TELEHEALTH/TELEMEDICINE IN
TEXAS
By: Edtrina Moss, MSN, RN
What is
Telemedicine/Telehealth?
Telemedicine - use of
medical information
exchanged from one site to
another via electronic
communications for the
purposes of evaluation,
diagnosis, consultation, or
treatment
Telehealth - used to
encompass a broader
definition of remote
healthcare that does not
always involve clinical
services.
TELEMEDICINE/TELEHEALTH
State of Telemedicine/Telehealth
in Texas
• Statewide Health Coordinating Council (SHCC)
convened in 2000
• Examined impact of telemedicine and
telehealth
• SB 789 passed in Texas Legislature May 2001
• Omnibus telemedicine bill to expand
availability in the state
• Establish regulatory framework for service
delivery
Recommendations of SHCC
• Designation of single agency/body
as authority for information &
projects in TX
• Develop interagency collaboration
• Develop interstate & international
telemedicine/telehealth initiatives &
information exchange
Other Concerns
Addressed by
SHCC
Shortage of health Professions
Licensing & Scope of Practice
Infrastructure
Training/Technical Assistance
Reimbursement
Project Planning &
Accountability
Privacy/Security
Future
Trends/Recommendations
So What Now?
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2011 – 2016 State Health Plan
Plan developed by SHCC
Created subcommittee: Technology Committee
Results
 Telemedicine services underutilized in state
 Training critical to success of implementation
 Need for collaboration among all stakeholders
 Marketing, adoption, and development critical to
process
 Next generation tools are vehicles toward
personalized medicine, i.e. video, remote bedside
monitoring, internet-based telecommunications, etc
TELEMEDICINE/TELEHEALTH
VENUES IN TEXAS
Plano, Texas
 Texas Telehealth
Technologies, Inc.
a medical information technology
company
provide information technology to the
medical and scientific community
brings together knowledge of international
experts in areas information technology,
clinical care, telemedicine, telehealth, health
promotion
AmeriDoc©
24/7 medical consultations
Medical information & advice
Diagnostic medical telephone consults
Prescriptions
Plano here
OTHER TEXAS VENUES
Dallas, Texas
Cardiocom
a medical software
nurse call center
Innovative telehealth solutions
Galveston, Texas
 UTMB Galveston TDCJ
Telemedicine for HIV care
Houston, Texas
Texas Children’s Center for Telehealth
first pediatric-based telemedicine program
to "go live" in 1993
http://www.texaschildrens.org/Professional
s/Telehealth/Default.aspx
Lubbock, Texas
Texas Tech University Health Sciences
Center
pioneer in applying live interactive video to
the practice of medicine
VETERANS HEALTH ADMINISTRATION
• Office of Telehealth
Services
• Uses health informatics,
disease management, &
telehealth technologies
• Changes location where
health care services
provided
• Target care/case
management
• Facilitates access to care
• Improves health
outcomes of veterans
• Ensure veterans get right
care, in the right place, at
the right time
• Uses home telehealth
(CCHT) and store &
forward telehealth
• CCHT helps veterans &
providers manage chronic
disease conditions
• Connects veteran to VA
hospital via regular
telephone line
MEDICARE PAYMENT OF
TELEMEDICINE
• Reimbursement divided into
3 areas
• Remote face-to-face via live
video conferencing
• Non face-to-face conducted
via live videoconferencing or
store & forward
telecommunication services
• Home telehealth services
REMOTE FACE-TO-FACE SERVICES
• Eligible facility located outside of Metropolitan
Statistical Area
• Services include consultation, office visits,
individual psychotherapy, and pharmacologic
management
• Eligible providers: physician, NP, PA, Nurse
Midwife, CNS, Clinical Psychologist, Clinical Social
Worker, RD
• Eligible facilities: Office of provider, hospital,
critical access hospital, rural health clinic,
federally qualified health center
REMOTE NON FACE-TO-FACE SERVICES
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•
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Services using telecommunications technology
Does not require patient to be present
Covered the same as when on-site at facility
