hhs perspective on u.s. telehealth

U.S. Department of Health and Human ServicesU.S. Department of Health and Human Services

Health Resources and Services AdministrationHealth Resources and Services Administration

HHS Perspective on U.S.HHS Perspective on U.S.TelehealthTelehealth

Dena S. Puskin, Sc.D.Dena S. Puskin, Sc.D.

Director, Office for the Advancement of Telehealth Director, Office for the Advancement of Telehealth

Office for the Advancement of TelehealthOffice for the Advancement of Telehealth

What We’ll Cover:What We’ll Cover:• What is telehealth/telemedicine?What is telehealth/telemedicine?

• An introduction to HRSA’s An introduction to HRSA’s telehealth office (OAT)telehealth office (OAT)

• Joint Working Group on Joint Working Group on TelemedicineTelemedicine

• Barriers and solutions to Barriers and solutions to advancing telehealthadvancing telehealth

• Status of TM in U.S.Status of TM in U.S.


What is Telehealth?What is Telehealth?

• TelehealthTelehealth - the use of telecom- - the use of telecom-munications in health servicesmunications in health services

• Term includes distance learning and Term includes distance learning and clinical care clinical care (also called telemedicine)(also called telemedicine)

• Other uses include administration, Other uses include administration, data sharing, and public healthdata sharing, and public health

Office for the Advancement of TelehealthOffice for the Advancement of TelehealthTELEVILLAGETELEVILLAGE

TELEHEALTH

JusticeJustice

LibrariesLibraries

TELEMEDICINETELEMEDICINE

BusinessBusiness

PublicPublicHealthHealth

HealthProfessionalEducation

ConsumerHealth

Services

Administration

K-12K-12EducationEducation

Examples of TelehealthExamples of Telehealth

Clinical examClinical exam Distance learning and Distance learning and patient educationpatient education

Real-Time TelemedicineReal-Time Telemedicine

• Provider presents Provider presents patient to remote patient to remote specialistspecialist

• Very interactiveVery interactive• Using special Using special

peripherals, peripherals, remote doctor can remote doctor can exam patient from exam patient from miles awaymiles away Remote specialist (on TV) uses digital

stethoscope to check patient’s heart.

Other ExamplesOther 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

Home HealthHome Health

• Low-cost Low-cost equipment that equipment that needs only a needs only a regular phone lineregular phone line

• Used to check Used to check vital signs, monitor vital signs, monitor medications, medications, visualize patient, visualize patient, provide enhanced provide enhanced supportsupport

Patient and nurse interacting during a “video home visit.”

Store-and-ForwardStore-and-Forward

• Primary care provider Primary care provider takes a still image and takes a still image and sends it to a sends it to a consulting physician consulting physician who later reviews it who later reviews it

• No real time No real time interaction between interaction between patient & consultantpatient & consultant

• Commonly used for Commonly used for dermatology, radiologydermatology, radiology

Clinician reviews scan which was forwarded for consultation.


Telemedicine Nationally *Telemedicine Nationally *

• Over 130 programs in 48 statesOver 130 programs in 48 states• Network of medical center “hub” Network of medical center “hub”

and about 10 rural “spokes”and about 10 rural “spokes”• Average 600 encounters a yearAverage 600 encounters a year• Average 25 clinical services per siteAverage 25 clinical services per site

* Information from the 1999 National Survey of Telemedicine Service Projects by the Association of Telehealth Service Providers


Expected BenefitsExpected Benefits

• Improve access to services in rural Improve access to services in rural and underserved areasand underserved areas

• Reduce travel time and lower costs Reduce travel time and lower costs

• Improve quality of health care through Improve quality of health care through more timely diagnosis and treatmentmore timely diagnosis and treatment

• Reduce isolation of rural practitionersReduce isolation of rural practitioners

• Expand educational offeringsExpand educational offerings


CharacteristicsCharacteristics• Most common services: mental health, Most common services: mental health,

dermatology, cardiology, orthopedicsdermatology, cardiology, orthopedics• Common settings: rural hospitals, Common settings: rural hospitals,

prisons, homes, school clinicsprisons, homes, school clinics• Three major types of telemedicine: Three major types of telemedicine:

1) store-and-forward 1) store-and-forward

2) real time2) real time3) remote monitoring3) remote monitoring


Educational and Educational and Administrative UsesAdministrative Uses

• Continuing Continuing educationeducation

• Patient Patient educationeducation

• Administrative Administrative meetingsmeetings

Rural providers can receive continuing education without the need to travel.


What is OAT?What is OAT?

