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Improving Access to Quality Health Care in Virginia through Information and Communication Technology: A Strategic Plan for the Development of a Telehealth.

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Presentation on theme: "Improving Access to Quality Health Care in Virginia through Information and Communication Technology: A Strategic Plan for the Development of a Telehealth."— Presentation transcript:

1 Improving Access to Quality Health Care in Virginia through Information and Communication Technology: A Strategic Plan for the Development of a Telehealth Infrastructure in the Commonwealth May 25, 2006

2 Legislative Guidance for VTN Strategic Plan Improvements Needed in Current Telemedicine Initiatives and Opportunities to Enhance Access and Quality." Document No.28 (2003) recommended:Improvements Needed in Current Telemedicine Initiatives and Opportunities to Enhance Access and Quality." Document No.28 (2003) recommended: that a comprehensive strategic planning process should be the first step …. to: that a comprehensive strategic planning process should be the first step …. to: Implement a comprehensive and integrated statewide TM/TH infrastructure. Establish collaborative systems to ensure interoperability among entities with authority and responsibility to process data and information.

3 Legislative Guidance The Report of the Secretary of Technology: A Joint Study to Establish Guidelines for Ensuring Compatibility among Telemedicine Equipment, House Document No. 18, 2000 Recommendations included: –develop guidelines that would ensure compatibility among telehealth equipment operated by state agencies and other affected entities; –catalog telehealth projects or programs throughout the Commonwealth; –Develop communication mechanism to facilitate dialog among practitioners of, and parties interested in, telehealth projects; –establish and maintain a listing of existing technical standards in telehealth telecommunications, –determine telehealth functional standards, –reduce redundant or overlapping telehealth efforts

4 What is Telemedicine? Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status - American Telemedicine Association website Examples include: Tele-radiology Tele-surgery Tele-pathology

5 What is Telehealth?. Telehealth encompasses a broader definition of remote healthcare that does not always involve clinical services. Telehealth services include a range of health care, health education, and public health related services facilitated by the use of video conferencing, imaging and and other communications technologies. Examples: Home health monitoring Bio-surveillance Patient translation services

6 What Types of Technologies are Used in Telehealth/Telemedicine? Telephone, fax Telephone, fax Local PCs Local PCs Email and Internet Email and Internet Store and forward of digital images Store and forward of digital images Real-time patient medical data and image exchange Real-time patient medical data and image exchange IP based Videoconferencing & Voice IP based Videoconferencing & Voice Fully integrated networks Fully integrated networks Low Tech HighTech

7 What are the Challenges of Rural Telehealth? The development of rural telecommunications is not profitable to large telecommunications companies, so the infrastructure can be inadequate and/or costly The development of rural telecommunications is not profitable to large telecommunications companies, so the infrastructure can be inadequate and/or costly Rural areas frequently have difficulties keeping up with the rapid advances in technology Rural areas frequently have difficulties keeping up with the rapid advances in technology Rural areas often lack the technical manpower and expertise to troubleshoot and provide technical assistance and training in the use of new technologies Rural areas often lack the technical manpower and expertise to troubleshoot and provide technical assistance and training in the use of new technologies

8 What are the Challenges for Urban Telehealth? Systemic health disparities are found in urban Virginia. The urban underserved populations share characteristics with their rural counterparts. These health disparities take place in the context of an overburdened and ineffectively used healthcare delivery infrastructure. The urban underserved, just as their rural counterparts are the most likely to use hospital emergency rooms for primary care because they have no alternative. long-term investments in linking their medical facilities to a telecommunications infrastructure designed to address some of the health disparity challenges.

9 The Virginia Telehealth Network (VTN) Began in November 2002 (under the auspices of the Virginia Department of Health Office of Health Policy) as an informal gathering of over 20 individuals representing 14 private and public agencies/organizations who were identified as key stakeholders involved in telehealth/telemedicine in Virginia. Began in November 2002 (under the auspices of the Virginia Department of Health Office of Health Policy) as an informal gathering of over 20 individuals representing 14 private and public agencies/organizations who were identified as key stakeholders involved in telehealth/telemedicine in Virginia. Is now comprised of over 80 individuals representing 50 public and private agencies/organizations Is now comprised of over 80 individuals representing 50 public and private agencies/organizations

