American Telemedicine Association 2013 Annual Meeting May 5, 2013 Austin, Texas. Telemedicine 201: Taking Your Program to the Next Level

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1 American Telemedicine Association 2013 Annual Meeting May 5, 2013 Austin, Texas Telemedicine 201: Taking Your Program to the Next Level Half Day Course Coordinated by the University of California Davis Health System American Telemedicine Association 1100 Connecticut Avenue NW, Suite 540 Washington, DC , fax

2 Center for Health and Technology Telemedicine Taking Your Program to the Next Level Sunday, May 5, 2013 ATA International Meeting and Exposition Austin Convention Center, Conference Room 19 A/B Austin, Texas Agenda 8:00 a.m. Welcome, Introductions and Overview Chaired by: Shelley Palumbo, MS, CCC-SLP, Chief Administrative Officer, Center for Health & Technology and Center for Virtual Care, UC Davis Health System, Sacramento, CA 8:10 Creating Collaborative Initiatives Jana Katz-Bell, MPH, Assistant Dean, Interprofessional Education, UC Davis School of Medicine and Betty Irene Moore School of Nursing 8:45 Beyond a Decade: Challenges to Sustainability Moderator: Jana Katz-Bell, MPH, Assistant Dean, Interprofessional Education, UC Davis School of Medicine and Betty Irene Moore School of Nursing 9:45 Break Dale C. Alverson, MD, Professor Emeritus of Pediatrics and Regents' Professor; Professor, Health Sciences Center Library and Informatics Center; Medical Director, Center for Telehealth and Cybermedicine Research; University of New Mexico Joe Tracy, MS, Vice President for Telehealth Services, Lehigh Valley Health Network, Allentown, PA 10:00 Varying Business Models: Assessment, Leadership and Planning Facilitator: Shelley Palumbo, MS, CCC-SLP Aaron E. Bair, MD, MSc, Associate Professor, Emergency Medicine; Medical Director, Center for Health and Technology and Center for Virtual Care; UC Davis Health System, Sacramento, CA Javeed Siddiqui, MD, MPH, Chief Medical Officer, TeleMed2U, Roseville, CA 11:00 a.m. Q & A / Wrap-up/Adjournment The Telehealth Education Program at UC Davis is accredited by the American Telemedicine Association

3 American Telemedicine Association Quality Healthcare Through Telecommunications Technology Telemedicine 201: Taking Your Program to the Next Level May 5, 2013 Center for Health and Technology UC Davis Health System

4 Information Please turn off cell phones Evaluation forms Location of restrooms Center for Health and Technology UC Davis Health System

5 The Center for Health and Technology UC Davis Health System 8:00 a.m. Welcome, Introductions and Overview 8:10 Creating Collaborative Initiatives 8:45 Beyond a Decade: Challenges to Sustainability 9:45 Break 10:00 Varying Business Models: Assessment, Leadership and Planning 11:00 a.m. Q & A / Wrap-up / Adjournment Accredited by the American Telemedicine Association

6 Jana Katz-Bell, MPH Assistant Dean, Interprofessional Programs UC Davis School of Medicine and Betty Irene Moore School of Nursing Jana Katz Bell is the Assistant Dean for Interprofessional Programs at UC Davis School of Medicine and the Betty Irene Moore School of Nursing. She served as Chief Administrative Officer for the UC Davis Center for Health and Technology since 1995 where she led this distinctive program. Under her leadership, the CHT won national and worldwide attention as one of the best Telemedicine Programs in the United States. Along with the Associate Vice Chancellor Thomas Nesbitt, Ms. Katz-Bell was responsible for the development and implementation of projects which supported the mission of the CHT as well as the University of California, Davis Health System. She currently works on statewide telehealth initiatives, the advancement of interprofessional goals, and is a core member of the launch team for the Betty Irene Moore School of Nursing at UC Davis. Ms. Katz-Bell received her bachelor s degree at the University of California, Davis, and her master s degree in public health at the University of California, Berkeley. In addition to her formal education and extensive background developing and managing telehealth programs, Ms. Katz Bell has become a nationally recognized speaker of telemedicine issues, her testimony during deliberations of the California State Legislature on Senate Bills 1665 and 2098 led to legislation which favors telemedicine reimbursement. Ms. Katz-Bell is Vice President of the Center for Telehealth and e-health Law, a national telehealth legal and regulatory resource center.

