1. Health Resources & Services Administration Office of Rural Health Policy Office for the Advancement of Telehealth Presented by Lawrence Bryant lbryant@hrsa.gov

2. HRSA - ORHP ORHP Community Based Division Border Health Division Hospital State Division Policy Research Team Administrative Office for the Advancement of Telehealth

3. Office for the Advancement of Telehealth (OAT) Mission To advance the use of telehealth technologies for improving access and quality of health care services for the underserved Serves as the operational focal point for coordinating and advancing the use of telehealth technologies.

4. OAT Linking with the Rural Initiative  Helping link Telehealth Grantees with other ORHP Grantees  Promoting the Telehealth Resource Centers to Rural Communities  Linking with USDA Distance Learning and Telehealth Programs

5. Telehealth vs. Telemedicine Telemedicine Telehealth Health Professions Education Administration Evaluation Research Homeland Security Public Health Consumer Education Regional Health Inform. Sharing

6. OAT Grant Program Objectives Improve Access Improve Quality of Services  Reduce Medical Errors  Work Force Development Foster Integrated Systems of Care Document Value Added of Telehealth Technologies

7. OAT Activities Telehealth Network Grants Licensure and Portability Telehealth Resource Centers Contracts Partnerships

8. OAT Grant Awards Awarded over $260 million in grants since 1989 Competitive and Congressionally- mandated projects

9. Telehealth Network Grants To demonstrate how telehealth technologies can be used through telehealth networks to: (1) expand access to, coordinate, and improve quality of health services; (2) improve and expand the training of health care providers; and (3) expand and improve the quality of health information available to health care providers, and to patients and their families Eligibility: TNGP--Open to urban and rural networks, but at least 50% of funding for rural areas.

10. Telehealth Grants Allow Grantees to... Purchase/lease equipment (up to 40% of grant) Pay for organizational development and operations Conduct internal evaluations on cost- effectiveness of services Provide clinical services, develop distance education programs, mentor/precept at a distance Promote collaboration in the region to improve the quality of and access to health services

11. Telehomecare Networks Evaluate the cost and effectiveness of remote vital sign monitoring of individual patients and the delivery of healthcare services to individuals in their place of residence by a healthcare provider using telecommunications technologies to exchange healthcare information over a distance.

12. Licensure Portability Grant Program Provides support for State professional licensing boards to carry out programs under which licensing boards of various States cooperate to develop and implement State policies that will reduce statutory and regulatory barriers to telemedicine.

13. Telehealth Resource Centers Regional Resource Centers California Telemedicine & eHealth Center (CTEC) Great Plains Telehealth Resource and Assistance Center (GPTRAC) Northwest Regional Telehealth Resource Center (NWRTC) Southwest Telehealth Resource Center National Resource Center Center for Telehealth and eHealth Law

14. Websites CTeL www.telehealthlawcenter.orgwww.telehealthlawcenter.org CTECwww.cteconline.orgwww.cteconline.org GPTRAC www.gptrac.orgwww.gptrac.org Southwest www.southwesttrc.orgwww.southwesttrc.org NRTRC www.nrtrc.orgwww.nrtrc.org

15. FY 10 Grant Competitions Telehealth Network Grant Program Licensure Portability Grant Program Telehealth Resource Center Grant Program

16. OAT ’ s Partners in Telehealth HRSA Bureaus and Offices Office of the National Coordinator (ONC) Indian Health Service CMS USDA FCC American Telemedicine Association National Rural Health Association

17. American Telemedicine Association http://www.atmeda.org http://www.atmeda.org Telemedicine Information Exchange http://tie.telemed.org/funding / Rural Assistance Center http://raconline.org AFHCAN Telehealth Solutions http://www.afhcan.org/ Other Resources

18. DEVELOPING A SUCCESSFUL TELEHEALTH PROGRAM Needs/Demand/Market Assessment What are the health care needs? Who else is providing the service? How do people in the area currently receive the service? Does specific and current data support the need/demand assessment? Does the project specifically address the needs in the area? Has the local community provided input into the market assessment, and if so, are these users, decision-makers, etc? How will the proposed technologogy meet the need? Are the telehealth technologies the only alternative? What health care resources/expertise/telehealth resources are available? Does the proposal build on those resources or duplicate them? Do the local citizens support the project (financially) and will they utilize it? How do you know they will utilize it?

