NMDOH TELEHEALTH PROJECT-SUMMIT Telehealth in New Mexico: Need for Coordination and Collaboration in the New Age of Healthcare Transformation Dale C. Alverson, MD Medical Director, Center for Telehealth University of New Mexico CMIO, New Mexico Health Information Collaborative June 16, 2015
Health Care Reform/PPACA Economic Downturn Emerging Enabling Information Communication Technologies Need for more Access to Care An Aging Population/Baby Boomers Critical Shortage of Healthcare Providers EHR Adoption/HIE Meaningful Use ICD10/11 PCMH ACOs A Time for Telemedicine & e-health
Telemedicine and ehealth: The General Concept
Defining Telemedicine and Telehealth Tele- comes from the Greek root word meaning distant or remote / at a distance. Tele-phone Tele-vision Tele-graph Tele-gram Tele-scope Tele-Etc, etc, etc a combining form meaning distant, especially transmission over a distance, used in the formation of compound words
So What is Telemedicine/Telehealth? The use of advanced telecommunications technologies to exchange health information and provide healthcare services across geographic, time, social and cultural barriers (J. Reid) Telehealth is more than just video-conferencing and encompasses health information exchange and a spectrum of health information technologies It is simply the delivery of health services at a distance (A. Darkins)
Back to the Future
So What is e-health? Healthcare practice supported by electronic processes and communication Includes Electronic Health Records (EHR), Computerized Physician Order Entry, and e-prescribing Health Information Exchange (HIE) Digital Health
Health Information Exchange and Telemedicine : A Complimentary Piece of the Puzzle
Telemedicine and Health Information Exchange (HIE) Telemedicine creates the virtual consultation and provision of service between providers and patients = access to care HIE creates the consolidated virtual medical record about the patient from a variety of electronic health records and sources = access to the patient s health information
How is Telehealth & e-health used? Clinical ( Telemedicine ): Direct Patient Care and Consultation, Case Reviews Educational: Providers, Students, and Patients Research: Community-based Participatory, Outcomes driven Public Health Administrative: Strategic planning, Operations Sharing Health Information Enhanced Disaster Response
Telehealth as an Integral Part of Our Healthcare System Becoming a Standard of Care/Part of Work Flow Avoiding Unnecessary Variations in Care Part of Patient protection and Affordable Care Act (PPACA) The Triple Aim : Patient Centered, Improved Outcomes, Reducing Costs Prevention: Avoiding ED visits and Hospitalization Pay For Performance (P4P) Accountable Care Organizations (ACOs) Impacting Ambulatory Sensitive Conditions Patient Centered Medical Home (PCMH)
Telehealth and Health Information Technologies: Part of the Solution in Creating the Medical Home and Enhancing Access
Hitting the Targets: The Triple AIM Improve Patient Access Telehealth Improve Health Outcomes Reduce Costs
Involving the Patient
Telehealth Networks Rural/Remote Health Providers Can Access Expert Medical Opinions, Knowledge, Education via Telehealth Rural or Remote Location Patient Student Local Health Provider Telehealth Network Audio High-Resolution Images & Video Consultation Direct Patient Care Case Reviews Education Training Specialty Medical Center Medical Specialty Teams Health Information Exchange Community-Based Research
Telehealth in New Mexico
