1. Diversified Partnerships in Telehealth
Irina Gelman, DPM, MPH, PhDc
Director of Public Health
Fulton County, NY 

2. Telehealth What is Telehealth?
The Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services defines telehealth as the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration.
Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications. [1]

3. Telemedicine How does telehealth differ from telemedicine?
Telemedicine technically refers only to clinical applications of technology, so it excludes applications such as patient and physician education, but some sources may use the two terms interchangeably. [2]

4. Telehealth NYSDOH Definition: Telehealth is limited to: Telemedicine
Store–and–forward
Remote patient monitoring
Telehealth excludes audio–only, fax–only and –only transmissions.

5. Telehealth NYSDOH Applications:
Telemedicine – "the use of synchronous two–way electronic audio visual communications to deliver clinical health care services which include the assessment, diagnosis, and treatment of a patient, while such patient is at the originating site and a telehealth provider is at a distant site."
Distant site – location of the telehealth provider
Originating site – location of the patient
Store and Forward – "the asynchronous, electronic transmission of a patient´s health information in the form of patient–specific digital images and/or pre–recorded videos from a provider at an originating site to a telehealth provider at a distant site."
Limited to ophthalmology, dermatology and other disciplines as determined
by the Commissioner.
Remote patient monitoring – "the use of synchronous or asynchronous electronic information and communication technologies to collect personal health information and medical data from a person at an originating site that is transmitted to a telehealth provider at a distant site for use in treatment and management of medical conditions that require frequent monitoring."

6. Telehealth Telehealth Parity:
New York became the 22nd state to pass telehealth parity legislation.
Telehealth parity law, effective January 1, 2016.
Requires commercial insurers and the Medicaid program to provide reimbursement for services delivered via telehealth if those services would have been covered if delivered in person.

7. Telehealth Medicaid Reimbursement:
Qualified telehealth providers must be licensed in NYS and enrolled in NYS Medicaid.
The "originating site" and the "distant site” for a telemedicine encounter must be staffed.
Pre-existing relationship.

8. Telehealth
Fulton County, NY is a rural area with restricted access to healthcare:
Limited provider panel
Remote location
Low overall population density
Resulting in poor heath outcomes

9. Fulton County, NY Population - 54,870 15.9% - 65 and over
21.2% - 17 and younger
Education – 7 school districts
85.7% Residents 25 years or older with high school diplomas
15.7% Bachelor’s degree or higher level of education
Poverty
16.2% Under the federal poverty level (11.8% U) (15.6% NYS)
18.6% Single parent households (16.6% U) (19.8% NYS)
21.9% Receive Medicaid
47.6% Children eligible for free or reduced lunch. [3]

10. Fulton County, NY Healthcare:
155 Registered Physicians (215 ARHN) (285 NYS)
92 Primary Care Physicians
1 Hospital
1 Urgent Care Clinic
13 Primary Care Clinics
19 Registered Physician Assistants
20 Nurse Practitioners

11. Fulton County, NY Health Outcomes: Overall health 49 Length of life 48
Quality of life
Health factors
Health behaviors
Clinical care
Social and economic
Physical environment

12. Fulton County, NY Leading causes of death: Premature death: 2) Cancer
1) Heart disease
2) Cancer
3) Chronic Lower Respiratory Disease
4) Stroke
5) Unintentional Injury
Premature death:
1) Cancer
2) Heart disease
4) Unintentional Injury
5) Stroke

13. Public Health Priorities:
Fulton County, NY
Public Health Priorities:
Fulton County is considered to be a Health Professional Shortage area
for Primary Care, Mental Health and Dental Care.
Obesity
30.9% - Adults (27.0% U)
19.5% - Public school children (16.7% U)
Smoking
29.0% - Adults (17.3% U)
Cancer
Ovarian
Colorectal
Prostate

14. Telehealth
Telehealth initiatives may provide a viable solution to the increased need for remote access to care.
Telehealth being the overarching concept that includes telemedicine and telemetry components.
The benefits of telehealth include evidence-based cost and time effectiveness, and may have a major impact on overall health outcomes.

15. Telehealth Fulton County Pilot:
Evaluation of patient-centered outcomes with regard to remote access to care.
Assess utilization rates and
value of such access.

16. Telehealth Pilot
In collaboration with community stakeholders and with the approval of the Fulton County Board of Supervisors:
DSRIP engagement funding utilized to set up health stations at the FMCC; Fulton County Office for the Aging and Youth; and the Fulton County Public Health Department.
An encrypted HIPAA/ FERPA compliant platform (VIDYO) will be utilized to connect our county residents, in real time, to a healthcare provider at the local Nathan Littauer or St. Mary’s hospitals, or any other provider of their choice.
The server will be housed with the Fulton County IT Department.

17. Countywide
According to a recent survey, approximately 70-75% of Fulton county residents have a smart phone.
A larger percentage utilize other technology such as laptops, tablets, personal computers.

18. Telehealth Countywide
Ideally, Fulton County residents will utilize their own personal smart devices in their homes, and throughout the community.
Health stations will be available as a supplement when alternate means of access are not feasible.

19. Public Health Utopia Clem Bezold, PhD, Chair and Futurist
Institute for Alternative Futures: Public Health 2030 for NYSACHO
October 10, 2014

20. References
[1]“Telehealth”. The Health Resources and Services Administration. [2]“Telemedicine”. The Health Resources and Services Administration. [3]“Fulton County Community Health Needs Assessment 2016”. Fulton County Public Health Department and Nathan Littauer Hospital. [4]“Health Outcomes”. NYS 2016 County Health Rankings. [5]“Health Professionals Shortage Areas”. U.S. DOHHS Health Resources and Services Administration(HRSA) data.

21. Resources
Gelman. I. TED: Telehealth expanding access to care

22. Thank you!