2. What is the Rural Health Care Pilot Program? The pilot program is an enhanced funding initiative intended to help public and non- profit health care providers construct state- and region-wide broadband networks to provide telehealth and telemedicine services throughout the nation.

3. Questions How would you define telemedicine and telehealth? What is health information technology? What is eHealth?

4. Definitions Telemedicine is the use of electronic communication and information technologies to provide or support institutionally based clinical care at a distance. Telehealth This term is often used to encompass a broader application of technologies to include distance education, consumer outreach, and other applications wherein electronic communications and information technologies are used to support healthcare services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers are all considered part of telehealth. The services provided via telemedicine range from primary care to the highly specialized care found in leading academic medical centers.

5. Types of Telemedicine Services The delivery of remote health services is used for a variety of purposes: ♦Specialist referral services typically involve a specialist assisting a general practitioner in rendering a diagnosis. This may involve a patient “seeing” a specialist over a live, remote consult or the transmission of diagnostic images and/or video along with patient data to a specialist for viewing later. ♦ Direct patient care such as sharing audio, video and medical data between a patient and a health professional for use in rendering a diagnosis, treatment plan, prescription or advice. This might involve patients located at a remote clinic, a physician’s office or home. ♦ Remote patient monitoring uses devices to remotely collect and send data to a monitoring station for interpretation. Such “home telehealth” applications might include using telemetry devices to capture a specific vital sign, such as blood pressure, glucose, ECG or weight. Such services can be used to supplement the use of visiting nurses. ♦ Medical education and mentoring, which range from the provision of continuing medical education credits for health professionals and special medical education seminars for targeted groups to interactive expert advice provided to another professional performing medical procedure. ♦ Consumer medical and health information includes the use of the Internet for consumers to obtain specialized health information and on-line discussion groups to provide peer-to-peer support.

6. Goals Improve the Quality of Healthcare (better outcomes, fewer errors) Increase Patient Access to Healthcare Reduce the Cost of Healthcare Increase Clinical Productivity and Revenues Provide onsite education and training programs for staff and patients

7. What are the benefits of this pilot program? A broadband network connecting multiple health care providers bringing innovative healthcare services to those areas of the country where the need is most acute. Linking statewide and regional health systems with a nationwide network of government research institutions, as well as academic, public, and private health care institutions that are important sources of medical expertise and information. Health care providers will gain increased access to advanced applications in continuing education and research. Enhancing the health care community’s ability to provide a rapid and coordinated response in the event of a national crisis.

8. Connectivity

9. Service Area

10. Lead Agencies Colorado Hospital Association Colorado Behavioral Healthcare Council

11. Funding Sources FCC Rural Health Care Pilot Program Infrastructure Award Colorado Hospital Association - $4.6M Colorado Behavioral Healthcare Council – $5.16M Matching Funds – $1.46M Colorado Health Foundation Administrative Management Funding- $150,000 Total Funding - $11.37M

12. FCC RHCPP Administrative Requirements : Competitive Bid Documentation Contract with Service Provider Participating HCP Agreements Form 466-A Form 466-A Attachment Network Cost Worksheet (NCW) Certifications Sustainability Plan Form 467 Monthly Invoice Processing

14. Network Architecture

15. Identify Stakeholder

16. Yes, All of US

17. IT Advisory Council Medical Advisory Council Business Advisory Council Governing Body Organization

18. HIT Advisory Council

20. Medical Advisory Council

30. Presentation of Survey Findings Summary of findings- highlights and trends –Aggregate of all respondents –Separated out by type and size of facility

31. Initial observations A total of 55 respondents - 57% are hospitals (75% are less than 200 beds, 2/3 of that less than 50 beds, 1/4 over 200 beds), 26% are clinics While 76% or respondents mentioned they have an IT plan as part of an overall organizational strategic plan, nearly 20% have no IT plan whatsoever. Nearly 35% of respondents have an EMR/EHR deployed in their facility Over 70% of facilities report paying $2,000 or more per month in telecommunications charges, yet only 20% of facilities have an FCC telecom award subsidy. T1 lines (70%) are the dominant broadband connection followed by DSL (32%), Cable (17%) and POTS (90% of voice com is over POTS) Nearly a third of respondents outsource some portion of their IT or used consultants to help them implement IT projects

