1. TELEHEALTH/TELEMEDICINE IN TEXAS By: Edtrina Moss, MSN, RN

2. What is Telemedicine/Telehealth ? TELEMEDICINE/TELEHEALTH Telemedicine - use of medical information exchanged from one site to another via electronic communications for the purposes of evaluation, diagnosis, consultation, or treatment Telehealth - used to encompass a broader definition of remote healthcare that does not always involve clinical services.

3. State of Telemedicine/Telehealth in Texas Statewide Health Coordinating Council (SHCC) convened in 2000 Examined impact of telemedicine and telehealth SB 789 passed in Texas Legislature May 2001 Omnibus telemedicine bill to expand availability in the state Establish regulatory framework for service delivery

4. Recommendations of SHCC Designation of single agency/body as authority for information & projects in TX Develop interagency collaboration Develop interstate & international telemedicine/telehealth initiatives & information exchange

5. Other Concerns Addressed by SHCC Shortage of health Professions Licensing & Scope of Practice Infrastructure Training/Technical Assistance Reimbursement Project Planning & Accountability Privacy/Security Future Trends/Recommendations

6. So What Now? 2011 – 2016 State Health Plan Plan developed by SHCC Created subcommittee: Technology Committee Results  Telemedicine services underutilized in state  Training critical to success of implementation  Need for collaboration among all stakeholders  Marketing, adoption, and development critical to process  Next generation tools are vehicles toward personalized medicine, i.e. video, remote bedside monitoring, internet-based telecommunications, etc

7. TELEMEDICINE/TELEHEALTH VENUES IN TEXAS Plano, Texas  Texas Telehealth Technologies, Inc. a medical information technology company provide information technology to the medical and scientific community brings together knowledge of international experts in areas information technology, clinical care, telemedicine, telehealth, health promotion  AmeriDoc© 24/7 medical consultations Medical information & advice Diagnostic medical telephone consults Prescriptions Plano here

8. OTHER TEXAS VENUES Dallas, Texas  Cardiocom a medical software nurse call center Innovative telehealth solutions Galveston, Texas  UTMB Galveston TDCJ Telemedicine for HIV care Houston, Texas  Texas Children’s Center for Telehealth first pediatric-based telemedicine program to "go live" in 1993 http://www.texaschildrens.org/Professional s/Telehealth/Default.aspx http://www.texaschildrens.org/Professional s/Telehealth/Default.aspx Lubbock, Texas  Texas Tech University Health Sciences Center pioneer in applying live interactive video to the practice of medicine

9. VETERANS HEALTH ADMINISTRATION Office of Telehealth Services Uses health informatics, disease management, & telehealth technologies Changes location where health care services provided Target care/case management Facilitates access to care Improves health outcomes of veterans Ensure veterans get right care, in the right place, at the right time Uses home telehealth (CCHT) and store & forward telehealth CCHT helps veterans & providers manage chronic disease conditions Connects veteran to VA hospital via regular telephone line

10. MEDICARE PAYMENT OF TELEMEDICINE Reimbursement divided into 3 areas Remote face-to-face via live video conferencing Non face-to-face conducted via live videoconferencing or store & forward telecommunication services Home telehealth services

11. REMOTE FACE-TO-FACE SERVICES Eligible facility located outside of Metropolitan Statistical Area Services include consultation, office visits, individual psychotherapy, and pharmacologic management Eligible providers: physician, NP, PA, Nurse Midwife, CNS, Clinical Psychologist, Clinical Social Worker, RD Eligible facilities: Office of provider, hospital, critical access hospital, rural health clinic, federally qualified health center

12. REMOTE NON FACE-TO-FACE SERVICES Services using telecommunications technology Does not require patient to be present Covered the same as when on-site at facility Example: Interpretation by physician of EEG or ECG reading transmitted via telephone Largest provider of these type is radiology No geographic or facility limitation on services

13. HOME TELEHEALTH Telehealth services are outside scope of Medicare home health benefit Does not provide coverage for Medicare home health services via telecommunications Does not permit substitution or use of telecommunications to provide home health services paid under home health PPS However, nothing precludes home health agency from adopting telemedicine to promote efficiencies Services will not be recognized or reimbursed by Medicare under home health benefit