10 Establishing the Baseline During 2003 - 2004, the VTN Infrastructure Work Group (IWG) designed a site survey to capture information about: Current telehealth infrastructure and capacity Future (next 36 months) plans for expansion of telehealth activities

11 VTN Consensus Based on the findings of the site survey a white paper was developed by the VTN IWG recommending the development of an integrated statewide telehealth network infrastructure and organization designed to meet the present and future needs of all VTN members The white paper was presented to approximately 100 participants who took part in the VTN Consensus Conference held in Natural Bridge, Virginia in May 2005. In September 2005, a Strategic Plan Task Force was formed and charged with developing a plan to establish a statewide telehealth communications infrastructure

12 Snapshot of Telehealth Sites (December 2003) Pound Norfolk Wise Cedar Bluffs Abington Wytheville Coving- ton Blacksburg Martinsville South Boston Lynchburg Farmville Williamsburg Newport News Portsmouth Petersburg Richmond Fredericksburg Alexandria Culpepper Leesburg Winchester Fairfax Harrisonburg Charlottesville Staunton Pennington Gap Big Stone Gap Norton Clintwood Gate City Grundy Vansant Tazewell Saltville Dungannon Konnarock St. Paul Marion Bland Bastion Pulaski (2) Salem Pearisburg Blacksville Lebanon Radford Christiansburg Floyd Stuart Galax Hillsville Clifton Forge Hot Springs Monterey Low Moor New Castle Laurel Fork Craigsville Danville Troy Madison Heights Goochland Powhatan Dillwyn Blackstone Boydton Catawba Warrenton Manassas Mitchells Burkeville Bowling Green Colonial Beach Jarratt Dahlgren Arlington Falls Church Warsaw Aylett Glen Allen Ashland Tappahannock St Stephens Church Chesapeake Heathsville Suffolk Callao Hayes Cheriton Accomack Franktown Hampton Virginia Beach Kilmarnock Saluda Charles City Vinton Chesterfield Montross Olney Hartfield Lancaster Nassawadox (17) (2) (3) (2) (4) (3) 2-H (2) Belle Haven Roanoke Bristol Front Royal (2) (11) (3) (2) Woodstock Lexington Newport News U.V.A. Community Service Board V.D.H. D.O.C. RAHEC EVTN VA Dept. of Mental Health (VDMHMRSAS) VCU. VT/VCOM X= hub = point of presence (POP) X X

13 VCU VDH UVA Dept. of Corrections However…Networks are Isolated VT/VCOMVDMHMRSAS/CSB Hospitals OTHERS

14 The Birth of a Vision VCU VDHUVA Dept. of Corrections Virginia Telehealth Network Provider offices Hospitals Home health patients Other Networks VT/VCOM VDMHMRSAS/CSB EMS- Satellite Geriatric facilities

15 VTN Goal To increase access to specialty care, ability to receive remote continuing education, reduced professional isolation, pooled costs to drive down connectivity charges To increase access to specialty care, ability to receive remote continuing education, reduced professional isolation, pooled costs to drive down connectivity charges

16 VTN 2006 VTN 2006 The Strategic Plan recommends development of a dedicated telehealth Infrastructure network, and organization – The Virginia Telehealth Network (VTN). –Note: VTN is not a telecommunications company and will not deploy new fiber. VTN will supply IP based MPLS services. VTN will utilize existing telecommunications network facilities and will act as a customer for proposed rural broadband initiatives. VTN will be available to all public and private healthcare related organizations, as well as individuals. VTN will ensure that all communities within Virginia will have the ability to access telehealth services via a broad range of access methods, from high bandwidth to dial-up modems. VTN will be available to all public and private healthcare related organizations, as well as individuals. VTN will ensure that all communities within Virginia will have the ability to access telehealth services via a broad range of access methods, from high bandwidth to dial-up modems. VTN will provide a flexible, scalable, manageable, secure, and cost effective network infrastructure capable of linking healthcare providers and patients within Virginia, as well as nationally and internationally to ensure that all Virginians have access to World class healthcare. VTN will provide a flexible, scalable, manageable, secure, and cost effective network infrastructure capable of linking healthcare providers and patients within Virginia, as well as nationally and internationally to ensure that all Virginians have access to World class healthcare. VTN will generates service revenues sufficient to ensure on going financial sustainability without the need for legislative subsidy after the initial seed funding. VTN will generates service revenues sufficient to ensure on going financial sustainability without the need for legislative subsidy after the initial seed funding.

