1. Statewide Rural Telehealth Network Innovative Policies for Developing a Statewide Rural Telehealth Network TELECOMMUNICATIONS CAPACITY Wyoming received funding from the FCC Rural Health Care Pilot Program to improve telecommunications for health care facilities throughout the state. As of 2011, 37 individual sites were provided with high-speed connectivity. Sites in the program included most of the state’s Critical Access Hospitals, as well as several primary care clinics and mental health/substance abuse centers. VIDEOCONFERENCING EQUIPMENT Funding from the Wyoming Hospital Association and the Wyoming Department of Health provided videoconferencing units to most of the FCC program sites. The state legislature recently provided funds for a managed desktop application server and over 100 individual licenses. These licenses are being distributed to health care providers in the state to facilitate telehealth connections in additional locations. REIMBURSEMENT Wyoming’s Medicaid/Medicare office instituted telehealth-specific reimbursement codes for most care categories, as well as an origination fee for sites presenting patients to providers via telehealth. All other major third-party payers in the state now also reimburse for care delivered by appropriate telehealth technology. LICENSING The Wyoming Board of Medicine implemented a “fast track” licensing process for physicians wishing to practice in the state on a limited basis via telehealth. Applications can be submitted online and do not require an interview by the Board. A background check is performed and applicants who qualify for the program can receive temporary licenses within two weeks. These licenses allow the physician to practice in Wyoming up to 12 days per calendar year. Physicians wishing to practice in the state more frequently can apply for a regular state license. SUSTAINABILITY As part of the FCC pilot program, the state prepared a ten-year sustainability plan for the network that includes cost reduction measures as well as revenue sources. The ultimate vision for the network is that of a member-based, independent, not-for-profit corporation with an elected board of directors, which will represent both public and private entities and be responsible for the management and operation of the network. A new Web site, www.wyomingtelehealth.org, has been developed to provide both information about telehealth in Wyoming and contacts for practitioners available through telehealth technology. According to the 2010 U.S. Census, Wyoming has a population of 563,626 people, making it the least populated state in the United States. With the ninth largest area of any state in the Union, Wyoming’s population density is also low. Many of Wyoming’s residents live in isolated communities, where accessibility to health professionals and services poses a significant challenge. Exacerbating this problem is the shortage of primary care providers and specialists in the state. Wyoming is ranked 47th among the fifty states in terms of physicians per 100,000 residents in the population and 50th among the states in terms of medical specialists per 100,000 residents in the population. Twenty-two of the state’s twenty-three counties qualify as Mental Health Professional Shortage areas. Wyoming’s rural nature combined with its shortage of health professionals make it so many of the state’s residents must either travel long distances, often through dangerous weather, to receive health care, or else forego obtaining necessary care. To begin to address these issues, the Wyoming Department of Health and the University of Wyoming obtained federal funding to establish the Wyoming Network for Telehealth, or WyNETTE. The initial purpose of WyNETTE was to support pilot projects in the state that aimed to increase acceptance of telehealth among health professionals. Most of these early activities centered on education and administration. However, in 2009, the Wyoming State Legislature established the Wyoming Telehealth Consortium, the purpose of which is to facilitate operation of a statewide telehealth network in Wyoming. The Consortium has been central to the state’s efforts to develop telehealth capacity and increase its adoption. As part of its work, the Consortium has helped develop a number of innovative policies within the state to support the growth of telehealth. Rex E. Gantenbein PhD Center for Rural Health Research and Education University of Wyoming http://www.uwyo.edu/health Conclusions As a result of these policy developments, health care facilities in Wyoming are moving rapidly ahead in the adoption of telehealth. Clinical applications currently in operation or in development include mental/behavioral health, dermatology and wound care, radiology, cardiology, ICU monitoring, ePrescribing, trauma care, and neurology/stroke, among others. Efforts are underway to expand access into more practitioner offices as well as public health offices in the state. The network also provides continuing educational opportunities for rural practitioners through video courses and seminars. This project was funded in part by grant D1BIT166426 from the HRSA ORHP Office for the Advancement of Telehealth. Innovations for Developing Telehealth in Wyoming Background