The California Telehealth Network:

Transcription

1 The California Telehealth Network: A Resource to Support Innovation Thomas Nesbitt, M.D., M.P.H. Associate Vice Chancellor, Strategic Technologies and Alliances Director, Center for Health and Technology Chief Scientist, CITRIS University of California, Davis

2 There is a growing g expectation that advanced information technology will transform our health care system.

3 One of the problems is that we are applying new technology to a broken model of care instead of using technology to facilitate a change in the model of care

4 These technologies can help facilitate a new, more efficient model of care across the economic and geographic spectrum.

5 Requirements for a sustainable Statewide technology enabled healthcare system A ubiquitous, broadband networks with guaranteed quality of service (for TM) Broad distribution of hardware and software in the field Standards for HIE, telemedicine, etc. Organizations focused on policy and regulatory changes that facilitate new models of care A technology competent health care workforce Research and development programs for device development and service delivery models

6 One of the essential requirements for an optimally functioning technology enabled health care system and research network is widely distributed broadband connectivity which is reliable, with explicit quality of service (QOS), security, privacy

7 FCC Rural Health Care Pilot Program Dedicated over $417 million for 69 pilot program networks Encourages regional broadband health care networks with connections to national backbones UPDATE!

8 Sites included in RHCPP Commissioner Martin Presentation to AHIC, Nov 13, 2007

9 The California i Telehealth lth Network: A digital health care highway

10 Consortium Members The Office of the Governor California Business, Transportation and Housing Agency (BTH) The California Emerging g Technology Fund (CETF) The California Public Utilities Commission (CPUC) The California Department of Managed Health Care (DMHC) The California Telemedicine & ehealth Center (CTEC) Rural Telehealth lth Networks The UC Office of the President University of California Davis Health System The Office of Statewide Health Planning and Development (OSHPD) California Health & Human Services Agency (CHHSA) The Corporation for Education Network Initiatives in California The California Office of Emergency Services (OES) The California Institute for Telecommunications and Information Technology The California Hospital Association (CHA) The California Health Foundation and Trust (CHFT) The California State Rural Health Association (CSRHA) The California Primary Care Association (CPCA)

11 FCC Rural Health Care Pilot Program: California s Goals Summarized Goal 1: Create statewide broadband network dedicated to health care with explicit QOS, privacy and security Goal 2: Link the California Telehealth Network (CTN) to a national backbone Goal 3: Leverage and build upon recent investments in telehealth Goal 4: Utilize CTN for ongoing disaster preparedness training

12 Technical Goals Extend broadband connections to 300+ rural health care providers in 3 years Facilitate use of stateof-the-art telehealth services Telemedicine Continuing Medical Education

13 Technical Highlights 1. Persistent, IP-Based connection, no dial-up 2. Dedicated End-to-End Connection, no Internet 3. Explicit Quality of Service (QOS) 4. Bandwidth exceed current needs Expandable 5. Interoperable Interoperable, peer-to-peer, Any-to-Any x 7 x 365 Monitoring 7. Secure, Private Network 8. Access to UC s, CSU s, other academic centers 9. Access to Internet 2

14 Current Status of the CTN Award of $22.1M from FCC California Emerging Technology Fund (CETF) providing $3.6M for 15% match and start-up funds $5M commitment from United Health Care Letter of Agency process (completed) Original goal was 319 Over 1000 locations represented in the received letters of agency USAC has qualified over 860 sites RFP has been posted on the USAC RHCPP web-site An award should be made in the next 60 days

15 FY 2007 FY 2007 Sites

16 Pilot 2009 Sites 4 to 14 3 to 4 2 to 3 1 to 2 1

17 Current Model

18 California Telehealth Network

19 California Telehealth Network

20 Two proposals were submitted on August 17, 2009 Title: The CTN Expansion and Enhancement Initiative NTIA Infrastructure (Middle Mile) NTIA Sustainable Adoption Program Expand CTN to 2000 sites over 2 years, support ehealth adoption programs, fund CTN operations to ensure sustainability TOTAL PROJECT = $55.4 million