• Began August 1998Began August 1998• Spun out of Office of Rural Spun out of Office of Rural

Health Policy at HRSAHealth Policy at HRSA• Staff of 14Staff of 14• FY 2000 budget of about FY 2000 budget of about

$20 million$20 million


OAT’s ResponsibilitiesOAT’s Responsibilities

• Manage HRSA videoconferencing networkManage HRSA videoconferencing network

• Administer telemedicine grantsAdminister telemedicine grants • Evaluate telehealth programsEvaluate telehealth programs • Develop telehealth policyDevelop telehealth policy

• Assess technology for HRSA and its Assess technology for HRSA and its granteesgrantees

• Develop distance learning programsDevelop distance learning programs


Distance LearningDistance Learning

• Develop multimedia productions Develop multimedia productions using satellite and Webusing satellite and Web

• Chair Public Health Council’s Chair Public Health Council’s Distance Learning WorkgroupDistance Learning Workgroup

• Lead HRSA strategic planning Lead HRSA strategic planning about distance learningabout distance learning

• Administer distance learning Administer distance learning projectsprojects


Technology AssessmentTechnology Assessment

• Goal: make educational programs Goal: make educational programs low-cost, high-quality, widely low-cost, high-quality, widely accessible to HRSA and its granteesaccessible to HRSA and its grantees

• Pilot test of satellite-to-desktop Pilot test of satellite-to-desktop distance learning system distance learning system

• Users view educational programs on Users view educational programs on their computer desktop either live (real their computer desktop either live (real time) or on-demandtime) or on-demand


Telehealth GrantsTelehealth Grants• Funded 19 new projects in FY 2000 through Funded 19 new projects in FY 2000 through

the Rural Telemedicine Grant Program the Rural Telemedicine Grant Program • Administered 40 other special or continuing Administered 40 other special or continuing

projectsprojects• Services must be in rural areasServices must be in rural areas• Goals: 1) increase accessGoals: 1) increase access 2) reduce provider isolation2) reduce provider isolation

3) develop integrated 3) develop integrated systems of care systems of care


Telehealth GrantsTelehealth Grants• Anticipate funding a total of 65-70 Anticipate funding a total of 65-70

projects in FY 2001, 19 0f which are projects in FY 2001, 19 0f which are through the Rural Telemedicine Grant through the Rural Telemedicine Grant Program Program

• Remaining projects are in urban and rural Remaining projects are in urban and rural areas and cover a range of technologies areas and cover a range of technologies and applicationsand applications

• e.g., distance learning, advanced brain e.g., distance learning, advanced brain imaging, infrastructure developmentimaging, infrastructure development


Policy DevelopmentPolicy DevelopmentJoint Working Group on Joint Working Group on

TelemedicineTelemedicine

• Federal interagency group that coordinates Federal interagency group that coordinates members’ telemedicine activitiesmembers’ telemedicine activities

• Ensures no overlap in Federal fundingEnsures no overlap in Federal funding• Provides a forum to share information, to Provides a forum to share information, to

educate its members, and to develop specific educate its members, and to develop specific actions that could reduce barriers to the use of actions that could reduce barriers to the use of telemedicine. telemedicine.


Policy DevelopmentPolicy Development

• Reports to CongressReports to Congress• Model for estimating Medicare Model for estimating Medicare

expenditures for expanded expenditures for expanded Telemedicine servicesTelemedicine services

• Guidelines on technical standards Guidelines on technical standards and privacyand privacy

• Author of upcoming Telemedicine Author of upcoming Telemedicine Report to CongressReport to Congress

• Filings about Universal ServiceFilings about Universal Service Fund Fund


Barriers to TelemedicineBarriers to Telemedicine

• Limited reimbursementLimited reimbursement• Clinical acceptance Clinical acceptance • High cost or limited availability of high High cost or limited availability of high

speed telecommunications linesspeed telecommunications lines• State licensure lawsState licensure laws• StandardsStandards• EvaluationEvaluation• SustainabilitySustainability


Emerging Issues/TrendsEmerging Issues/Trends• Technology ChangesTechnology Changes: NGI; Digitization : NGI; Digitization

of information/growth of wirelessof information/growth of wireless technologytechnology

• Policy LagPolicy Lag:: HIPPA; Technical HIPPA; Technical Standards; Spectrum AllocationStandards; Spectrum Allocation

• Aging DemographicsAging Demographics:: Long-term Long-term Care/home care; urban telemedicineCare/home care; urban telemedicine

• GlobalizationGlobalization: : trade issues; cross-trade issues; cross-nation legal challenges (e.g., prescription nation legal challenges (e.g., prescription drug trade; licensure)drug trade; licensure)


Necessary StepsNecessary Steps• Better evaluation to improve acceptance Better evaluation to improve acceptance

and reimbursement and reimbursement • Improved Infrastructure/Lower Improved Infrastructure/Lower

telecommunication and equipment costs telecommunication and equipment costs • Improve standardization of equipment Improve standardization of equipment

and practicesand practices• Address Privacy/Security/Address Privacy/Security/

ConfidentialityConfidentiality


Contact us!Contact us!

PhonePhone301.443.0447301.443.0447

Web siteWeb sitehttp://telehealth.hrsa.govhttp://telehealth.hrsa.gov

hhs perspective on u.s. telehealth

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