improving access to quality health care in virginia through information and communication...
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Improving Access to Quality Health Improving Access to Quality Health Care in Virginia through Information Care in Virginia through Information
and Communication Technology: and Communication Technology:
A Strategic Plan for Telehealth A Strategic Plan for Telehealth in the Commonwealthin the Commonwealth
November 18, 2005 November 18, 2005
VRHA Annual Fall ConferenceVRHA Annual Fall Conference
What is Telehealth?What is Telehealth?
Telehealth is the use of electronic informationTelehealth is the use of electronic information
and telecommunications technologies and telecommunications technologies
to support long-distance clinical health care,to support long-distance clinical health care,
patient and professional health-related education, patient and professional health-related education,
public health and health administration.public health and health administration.
What Types of Technologies are What Types of Technologies are Used in Telehealth?Used in Telehealth?
Telephone, faxTelephone, fax Computers, printers, scannersComputers, printers, scanners Email and InternetEmail and Internet Store and forward of digital imagesStore and forward of digital images Real-time patient data exchangeReal-time patient data exchange VideoconferencingVideoconferencing Fully integrated networksFully integrated networks
Low Tech
HighTech
The Institutes of Medicine report "Crossing the The Institutes of Medicine report "Crossing the Quality Chasm" (Ross et al, 2001) stated that Quality Chasm" (Ross et al, 2001) stated that "information technology must play a central "information technology must play a central
role in the redesign of the health care system."role in the redesign of the health care system."
It could be argued that nowhere is information It could be argued that nowhere is information technology potentially more critical in the technology potentially more critical in the redesign of healthcare than in rural areas.redesign of healthcare than in rural areas.
Can Rural Telehealth Work?Can Rural Telehealth Work?California Program on Access to Care: California Program on Access to Care:
Study HypothesesStudy Hypotheses
Rural health care entities often have difficulty maintaining market share
Perceptions of quality play a role in rural residents’ decisions to leave community for care
Telehealth has the potential to bring expertise to rural communities and increase the scope of locally available services which may improve perceptions of local care
Can Rural Telehealth Work?Can Rural Telehealth Work?California Program on Access to Care: California Program on Access to Care:
Study DesignStudy Design
Marketing research firm conducted 500 random phone surveys in 7 rural communities to assess
perception and utilization of local health care
Telehealth was implemented in the 7 communities
Seventeen months later, marketing research firm randomly contacted 500 residents in the same communities to assess perception and utilization of local health care
Can Rural Telehealth Work?Can Rural Telehealth Work?
California Program on Access to Care: California Program on Access to Care: Study FindingsStudy Findings
Respondents with a lower perception of the quality of local health were more likely to travel outside the community, and this relationship was stronger for those with a higher income.
Rural residents familiar with local telehealth efforts had a significantly higher opinion of local healthcare quality.
Can Rural Telehealth Work?Can Rural Telehealth Work?
California Program on Access to Care: California Program on Access to Care: Study Findings (continued)Study Findings (continued)
The benefits of rural telehealth could include:
Potential reduction in health care costs Keeping patients local retains direct and indirect health care $$ When patients leave the community for
health care, their purchasing dollars go with them to the urban community
What are the Challenges What are the Challenges of Rural Telehealth?of Rural Telehealth?
The development of rural telecommunications is not The development of rural telecommunications is not profitable to large telecommunications companies, so profitable to large telecommunications companies, so the infrastructure can be inadequate and/or costly the infrastructure can be inadequate and/or costly
Rural areas frequently have difficulties “keeping up” Rural areas frequently have difficulties “keeping up” with the rapid advances in technologywith the rapid advances in technology
Rural areas often lack the technical manpower and Rural areas often lack the technical manpower and expertise to troubleshoot and provide technical expertise to troubleshoot and provide technical assistance and training in the use of new technologiesassistance and training in the use of new technologies
The Virginia Telehealth Network (VTN)The Virginia Telehealth Network (VTN)
Began in November 2002 as an informal Began in November 2002 as an informal gathering of over 20 individuals gathering of over 20 individuals representing 14 private and public representing 14 private and public agencies/organizations who were agencies/organizations who were identified as key stakeholders involved in identified as key stakeholders involved in telehealthtelehealth
Is now comprised of over 80 individuals Is now comprised of over 80 individuals representing 50 public and private representing 50 public and private agencies/organizationsagencies/organizations
Purpose of the VTNPurpose of the VTN
to facilitate networking, to facilitate networking,
to explore opportunities for collaboration, to explore opportunities for collaboration,
to improve the current telehealth infrastructure; to improve the current telehealth infrastructure; andand
to improve the current utilization of telehealth. to improve the current utilization of telehealth.
