin, Sc.D. U.S. Department of Health and Human Services Health Resources and Services Administration
  • 2. Vision for America NO MATTER WHO YOU ARE OR WHERE YOU ARE YOU GET THE HEALTH CARE YOU NEED WHEN YOU NEED IT
  • 3. Telehealth vs. Telemedicine Telehealth Regional Health Health Inform. Professions Sharing Education Consumer Administration Telemedicine Education Public Evaluation Health Research Homeland Security
  • 4. Patient Urgent Care Messaging Home Care Long Term Telehealth Office Visit Hospitals Live Pt-MD Care Health Public work Care Delivery Systems Electronic Health Records Telecommunications Informatics Infrastructure National Health Information Infrastructure And Telehealth
  • 5. A Different Kind of Toolbox • Telehealth can be thought of as a tool box of technologies applied to diverse health care needs in a wide range of settings to connect people to improve access to health care services.
  • 6. History of U.S. Involvement in Telehealth • Initiated telemedicine – Dates back to 1880s after invention of the telephone • Early U.S. Telehealth/Telemedicine – Nebraska Medical Center - 1955 – Massachusetts General Hospital/Logan International Airport Medical Station - 1967 – Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC) – 1972- 1975 – Alaska ATS-6 Satellite Biomedical Demonstration – 1971 – Texas Tech -1989 6
  • 7. Does Telehealth “Work” • Answer depends on clinical service, setting, and implementation • What we think we know:  Telehealth services can improve access in rural communities  Telehealth can improve quality of care  Telehealth services do not necessarily improve productivity; depends on workflow design  Telehealth: Cost-effectiveness shown in closed systems, such as the VA, Kaiser, and limited small studies of non-closed systems - “free-world.”
  • 8. Summary of Key Challenges • Reimbursement/Start-up Costs • Infrastructure • Re-engineering Practice/Clinical Acceptance • Evaluating cost/effectiveness, value-added • Financial Sustainability • Licensure/credentialing/scope of practice • HIPAA • Integration with EHRs/Health Information Exchange at “Point of Care” • Over-abundance of information about telehealth technologies -- few trusted resources
  • 9. Reimbursement • Contracts • Medicaid – 23 states • Private Plans – Recommend obtaining advance approval – State Laws mandating coverage (e.g., Maine) • Medicare
  • 10. Licensure/Privileging • Licensure – Significant variability in definitions and details of regulation – Current licensure language (where it exists) requires licensure in state where client receives service – Exception: Nurse Compact • Credentialing/Privileging – CMS/JCAHO Policies – FCC Broadband Report
  • 11. Other Policy Considerations • FDA Approval • Telecommunications regulations: Broadband Report • Anti-kickback laws • Anti-trust laws • EHR/Meaningful Use
  • 12. Addressing Telehealth Challenges: Demonstrating Value- Added Improve Clinical Acceptance:  Demonstrate efficacy in broader range of clinical services and settings • Reengineering Practice  Impact of Telehealth on work-flow and productivity • Financial Sustainability:  Cost-effectiveness/not simply reducing costs  Alignment of incentives • Workforce:  Address health professions shortages and maldistribution in light of increased demand due to demographics and expanded coverage
  • 13. Family Health Institute Reductions in HgbA1c with Treatment by Race /Language 8.5 8 7.5 7 6.5 1st HgbA1C Most Recent White 7.23 6.95 Black 7.80 7.44 Latino-Eng 8.02 7.75 Latino- Span 8.12 7.81 Other 7.82 7.48
  • 14. Telehealth Grants Projected (FY 2010) • Telehealth Resource Center Grant Program – 3 Yr Grants – 10 Regional Centers [6 new] – 2 Tele-home care Centers – 1 Legal and Regulatory Center • Telehealth Network Grant Program (including home health) – 24-25, 3-Yr Grants (7-8 new grants) – Collaborative Tele-home care evaluation • Licensure Portability Grant Program – Federation of State Medical Boards (2nd year of 3-Yr grant) • Licensure Portability ARRA Initiative – 2, 2-Yr Grants: $1 million to be awarded in February 2010
  • 15. Telehealth Resource Centers • ARIZONA TELEHEALTH RESOURCE CENTER* • CALIFORNIA TELEHEALTH AND E-HEALTH CENTER* • CENTER FOR TELEHEALTH & E-HEALTH LAW • MIDWEST ALLIANCE FOR TELEHEALTH AND TECHNOLOGIES RESOURCES • NORTHEAST TELEHEALTH RESOURCE CENTER • GREAT PLAINS TELEHEALTH RESOURCE* CENTER • NORTHWEST TELEHEALTH RESOURCE CENTER*
  • 16. Telehealth Resource Center Map
  • 17. HRSA Health IT Toolbox • A comprehensive online compilation of health IT planning, implementation and evaluation resources to support the implementation of health IT for safety net providers. • The HRSA Health IT 17
  • 18. Telehealth Toolboxes/Modules • Current Toolbox Modules –Operations – Legislation and Regulation – Medicare Reimbursement Policies – Marketing –Training • Toolbox Modules To Come – Evaluation – Business Planning – Technology Assessment
  • 19. Technical Assistance/Information http://www.HRSA.gov/telehealth http://healthit.ahrq.gov/ http://telehealthresourcecenter.org Grants Information http://www.grants.gov
  • 20. Other Resources •American Telemedicine Association http://www.atmeda.org
  • 21. CONTACT 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@hrsa.gov

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