The FCC Rural Health Care Pilot Program: Improving Access and Quality of Health Care throughout California Thomas Nesbitt, M.D., M.P.H. Executive Associate Dean, School of Medicine Director, Center for Health and Technology University of California, Davis

The explosion of new knowledge and information in the health sciences is ironically creating greater disparities in the quality of health care services.

If we discover a cure for cancer, but only half the people have access to it, we have only discovered half the cure for cancer. Medical Science, no matter how good it is, is worthless if not applied appropriately to patients who need it

Advances in telecommunications and information technologies can help to redistribute health care knowledge and expertise to where and when it is needed

These technologies can help facilitate a new, more efficient model of care across the economic and geographic spectrum.

The role of information and telecommunication technology in health care

Telemedicine Interactive healthcare over distance using technology Telemedicine brings the expertise of a specialist to the point of care and allows that expertise to be customized to that patient

UC Davis Telemedicine Services Pediatric Critical Care Pediatric Sexual Abuse QA OB/GYN Pediatric Cardiology Surgical Oncology Allergy Occupational Medicine Child Development Burn Genetics Transplant Urology Pediatric Rheumatology Pulmonary Plastic Surgery Pediatric PM&R Podiatry Hematology Pediatric Urology Pediatric Gastroenterology Oncology Pediatric Hematology/Oncology Surgery Cardiology Pediatric Endocrinology Pediatric Nephrology Gastroenterology Infectious Disease Pediatric Neurology Pain Management Pediatric Genetics Nephrology Psychology Rheumatology Neurology Hepatology Otolaryngology Pediatric Obesity Orthopaedics Nutrition Endrocrinology Psychiatry Dermatology

Medical Peripherals General Exam Camera Otoscope Nasopharyngoscope Electronic stethoscope

Outpatient Telemedicine

Telemedicine in the Hospital Setting Hospitalized patients are much sicker than in the past Having the right expertise at the point of care 24/7 is essential Access to specialty expertise is a significant challenge for smaller hospitals Telemedicine can bring that expertise to the emergency room or to the inpatient bedside

Emergency Room Telemedicine

Redistributing Expertise in the Inpatient Setting

Requirements for a successful statewide telehealth network Broadband connectivity –Reliability –Quality of Service (QOS) –Security –Privacy Equipment –At specialty and remote sites A trained workforce

Proposition 1D Proposition 1D: K-University Public Education Facilities Bond Act of 2006 –“…the amount of $200 million shall be used for capital improvements that expand and enhance medical education programs with an emphasis on telemedicine aimed at developing high-tech approaches to health care.”

California’s Proposition 1D Passes “With Proposition 1D we will be able to connect our best hospitals and our best medical schools with clinics in remote areas all over the state of California.” --Governor Arnold Schwarzenegger UC Davis Pediatric Telehealth Colloquium

The California Telehealth Network: A digital health care highway

Current State

FCC Rural Health Care Pilot Program Dedicated over $417 million for 69 pilot program networks Encourages regional broadband health care networks with connections to national backbones UPDATE!

Consortium Members The Office of the Governor California Business, Transportation and Housing Agency (BTH) The California Emerging Technology Fund (CETF) The California Public Utilities Commission (CPUC) The California Department of Managed Health Care (DMHC) The California Telemedicine & eHealth Center (CTEC) Rural Telehealth Networks The UC Office of the President University of California Davis Health System The Office of Statewide Health Planning and Development (OSHPD) California Health & Human Services Agency (CHHSA) The Corporation for Education Network Initiatives in California The California Office of Emergency Services (OES) The California Institute for Telecommunications and Information Technology The California Hospital Association (CHA) The California Health Foundation and Trust (CHFT) The California State Rural Health Association (CSRHA) The California Primary Care Association (CPCA)

FCC Rural Health Care Pilot Program: California’s Goals Summarized Goal 1: Create statewide broadband network dedicated to health care with explicit QOS, privacy and security Goal 2: Link the California Telehealth Network (CTN) to a national backbone Goal 3: Leverage and build upon recent investments in telehealth Goal 4: Utilize CTN for ongoing disaster preparedness training

Technical Goals Extend broadband connections to 300+ rural health care providers in 3 years Address technical and cost constraints Facilitate use of state- of-the-art telehealth services –Telemedicine –Continuing Medical Education

Current Status of the CTN Award of $22.1M from FCC California Emerging Technology Fund (CETF) providing $3.6M for 15% match and start-up funds Letter of Agency process (completed) Original goal was 319 Nearly 1000 locations represented in the received letters of agency USAC has qualified over 730 sites RFP has been submitted for posting on the USAC RHCPP web-site

Current State TAHOE-FOREST HEALTH SYSTEM FREMONT-RIDEOUT CANCER CENTER UCDAVIS HEALTH SYSTEM MAYERS MEMORIAL HOSPITAL ROUND VALLEY INDIAN HEALTH CENTER

Current Model

California Telehealth Network

This effort has not only led to the next generation of telecommunication for under served areas but has also led to a new focus on telehealth in the State as well as a new level of collaboration among stakeholders

How will all of this benefit Californians?

The FCC Rural Health Care Pilot Program: Improving Access and Quality of Health Care throughout California Thomas Nesbitt, M.D., M.P.H. Executive Associate Dean, School of Medicine Director, Center for Health and Technology University of California, Davis