NMDOH TELEHEALTH PROJECT-SUMMIT
Telehealth in New Mexico:
Need for Coordination and
Collaboration in the New Age of
Healthcare Transformation
Dale C. Alverson, MD
Medical Director, Center for Telehealth
University of New Mexico
CMIO, New Mexico Health Information Collaborative
June 16, 2015
Health Care Reform/PPACA
Economic Downturn
Emerging Enabling Information
Communication Technologies
Need for more Access to Care
An Aging Population/Baby Boomers
Critical Shortage of Healthcare Providers
EHR Adoption/HIE
Meaningful Use
ICD10/11
PCMH
ACOs
A Time for Telemedicine & e-Health
Telemedicine and eHealth:
The General Concept
Defining Telemedicine and
Telehealth
“Tele-” comes from the Greek root word meaning
“distant or remote”/ “at a distance”.
•
•
•
•
•
•
Tele-phone
Tele-vision
Tele-graph
Tele-gram
Tele-scope
Tele-Etc, etc, etc
a combining form meaning “distant,” especially “transmission over a
distance,” used in the formation of compound words
So What is
Telemedicine/Telehealth?
• The use of advanced telecommunications technologies to
exchange health information and provide healthcare services
across geographic, time, social and cultural barriers (J. Reid)
• Telehealth is more than just video-conferencing and
encompasses health information exchange and a spectrum of
health information technologies
• It is simply the delivery of health services at a distance (A.
Darkins)
“Back to
the Future”
So What is e-Health?
• Healthcare practice supported by electronic processes and
communication
• Includes Electronic Health Records (EHR), Computerized
Physician Order Entry, and e-Prescribing
• Health Information Exchange (HIE)
• “Digital Health”
Health Information Exchange and
Telemedicine :
A Complimentary Piece of the Puzzle
Telemedicine
and
Health Information Exchange (HIE)
• Telemedicine creates the “virtual” consultation and
provision of service between providers and patients
= access to care
• HIE creates the consolidated “virtual” medical record
about the patient from a variety of electronic health
records and sources
= access to the patient’s health information
How is Telehealth & e-Health used?
• Clinical (“Telemedicine”): Direct Patient Care and Consultation, Case
Reviews
• Educational: Providers, Students, and Patients
• Research: Community-based Participatory, Outcomes driven
• Public Health
• Administrative: Strategic planning, Operations
• Sharing Health Information
• Enhanced Disaster Response
Telehealth as an Integral Part of
Our Healthcare System
•
•
•
•
•
•
•
•
•
Becoming a Standard of Care/Part of Work Flow
Avoiding Unnecessary Variations in Care
Part of Patient protection and Affordable Care Act (PPACA)
The “Triple Aim”: Patient Centered, Improved Outcomes,
Reducing Costs
Prevention: Avoiding ED visits and Hospitalization
Pay For Performance (P4P)
Accountable Care Organizations (ACOs)
Impacting Ambulatory Sensitive Conditions
Patient Centered Medical Home (PCMH)
Telehealth and
Health Information Technologies:
Part of the Solution in Creating the Medical Home and
Enhancing Access
Hitting the Targets: “The Triple AIM”
Improve
Patient
Access
Telehealth
Improve
Health
Outcomes
Reduce
Costs
Involving the Patient
Telehealth Networks
Rural/Remote Health Providers Can Access Expert Medical Opinions, Knowledge,
Education via Telehealth
Rural
or Remote
Location
Telehealth
Network
Audio
High-Resolution Images & Video
Patient
Student
Local Health
Provider
Specialty
Medical Center
Medical
Specialty
Teams
Consultation
Direct Patient Care
Case Reviews
Education
Training
Health Information Exchange
Community-Based Research
Telehealth in New Mexico
Brief History of Telehealth Milestones in NM
• UNM Center for Telehealth founded through state
legislation and started in 1995
• Other HealthCare providers becoming involved in
Telehealth Activities 2000
• The ECHO project launched in 2003 as a Hepatitis C
educational, case-review model
• NM Telehealth Alliance, non-profit 501c3 founded
in 2004
• NM Telehealth Act passed into law 2004
• Medicaid established Telemedicine rules in 2007
• NM Telehealth and HIT Commission formed in 2007
• FCC Southwest Telehealth Access Grid Proposal
approved 2007; Brings in $15.4 million federal
funds for broadband connectivity
Brief History of Telehealth Milestones in NM (cont.)
