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Telemedicine in California: Improving Access and Quality of Health Care

Telemedicine in California: Improving Access and Quality of Health Care. Thomas Nesbitt, M.D., M.P.H. Executive Associate Dean, School of Medicine Director, Center for Health and Technology University of California, Davis.

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Telemedicine in California: Improving Access and Quality of Health Care

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  1. Telemedicine in California: Improving Access and Quality of Health Care Thomas Nesbitt, M.D., M.P.H. Executive Associate Dean, School of Medicine Director, Center for Health and Technology University of California, Davis

  2. The explosion of new knowledge and information in the health sciences is ironically creating greater disparities in the quality of health care services.

  3. If we discover a cure for cancer, but only half the people have access to it, we have only discovered half the cure for cancer. Medical Science, no matter how good it is, is worthless if not applied appropriately to patients who need it

  4. Advances in telecommunications and information technologies are helping to redistribute health care knowledge and expertise where and when it is needed.

  5. The IOM 2001 report "Crossing the Quality Chasm" stated that "information technology must play a central role in the redesign of the health care system."

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

  7. Clinical Care Involves Making DecisionsIn order for the next best decision to be made: • It is critical that complete, current and accurate information about the patient is immediately available at the point of care (EHRs) • It is critical that the most up-to-date scientific medical information is available at the point of care and can be customized and appropriately applied to that patient

  8. Access to current medical science for the next clinical decision

  9. Elements of a Distributed, Technology Enabled Health Care System • Care at Home and in the Community • Ambulatory, Clinic and Community Care • Hospital Care • Public and population health, disaster health, large scale emergency response

  10. Telemedicine in the Outpatient Setting • Telemedicine brings the expertise of a specialist to the point of care and allows that expertise to be customized to that patient Interactive healthcare over distance using technology

  11. General ExamCamera Nasopharyngoscope Electronic stethoscope Otoscope Medical Peripherals

  12. Telemedicine in the Hospital Setting

  13. Reducing Costs and Improving Quality in the Hospital • Hospitalized patients are much sicker than in the past • Having the right information at the point of care 24/7 is essential • Electronic Medical Records (EMRs) are reducing errors made from not having correct patient related information, right dose of drug, etc. • Need the right medical science at the bedside at the right time

  14. Emergency Room Telemedicine

  15. Redistributing Expertise in the Inpatient Setting Neonatal and Pediatric Intensive Care funded in part by William Randolph Hearst Foundation

  16. What is the Future of Telemedicine in California?

  17. Current Investments in Telemedicine in California • Foundation Support – TCE, CETF, CHCF, Blue Shield Foundation • Government Efforts to Increase Telemedicine • California Prop 1D and Broadband Initiative • FCC grant program • California Advanced Services Fund

  18. Governor Schwarzenegger Executive Order for Health IT and Proposition 1D • Executive Order for Health IT • Statewide eHealth Forum October 12, 2006 • Encourage Telemedicine and Health IT • 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.”

  19. 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  UC Davis Pediatric Telehealth Colloquium

  20. FCC Rural Health Care Pilot Program • Dedicated over $417 million for 69 pilot program networks • Pays flat 85% of telecommunication related expenses • Encourages regional broadband health care networks with connections to national backbones UPDATE!

  21. The Office of the Governor California Business, Transportation and Housing Agency (BTH) The California Emerging 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 Networks The UC Office of the President University of California Davis Health System Other Partners 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) Consortium Members

  22. ProposedNetworkDesign • Up to $22.1M • California Emerging Technology Fund (CETF) providing 15% match and start-up funds $3.6M

  23. Technical Goals • Extend broadband connections to 300+ rural health care providers in 3 years • Address technical and cost constraints • Facilitate use of state-of-the-art telehealth services • Telemedicine • Continuing Medical Education

  24. California Advanced Service Fund • $100 Million funding for infrastructure build-out to bring broadband to unserved and underserved areas of the State • Funded by 0.25% surcharge on phone end users’ bills by CPUC • 40% match for infrastructure build-out projects • Awards based on scoring criteria • There is significant potential synergy with the CTN

  25. How will all of this benefit Californians?

  26. Summary • Medical science that can significantly improve the health of people with access to it is increasing • Advanced information and telecommunications technologies have a central role to play in bringing health care expertise to the point of need • Unprecedented resources are being invested in telemedicine infrastructure and equipment • Resources to support the operational transition to this new model of care will still be necessary if we are to take full advantage of the investments already committed

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