1. 4 th Annual Telehealth Summit of SC OCT 15-16, 2015 The Nuts and Bolts of Building a Telehealth Program Rena Brewer, RN, MA Southeastern Telehealth Resource Center This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number G22RH202-12-05-00 under the Telehealth Resource Center Grant Program for $325,000. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

3. telehealthresourcecenters.org Links to all TRCs National Webinar Series Reimbursement, Marketing, and Training Tools

4. On August 20, 2010, Georgia Partnership for TeleHealth was awarded a HRSA grant from the Office for the Advancement of TeleHealth: Southeastern TeleHealth Resource Center. Grant Re-Awarded AUG 2013 Goal: To offer technical assistance in order to advance telehealth services in the region: GA, FL, AL, SC.

5. SETRC provides an applied approach to telehealth education and technical assistance services in order to streamline implementation and better utilize telehealth applications and technology in the region. Strategies: 1. Form State TeleHealth Workgroups: To provide insight and direction regarding the advancement of telehealth in Florida and to encourage collaboration among existing telehealth networks and programs. 2. Provide TeleHealth Education: The National School of Applied Telehealth 3. Promote TeleHealth Awareness Summits / Conferences

6. Telehealth The use of telecommunications technology to support and deliver healthcare from a distance.

7. TELEHEALTH APPLICATIONS Clinical Services – Patient / Provider Consultations; such as Primary Care, Specialty Care, ICU Monitoring, Emergency/ Stroke Services, Chronic Care Monitoring / Home Monitoring, Employee Health Care Live / Synchronous–Video, Interactive, Face to Face Both the patient and the healthcare provider are available in real time and can communicate as though in the same room. In some settings, digital diagnostic equipment such as a stethoscope, otoscope and exam camera in the hands of a patient presenter can allow the healthcare provider to conduct an actual exam on the patient. Store & Forward / Asynchronous Used when face to face interaction is not required; Radiology, Dermatology, Pathology, Home Monitoring, etc. Educational Services – Patient and Clinical Staff Education. Administrative Support – Video Conferencing for One-One Meetings or Multi-Point Meetings.

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9. Telehealth Advantages Increased Access to Care Increased Access to Care Enhanced support to Patients and Families Enhanced support to Patients and Families Increased Access to Information. Increased Access to Information. Increased Access to Training Increased Access to Training Cost Savings Cost Savings

10. Cost Savings Improved Patient Outcomes – Improved Disease Management – Decreased Need for Crisis Care Travel Cost Reduced (Patients & Providers) Health Care Facilities Expand Services without hiring Full Time Providers (Neurology, Neonatology, etc.)

11. The Nuts and Bolts of Building a Telehealth Program How to build a firm foundation. No pay, No play! Reimbursement matters! Partnering with physicians, politicians, and plenty of other people. Sustaining a Successful Telemedicine Program. Expand, Expand, Expand! Think outside the box! 11

12. A Firm Foundation Develop a Strategy – define the primary objective(s) of the telehealth program – such as better patient care, increased revenues, increased competitiveness and market share, cost efficiencies, etc. Dedicate Resources – organizations that allocate resources of funding, time, and human capital to telehealth create much better chances of success. Develop the Infrastructure to Support Services- Many pilot efforts have failed due to poorly designed network connectivity, complicated clinical workflows, confusing technology user experiences, unreliable equipment and often times these problems aren’t discovered until the systems have been rolled out and the negative results are felt firsthand by doctors and patients. More than a few telehealth carts are sitting in storage closets because they failed to work when they were needed most — and the medical staff moved on to other alternatives. 12

13. The Nuts and Bolts of Building a Telehealth Program No pay, No play! Reimbursement matters! Medicare Medicaid (varies state to state) Private Payers (parity laws in 29 states) Service Contracts Partnering with physicians, politicians, and plenty of other people. Pay attention to regulations & policies: medical boards, licensing requirements, etc.. 13

14. The Nuts and Bolts of Building a Telehealth Program Sustaining a Successful Telemedicine Program. Strategies Dependent Upon: Revenue Stream Cost Avoidance Added Value Shared Savings Expand, Expand, Expand! Think outside the box! Increase Services: specialties & locations-schools, colleges, nursing homes, community outreach, ED Frequent Flyers Add Employee Services 14

15. Barriers and Possible Reasons for the slow adoption of Telehealth: Human Factor – Low awareness by providers & patients of telehealth and its benefits – Reluctance to change or embrace technology Lack of Wide-Scale Reimbursement – Reluctance of many insurers to pay for services – Medicare reimbursement restrictions – Medicaid reimbursement varies from state to state Regulations – Licensure of physicians / providers in multiple states – Credentialing of providers Technology – Hardware/Software Cost* (*Note: The industry is moving to higher quality / lower cost solutions) – Disconnected Health Information because of the lack of standards & interoperability between systems / networks – Limited broadband access for patients in some regions

16. Next Steps….. Take Action Become Telehealth Smart – SE Telehealth Resource Center: www.setrc.uswww.setrc.us – Attend regional & national telehealth conferences – Attend monthly free telehealth webinars: www.telehealthresourcecenter.org www.telehealthresourcecenter.org Become a Telehealth Champion in your organization / community.

17. 17 NSAT is the education arm of the SETRC and delivers standardized, accredited, and affordable telehealth instruction. The online Telemedicine / Telehealth Certification courses instruct on the essentials of telehealth and prepare individuals to become valuable members of a telehealth team. A completion certificate with 0.3 CEU/3 credit hours for this course will be awarded when all Learning Outcomes Conditions have been met. As an IACET Authorized Provider, HomeTown Health University (NSAT) offers continuing education units (CEUs) for its programs that qualify under IACET guidelines (www.iacet.org)www.iacet.org

18. The Certified Telemedicine Presenter Course is designed so that its graduates will gain insights and skills in order to correctly and confidently present patients during virtual encounters with healthcare providers and a variety of specialists. The Certified Telehealth Coordinator Course is designed so that its graduates will gain insights and skills to successfully implement, coordinate, and manage a telehealth program. The Certified Telehealth Liaison Course is designed so that its graduates will gain insights and confidence to successfully serve as a leader, promoter, and marketer in the telehealth industry. 18 NSAT TeleHealth Courses

19. NSAT Students National (42 States) & International (16 Foreign) 19

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21. www.setrc.us www.nationalschoolofappliedtelelehealth.org Lloyd.sirmons@setrc.us Rena.brewer@gatelehealth.org

22. Resources / References Southeastern Telehealth Resource Center: www.setrc.uswww.setrc.us Medicare: https://www.cms.gov/outreach-and-education/medicare-learning-network- mln/mlnproducts/downloads/telehealthsrvcsfctsht.pdfhttps://www.cms.gov/outreach-and-education/medicare-learning-network- mln/mlnproducts/downloads/telehealthsrvcsfctsht.pdf Center for Connected Health Policy TRC: http://cchpca.org/http://cchpca.org/ Telehealth Resource Centers: http://www.telehealthresourcecenter.org/http://www.telehealthresourcecenter.org/ 22