7 Aaron Bair, MD, MSc Associate Professor, Dept. of Emergency Medicine Medical Director, Center for Health and Technology and Center for Virtual Care University of California, Davis Dr. Bair is the medical director for the Center for Health and Technology (CHT) and the Center for Virtual Care at UC Davis. He is also the director of emergency medicine simulation training and the Medical Simulation Fellowship. As Medical Director for the Center for Health and Technology, Dr. Bair provides oversight of clinical telehealth activities, including clinical quality improvement, and serves as a liaison between remote Telemedicine sites and UC Davis consultants. Dr. Bair is responsible for the advancement of telehealth system-wide. Under his leadership the Center for Health and Technology continues to evaluate, research and integrate new telehealth applications, resulting in new programs and partnerships. Dr. Bair s research interests are focused on procedural competency and computational modeling (patient flow and surge capacity). Dr. Bair also serves as Medical Director for Emergency Medical Services in Solano County and is the Director for Disaster Preparedness for the Department of Emergency Medicine.

8 Dale C. Alverson, MD Professor of pediatrics and Regents Professor on faculty, University of New Mexico Director of the Center for Telehealth and Cybermedicine Research, UNM Dr. Dale Alverson is a professor of pediatrics and Regents Professor on faculty at the University of New Mexico (UNM), School of Medicine. He is the Director of the Center for Telehealth and Cybermedicine Research (CfTH) at UNM. In that role he has been involved in the planning, implementation, research, and evaluation of telemedicine systems in New Mexico. Dr. Alverson has been appointed by the Governor as a Commissioner on the New Mexico Telehealth and Health Information Technology Commission and is on the Board of the New Mexico Telehealth Alliance, having served as a prior chairman. He is also on the Board of LCF Research in New Mexico addressing the advancement and meaningful use of health information exchange, adoption of electronic health records, and integration with telemedicine. Dr. Alverson is the immediate past ATA President; the UNM Center for Telehealth was given the ATA President s Institutional Award 2007 for its efforts in advancing telehealth locally, nationally, and internationally. He is also involved in several international telehealth projects, particularly with projects in Latin America, as well as ongoing initiatives for the development of collaborations with telehealth programs in Africa, India, Nepal, Iraq, Afghanistan, and several other countries.

9 Joseph A. Tracy, MS (Stevens Institute of Technology) Vice President - Telehealth Services Lehigh Valley Health Network Allentown, PA Mr. Tracy has been working in the area of telehealth since Joe is currently Vice President for Telehealth Services at Lehigh Valley Health Network (LVHN). Joe currently Chairs the American Telemedicine Association s (ATA) Institutional Council and is the immediate past President of the Center for Telehealth and e-health Law (CTeL). In 2003, Mr. Tracy accepted the American Telemedicine Association President s Award on behalf of the Missouri Telehealth Network. In 2006, Joe accepted ATA s Leadership Award in recognition of his contributions to the advancement of telemedicine. Mr. Tracy drafted the telehealth Medicare reimbursement language for the Southern Governors Association in 1999 and for U.S. Senate Bill 2505, which significantly improved Medicare reimbursement for telehealth in October Joe is also the Editor of A Guide to Getting Started in Telemedicine, published by the federal Office for the Advancement of Telehealth.

10 Javeed Siddiqui, MD, MPH Founder & Chief Medical Officer TeleMed2U Roseville, CA Dr. Siddiqui is the founder of TeleMed2U where he serves as its Chief Medical Officer with oversight of the company s clinical and technical program development. Prior to TeleMed2U, from Siddiqui co-developed and directed one of the nation s leading academic telemedicine programs at the University of California Davis Medical Center in Sacramento, CA. During his tenure he served as associate medical director for the Center for Health and Technology and as medical director for the telemedicine clinics. From , Dr. Siddiqui secured significant federal and state grant support to develop the first private sector inpatient infectious diseases telemedicine consultative service in the United States. He has authored articles in peer-reviewed journals, published manuscripts and abstracts and presented at national and international medical industry conferences.