Brief History of Telehealth Milestones in NM UNM Center for Telehealth founded through state legislation and started in 1995 Other HealthCare providers becoming involved in Telehealth Activities 2000 The ECHO project launched in 2003 as a Hepatitis C educational, case-review model NM Telehealth Alliance, non-profit 501c3 founded in 2004 NM Telehealth Act passed into law 2004 Medicaid established Telemedicine rules in 2007 NM Telehealth and HIT Commission formed in 2007 FCC Southwest Telehealth Access Grid Proposal approved 2007; Brings in $15.4 million federal funds for broadband connectivity
Brief History of Telehealth Milestones in NM (cont.) Parity telemedicine reimbursement laws passed in 2013 Broadband Assessment and Recommendations: Education, Healthcare, and Economic Development; Report released 2013 Medicaid updated Telemedicine Rules in 2014 Removed rural requirements for originating sites No longer required a certified health professional be with the patient at the originating site Allows use of store and forward applications Telehealth Fund created at NM DOH July 2014 Neurosurgery Tele-stroke CMS ACCESS Grant funded $15 million 2014 New Mexico receives very high grades from the American Telemedicine Association (ATA) on a national level when compared to other states 2015
Insurance Coverage for Telemedicine Services Passed and Signed into Law 2013 Introduced by: Sen. Jerry Ortiz y Pino (D) and Rep. Stephen Easley (D) New Mexico Telehealth Act Passed and Signed into Law 2004 Introduced by: Rep. Danice Picraux(D) and Supported by Sen. Susan Wilson-Beffort (R) SENATE BILL 69 HOUSE BILL 171 HOUSE BILL 581 46TH LEGISLATURE - STATE OF NEW MEXICO
ECHO: Treatment Outcomes Outcome ECHO UNMH P-value N=261 N=146 Minority 68% 49% P<0.01 SVR (Cure) Genotype 1/4 50% 46% NS SVR (Cure) Genotype 2/3 70% 71% NS SVR=sustained viral response NEJM : 364: 23, June 9-2011, Arora S, Thornton K, Murata G, et.al.
Direct Patient Care Maternal Fetal Medicine-High Risk Pregnancy Genetic Counseling
School Based Health Centers
Telehealth assistants at the school or child care center provide the link to examine the eyes, ears, throat, lungs and skin. Videoconferencing provides the face to face interaction. Getting providers to think of their desktop computer as an exam room is the trick. Dr. Neil Herendeen 24
Family Visitation
Store and Forward Capturing an image and storing it to then be forwarded for review by a medical specialists Examples include teleradiology, telepathology and teledermatology, tele-ophthalmology (retinal scans) Telemedicine or HIE?/It s about connecting patients and providers to achieve better care Teleradiology and Image Transfer Web-Based Portals
Diabetic Retinopathy Retinal Scans:
Trauma Triage 44% Transfer Avoidance 27% Management Recommendation Changes Moya M, Valdez J, Yonas H, Alverson DC. The Impact of a Telehealth Webbased Solution on and Consultation. Telemedicine and ehealth, 2010; 16:945-949
Access to Critical Cerebral Emergency Support Services (ACCESS): Expanding New Mexico's telehealth network to include all 30 hospitals statewide. CMS Innovation Grant $15 million
http://hsc.unm.edu/emermed/ped/childready/cr.shtml
Behavioral Health Center for Rural and Community Behavioral Health (CRCBH) Psych Emergency Services (PES) http://psychiatry.unm.edu/centers/crcbh/index.html Behavioral Health Services PTSD/TBI Suicide Prevention IRA HAYES
Teledermatology (Store and Forward)
ENVISION http://www.envisionnm.org/index.php/telehealth/comm-tc/ CYBER CF (Cystic Fibrosis) Support Groups Transitions of Care Consultative Clinic Pediatric Intensive Care Pediatric Cardiology Pediatric Oncology
Southwest Telehealth Access Grid (SWTAG): a Network of Networks that can support both Telehealth and HIE FCC RHCPP Awarded $15.5 million to cover 85% of build-out and operations of broadband networks for healthcare
Navajo Rural Health Project Hospital Chapter House Navajo Homes Broadband Connection C.H.R. Community Health Representative (C.H.R.)
