Improving Access to Quality Health Care in Virginia through Telehealth

1. Improving Access to Quality Health Care in Virginia through Information and Communication Technology: A Strategic Plan for Telehealth in the Commonwealth November 18, 2005 VRHA Annual Fall Conference

2. What is Telehealth? Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.

3. Telephone, fax Computers, printers, scanners Email and Internet Store and forward of digital images Real-time patient data exchange Videoconferencing Fully integrated networks What Types of Technologies are Used in Telehealth? Low Tech HighTech

4. The Institutes of Medicine report "Crossing the Quality Chasm" (Ross et al, 2001) stated that "information technology must play a central role in the redesign of the health care system." It could be argued that nowhere is information technology potentially more critical in the redesign of healthcare than in rural areas.

5. Can Rural Telehealth Work? California Program on Access to Care: Study Hypotheses • Rural health care entities often have difficulty maintaining market share • Perceptions of quality play a role in rural residents’ decisions to leave community for care • Telehealth has the potential to bring expertise to rural communities and increase the scope of locally available services which may improve perceptions of local care

6. Can Rural Telehealth Work? California Program on Access to Care: Study Design • Marketing research firm conducted 500 random phone surveys in 7 rural communities to assess perception and utilization of local health care • Telehealth was implemented in the 7 communities • Seventeen months later, marketing research firm randomly contacted 500 residents in the same communities to assess perception and utilization of local health care

7. Can Rural Telehealth Work? California Program on Access to Care: Study Findings • Respondents with a lower perception of the quality of local health were more likely to travel outside the community, and this relationship was stronger for those with a higher income. • Rural residents familiar with local telehealth efforts had a significantly higher opinion of local healthcare quality.

8. Can Rural Telehealth Work? California Program on Access to Care: Study Findings (continued) The benefits of rural telehealth could include: • Potential reduction in health care costs • Keeping patients local retains direct and indirect health care $$ • When patients leave the community for health care, their purchasing dollars go with them to the urban community

9. What are the Challenges of Rural Telehealth? • The development of rural telecommunications is not profitable to large telecommunications companies, so the infrastructure can be inadequate and/or costly • Rural areas frequently have difficulties “keeping up” with the rapid advances in technology • Rural areas often lack the technical manpower and expertise to troubleshoot and provide technical assistance and training in the use of new technologies

10. The Virginia Telehealth Network (VTN) • Began in November 2002 as an informal gathering of over 20 individuals representing 14 private and public agencies/organizations who were identified as key stakeholders involved in telehealth • Is now comprised of over 80 individuals representing 50 public and private agencies/organizations

11. Purpose of the VTN • to facilitate networking, • to explore opportunities for collaboration, • to improve the current telehealth infrastructure; and • to improve the current utilization of telehealth.

12. Establishing the Baseline • During 2003 - 2004, the VTN Infrastructure Work Group (IWG) designed a site survey to capture information about: • Current telehealth infrastructure and capacity • Future (next 36 months) plans for expansion of telehealth activities

13. Snapshot of Telehealth Sites (December 2003) X= hub U.V.A. = point of presence (POP) Community Service Board V.D.H. Winchester D.O.C. Leesburg Arlington RAHEC Falls Church EVTN Woodstock Front Royal Fairfax VA Dept. of Mental Health (VDMHMRSAS) (2) Alexandria VCU. Manassas VT/VCOM Warrenton Harrisonburg Culpepper Monterey Colonial Beach Fredericksburg Dahlgren (2) (2) Craigsville Montross Staunton Mitchells Olney Warsaw Charlottesville Hot Springs Accomac St Stephens Church Callao Bowling Green Troy Clifton Forge Heathsville Ashland (2) Coving- Aylett Tappanahanock Nassawadox (4) (3) Glen Allen Kilmarnock Low Moor Goochland ton Belle Haven Dillwyn Saluda Franktown Lexington Vinton (2) (2) Lancaster Richmond New Castle Powhatan Grundy (11) Hartfield Chesterfield Lynchburg (3) Blacksburg Roanoke Farmville Cheriton Charles City X Vansant (2) Madison Heights Petersburg X Salem Clintwood (2) Bastion Williamsburg Tazewell Christianburg Hayes Pound Pearsburg Blackstone Hampton Cedar Bluffs Bland Dungannon Newport News Newport News Wise St. Paul Radford Burkeville Big Stone Gap Wytheville (17) Virginia Beach Catawba Portsmouth Lebannon Norfolk Saltville Jarratt Blacksville Pulaski Boydton (3) 2-H Norton Floyd Martinsville Marion (2) Abington South Boston Laurel Fork Chesapeake Hillsville Suffolk Pennington Gap Gate City Konnarock Galax Danville Stuart Bristol

14. Hospitals VDH VDMHMRSAS/CSB VT/VCOM VCU UVA Dept. of Corrections However…Networks are Isolated

15. Where To From Here? Based on the findings of the site survey. The VTN IWG developed a white paper that delineated the strengths and weaknesses of the existing telehealth infrastructures. In that white paper was the recommendation for the development of a statewide integrated telehealth network.

16. The Birth of a Vision Dept. of Corrections Other Networks Virginia Telehealth Network VT/VCOM VDH VCU UVA VDMHMRSAS/CSB EMS- Satellite Provider offices Geriatric facilities Hospitals Home health patients

17. The Next Step The Development of a Statewide Strategic Telehealth Plan for the Governor’s Consideration is In Progress .

18. The Strategic Planning Team • Michael Aisenberg – Liberty Alliance/Verisign • Ed Bostick – Rappahannock Area Health Education Center • Peter Buccellato – Knowledge Providers Group • Rebecca Davis – Virginia Rural Health Association • Steve Gillis– Telehealth Solutions Group • David Heise– Telehealth Solutions Group/MCI • Jay Sanders – The Global Telemedicine Group

19. Guiding Principles • Consumer Choice • End-user Driven Policies • Any to Any Connectivity (Open Access) • Scalability (Bandwidth Tailored to Need) • Geographic Parity • Financially Self Sustaining • Rapid Adoption of Telehealth Applications

23. Anticipated Benefits • Interoperability • Compatibility of equipment • Group purchasing • Technical assistance • Calendaring/scheduling

24. Outline • Executive Summary • Introduction/Background • Needs • Vision • Recommendations • Technical and Clinical Specs • Standards • Architectural Design • Business Case • Administration and Oversight

25. Review and Comment • Download this Powerpoint presentation and see the very rough first draft of the strategic plan on Tuesday November 22 at http://www.vdh.virginia.gov/primcare/center/vtn/info.asp • Send feedback to Ed Bostick at edat1218@yahoo.com

26. For More Info… Contact: Kathy H. Wibberly, Ph.D. Virginia Dept. of Health Office of Health Policy and Planning 804-864-7429 Kathy.Wibberly@vdh.virginia.gov