Telehealth and Public Health Emergencies and Disaster Medical Responses

1. Telehealth and Public Health Emergencies and Disaster Medical Responses February 6, 2009 Lara Lamprecht

2. Report to Congress • Fulfillment of PHS Act Section 319D (f) as amended by Pandemic and All Hazards Preparedness Act (PAHPA) (December 2006) • Scope limited to Telehealth initiatives that could be utilized to optimize Emergency Support Function #8 efforts in service to the public during public health emergencies (PHE) or disaster medical responses (DMR)

3. Process to Create Report • ASPR policy process mechanisms to obtain the proper utility of and format for a national Telehealth inventory • ASPR-led multi-agency Telehealth Working Group • Created a working definition of Telehealth • Input garnered from internal and external entities • Department of Health and Human Services’ (HHS) Enterprise Governance Board • National Biodefense Science Board (NBSB) • Institute of Medicine (via Dispensing Medical Countermeasures for Public Health workshop)

4. Working Definition for Telehealth Electronic information, infrastructure considerations, clinical, administrative applications and communication technology applied to improving health and maximizing patient outcomes with specific application to public health emergencies and disaster medical responses

5. Content of Report • Working definition for Telehealth • Inventory of existing Telehealth initiatives applicable to PHE or DMR • Integration of Telehealth into NDMS practice • Recommendations for improved interagency practices and cooperation • Establishment and improvement of payment or reimbursement for telemedicine resources • Preparation and integration of the electronic medical record • Public-private collaboration to leverage existing networks • Information technology and telephonic connectivity to enhance the applications to mass casualty event, or PHE and DMR

6. Working Group Identified Challenges • Integration of existing Telehealth and ehealth resources and programs • Expansion of communication technology • Establishment of uniform information standards • Implementation of Telehealth and ehealth throughout the public and private sectors at local, state and national levels • Estimation of the type and amount of resources which will be required • Determination of the role the Federal Government should play in integrating existing Telehealth and ehealth resources and programs

7. Recommendations • Apply existing clinical and technical practices, networks and technological capabilities for information transfer, and rapidly insert intellectual and clinical consultation into remote and compromised environments during a response • Use existing and uniform accounting and electronic asset and reimbursement strategies for Telehealth materials and services to • Improve situational awareness • Enhance overall incident management • Accurately represent the event to facilitate crisis decision-making • Inform event review and lessons learned by providing data for objective evaluation to determine reliable best practices (for swifter recovery and improved patient outcomes) • Properly apply Telehealth tools to capture potentially the “arc” of a patient’s encounter with the system, course of care, and final disposition

8. Recommendations • NBSB recommendation that a Task Force • Address Working Group identified challenges and advise on a national strategy for Telehealth and ehealth application to PHE and DMR • Consider the proper matching of PHE response and disaster medicine tactics with twenty-first century technology • IOM recommendation that a Forum be held to address • Health Informatics (ehealth, Telehealth, IT considerations) In Public Health Emergencies and Disaster Medical Response “21st Century Response” • Three specific topics • EMR compatibility: NDMS, public healthcare, private healthcare • Innovative Response: Consultation, Countermeasures, Tracking, Compensation, Confidentiality • Interoperability: ESFs 5, 6, 8, 9, etc.

9. Next Steps • Development of a national strategy to incorporate Telehealth applications into PHE and DMR including: • Credentialing • Portability • Information exchange regarding adverse actions • Waiving of licensing requirements • Internal Working Group • External input on strategic considerations • NBSB Task Force • Materials generated by IOM and other independent, objective entities • EGB