11 Shelley Palumbo, MS, CCC-SLP Chief Administrative Officer Center for Health and Technology and Center for Virtual Care University of California, Davis Shelley Palumbo is Chief Administrative Officer for the Center for Health and Technology and Center for Virtual Care at UC Davis. Since joining the CHT, Shelley has been active in advancing the telemedicine program through program and policy development, operational and grant management, specialty recruitment, and reimbursement initiatives. As the field of telehealth evolves, Shelley is responsible for guiding the CHT and collaborating with clinicians to integrate telehealth into their practices. She is responsible for the CHT's successful implementation of several local and statewide initiatives and is frequently called upon by colleagues across the country for guidance when setting up their programs. Prior to UCDHS, Shelley worked in clinical and managerial healthcare positions specializing in neurorehabilitation. She holds a Master s degree in Speech-Language Pathology, is certified through the American Speech-Language-Hearing Association and is a licensed practitioner in the state of California. Shelley s experience includes working with children and adults in acute home and community rehabilitation, acute rehabilitation, outpatient, transitional living, home health, skilled nursing, and a non-public school setting. Shelley has presented to local and national audiences on brain injury rehabilitation, as well as on various aspects of telemedicine.

12 American Telemedicine Association Quality Healthcare Through Telecommunications Technology Creating Collaborative Initiatives Jana Katz-Bell, MPH Assistant Dean, Interprofessional Programs UC Davis School of Medicine Betty Irene Moore School of Nursing May 5, 2013 Center for Health and Technology UC Davis Health System

13 Presentation Overview State-level examples Approaches and messaging Key elements for success Example presentation for thought leaders

14 Variation in State-Wide Approaches Lead organization varies By funding source By legislation Governor s office initiative University-facilitated state networks Usually in states with one school of medicine Collaborators by necessity

15 History of Telemedicine in Georgia November 1991 the Medical College of Georgia commenced a telemedicine pilot project between MCG and Dodge County Hospital in Eastman, Georgia. The pilot project was successful and evolved into MCG s Telemedicine Program by 1993 expanded to seven sites, March 1992, then Governor Miller signed into law Senate Bill 144, The Distance Learning and Telemedicine Act of 1992, mandated a statewide telecommunications network be established to support both a statewide distance learning program and a statewide telemedicine program.

16 History of Telemedicine in Arizona Arizona Telemedicine Program was developed in 1996 by legislative act A budget of $1.2 million to establish an 8 site pilot project The program has developed a membership fee model that has resulted in creating a network of networks with connectivity to 100+ sites within Arizona

17 New Mexico Consortium A driving force in New Mexico was the goal to share bandwidth to remote locations The NM Telehealth Alliance is a tax-exempt 501(c)(3) non-profit corporation dedicated to promoting telehealth solutions to deliver quality healthcare throughout the state.

18 History of Telehealth in California 1992 to 1996 UC Davis Remote Fetal Monitoring project 1992 Kaiser Home Health Project Randomized clinical trial Stanford TM program (Local & International) Riverside County Psychiatry Program

19 The California Telehealth/Telemedicine Coordinating Project Planning Committee A grassroots committee emerges First Statewide Planning Effort Funded by several foundations and the Office of Statewide Planning and Development Involved 60 individuals from State Government, Payers, Hospitals, provider groups, telecom, foundations and academic medicine Mission to support the emergence of telehealth/ telemedicine networks to benefit Californians

20 California Telehealth and Telemedicine Coordination Project A comprehensive report in January 1996 including: Status of telecommunications infrastructure Telemedicine policy issues with recommendations Legislation SB 1665 required reimbursement policies from payers California Telemedicine and Telehealth Center (CTEC) A statewide resource center

21 State of California Present at legislative hearings Rural caucus to provide educational programs Core collaborations cemented: California State Rural Health Association, The Children s Partnership, Legislators, Governor s office, etc

22 CTEC Expands Resources

23 Center for Connected Health Policy The California Health Care Foundation created CCHP as a centralized policy resource to help spur broad statewide adoption of telehealth technologies. The investment is leveraged by HRSA that selected CCHP as a National Telehealth Resource Center

24 Telehealth in California The outcome of nearly 20 years of grass-roots collaboration

25 Proposition 1D: K-University Public Education Facilities Bond Act of 2006 the amount of $200 million shall be used for capital improvements that expand and enhance medical education programs with an emphasis on telemedicine aimed at developing high-tech approaches to health care.

26 California s Proposition 1D Passes With Proposition 1D we will be able to connect our best hospitals and our best medical schools with clinics in remote areas all over the state of California. 10/27/2006 UC Davis Pediatric Telehealth Colloquium Governor Arnold Schwarzenegger

27 California Telehealth Network A statewide broadband partnership for telehealth dedicated to providing access to high quality health care in rural and medically underserved areas in California. Over 360 sites enrolled; 180 health care sites with access to the network CTN Board of Directors made up of a blend of representatives from the areas of healthcare, technology, reimbursement, policy and advocacy.