Establishing the BaselineEstablishing 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
Snapshot of Telehealth Sites Snapshot of Telehealth Sites (December 2003)(December 2003)
Pound
Norfolk
WiseCedar Bluffs
Abington
Wytheville
Coving-ton
Blacksburg
MartinsvilleSouth Boston
LynchburgFarmville
Williamsburg
Newport News
Portsmouth
Petersburg
Richmond
Fredericksburg
Alexandria
Culpepper
Leesburg
Winchester
Fairfax
Harrisonburg
Charlottesville
Staunton
Pennington Gap
Big StoneGap
Norton
Clintwood
Gate City
Grundy
Vansant
Tazewell
Saltville
Dungannon
Konnarock
St. Paul
Marion
Bland
Bastion
Pulaski(2)
Salem
Pearsburg
BlacksvilleLebannon
Radford
Christianburg
Floyd
StuartGalax
Hillsville
Clifton Forge
Hot Springs
Monterey
Low Moor
New Castle
Laurel Fork
Craigsville
Danville
Troy
Madison Heights
Goochland
Powhatan
Dillwyn
Blackstone
BoydtonCatawba
Warrenton
Manassas
Mitchells
Burkeville
Bowling Green
Colonial Beach
Jarratt
Dahlgren
ArlingtonFalls Church
Warsaw
AylettGlen AllenAshland
Tappanahanock
St Stephens Church
Chesapeake
Heathsville
Suffolk
Callao
Hayes
Cheriton
Accomac
Franktown
Hampton
Virginia Beach
KilmarnockSaluda
Charles City
Vinton
Chesterfield
MontrossOlney
HartfieldLancaster
Nassawadox
(17)
(2) (2)
(2)
(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)
XX
VCU VDH
UVA
Dept. of Corrections
However…Networks are IsolatedHowever…Networks are Isolated
VT/VCOM
VDMHMRSAS/CSB
Hospitals
Where To From Here?Where To From Here?
Based on the findings of the site survey. The VTN IWG developed a white paper that delineated the strengths and weaknesses of the existing telehealth infrastructures.
In that white paper was the recommendation for the development of a statewide integrated telehealth network.
The Birth of a VisionThe Birth of a Vision
VCUVDH
UVA
Dept. of Corrections
Virginia Telehealth Network
Provider offices
HospitalsHome health
patients
Other Networks
VT/VCOM
VDMHMRSAS/CSB
EMS-Satellite
Geriatric facilities
The Next Step The Next Step
The Development of a Statewide Strategic
Telehealth Plan for the Governor’s Consideration is
In Progress
.
The Strategic Planning TeamThe Strategic Planning Team
Michael Aisenberg – Liberty Alliance/Verisign
Ed Bostick – Rappahannock Area Health Education Center
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
Guiding PrinciplesGuiding Principles
Consumer Choice Consumer Choice End-user Driven Policies End-user Driven Policies Any to Any Connectivity (Open Access)Any to Any Connectivity (Open Access) Scalability (Bandwidth Tailored to Need)Scalability (Bandwidth Tailored to Need) Geographic Parity Geographic Parity Financially Self SustainingFinancially Self Sustaining Rapid Adoption of Telehealth ApplicationsRapid Adoption of Telehealth Applications
OTHER IP HEALTH
NETWORKS
VTN SUBNETWORK
VTN SUBNETWORK
VTN BACKBONE(VIRGINA TELEHEALTH NETWORK)
Remote Sites
Remote Sites
Remote Sites
Remote Sites
Remote Sites
Remote Sites
Remote Sites
Remote Sites
Remote Sites
VTAP
VTAP – Virginia TeleHealth Access PointVTSAP – Virginia TeleHealth Secondary Access Point
VTSAP
VTSAP
VTSAP VTSAP VTSAP
Remote SitesRemote Sites
Remote Sites
VIRGINIA TELEHEALTH
NETWORK
Remote Sites Remote Sites
OSC3 BackboneOSC3 Backbone
OSC3 Backbone
DS3 BackboneDS3 Backbone
VTAP
VTAP
DS3 Backbone
Other IP Networks
Public InternetNetwork
Local Carrier
NETWORK VTAP
NetworkRouter
NNI type of Connection
WiFi
WiMAX
Dial lines toLocal Carrier
Firewell
Direct Connection
TO BACKBONE
Remote Sites
Remote Sites
Remote Sites
Remote Sites
Remote Sites
Anticipated BenefitsAnticipated Benefits
InteroperabilityInteroperability Compatibility of equipmentCompatibility of equipment Group purchasingGroup purchasing Technical assistance Technical assistance Calendaring/scheduling Calendaring/scheduling
OutlineOutline
Executive SummaryExecutive Summary Introduction/BackgroundIntroduction/Background NeedsNeeds VisionVision RecommendationsRecommendations
Technical and Clinical SpecsTechnical and Clinical Specs StandardsStandards Architectural DesignArchitectural Design Business CaseBusiness Case Administration and OversightAdministration and Oversight
Review and CommentReview and Comment
Download this Powerpoint presentation and see the Download this Powerpoint presentation and see the very rough first draft of the strategic plan on very rough first draft of the strategic plan on Tuesday November 22 at Tuesday November 22 at http://www.vdh.virginia.gov/primcare/center/vtn/info.http://www.vdh.virginia.gov/primcare/center/vtn/info.aspasp
Send feedback to Ed Bostick at Send feedback to Ed Bostick at edat1218@yahoo.comedat1218@yahoo.com
For More Info…For More Info…
Contact:Contact:
Kathy H. Wibberly, Ph.D.Kathy H. Wibberly, Ph.D.
Virginia Dept. of HealthVirginia Dept. of Health
Office of Health Policy and PlanningOffice of Health Policy and Planning
804-864-7429804-864-7429
Kathy.Wibberly@vdh.virginia.govKathy.Wibberly@vdh.virginia.gov
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