17 Health And Human Resources FY 07-08 Department Of Health $840,203; $1,294,853 GF GA appropriation defrays initial VTN subscriber costs for rural locations. This includes VTN services such as: –Access –Video bridging –Equipment rental, install, maintenance and training –USF cost recovery assistance

18 VTN Network Design & Business Case

19 VTN Benefits VTN provides cost-savings for medical facilities and healthcare providers. VTN provides immediate access to 24/7 technical assistance for interconnectivity problems that have in the past created obstacles to the adoption of telehealth services for primary care, home health monitoring, treatment and follow-up. VTN provides a travel alternative for patients and their families who must often travel great distances at their own expense to receive appropriate healthcare. VTN provides a means for patients throughout Virginia to enjoy the continuity of care that can be delivered through telehealth applications which rely on a broadband infrastructure.

20 VTN Benefits (cont) VTN provides the only comprehensive means in Virginia to ensure full-scale interactive broadcast messaging to all medical and social services professionals in times of national threats and disease outbreaks. VTN provides the necessary infrastructure for patient health record exchanges. VTN positions the Commonwealth to become a national leader in the delivery of TH/TM services.

21 VTN NETWORK

22 Access to ALL

23 VTN Phase I & II Physical Layout

24 VTN Example of a Virtual (VPN) Layout VPN Region 1 VPN Region 4 Health Center Tier1 VPN Region 2 VPN Region 3 Tier2 3 This example shows a network that is composed of 4 VPNs. Region 1 and Region 2 need their users to talk to region 4. Region 3 is isolated from region 4. However, regions can be re-configured as needed.

25 Business Case Assumptions User fees based on access speed and services used: –Video conferencing –Web meeting –Equipment rental –Video bridging –USF cost recovery assistance –Central scheduler software At 4 year 300 remote sites and 40 large users –Remote site: Rural or free clinics or home TM (through a provider). Future, remote sites could include nursing homes, area agency on aging sites, assisted living facilities etc. –Large users: Universities, tertiary and secondary health systems

26 VTN Users' Forecast Large number of remote sites assumes increasing adoption of home telemedicine

27 VTN Capacity Forecast

28 VTN Business Case

29 VTN Revenue Forecast Year 1 Total $442KYear 2 Total $1,246K Year 3 Total $2,307K Year 4 Total $4,002K

30 Next Steps

31 Next Step Appropriate state monies to (a) provide operational expenses for VTN to implement the two pilot projects included in the Strategic Plan in FY07 and FY08, and (b) leverage an estimated Rural Utility Services (RUS) loan/grant of $1.8 million. Recommend state appropriation of $840,203 for Year 1, and $1,294,853 for Year 2 for VTN start-up and operations. Total appropriation: $2,135,056. Recommend state appropriation of $840,203 for Year 1, and $1,294,853 for Year 2 for VTN start-up and operations. Total appropriation: $2,135,056.

32 Next Step Establish a nonprofit corporation to implement the Strategic Plan for the Virginia Telehealth Network Infrastructure. Recommend VTN governance begins with volunteer representation by VTN end-users and interested parties; and through VDH sponsorship transition VTN to a representative organization of end-users within 12 months. Recommend VTN governance begins with volunteer representation by VTN end-users and interested parties; and through VDH sponsorship transition VTN to a representative organization of end-users within 12 months.

33 Next Step Establish collaborative relationships with major stakeholders in Virginia Investigate the possibility of establishing VPOPs in key locations in Virginia (i.e. UVA, VCU,VCOM, EVMS etc.). Including: VTN Network equipment on site VTN Network equipment on site contracting for university technical services contracting for university technical services VTN lease of space and electric power VTN lease of space and electric power

34 The Strategic Plan Task Force Michael Aisenberg – Liberty Alliance/Verisign Ed Bostick – Northern Neck Middle Peninsula Telehealth Consortium Peter Buccellato – Knowledge Providers Group Rebecca Davis – Virginia Rural Health Association Steve Gillis – Telehealth Solutions Group David Heise – Telehealth Solutions Group/MCI Jay Sanders – The Global Telemedicine Group


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