1. Telemedicine Industry Overview & Key Issues

2. Telemedicine: The use of advanced telecommunications technologies to exchange health information and provide healthcare services across geographic, time, social and cultural barriers.

3. Formats for Health Information Physiologic Tones/Voice (sound) Data (text) Images (graphics) Motion Video Virtual Reality (telepresence)

4. Real-Time -vs- Store/Forward Emergency Medicine Implies that the patient and/or provider are direct participants Provides the most rich human interactions Non-Emergencies Eases the demands of scheduling placed upon individuals Review and respond at more convenient times

5. Telemedicine Applications Psychiatry Dermatology Cardiology Ophthalmology Orthopedics Wound Care Emergency Medicine Correctional Healthcare Extended Care Home Care Continuing Medical Education Radiology Conduct Administrative Meetings

6. Users of Telemedicine Primary Care Physicians Specialists Hospital Networks Correctional Facilities Military Off-shore Facilities Nursing Homes Home Health Care Rural & Urban providers University & Teaching Hospitals International Health Organizations

7. Fast Growing Applications…. Correctional Health Care... Texas State Dept. of Corrections saved an estimated $495,000 in the first 20 months of operation using Telemedicine to reduce unnecessary inmate transports. 1 GAO Report to Congress 2/97 Home Health Care... Population demographics of the US are expected by the tear 2020, to produce 10 million functionally impaired elderly who will need home care. 2 Electronic House Calls 21st Century Options Consumer Research Institute, Washington, DC 1995 Ophthalmology… Screening for Diabetic Retinopathy, a leading cause of blindness worldwide Wound Care… Hospitals & Extended Care Facilities decreasing time to wellness, reducing costs

8. The Need For Telemedicine in Urban Health Care Settings Inherent inefficiencies in utilization: - Not having the right information in front of the provider at the right time - Missing, delayed or incomplete information - Repeat visits generated because of lack of information.

9. The Need For Telemedicine in Urban Healthcare Settings Specialist Physician Resource Distribution - Wait times to access physicians result in delays in delivering patient care - Some specialties suffer from mal-distribution - Sub-specialist physicians require large service area populations

10. Reimbursement The patient is in the presence of the Primary Care Provider (PCP) therefore the PCP should expect to be reimbursed for a normal office visit or more, if new or additional services are provided. The absence of reimbursement for telemedicine services is almost invariably an issue specific to the consulting physician.

11. Beginning January 1st 1999, physicians will be reimbursed for telemedical consults if they are serving an area designated as a HPSA (Health Professional Shortage Area). There are some 2,700 HPSA’s in the U.S. Reimbursement

12. $California (MediCAL) $Montana (Blue Cross) $Virginia $West Virginia (PEIA) $Kansas (Blue Cross) $ Arkansas $ Georgia $ Idaho $ South Dakota HCFA currently reviewing  HCFA currently reviewing  Teleradiology is reimbursed (w/restrictions)  Reimbursement for consults approved in some states

13. Licensing and Liability Licensure guidelines vary state to state No clear laws or standards in effect to guide Telemedicine or interstate consults Responsibility generally lies with the physician with the patient “Telemedicine Rider” on malpractice policies

14. Licensing and Liability “As long as the patient’s care remains under the control of the Primary Care Provider, and the specialist physician remains in a consulting role, the consultant incurs no more risk than that associated with a telephone consult” ( prevailing opinion of physicians using telemedicine and of Hospital Q/A Departments)

15. Everyone Benefits Eliminates Isolation Enhances the scope of services provided Improved Image Increases Professional Satisfaction PCP’s learn how to manage the more frequent problems for which consults are sought, without Teleconsults

16. Everyone Benefits Retention of patients High Patient Satisfaction Improved access to educational opportunities Allows many patients to be seen by their Primary Care Provider and specialist simultaneously Avoid duplicate testing

17. Everyone Benefits Maximizes utilization of the Primary Care Provider A tool to deliver cost-effective care to achieve strategic operational and financial superiority over the competition Allows the distribution of specialized physician expertise over a wider service area than if the specialist had to be physically present to provide care