28 Broadband Technology Opportunities Program NTIA Sustainable Broadband Adoption $9.1 million federal award $4.7 million match $13.8 million total project

29 Key Partners Match Partners National Coalition for Health Integration The California HealthCare Foundation United HealthCare University of California Training Partners California Community Colleges California State Library UC Division of Agriculture & Natural Resources UC Davis Extension California Health Information Partnership & Services Organization UC Davis Health Informatics The California Rural Indian Health Board, Inc. California Telemedicine and ehealth Center UC Davis Center for Health & Technology

30 The Three Components of the BTOP Grant 1. Low cost access to a state-of-the-art statewide managed, medical grade broadband network (CTN); 2. Establish Model ehealth Communities Strategic placement of ehealth equipment; 3. Community-based modular training program focused on broadband dependent technologies.

31 Proposition 1D, coupled with funding from the FCC and private foundations provides California with the opportunity to achieve technology-enabled healthcare reform

32 Advocacy and Policy Development

33 Messaging and Communications Message should be more than telehealth reimbursement and more $$ -- Prepare for the future of healthcare delivery Be able to consistently articulate the big vision in a statement: e.g. Telecommunications technology in health care is essential to improve access and quality for underserved populations Not a panacea, don t overstate its value

34 A Single Organization Cannot Advance Telehealth Must align with other key organizations Hospital and clinic organizations, advocacy groups, foundations Understand their issues, educate why telehealth can help Allies are important but so is a lack of enemies Find out who is against telehealth privacy groups, state fraud people Be willing to give others credit

35 Diverse Partnerships Corrections and Youth Authority State Departments of Public Health, Health and Human Services, Emergency Response Veterans Affairs Indian Health Service Public and private schools of medicine, pharmacy, optometry, nursing, dentistry Advocacy groups, especially children s groups For profit telehealth organizations

36 Leverage the Power of Consumer Groups Patient protection and rights need to be addressed If viewed as a substitute to traditional care, rather than a supplement, it may be problematic Example: Parkinson s Disease community

37 Coordinated Approach to Legislation and Regulation Collective voices can effectively respond to legislative issues and regulatory barriers Competitors working together create the most powerful consortium since it demonstrates an overarching need

38 Critical Elements to Successful State Legislation Find a champion in the state legislature California Example The Telemedicine Development Act of 1996 State Senator Mike Thompson s staffer worked closely with a consortium to craft language A decision-maker in Department of Health Services attended the same meetings Without the legislative and agency representation buy-in, a disconnect can occur in implementation

39 There is no limit to what can be accomplished if it doesn't matter who gets the credit. Ralph Waldo Emerson

40 Some Basic Thoughts on Advocacy Anecdotal cases are as important as good data you need both Video testimonials, good presentations, repeat the message over and over Find key champions Get policy makers or organizational executives to make telehealth their issue -- you are there to help them

41 Now versus Then Then 90% of our efforts involved education on what telehealth is ; why it is not evil Now Telehealth is well known and is supported by literature State economies are terrible; health reform is coming/here Telehealth must improve access and quality while saving $$

42 Video Example

43 American Telemedicine Association Quality Healthcare Through Telecommunications Technology Creating Collaborative Initiatives Jana Katz-Bell, MPH Assistant Dean, Interprofessional Programs UC Davis School of Medicine Betty Irene Moore School of Nursing May 5, 2013 Center for Health and Technology UC Davis Health System

44 American Telemedicine Association Quality Healthcare Through Telecommunications Technology Beyond a Decade: Challenges to Sustainability Joe Tracy, MS Vice President for Telehealth Services Lehigh Valley Health Network Allentown, PA Dale C. Alverson, MD Professor Emeritus of Pediatrics and Regents' Professor; Professor, Health Sciences Center Library and Informatics Center; Medical Director, Center for Telehealth and Cybermedicine Research University of New Mexico Albuquerque, NM Moderator: Jana Katz-Bell Assistant Dean, Interprofessional Education UC Davis School of Medicine and Betty Irene Moore School of Nursing Sunday, May 5, 2013

45 Course Objectives Anticipate unexpected challenges associated with sustaining a TM Program Understand potential issues related to integration of telemedicine within a health system and with other technologies Center for Health and Technology UC Davis Health System

