Improving Access to Quality Health Care in Virginia through Information and Communication Technology: A Strategic Plan for Telehealth in the Commonwealth.

Improving Access to Quality Health Improving Access to Quality Health Care in Virginia through Information Care in Virginia through Information

and Communication Technology: and Communication Technology:

A Strategic Plan for Telehealth A Strategic Plan for Telehealth in the Commonwealthin the Commonwealth

November 18, 2005 November 18, 2005

VRHA Annual Fall ConferenceVRHA Annual Fall Conference

What is Telehealth?What is Telehealth?

Telehealth is the use of electronic informationTelehealth is the use of electronic information

and telecommunications technologies and telecommunications technologies

to support long-distance clinical health care,to support long-distance clinical health care,

patient and professional health-related education, patient and professional health-related education,

public health and health administration.public health and health administration.

What Types of Technologies are What Types of Technologies are Used in Telehealth?Used in Telehealth?

Telephone, faxTelephone, fax Computers, printers, scannersComputers, printers, scanners Email and InternetEmail and Internet Store and forward of digital imagesStore and forward of digital images Real-time patient data exchangeReal-time patient data exchange VideoconferencingVideoconferencing Fully integrated networksFully integrated networks

Low Tech

HighTech

The Institutes of Medicine report "Crossing the The Institutes of Medicine report "Crossing the Quality Chasm" (Ross et al, 2001) stated that Quality Chasm" (Ross et al, 2001) stated that "information technology must play a central "information technology must play a central

role in the redesign of the health care system."role in the redesign of the health care system."

It could be argued that nowhere is information It could be argued that nowhere is information technology potentially more critical in the technology potentially more critical in the redesign of healthcare than in rural areas.redesign of healthcare than in rural areas.

Can Rural Telehealth Work?Can Rural Telehealth Work?California Program on Access to Care: California Program on Access to Care:

Study HypothesesStudy 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

Can Rural Telehealth Work?Can Rural Telehealth Work?California Program on Access to Care: California Program on Access to Care:

Study DesignStudy 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

Can Rural Telehealth Work?Can Rural Telehealth Work?

California Program on Access to Care: California Program on Access to Care: Study FindingsStudy 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.

Can Rural Telehealth Work?Can Rural Telehealth Work?

California Program on Access to Care: California Program on Access to Care: Study Findings (continued)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

What are the Challenges What are the Challenges of Rural Telehealth?of Rural Telehealth?

The development of rural telecommunications is not The development of rural telecommunications is not profitable to large telecommunications companies, so profitable to large telecommunications companies, so the infrastructure can be inadequate and/or costly the infrastructure can be inadequate and/or costly

Rural areas frequently have difficulties “keeping up” Rural areas frequently have difficulties “keeping up” with the rapid advances in technologywith the rapid advances in technology

Rural areas often lack the technical manpower and Rural areas often lack the technical manpower and expertise to troubleshoot and provide technical expertise to troubleshoot and provide technical assistance and training in the use of new technologiesassistance and training in the use of new technologies

The Virginia Telehealth Network (VTN)The Virginia Telehealth Network (VTN)

Began in November 2002 as an informal Began in November 2002 as an informal gathering of over 20 individuals gathering of over 20 individuals representing 14 private and public representing 14 private and public agencies/organizations who were agencies/organizations who were identified as key stakeholders involved in identified as key stakeholders involved in telehealthtelehealth

Is now comprised of over 80 individuals Is now comprised of over 80 individuals representing 50 public and private representing 50 public and private agencies/organizationsagencies/organizations

Purpose of the VTNPurpose of the VTN

to facilitate networking, to facilitate networking,

to explore opportunities for collaboration, to explore opportunities for collaboration,

to improve the current telehealth infrastructure; to improve the current telehealth infrastructure; andand

to improve the current utilization of telehealth. to improve the current utilization of telehealth.

Establishing the BaselineEstablishing 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

Snapshot of Telehealth Sites Snapshot of Telehealth Sites (December 2003)(December 2003)

Pound

Norfolk

WiseCedar Bluffs

Abington

Wytheville

Coving-ton

Blacksburg

MartinsvilleSouth Boston

LynchburgFarmville

Williamsburg

Newport News

Portsmouth

Petersburg

Richmond

Fredericksburg

Alexandria

Culpepper

Leesburg

Winchester

Fairfax

Harrisonburg

Charlottesville

Staunton

Pennington Gap

Big StoneGap

Norton

Clintwood

Gate City

Grundy

Vansant

Tazewell

Saltville

Dungannon

Konnarock

St. Paul

Marion

Bland

Bastion

Pulaski(2)