19. DEVELOPING A SUCCESSFUL TELEHEALTH PROGRAM - Continued Goals and Objectives Project goals must specifically address the identified needs/demand Objectives must relate to project goals, be measurable, outcome oriented, time limited and achievable Process (i.e., setting up a telehealth network) IS NOT A GOAL Does the project provide quantifiable benefits such that the capital investment and operating expenses can be justified? Does the project incorporate an ongoing process for evaluation such that progress to achieving goals and objectives can be measured? Does the evaluation model clearly define: –Inputs –Process –Outputs –Outcomes –Costs

20. DEVELOPING A SUCCESSFUL TELEHEALTH PROGRAM - Continued Physician/Clinician Acceptance/Support Is the technology designed to integrate/work seamlessly with existing healthcare practice? Does the project have clinical champions and incorporate sufficient technical support? Have the clinicians “bought-in” to the technology? Do you have a number of clinical champions? Is there adequate technical support to clinicians? Are the network sites on board?

21. DEVELOPING A SUCCESSFUL TELEHEALTH PROGRAM - Continued Strategic Planning Do network partners understand roles and responsibilities? (MOAs) Is there a formal governing body? Are the project developers familiar with other telehealth systems? Do local citizens have an active role in ongoing management? Is there a marketing plan for the community? Have sufficient resources been allocated to management and operation of the project? Training? Technical Support?

22. DEVELOPING A SUCCESSFUL TELEHEALTH PROGRAM - Continued Strategic Planning (continued) Has a specific implementation work plan with timelines been developed? Have specific individuals been designated and their roles defined? Have operating procedures and clinical protocols been established? Are all network partners aware of their respective roles and responsibilities? Where possible, does the project incorporate multiple uses (including clinical care, distance learning, clinical information systems, and patient records)?

23. DEVELOPING A SUCCESSFUL TELEHEALTH PROGRAM - Continued Purchasing Equipment/Software/Telecom Services –A Thorough Assessment: Does the equipment/software meet all current and emerging standards for interoperability/data exchange Does the equipment/network design optimize the available telecommunications infrastructure System appropriateness - Have all technological options been considered? Is the option chosen to meet project goals and objectives the most cost-effective means of deployment? (e.g. costs versus benefits) Does the system allow for upgrades and can it communicate with other networks? (Stay away from proprietary hardware and software, use “open systems”)

24. DEVELOPING A SUCCESSFUL TELEHEALTH PROGRAM - Continued Purchasing Equipment/Software/Telecom Services –A Thorough Assessment (Continued): Can the system be operated and maintained with available resources? (In house versus outside technical support) Can the system be easily used by clinicians and patients? Can the network generate sufficient revenue or achieve sufficient cost savings to cover telecommunications charges, equipment depreciation, maintenance and other system-related costs? Is the proposed equipment proven to work in the project setting? (i.e., space, lighting, acoustics, ease of use) Consider vendor and telecommunications service contracts, extended warranties, where appropriate. What is the maximum “down-time” when a system malfunctions?

25. DEVELOPING A SUCCESSFUL TELEHEALTH PROGRAM - Continued Sustainability \Will the project generate sufficient revenue or cost savings to be sustained financially? Is there a long-term strategic plan for the program? Does that plan consider the telehealth program as revenue or a cost center? Where possible, does the project serve various venues or provide for multiple uses? (hospitals, schools, community facilities) Can the project sell its services for ancillary uses? Is there a means to monitor and evaluate program performance and provide any “mid-course corrections” or changes as conditions warrant?

26. DEVELOPING A SUCCESSFUL TELEHEALTH PROGRAM - Continued Sustainability (continued) Is there a plan for loss of key employees? Is there a plan for sustaining and increasing clinical champions? Does project leadership keep abreast of all reimbursement and funding opportunities? Is there an ongoing plan for ongoing local community support and collaboration with other entities? (community advisory groups, larger healthcare providers) Is there an ongoing public relations and marketing effort?