# Presentation: 193730

## Overview of HRSA Telehealth 

**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**

**February 15, 2007**

## Telehealth vs. Telemedicine

**Telemedicine**

**Telehealth**

**Health**
**Professions**
**Education**

**Administration**

**Evaluation**
**Research**

**Homeland Security**

**Public**
**Health**

**Consumer**
**Education**

**Regional**
**Health Inform.**
**Sharing**

## Office of Health Information Technology

## OHIT/OAT VISION

**NO MATTER WHO YOU ARE ****OR ****WHERE YOU ARE****YOU GET ****THE HEALTH CARE YOU NEED**
**WHEN YOU NEED IT**

## Educational and Administrative Uses

-  Continuing 		education
-  Patient 		education
-  Administrative 	meetings

**Providers can receive continuing education without the need to travel.**

**Notes:**
Early telemedicine put a heavy emphasis on these activities. And they are still important.

Home Land Security, early alert systems.

## 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.**

## Slide 7

## 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.**

**Combined Approach Example**

## Emerging Technology

**Emerging Technology**
**Applications**

** ****Emphasis on low cost applications**
** ****Applications that improve quality of**
**	****care**
** ****Integration of information systems ****	****within institutions and across health ****	****care institutions**

## Slide 11

## Inland Northwest Telepharmacy System

## Home Health

**Home Health**

**Low-cost equipment that needs only a regular phone line**
**Used to check vital signs, monitor medications, visualize patient, provide enhanced support**

**Patient and nurse interacting during a “video home visit.”**

**Notes:**
Home care: issue of underserved not just one of rural but of elderly, urban poor, etc.  Discuss aging of population, need to use technology, monitoring, Sadie, etc

Matching needs to affordable resources.  Simple phone based systems, level of need.  Then go to next slide

## Slide 14

## Congestive Heart Failure Monitoring

- Home

- Clinic

**Standard**
**Phone**
**Line**

## Disease Management

**Disease Management**

## Slide 17

## Informatics

**Informatics**

## Telehealth can be thought of as a 	tool box of diverse technologies 	applied to diverse health care 	needs in a wide range of health 	care settings.

 Dynamic field both in terms of 	technologies and how those 	technologies might be applied

** ****Dynamic field both in terms of ****	****technologies and how those ****	****technologies might be applied**

**Bottom Line**

## PL 107-251 Health Care Safety Net Amendments of 2002 (October 26, 2002)

** ****Established OAT**
** ****Amended the Public Health Service Act to ****	****add:**
*Section 330I: *
*Telehealth Network Grant Program **(grants first **	**awarded end of FY 2003)*
*Telehealth Resource Center Grant Program*
*	**(grants to be awarded at end of FY 2006)*
* **Section 330L: Licensure Portability Grant **	**Program **(2 grants to be awarded at end** **of FY 06)*

## Congress’s Intent in Establishing OAT and its Programs : Advance Telehealth Practice

**“****Seed the Field”**
**Pilot/demonstration projects**
**Establish a focal point for coordinating telehealth activities **
**Provide technical assistance**
**Disseminate model practices and lessons learned**
**Promote collaboration/promote synergy**
**Identify options for addressing barriers to the effective use of telehealth technologies**

## Some Specifics

**Directory**
**Listserv**
**Technical assistance documents**
**Website**
**Annual meeting**
** ****ATA mini-meeting**
** ****Joint Working Group on Telehealth/Telemedicine **
** ****Ongoing resource to public**
** ****Policy support**

## OAT’s Partners in Telehealth

-   **Grantees, Private Sector ****	****Organizations, States**
**  ****Chair Joint Working Group on ****	****Telemedicine/Telehealth**** **
***Department of Commerce***
***Department of Agriculture***
*** ******Department of Defense***
***NIH/NLM***
***CDC***
***AHRQ***
*** ******Many others***
*** *****Office of the National Coordinator (ONC) **

**Office for the Advancement of Telehealth (OAT)**
** ****Grant Awards**

** ****Awarded over $250 million in ****	****grants since 1989**
** ****FY2005: Approximately $34 ****	****million**
**Competitive and Congressionally-**
**	****mandated projects**
**FY2005: 159 programs, in 47 ****	****States and District of Columbia**