Telehealth: Dynamic Emerging Technologies
Video Options H.323 Video Conferencing Systems (e.g. Polycom, Tandberg and use of IP addresses) H.324 Video phones (analog) Video SIP Client (e.g. Jabber, federated MS Lync etc.) Cloud based video conferencing (e.g. Vidyo, Zoom): hosted or non-hosted, BYOD WebRTC (Real Time Communications): Secure Web browser access
Telehealth Toolkit Videophone (H.324) SaaS (SIP&the Cloud) Skype Software IP Based (H.323) Desktop IP Based (H.323) Small Conference Room IP Based (H.323)
Hand Held Devices- mhealth iphone Droid iphone Smart Phones and Tablets
Remote Monitoring The Smart Band-Aid
Smart Phone Snap-Ons or Blue Tooth to Mobile Devices TytoCare
Eye exams via your Smart Phone
Google Glass (A Passing Fad?) Rafael Grossmann, MD, FACS at Google Glass's first surgical appearance Tele-mentoring, Tele-Supervision, Teaching &Training
Telehealth Resources
The New Mexico Telehealth Alliance Telehealth Alliance Networks of Networks Represents a consortium of public and private health care stakeholders: Neutral Territory (501c3) Providers Consumers Telehealth Expertise Reflects the diversity of our health care delivery system in New Mexico Enables collaboration Communication Networks Social Networks
The 4 C s Cooperation Coordination Collaboration Communication
ATA Interstate Telehealth DG
http://www.telehealthresourcecenter.org/
http://www.americantelemed.org Interstate Telehealth Discussion Group
http://ctel.org/
The Future and Next Steps
Telehealth Planning: Keys to successful implementation Feasibility and Needs Assessment Technology Planning: Platforms for both consulting and originating sites, connectivity, security Operations Planning: Workflow, workforce, C/P, Licensure, Documentation/Integration with EHR, scheduling vs. 24/7- emergencies, reimbursement (parity legislation) Business Planning: Integration with strategic direction, Sustainability, ROI Evaluation Planning: data collection, metrics of success CQI
Legal and Regulatory Ramifications HIPAA/HITECH FDA/FCC Liability and Malpractice Insurance/Risk Reduction Standards of Care Credentialing/Privileging and Licensure
Telehealth: Next Steps (7) and Strategic Path Forward in New Mexico 1. Coordination and Collaboration 2. Meeting Healthcare Needs 3. Overcoming Barriers 4. Connectivity and Technical Support Services 5. Network of Telemedicine Clinic Originating Sites 6. HIE Integration 7. Research and Evaluation, ROI, Value Based Accountability (VBA)
1. Need for Centralized NM Telehealth Resource Center Enhance coordination of telehealth services and provide platform for collaboration Provide a listing and contacts (Data Base/ Catalogue ) for specific available telehealth services Answer question regarding provision and receiving of telehealth services Provide telehealth education and training as needed Follow established guidelines and standards of care Evaluate the impact and provide CQI Serve as a single point of contact for other entities interested in telehealth
2. Ongoing Needs Assessment Telehealth services should be implemented that address define healthcare needs of communities, providers, and patients throughout NM Develop ongoing periodic surveys for needs assessments
3. Identify Issues and Barriers Affecting Telehealth Services Work with the Legislature, Governor s office, and State Departments, along with Governing and Regulatory Bodies to address those barriers and find solutions
4. Develop Affordable Appropriate Broad-band and Technical Support Services Develop Cash Match Fund for Federal Programs (FCC HCF, USDA DLT Grants) Work with DoIT Work with telecommunication industry Provide support services for the FCC and USDA related healthcare programs and subsidies Contract for secure, reliable NOC services
5. Develop Network of Telemedicine Clinic Originating Sites
6. Integrate with Health Information Exchange (HIE) initiatives Patient healthcare information, medical history, and documentation should go hand-in-hand with telemedicine services, similar to in-person services
7. Continued Quality Improvement Research and Evaluation Value-Based Accountability Return on Investment Meeting the Triple Aim Ongoing Assessment
Promoting Adoption and Overcoming Barriers It takes a Transdisciplinary Team and Collaboration Belief in the Value Demonstrating the Value Dedication Persistence
Questions & Comments?