Example: Interpretation by physician of EEG or
ECG reading transmitted via telephone
• Largest provider of these type is radiology
• No geographic or facility limitation on services
HOME TELEHEALTH
• Telehealth services are outside scope of Medicare
home health benefit
• Does not provide coverage for Medicare home health
services via telecommunications
• Does not permit substitution or use of
telecommunications to provide home health services
paid under home health PPS
• However, nothing precludes home health agency from
adopting telemedicine to promote efficiencies
• Services will not be recognized or reimbursed by
Medicare under home health benefit
THE TEXAS TELEMEDICINE PROVIDER
NETWORK, PURSUANT TO SB 1340
(MEDICAID)
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Texas Administrative Code, §354.1430(2)
Hub Site Provider
Physicians
Hospitals
Teaching Hospitals
Tertiary Center
Health Clinic
THE TEXAS TELEMEDICINE REMOTE SITE
PROVIDERS, PURSUANT TO SB 1340
(MEDICAID)
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Texas Administrative Code, §354.1430(4)
Located in Rural Medically Underserved Areas
Physicians
APNs
CNMs (Certified nurse midwife)
Hospital
Federally Qualified Health Center
Rural Health Clinic
THE TEXAS TELEMEDICINE REMOTE SITE
LOCATIONS, PURSUANT TO SB 1340
(MEDICAID)
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Texas Administrative Code, §354.1432(a)(3)
Practitioner’s Office
Rural Health Clinic
Federally Qualified Health Clinic
Inpatient Hospital
Outpatient Hospital
Emergency Room
ICF-MR Facility
BARRIERS TO
STATEWIDE
IMPLEMENTATION
• Limited to physician services in rural or
underserved areas
• Laws that expand service
• Training
• Education of the consumer/public
• More formal education programs
• Practitioner buy-in
• Marketing of benefits of technology
• Limited reimbursement policies, i.e.
Medicare’s limited home telehealth
policy
NURSING’S ROLE IN IMPLEMENTATION
 Play important role in the development, deployment, and
utilization of telemedicine and telehealth
 Developed leadership roles in Telehealth organizations
 Join Special Interest Groups i.e. American Telemedicine
Association for telehealth nurses
 Learning how to use the telemedicine medical devices
 Become techno-savvy in using other software
applications
Collaborate with information technology staff, biomedical
engineers, and telehealth physicians
 Assist in development of telehealth guidelines, policies,
and procedures
 Review and understand applicable Health Insurance
Portability and Accountability Act (HIPAA) laws with use of
telehealth applications
 Learn evolution of telehealth/telemedicine/e-health
technologies and how used in healthcare
 Some schools have developed courses on telemedicine/
telehealth i.e. Nelda C. Stark College of Nursing and Center
for Telenursing and Health Informatics at Texas Woman's
University
References
American Telemedicine Association. (2008). Medicare Payment of Telemedicine and Telehealth
Services. Retrieved from
http://www.americantelemed.org/files/public/policy/Medicare_Payment_Of_Services.pdf
ok04.pdf.
Castelli, D. (n.d.). Telehealth Technologies Addressing the Global Impending Nursing Shortage.
Retrieved from Lippincott’s Nursing Center.com website:
http://www.nursingcenter.com/CareerCenter/static.asp?pageid=800469.
Health and Human Services Commission. (2006). Telemedicine in Texas Medicaid. Retrieved from
www.hhsc.state.tx.us/news/06_Telemedicine_Texas_Medicaid.pdf.
Health and Human Services Commission. (2010). Telemedicine Medical Services in Texas
Medicaid, Biennial Report to the Texas Legislature. Retrieved from
www.hhsc.state.tx.us/reports/2010/Telemedicine-Medical-Services-0910.pdf.
HIV Education Prison Project. (2000). Telemedicine in Practice: Texas Department of Criminal
Justice. HEPP News, 3(5). Retrieved from
www.idcronline.org/%252E%252E/archives/may00/may.pdf.
Texas Statewide Health Coordinating Council. (2002). The State of Telemedicine and Telehealth in
Texas. Retrieved from www.dshs.state.tx.us/chs/shcc/reports/tmreport.pdf.
Texas Statewide Health Coordinating Council. (2011). 2011-2016 Texas State Health Plan.
Retrieved from www.dshs.state.tx.us/chs/shcc/reports/SHP2011-2016/.