21 NTIA Infrastructure Proposal Federal request of $29.6 with $7.4 match (Total $37M) United Healthcare ($4.4M) California Healthcare Foundation ($2M) California Emerging Technologies Fund ($1M) Leverage the CTN as shovel ready adding 1137 sites Provide medical grade bandwidth, firewall protection, and telecommunications equipment at the site to connect to CTN Enhanced funding at existing CTN sites

22 NTIA Infrastructure Proposal (con t) CTN grant staff identified over 30,000 potential sites: Clinics, hospitals, skilled nursing facilities, pharmacies, physician offices, county mental health facilities, county managed care plans, senior centers, school-based health clinics, cancer centers, tumor registries, group homes for developmentally disabled persons, county EMS

23 NTIA Sustainable Adoption Proposal Federal request of $13.2 M with match of $4.6M University of California, Proposition 1D ($2M) National Coalition for Health Integration ($2M) United HealthCare ($600K) Fund 26 FTE including 18 FTE to support CTN operations and 8 ehealth educators to advance the adoption of ehealth Develop and implement a 90-hour ehealth educator training certificate consisting of 30 hours of on-site education and 60 hours of on-line training Develop 20 hours of on-line coursework Introduction to ehealth Implementation to prepare ehealth site coordinators (in coordination with HITECH efforts) Create 2 hours of on-line CTN orientation for all CTN sites

24 NTIA Sustainable Adoption Proposal (con t) Enhance sustainability and management of the CTN through a Customer Management Application Distribute $2.6M in training scholarships to 200 individuals to become community ehealth educators Distribute ib t $5M to support 200 ehealth Implementation Coordinators ($25K stipend) Distribute $2M in equipment e to community sites (up to $20K) Support the transition of the CTN to a non-profit corporation

25 Proposition 1D Proposition 1D: K-University Public Education Facilities Bond Act of 2006 the amount of $200 million shall be used for capital improvements that expand and enhance medical education programs with an emphasis on telemedicine aimed at developing high-tech approaches to health care.

26 California s Proposition 1D Passes With Proposition 1D we will be able to connect our best hospitals and our best medical schools with clinics in remote areas all over the state of California. Governor Arnold Schwarzenegger 10/27/2006 UC Davis Pediatric Telehealth Colloquium

27 Project Scope Telemedicine Resource Center & Rural PRIME Facility Four-story addition to UC Davis School of Medicine Education Building 52,141 gross square feet Total project cost of $36,000,000 (includes approximately $6M for equipment)

28 Telemedicine Resource Center & Rural PRIME Facility View from the Courtyard

29 Project Goals Telemedicine Resource Center & Rural PRIME Facility Provide a training resource for entire UC system and partner organizations Enhance learning opportunities for all medical students and other members of the healthcare team at UC Davis Facilitate implementation of Rural PRIME Program Training the next generation of medical students and residents how to incorporate telemedicine into their practice

30 CTN as a platform for research and development What if you could use this entire network as your research and development laboratory?

31 The Value of the CTN for R&D Represents 900 to 2000 health care anchor institutions that have already self-identified as being interested in technology solutions to health care Managed network, single point of contact, data collection and management on uses of broadband Subsidized broadband connectivity, expandable bandwidth on demand With ARRA, RECs and Prop 1D funding, equipment and training resources

32 Using CTN to facilitate technology trials, and service model development Recruit and/or follow-up with health care providers through video conferencing Identify sites /assess interested in study Interview potential subjects and/or families for possible inclusion in studies/ provide informed consent Follow-up with participants over distance during study Educate providers regarding new technologies and associated services models

33 Using the CTN to Facilitate Technology Trials Deliver study interventions or services to remote communities via video Administer an evaluation from the expert over video Provide support services for study Training individuals in remote sites to conduct study protocols and collect data Training remote professionals over video Video mentoring early in process Video monitoring of research at distant site Quickly evaluate adverse events at remote site

34 How this all comes together All patients have a primary medical home, with EHRs Data from EHRs flow into accessible data repositories All health providers, academic health systems and technology development researchers are able to exchange health information and connect via videoconferencing via a secure network with explicit QOS New technologies are developed and implemented under new services models

35 Summary Advanced information and telecommunications technologies have a central role to play in transforming our health care system Currently there is an unprecedented financial and political investment in this approach The CTN can serve as a laboratory for clinicians, University researchers, industry and government to development new technologies and service models that improve access and quality while decreasing costs of care