14. THE TEXAS TELEMEDICINE PROVIDER NETWORK, PURSUANT TO SB 1340 (MEDICAID) Texas Administrative Code, §354.1430(2) Hub Site Provider Physicians Hospitals Teaching Hospitals Tertiary Center Health Clinic

15. THE TEXAS TELEMEDICINE REMOTE SITE PROVIDERS, PURSUANT TO SB 1340 (MEDICAID) Texas Administrative Code, §354.1430(4) Located in Rural Medically Underserved Areas Physicians APNs CNMs (Certified nurse midwife) Hospital Federally Qualified Health Center Rural Health Clinic

16. THE TEXAS TELEMEDICINE REMOTE SITE LOCATIONS, PURSUANT TO SB 1340 (MEDICAID) Texas Administrative Code, §354.1432(a)(3) Practitioner’s Office Rural Health Clinic Federally Qualified Health Clinic Inpatient Hospital Outpatient Hospital Emergency Room ICF-MR Facility

17. BARRIERS TO STATEWIDE IMPLEMENTATION Limited to physician services in rural or underserved areas Laws that expand service Training Education of the consumer/public More formal education programs Practitioner buy-in Marketing of benefits of technology Limited reimbursement policies, i.e. Medicare’s limited home telehealth policy

18. NURSING’S ROLE IN IMPLEMENTATION  Play important role in the development, deployment, and utilization of telemedicine and telehealth  Developed leadership roles in Telehealth organizations  Join Special Interest Groups i.e. American Telemedicine Association for telehealth nurses  Learning how to use the telemedicine medical devices  Become techno-savvy in using other software applications  Collaborate with information technology staff, biomedical engineers, and telehealth physicians  Assist in development of telehealth guidelines, policies, and procedures  Review and understand applicable Health Insurance Portability and Accountability Act (HIPAA) laws with use of telehealth applications  Learn evolution of telehealth/telemedicine/e-health technologies and how used in healthcare  Some schools have developed courses on telemedicine/ telehealth i.e. Nelda C. Stark College of Nursing and Center for Telenursing and Health Informatics at Texas Woman's University

19. References American Telemedicine Association. (2008). Medicare Payment of Telemedicine and Telehealth Services. Retrieved from http://www.americantelemed.org/files/public/policy/Medicare_Payment_Of_Services.pdf ok04.pdf. http://www.americantelemed.org/files/public/policy/Medicare_Payment_Of_Services.pdf ok04.pdf Castelli, D. (n.d.). Telehealth Technologies Addressing the Global Impending Nursing Shortage. Retrieved from Lippincott’s Nursing Center.com website: http://www.nursingcenter.com/CareerCenter/static.asp?pageid=800469. http://www.nursingcenter.com/CareerCenter/static.asp?pageid=800469 Health and Human Services Commission. (2006). Telemedicine in Texas Medicaid. Retrieved from www.hhsc.state.tx.us/news/06_Telemedicine_Texas_Medicaid.pdf. www.hhsc.state.tx.us/news/06_Telemedicine_Texas_Medicaid.pdf Health and Human Services Commission. (2010). Telemedicine Medical Services in Texas Medicaid, Biennial Report to the Texas Legislature. Retrieved from www.hhsc.state.tx.us/reports/2010/Telemedicine-Medical-Services-0910.pdf. www.hhsc.state.tx.us/reports/2010/Telemedicine-Medical-Services-0910.pdf HIV Education Prison Project. (2000). Telemedicine in Practice: Texas Department of Criminal Justice. HEPP News, 3(5). Retrieved from www.idcronline.org/%252E%252E/archives/may00/may.pdf. www.idcronline.org/%252E%252E/archives/may00/may.pdf Texas Statewide Health Coordinating Council. (2002). The State of Telemedicine and Telehealth in Texas. Retrieved from www.dshs.state.tx.us/chs/shcc/reports/tmreport.pdf.www.dshs.state.tx.us/chs/shcc/reports/tmreport.pdf Texas Statewide Health Coordinating Council. (2011). 2011-2016 Texas State Health Plan. Retrieved from www.dshs.state.tx.us/chs/shcc/reports/SHP2011-2016/.www.dshs.state.tx.us/chs/shcc/reports/SHP2011-2016/