## Programs Currently Managed by OAT

**Telehealth Network Grant Program (TNGP)**
**Telehealth Resource Center Grant Program Licensure Portability Program **
**Congressionally Mandated Projects (CMPs), i.e., earmarks**

## Telehealth New 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**

## 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.**

## Office for the Advancement of Telehealth (OAT)

**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**

**Telehealth Resource Center Grants**
**California Health Foundation and Trust**
**Regional Medical Center at Lubec**
**Marquette General Hospital**
**St. Vincent Foundation**
**Avera Rural Health Institute (ARHI)**
**Center for Telehealth and E-Health Law**
**Licensure Portability Grants**** **
**National Council of State Boards of Nursing**
**Federation of State Medical Boards of the United States, Inc.**

## Characteristics of the OAT Grants

-   **Distance Learning**
**  ****Telemedicine**
**  ****Informatics**
**  ****Public Health**

## 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**

## How Earmarks are Different from Other Telehealth Grants

-   **Recently,**** ****earmarks are under****	****the HRSA ****	****budget line, not the telehealth line**
**  ****Although TNGPs are diverse, earmarks ****	****are incredibly diverse**
*** *****Awards range from $50,000 to over $1 ****	****million/year**
*** ******Scope ranges from laying a fiber optic line or ******	******establishing brain imaging center to traditional  telemedicine service development ***
**  ****Evaluating earmark programs**

## Accomplishments

**Number of sites: *****Dramatic growth nationwide: In TNGP program alone over 700 sites – Provide service in 239 underserved rural communities (pop: 3.8 million)***
**The field of telehealth has advanced: Informed policy/*****Issues have changed/technology evolved/applications diversified***
**A community has been created: e.g., *****Listserv and Annual Meeting***
**Trusted vehicle for knowledge exchange/ promoted evaluation**
**Seed money that grantees can use to leverage other funds**
** ****Policy Impact: Reimbursement/Evaluation**

## Evaluation

** ****Individual Programs**
** ****Directory: Basic Program ****	****	****	****Statistics**
** ****Progress Reports**
**GPRA Reporting System**
** *****Web-based***
*** ******OAT established uniform definitions***
*** ******Intermediate measures***

## Evaluation Example

## $$$ 

**Reimbursement Principle**
**	*****FORM FOLLOWS FUNCTION***
***	******FUNCTION FOLLOWS ******	******FUNDING***

-  **MEDICARE**
** ****MEDICAID**
** ****PRIVATE PAY**

***$$$ ***

**TELEMEDICINE COVERAGE**
**The Five Questions**

** ****Who **
**Patients**
**Professionals**
** ****What**
** ****Services**
** ****Mode of Interaction**** **
**Interactive**
**Store-and-Forward**
** ****Where**
** ****Sites/Settings**
** ****Geography**
**	****	****	**
** ****How**

**MEDICAID**
**In 2003, 23 states had some coverage of telemedicine Services under Medicaid**

**Private Pay**
**American Telemedicine Association Study**

##  ISSUES:PAYMENT JUST

**THE BEGINNING**

** ****LICENSURE/SCOPE OF ****	****PRACTICE**
** ****CREDENTIALING**
** ****ON-LINE HEALTH CARE**
** ****PRIVACY/SECURITY**
** ****INFRASTRUCTURE**
** ****ACCOUNTABILITY/PART**

**FUTURE**

-  **Growth in demand for health ****	****	****care services inevitable**
** ****Shortages of key care-giving ****	****	****personnel will continue**
** ****Changes in technology will drive a ****	****shift in how we provide health care**
** ****Integration of the electronic medical ****	****record and telemedicine critical to ****	****the survival of telemedicine services**
-  **SHORT-TERM SAVINGS NOT THE ****	****ONLY LITMUS TEST**

## Cycle of Excellence

**EVALUATION**
**Learn, Analyze, **
**Develop **
**“****Best Practices”**

**GRANTS/**
**PROGRAM**
**  ****DEVELOPMENT**

**POLICY DEVELOPMENT**