Salem

Pearsburg

BlacksvilleLebannon

Radford

Christianburg

Floyd

StuartGalax

Hillsville

Clifton Forge

Hot Springs

Monterey

Low Moor

New Castle

Laurel Fork

Craigsville

Danville

Troy

Madison Heights

Goochland

Powhatan

Dillwyn

Blackstone

BoydtonCatawba

Warrenton

Manassas

Mitchells

Burkeville

Bowling Green

Colonial Beach

Jarratt

Dahlgren

ArlingtonFalls Church

Warsaw

AylettGlen AllenAshland

Tappanahanock

St Stephens Church

Chesapeake

Heathsville

Suffolk

Callao

Hayes

Cheriton

Accomac

Franktown

Hampton

Virginia Beach

KilmarnockSaluda

Charles City

Vinton

Chesterfield

MontrossOlney

HartfieldLancaster

Nassawadox

(17)

(2) (2)

(2)

(2)(3)

(2)

(4)

(3) 2-H

(2)

Belle Haven

Roanoke

Bristol

Front Royal

(2)

(11)(3)

(2)

Woodstock

Lexington

Newport News

U.V.A.

Community Service Board

V.D.H.

D.O.C.

RAHEC

EVTN

VA Dept. of Mental Health (VDMHMRSAS)

VCU.

VT/VCOM

X= hub

= point of presence (POP)

XX

VCU VDH

UVA

Dept. of Corrections

However…Networks are IsolatedHowever…Networks are Isolated

VT/VCOM

VDMHMRSAS/CSB

Hospitals

Where To From Here?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.

The Birth of a VisionThe Birth of a Vision

VCUVDH

UVA

Dept. of Corrections

Virginia Telehealth Network

Provider offices

HospitalsHome health

patients

Other Networks

VT/VCOM

VDMHMRSAS/CSB

EMS-Satellite

Geriatric facilities

The Next Step The Next Step

The Development of a Statewide Strategic

Telehealth Plan for the Governor’s Consideration is

In Progress

.

The Strategic Planning TeamThe 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

Guiding PrinciplesGuiding Principles

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

OTHER IP HEALTH

NETWORKS

VTN SUBNETWORK

VTN SUBNETWORK

VTN BACKBONE(VIRGINA TELEHEALTH NETWORK)

Remote Sites

Remote Sites

Remote Sites

Remote Sites

Remote Sites

Remote Sites

Remote Sites

Remote Sites

Remote Sites

VTAP

VTAP – Virginia TeleHealth Access PointVTSAP – Virginia TeleHealth Secondary Access Point

VTSAP

VTSAP

VTSAP VTSAP VTSAP

Remote SitesRemote Sites

Remote Sites

VIRGINIA TELEHEALTH

NETWORK

Remote Sites Remote Sites

OSC3 BackboneOSC3 Backbone

OSC3 Backbone

DS3 BackboneDS3 Backbone

VTAP

VTAP

DS3 Backbone

Other IP Networks

Public InternetNetwork

Local Carrier

NETWORK VTAP

NetworkRouter

NNI type of Connection

WiFi

WiMAX

Dial lines toLocal Carrier

Firewell

Direct Connection

TO BACKBONE

Remote Sites

Remote Sites

Remote Sites

Remote Sites

Remote Sites

Anticipated BenefitsAnticipated Benefits

InteroperabilityInteroperability Compatibility of equipmentCompatibility of equipment Group purchasingGroup purchasing Technical assistance Technical assistance Calendaring/scheduling Calendaring/scheduling

OutlineOutline

Executive SummaryExecutive Summary Introduction/BackgroundIntroduction/Background NeedsNeeds VisionVision RecommendationsRecommendations

Technical and Clinical SpecsTechnical and Clinical Specs StandardsStandards Architectural DesignArchitectural Design Business CaseBusiness Case Administration and OversightAdministration and Oversight

Review and CommentReview and Comment

Download this Powerpoint presentation and see the Download this Powerpoint presentation and see the very rough first draft of the strategic plan on very rough first draft of the strategic plan on Tuesday November 22 at Tuesday November 22 at http://www.vdh.virginia.gov/primcare/center/vtn/info.http://www.vdh.virginia.gov/primcare/center/vtn/info.aspasp

Send feedback to Ed Bostick at Send feedback to Ed Bostick at [email protected]@yahoo.com

For More Info…For More Info…

Contact:Contact:

Kathy H. Wibberly, Ph.D.Kathy H. Wibberly, Ph.D.

Virginia Dept. of HealthVirginia Dept. of Health

Office of Health Policy and PlanningOffice of Health Policy and Planning

804-864-7429804-864-7429

[email protected]@vdh.virginia.gov