32. Observations continued Among rural facilities, the majority do not outsource their internal IT functions or maintenance. Very few use hosted web services (ASP delivery model) for management or clinical applications Hospitals tend to use fewer consultants than clinics (they have more in-house resources). The majority of facilities try to maintain their equipment and network management onsite The majority of hospitals, with fewer clinics, have HL7 Interfaces for the following applications: Billing & claims management Laboratory services Patient accounting

33. Observations continued Nearly 70% of facilities do not have a physician portal or dashboard For those that do: the doctors use if to retrieve diagnostic test results; electronic signatures, and order entry Nearly 90% do not have a patient portal or dashboard For those that do: Billing/claims payment is the primary use Over 80% of clinics and 90 % of hospitals use a clearinghouse for claims submission Nearly 80% of hospitals shared over 100+ PACS images, 15% of clinics did not share any Half of the respondents do not have a pharmacy order management system nor a clinical decision support system Less than 20% have implemented the following: Ambulatory Lab, PACs and Pharmacy Order Entry Nearly a third do not have physician or nurse documentation software

34. Observations continued Over a third of respondents have never attended a clinical, educational or administrative live video conferencing event Physician and nurse CE were the most popular education events Less than 10% have attended more than 16+ events. Of those, over 60% saying it was a positive experience (it saved time and money related to travel, was easy to use, and provided a high value educational experience) While most attendees are clinical providers, there is a need for: distance learning programs for bio-medical and lab technicians; conducting virtual grand rounds; tumor & immunization boards, implementing/monitoring disease management While most facilities have specialists affiliated with them (provide onsite clinics), few have doctors doing video consults

35. Observations continued Nearly every respondent has wireless laptops on site although very few are using them for video- conferencing purposes Nearly half the respondents are planning to use slate PC or tablets within the next year More than half the respondents are or will be using handheld bar code scanning within the next 12 months More than half of the under 50 bed sites are or will be supporting PDAs while nearly 75% of the larger facilities already do so

36. Concerns/issues regarding the adoption of telemedicine services. 90% cited cost to operate 90% cited lack of physician adoption (technophobic) 90% cited reimbursement and lack of technical support 93% cited the need for a sustainable business model 80% cited a lack of activity (small volume of consults) 80% cited a need for a measurable ROI 80% cited existing referral patterns as a concern 67% cited malpractice & liability exposure as potential issues

37. Who is your vendor for the following applications? Electronic medical record (EMR)- Meditech, NextGen, eClinical Works, Heartland, Allscripts, CPSI Computerized physician order entry (CPOE)-Meditech, eClinical Works, CPSI, Heartland, McKesson PACS/imaging- Clinical decision support- Meditech, Physician documentation- Meditech, NextGen Nursing documentation- Meditech, NextGen, Heartland Pharmacy Management- Cerner, Allscripts, McKesson Laboratory- LabCorp, RHS Practice Management- Cerner, Meditech,

38. Summary Thoughts Develop overall network implementation program and guide/assist individual facility strategic IT planning process CIO’s have to be involved in any solution that is IT based, CNO’s and CMO’s must be consulted on clinical applications, but it is necessary to keep the CEO and CFO involved in the process as much as possible. All must be project champions Implementations of clinical documentation, EMR, and CPOE systems will increase significantly from 2009 - 2014. Always provide continuing educational value and ongoing user training Maintain high quality and consistent network performance Implement self-sustaining business model services-generate network revenue. Develop vendor partnerships Encourage participation & collaboration between patients, providers, payers

39. How we go forward

40. Information Technology Services Covered CTN can provide assistance to award sites in evaluating and prioritizing the following IT Services: –Telemedicine & Telehealth –Electronic Medical & Health Record (EMR & EHR) –Computerized Physician Order Entry (CPOE) –ePrescribing and medication management –Digital Picture Archiving System (PACS) –Laboratory Information System (LIS) –Clinical Decision Support System (CDSS) –Asset management and patient tracking (RFID)

41. Strategic Planning Process CTN can assist award sites in developing a strategic planning process –Develop project scope, guidelines, policies, and procedures –Establish organizational commitment and governance –Identify project champion(s) & potential partners –Create IT Steering Committee, team leaders, & user groups –Form communication protocols –Establish timelines, budget, and accountability –Schedule activities

42. Product selection process CTN can assist award sites with IT product selection by developing: –Requirements definition –RFP preparation –Vendor Evaluation –Site visits –Vendor demonstrations –Vendor selection –Contract negotiations