Transcript Telemedicine`s Role in the Rural Hospital

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
Legislative Guidance for VTN
Strategic Plan
“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:

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.
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
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
What is Telehealth?
Telehealth encompasses a broader definition of
remote healthcare that does not always involve
. services include a
clinical services. Telehealth
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
What Types of Technologies are
Used in Telehealth/Telemedicine?
Low Tech




Telephone, fax
Local PCs
Email and Internet
Store and forward of digital
images
 Real-time patient medical data
and image exchange
 IP based Videoconferencing &
HighTech
Voice
 Fully integrated networks
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
 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
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.
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.
 Is now comprised of over 80 individuals
representing 50 public and private
agencies/organizations
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
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
Snapshot of Telehealth Sites
(December 2003)
X= hub
= point of presence (POP)
U.V.A.
Community Service Board
V.D.H.
Winchester
D.O.C.
Leesburg
RAHEC
EVTN
Woodstock
Front Royal
VA Dept. of Mental Health (VDMHMRSAS)
VCU.
Arlington
Falls Church
Fairfax
(2)
Alexandria
Manassas
VT/VCOM
Warrenton
Harrisonburg
Culpepper
Monterey
Colonial Beach
Dahlgren
(2)
Montross
Mitchells
Olney
Warsaw
Charlottesville
St Stephens Church
Callao
Bowling Green
Fredericksburg
Craigsville
(2)
Staunton
Hot Springs
Clifton Forge
CovingLow Moor
ton
Lexington
New Castle
Grundy
Clintwood
Troy
Dillwyn
(2)
(2)
Ashland
Aylett
Goochland Glen Allen
Vansant
Tazewell
Blacksburg
Roanoke
(2)
Madison Heights
Salem
X
Bastion
Christiansburg
Pearisburg
Bland
Radford
Wytheville
Pound
Dungannon Cedar Bluffs
Wise
St. Paul
Big Stone
Lebanon
Gap
Saltville Blacksville
Pulaski
Norton
Floyd
Marion
(2)
Abington
Hillsville Laurel Fork
Pennington Gate City
Konnarock Galax
Stuart
Gap
Bristol
Richmond
(11)
Farmville (3)
Petersburg
(2)
Powhatan
Lynchburg
Accomack
Heathsville
(3) Kilmarnock
Belle Haven
Saluda
Vinton
Lancaster
Hartfield
Chesterfield
(2)
Tappahannock
Cheriton
Charles City
Williamsburg
Blackstone
Hayes
Hampton
Newport News
(17)
Portsmouth Norfolk Virginia Beach
(3) 2-H
Newport News
Catawba
Burkeville
Boydton
South Boston
Martinsville
Danville
Jarratt
(4) Nassawadox
Franktown
Suffolk
Chesapeake
However…Networks are Isolated
Hospitals
OTHERS
VCU
VDH
VT/VCOM
Dept. of Corrections
VDMHMRSAS/CSB
UVA
The Birth of a Vision
VT/VCOM
VCU
VDH
VDMHMRSAS/CSB
Other Networks
Virginia
Telehealth Network
Dept. of Corrections
EMSSatellite
UVA
Geriatric
facilities
Home health
patients
Provider
offices
VTN Goal
“To increase access to specialty care, ability
to receive remote continuing education,
reduced professional isolation, pooled
costs to drive down connectivity charges”
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 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.”
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
VTN Network Design &
Business Case
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.
VTN Benefits (con’t)
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.
VTN NETWORK
Remote Sites
Remote Sites
OTHER IP
HEALTH
NETWORKS
VTN BACKBONE
VIRGINIA TELEHEALTH NETWORK
VTN
SUB NETWORK
VTN
SUB NETWORK
Remote Sites
Remote Sites
Remote Sites
Remote Sites
Access to ALL
Remote Sites
Local Carrier
Dial lines to
Local Carrier
Remote Sites
Direct
Connection
NETWORK
VTAP
TO
BACKBONE
Network
Router
Firewell
Remote Sites
WiMAX
NNI type of
Connection
Public Internet
Network
WiFi
Remote Sites
Other IP
Networks
Remote Sites
VTN Phase I & II Physical Layout
Remote Sites
VTSAP
Remote Sites
DS3 Backbone
VTAP (?)
OSC3 Backbone
OSC3 Backbone
VIRGINIA
TELEHEALTH
NETWORK
Remote Sites
VTAP (UVA)
Remote Sites
VTAP (VCU)
OSC3 Backbone
VTSAP
DS3 Backbone
VTSAP
VTSAP
DS3 Backbone
Remote Sites
VTSAP
Remote Sites
Remote Sites
Remote Sites
VTAP – Virginia TeleHealth Access Point
VTSAP – Virginia TeleHealth Secondary Access Point
VTN Example of a Virtual (VPN) Layout
Health Center
Health Center
VPN
Region 4
Tier1
Tier2
VPN
Region 1
VPN
Region 2
3
VPN
Region 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.
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
VTN Users' Forecast
350
300
250
200
Large Sites
Remote Sites
150
100
50
0
Yr 1
Yr 2
Yr 3
Yr 4
Large number of remote sites assumes increasing adoption of home telemedicine
VTN Capacity Forecast
800
700
600
500
# of Customers
Bandwidth (Mbps)
400
300
200
100
0
Yr 1
Yr 2
Yr 3
Yr 4
VTN Business Case
$4,500,000
$4,000,000
$3,500,000
$3,000,000
$2,500,000
Seed Money
Loans/Grants
VTN Revenues
$2,000,000
$1,500,000
$1,000,000
$500,000
$0
YR 1
YR 2
YR 3
YR 4
VTN Revenue Forecast
Year 1 Total $442K
Access Services
Video Services
Web Meeting
Equipment Lease
Home Telemedicine
Year 3 Total $2,307K
Acces Services
Year 2 Total $1,246K
Access Services
Video Services
Web Meeting
Equipment Lease
Home
Tememedicine
Year 4 Total $4,002K
Access Services
Video Services
Video Services
Web Meeting
Web Meeting
Equipment Lease
Equipment Lease
Home
TeleMedicine
Home TeleMedicine
Next Steps
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.
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.
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
 contracting for university technical services
 VTN lease of space and electric power
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