Developing the Telehealth Workforce MATRC 2013 Summit David Cattell Gordon Director, Office of Telemedicine Co-Director, Healthy Appalachia Institute Instructor, Public Health Sciences, Nursing March 18, 2013

Purpose of Presentation Are we at a tipping point? What are the indicators? What are the consequences? What are the resources? What training is needed? What are the opportunities? Where we are headed?

The Tipping Point in Telemedicine The tipping point is that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire. If you want to bring a fundamental change in people's belief and behavior...you need to create a community around them, where those new beliefs can be practiced and expressed and nurtured. It’s not just the network stupid, it’s the network.

Engage Moving to warp speed: Broadband speeds continue to trend faster across all provider segments; In Virginia, average speeds have doubled since Expanding the universe: Continued increase in broadband penetration; Communities & providers are starting to see broadband as a public health metric. Resistance is futile: The Commonwealth is now national leader in the use of telehealth - 54% utilization by health systems; EMRs & HIEs continues to grow (VA is 4 th ). Going where no one has gone before: CVS, home monitoring, EMS… Policy, Practice and Reimbursement is paving the way

Technology is Exploding  Costs continue to decline  Access continues to increase–mobile, 4G…  Adoption of standards-based operations  Greater movement to the desktop and hand-held  Processes are becoming simpler

Demand is Growing Patient Encounters TOTAL30,120+ FY %4,563 Monthly Avg TOTAL VA MILES SAVED Fiscal Year Progress

Specialty Services Are Increasing Examples of Innovative Thinking Stroke Network Video-colposcopy Remote Home Monitoring ALS & Huntington’s Clinic High Risk OB Clinic Stone Clinic Diabetic Retinopathy Cystic Fibrosis Clinic Ostomy Clinic Surgical Clinic Emergency Tele-psychiatry Pediatric Inpatient Research 40+

Partner Networks are Rapidly Expanding  Community Hospitals  Health Systems  Rural Clinics (FQHCs, Free Clinics)  Virginia Department of Health  Virginia Department of Corrections  Community Service Boards  School Health  Nursing Facilities  PACE Programs  Home Telehealth 108

Commitments to Telehealth are Increasing Federal  Grant funding (HRSA, USDA, Commerce)  Medicare Reimbursement (rural)  CMMI  Rural healthcare support mechanism (USF)  Indian Health Service  Veteran’s Telehealth  Military Telehealth  NIST  FDA  FCC Healthcare Connect State of Virginia  Virginia Health Reform Initiative  Virginia Medicaid  State Rural Health Plan  Virginia Cancer Plan  State Stroke Systems of Care Task Force  Virginia Telehealth Network  Virginia Department of Health  Joint Commission of Health Care  Tobacco Indemnification Commission  Medical Schools  Health Systems  Medical Society of Virginia  Mandated Coverage

Benefits of Telehealth Are Well-Established  Patients  Timely access to locally unavailable services  Spared burden and cost of transportation  Improvement in quality of care  Health Professionals  Access to collaborative consultative services and CME  Spared burden and cost of time and travel  Referral network  Rural Communities  Enhanced healthcare/economic empowerment  Health Systems  Increased accessibility and state-wide presence

Radically Changing Health Care Environment Demands for Preventing Readmission Focus on Accountable Care Increased Outreach to Veterans Success of Home Monitoring Pilots Federal Support such as FCC Healthcare Connect Increasing Medicaid Patients Medical Homes

The Problem: Limited Telehealth Workforce Limited training for health professionals Example: no set curriculum at UVA Limited number of training programs Few advanced degree programs See one, do one, teach one model Use of physicians to work equipment The consequences…..

Moving From Blue Screen to Full View HD Formation of the STAR Center Establishment of the Certified Telehealth Technologist Putting the right person in the right place with the right skills Improved Capacity in Communities Standardized Training/Setting the Standard Mission: To increase access to health care, improve health outcomes

The Southside Telehealth Training and Resource Center Partnerships

Goals The Star Center Address shortages and access to care by training a workforce proficient in employing technologies Develop a telehealth simulation lab at NCI Train 250 telehealth technologists by Fall 2013 Deploy capability throughout the Commonwealth and MATRC region Create a standardized curriculum and delivery model Evaluate outcomes of the training Foster develop of regional telehealth networks, remote patient monitoring

Training Topics Overview of Telemedicine Impact on Community Health Best Practices in Telemedicine Tools of the Trade Etiquette and Protocols Home & Healthy: Remote Patient Monitoring Technology Lab Experiences Application to Community

Opportunities ED Techs ED Nursing CNAs Home Health Workers Clinic LPNs and RNS Paramedics Home Monitoring Center Staff Inpatient Staff Advance Practice Nurses Community Health Workers IT Professionals Administrators

Applications Telemedicine Telestroke Programs Patient Monitoring Access to Specialty Services Community Health Emergency Departments Population Health Hospitals, Clinics Accountable Care Organizations Inpatient Units Correctional Telemedicine Schools Nursing Homes etc.

Benefits of a Trained Telehealth Workforce  Continues establishment of telehealth networks  Lets physicians do what they do best  Ensures standardized skills & training  Allows for rapid incorporation of new technology  Facilitates ease of integrate with health information systems  Responds rapidly to increased competition  Integrates TMED into mainstream medicine  Develops novel approaches  Improves outcomes  Advances remote patient monitoring

Questions & Contacts Leanna Blevins New College Institute Edie Bowles Virginia Telehealth Network Kathy Wibberly Mid-Atlantic Telehealth Resource Center MATRC4U David C. Gordon UVA Office of Telemedicine