• Parity telemedicine reimbursement laws passed in
2013
• Broadband Assessment and Recommendations:
Education, Healthcare, and Economic
Development; Report released 2013
• Medicaid updated Telemedicine Rules in 2014
• Removed rural requirements for originating sites
• No longer required a certified health professional be
with the patient at the originating site
• Allows use of store and forward applications
• Telehealth Fund created at NM DOH July 2014
• Neurosurgery Tele-stroke CMS ACCESS Grant
funded $15 million 2014
• New Mexico receives very high grades from the
American Telemedicine Association (ATA) on a
national level when compared to other states 2015
Insurance Coverage for
Telemedicine Services
Passed and Signed into Law
2013
New Mexico Telehealth Act
Passed and Signed into Law
2004
Introduced by:
Sen. Jerry Ortiz y Pino (D)
and
Rep. Stephen Easley (D)
Introduced by:
Rep. Danice Picraux(D)
and
Supported by
Sen. Susan Wilson-Beffort (R)
SENATE BILL 69
HOUSE BILL 581
HOUSE BILL 171
46TH LEGISLATURE - STATE OF NEW
MEXICO
ECHO: Treatment Outcomes
Outcome
ECHO
UNMH P-value
N=261
N=146
Minority
68%
49%
P<0.01
SVR (Cure) Genotype 1/4
50%
46%
NS
SVR (Cure) Genotype 2/3
70%
71%
NS
SVR=sustained viral response
NEJM : 364: 23, June 9-2011, Arora S, Thornton K, Murata G,
et.al.
Direct Patient Care
Maternal Fetal Medicine-High Risk Pregnancy
Genetic Counseling
School Based Health Centers
Telehealth assistants at the school or
child care center provide the link to
examine the eyes, ears, throat, lungs
and skin.
Videoconferencing provides the “face
to face” interaction.
“Getting providers to think of their
desktop computer as an exam room
is the trick.” Dr. Neil Herendeen
24
Family Visitation
“Store and Forward”
• Capturing an image and storing it to then be forwarded for review by
a medical specialists
• Examples include teleradiology, telepathology and teledermatology,
tele-ophthalmology (retinal scans)
• “Telemedicine” or HIE?/It’s about connecting patients and providers
to achieve better care
Teleradiology and Image Transfer
Web-Based Portals
Diabetic
Retinopathy
Retinal Scans:
Trauma Triage
44% Transfer
Avoidance
27% Management
Recommendation
Changes
Moya M, Valdez J,
Yonas H, Alverson
DC. The Impact of
a Telehealth Webbased Solution on
and Consultation.
Telemedicine and
eHealth, 2010;
16:945-949
Access to Critical Cerebral Emergency Support Services (ACCESS):
Expanding New Mexico's telehealth network to include all 30
hospitals statewide. CMS Innovation Grant
$15 million
http://hsc.unm.edu/emermed/PED/ChildReady/CR.shtml
Behavioral Health
Center for Rural and Community
Behavioral Health (CRCBH)
Psych Emergency Services (PES)
http://psychiatry.unm.edu/centers/crcbh/index.html
Behavioral Health Services – PTSD/TBI
Suicide Prevention
IRA HAYES
Teledermatology (Store and Forward)
ENVISION
http://www.envisionnm.org/index.php/telehealth/comm-tc/
CYBER CF (Cystic Fibrosis)
Support Groups
Transitions of Care
Consultative Clinic
Pediatric Intensive Care
Pediatric Cardiology
Pediatric Oncology
Southwest Telehealth Access Grid (SWTAG):
a “Network of Networks” that can support both Telehealth and HIE
FCC RHCPP
Awarded $15.5 million to cover 85% of build-out and
operations of broadband networks for healthcare
Navajo Rural Health Project
Hospital
Chapter House
Navajo Homes
Broadband Connection
C.H.R.
Community Health Representative (C.H.R.)
Telehealth:
Dynamic
Emerging
Technologies
Video Options
• H.323 Video Conferencing Systems (e.g.
Polycom, Tandberg and use of IP addresses)
• H.324 Video phones (analog)
• Video SIP Client (e.g. Jabber, federated MS
Lync etc.)
