HHS Perspective on U.S. Telehealth

1. HHS Perspective on U.S.Telehealth Dena S. Puskin, Sc.D. Director, Office for the Advancement of Telehealth

2. What We’ll Cover: What is telehealth/telemedicine? Status of TM in U.S. An introduction to HRSA’s telehealth office (OAT) Joint Working Group on Telemedicine Barriers and solutions to advancing telehealth

3. What is Telehealth? • Telehealth - the use of telecom-munications in health services • Term includes distance learning and clinical care (also called telemedicine) • Other uses include administration, data sharing, and public health

5. Examples of Telehealth Clinical exam Distance learning and patient education

6. Real-Time Telemedicine • Provider presents patient to remote specialist • Very interactive • Using special peripherals, remote doctor can exam patient from miles away Remote specialist (on TV) uses digital stethoscope to check patient’s heart.

7. Other Examples Patient in rural ER gets benefit of local care plus remote consultation with specialists. Remote doctor examines a patient’s inner ear from a remote location

8. Home Health • Low-cost equipment that needs only a regular phone line • Used to check vital signs, monitor medications, visualize patient, provide enhanced support Patient and nurse interacting during a “video home visit.”

9. Store-and-Forward • Primary care provider takes a still image and sends it to a consulting physician who later reviews it • No real time interaction between patient & consultant • Commonly used for dermatology, radiology Clinician reviews scan which was forwarded for consultation.

10. Telemedicine Nationally * • Over 130 programs in 48 states • Network of medical center “hub” and about 10 rural “spokes” • Average 600 encounters a year • Average 25 clinical services per site * Information from the 1999 National Survey of Telemedicine Service Projects by the Association of Telehealth Service Providers

11. Expected Benefits • Improve access to services in rural and underserved areas • Reduce travel time and lower costs • Improve quality of health care through more timely diagnosis and treatment • Reduce isolation of rural practitioners • Expand educational offerings

12. Characteristics • Most common services: mental health, dermatology, cardiology, orthopedics • Common settings: rural hospitals, prisons, homes, school clinics • Three major types of telemedicine: 1) store-and-forward 2) real time 3) remote monitoring

13. Educational and Administrative Uses Continuing education Patient education Administrative meetings Rural providers can receive continuing education without the need to travel.

14. What is OAT? • Began August 1998 • Spun out of Office of Rural Health Policy at HRSA • Staff of 14 • FY 2000 budget of about $20 million

15. OAT’s Responsibilities Administer telemedicine grants • Manage HRSA videoconferencing network Evaluate telehealth programs Develop telehealth policy Assess technology for HRSA and its grantees Develop distance learning programs

16. Distance Learning • Develop multimedia productions using satellite and Web • Chair Public Health Council’s Distance Learning Workgroup • Lead HRSA strategic planning about distance learning • Administer distance learning projects

17. Goal: make educational programs low-cost, high-quality, widely accessible to HRSA and its grantees Pilot test of satellite-to-desktop distance learning system Users view educational programs on their computer desktop either live (real time) or on-demand Technology Assessment

18. Telehealth Grants • Funded 19 new projects in FY 2000 through the Rural Telemedicine Grant Program • Administered 40 other special or continuing projects • Services must be in rural areas • Goals: 1) increase access 2) reduce provider isolation 3) develop integrated systems of care

19. Telehealth Grants • Anticipate funding a total of 65-70 projects in FY 2001, 19 0f which are through the Rural Telemedicine Grant Program • Remaining projects are in urban and rural areas and cover a range of technologies and applications • e.g., distance learning, advanced brain imaging, infrastructure development

20. Policy DevelopmentJoint Working Group on Telemedicine • Federal interagency group that coordinates members’ telemedicine activities • Ensures no overlap in Federal funding • Provides a forum to share information, to educate its members, and to develop specific actions that could reduce barriers to the use of telemedicine.

21. Policy Development • Reports to Congress • Model for estimating Medicare expenditures for expanded Telemedicine services • Guidelines on technical standards and privacy • Author of upcoming Telemedicine Report to Congress • Filings about Universal Service Fund

22. Barriers to Telemedicine • Limited reimbursement • Clinical acceptance • High cost or limited availability of high speed telecommunications lines • State licensure laws • Standards • Evaluation • Sustainability

23. Emerging Issues/Trends • Technology Changes: NGI; Digitization of information/growth of wireless technology • Policy Lag: HIPPA; Technical Standards; Spectrum Allocation • Aging Demographics: Long-term Care/home care; urban telemedicine • Globalization: trade issues; cross-nation legal challenges (e.g., prescription drug trade; licensure)

24. Necessary Steps • Better evaluation to improve acceptance and reimbursement • Improved Infrastructure/Lower telecommunication and equipment costs • Improve standardization of equipment and practices • Address Privacy/Security/ Confidentiality

25. Contact us!Phone301.443.0447Web sitehttp://telehealth.hrsa.gov