46 Beyond a Decade: Challenges to Sustainability Beyond a Decade: Challenges to Sustainability What do you think are the most important 2-3 reasons your program has endured and is thriving? Lehigh Valley Health Network Finding the right mix of services to Increase access to care to LVHN Service Lines; Reduce length of stay; Cut costs; and Culture that embraces technology at all levels. University of New Mexico Applying Diffusion of Innovation Theory and engaging users to promote adoption Planning: Tech, Operations, Business, Evaluation with Team approach Distributed decentralized Network bringing telehealth to the users

47 Beyond a Decade: Challenges to Sustainability Beyond a Decade: Challenges to Sustainability As we evolve to a world of technology-enabled healthcare, how has your organization converged telehealth and the EHR? Lehigh Valley Health Network Involving key stakeholders (clinical, administrative, information services) at the beginning of every project (e.g., LVHN s Advanced ICU and TeleBurn programs) to ensure information being captured is routed to the correct systems. University of New Mexico Joined forces with our ONC supported HITREC and HIE (NMHIC) as part of strategic direction Implementing in targeted environments; e.g. Emergency Departments, to demonstrate value Participating in Medical Informatics Programs

48 Beyond a Decade: Challenges to Sustainability Beyond a Decade: Challenges to Sustainability Has your telehealth leadership contributed to your organization s positioning for healthcare reform? Lehigh Valley Health Network University of New Mexico Leaders at all levels with LVHN thinking about how we can use technology to: (1) Use technology to increase access to care, while allowing patients to stay in their local community (2) Use technology to increase access to profitable service lines (3) Use technology to lose less Aligned with University HSC Office of Community Health to become institutionalized Working with UNM Medical Group as part of practice plan Working at State level to promote added value of Telehealth and HIT to a transforming health system

49 Beyond a Decade: Challenges to Sustainability Beyond a Decade: Challenges to Sustainability What did your program look like in the first year and at the five year mark? Lehigh Valley Health Network Year programs (TeleHomecare & TeleICU) No centralized telehealth component at LVHN Year programs and growing Centralized component for management Internal Telehealth Steering Groups University of New Mexico 1995: Small and learning, began strategic planning and needs assessment, minimal activity 2000: Obtained federal grants, and began expanding staff, and telehealth activities. Engaged champions and promoted the potential value of telehealth.

50 Beyond a Decade: Challenges to Sustainability Beyond a Decade: Challenges to Sustainability What do you consider your most pressing challenges for the next 2-3 years? Lehigh Valley Health Network University of New Mexico Initial thoughts under proposed health reform programs use technology to: Keep medical patients in their local area. Lose Less under 30 day readmission rules. Helping smaller facilities remain viable. Defining the site of service Adjusting to dynamically changing healthcare environment ( The Perfect Storm ). Becoming more fully integrated into healthcare, remove the mystic of being outside the mainstream, engage the consumer Demonstrating value of telehealth; Triple Aims Incorporating emerging new technologies; e.g. Mobile devices, software enabled platforms, SIP.

51 Questions?

52 American Telemedicine Association Quality Healthcare Through Telecommunications Technology Varying Business Models: Assessment, Leadership and Planning Aaron Bair, MD, MSc, Associate Professor, Emergency Medicine Medical Director, Center for Health and Technology & Center for Virtual Care UC Davis Health System Javeed Siddiqui, MD, MPH Chief Medical Officer TeleMed2U Roseville, California Moderator: Shelley Palumbo, MS, CCC-SLP Chief Administrative Officer Center for Health and Technology & Center for Virtual Care UC Davis Health System Sunday, May 5, 2013

53 Course Objectives Identify key steps to leading differing organizations through change List areas of importance when assessing telehealth applications Describe ways to accommodate various information and data management systems Communicate areas of preparation and potential impact from Affordable Care Act Discuss models of care through telehealth Center for Health and Technology UC Davis Health System

54 Topics of Discussion Leading broad change Assessment of telehealth applications Information and data management Affordable Care Act Models of care Center for Health and Technology UC Davis Health System

55 American Telemedicine Association Quality Healthcare Through Telecommunications Technology Varying Business Models: Assessment, Leadership and Planning Aaron Bair, MD, MSc, Associate Professor, Emergency Medicine Medical Director, Center for Health and Technology & Center for Virtual Care UC Davis Health System Javeed Siddiqui, MD, MPH Founder & Chief Medical Officer TeleMed2U Roseville, California Moderator: Shelley Palumbo, MS, CCC-SLP Chief Administrative Officer Center for Health and Technology & Center for Virtual Care UC Davis Health System Sunday, May 5, 2013

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