• Cloud based video conferencing (e.g. Vidyo,
Zoom): hosted or non-hosted, BYOD
• “WebRTC” (Real Time Communications):
Secure Web browser access
Telehealth
Toolkit
SaaS (SIP&the
Cloud)
Videophone (H.324)
Skype
Software IP Based (H.323)
Desktop IP Based (H.323)
Small Conference Room IP Based (H.323)
Hand Held Devices- “mHealth”
iPhone
Droid
iPhone
Smart Phones and Tablets
Remote Monitoring
The “Smart Band-Aid”
Smart Phone “Snap-Ons”
or Blue Tooth to Mobile Devices
TytoCare
Eye exams via your Smart Phone
“Google Glass”
(A Passing Fad?)
Rafael Grossmann, MD, FACS at
Google Glass's first surgical
appearance
Tele-mentoring, Tele-Supervision, Teaching &Training
Telehealth Resources
The New Mexico Telehealth Alliance
Telehealth Alliance
“Networks of Networks”
• Represents a consortium of public
and private health care
stakeholders: “Neutral Territory”
(501c3)
Providers
Consumers
Telehealth
Expertise
Communication
Networks
• Reflects the diversity of our health
care delivery system in New Mexico Social Networks
• Enables collaboration
The 4 “C’s”
Cooperation
Coordination
Collaboration
Communication
ATA Interstate Telehealth DG
http://www.telehealthresourcecenter.org/
http://www.americantelemed.org
Interstate Telehealth Discussion Group
http://ctel.org/
The Future and Next Steps
Telehealth Planning:
Keys to successful implementation
• Feasibility and Needs Assessment
• Technology Planning: Platforms for both consulting and
originating sites, connectivity, security
• Operations Planning: Workflow, workforce, C/P, Licensure,
Documentation/Integration with EHR, scheduling vs. 24/7emergencies, reimbursement (parity legislation)
• Business Planning: Integration with strategic direction,
Sustainability, ROI
• Evaluation Planning: data collection, metrics of success
• CQI
Legal and Regulatory Ramifications
• HIPAA/HITECH
• FDA/FCC
• Liability and Malpractice Insurance/Risk Reduction
• Standards of Care
• Credentialing/Privileging and Licensure
Telehealth: Next Steps (7) and
Strategic Path Forward in New Mexico
1.
Coordination and Collaboration
2.
Meeting Healthcare Needs
3.
Overcoming Barriers
4.
Connectivity and Technical Support Services
5.
Network of Telemedicine Clinic Originating Sites
6.
HIE Integration
7.
Research and Evaluation, ROI, Value Based Accountability (VBA)
1. Need for Centralized
NM Telehealth Resource Center
• Enhance coordination of telehealth services and
provide platform for collaboration
• Provide a listing and contacts (Data Base/“Catalogue”)
for specific available telehealth services
• Answer question regarding provision and receiving of
telehealth services
• Provide telehealth education and training as needed
• Follow established guidelines and standards of care
• Evaluate the impact and provide CQI
• Serve as a single point of contact for other entities
interested in telehealth
2. Ongoing Needs Assessment
• Telehealth services should be implemented that
address define healthcare needs of communities,
providers, and patients throughout NM
• Develop ongoing periodic surveys for needs
assessments
3. Identify Issues and Barriers
Affecting Telehealth Services
• Work with the Legislature, Governor’s office, and
State Departments, along with Governing and
Regulatory Bodies to address those barriers and
find solutions
4. Develop Affordable Appropriate
Broad-band and Technical Support Services
• Develop “Cash Match Fund” for Federal Programs
(FCC HCF, USDA DLT Grants)
• Work with DoIT
• Work with telecommunication industry
• Provide support services for the FCC and USDA
related healthcare programs and subsidies
• Contract for secure, reliable NOC services
5. Develop Network of Telemedicine Clinic
Originating Sites
6. Integrate with Health Information
Exchange (HIE) initiatives
• Patient healthcare information, medical history,
and documentation should go hand-in-hand with
telemedicine services, similar to in-person services
7. Continued Quality Improvement
• Research and Evaluation
• Value-Based Accountability
• Return on Investment
• Meeting the Triple Aim
• Ongoing Assessment
Promoting Adoption and
Overcoming Barriers
• It takes a Transdisciplinary Team and
Collaboration
• Belief in the Value
• Demonstrating the Value
• Dedication
• Persistence
Questions & Comments?