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Telemedicine in California: Improving Access and Quality of Health Care. Thomas Nesbitt, M.D., M.P.H. Executive Associate Dean, School of Medicine Director, Center for Health and Technology University of California, Davis. - PowerPoint PPT Presentation
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Telemedicine in California: Telemedicine in California:
Improving Access and Quality of Improving Access and Quality of Health CareHealth Care
Thomas Nesbitt, M.D., M.P.H.Thomas Nesbitt, M.D., M.P.H.Executive Associate Dean, School of Medicine Executive Associate Dean, School of Medicine
Director, Center for Health and TechnologyDirector, Center for Health and TechnologyUniversity of California, DavisUniversity of California, Davis
The explosion of new The explosion of new knowledge and information in knowledge and information in
the health sciences is ironically the health sciences is ironically creating greater disparities in creating greater disparities in
the quality of health care the quality of health care services.services.
If we discover a cure for If we discover a cure for cancer, but only half the cancer, but only half the
people have access to it, we people have access to it, we have only discovered half the have only discovered half the
cure for cancer.cure for cancer.
Medical Science, no matter Medical Science, no matter how good it is, is worthless if how good it is, is worthless if not applied appropriately to not applied appropriately to
patients who need it patients who need it
Advances in Advances in telecommunications and telecommunications and
information technologies are information technologies are helping to redistribute health helping to redistribute health
care knowledge and expertise care knowledge and expertise where and when it is needed. where and when it is needed.
The IOM 2001 report The IOM 2001 report "Crossing the Quality Chasm" "Crossing the Quality Chasm"
stated that "information stated that "information technology must play a central technology must play a central
role in the redesign of the role in the redesign of the health care system." health care system."
These technologies can help These technologies can help facilitate a new, more efficient facilitate a new, more efficient
model of care across the model of care across the economic and geographic economic and geographic
spectrum. spectrum.
Clinical Care Involves Making Clinical Care Involves Making DecisionsDecisions
In order for the next best decision to be made:In order for the next best decision to be made:
It is critical that complete, current and It is critical that complete, current and accurate information about the patient is accurate information about the patient is immediately available at the point of care immediately available at the point of care (EHRs)(EHRs)
It is critical that the most up-to-date It is critical that the most up-to-date scientific medical information is available scientific medical information is available at the point of care and can be at the point of care and can be customized and appropriately applied to customized and appropriately applied to that patient that patient
Access to current medical Access to current medical science for the next clinical science for the next clinical
decision decision
Elements of a Distributed, Elements of a Distributed, Technology Enabled Health Technology Enabled Health
Care SystemCare System
1.1. Care at Home and in the CommunityCare at Home and in the Community
2.2. Ambulatory, Clinic and Community Care Ambulatory, Clinic and Community Care
3.3. Hospital CareHospital Care
4.4. Public and population health, disaster Public and population health, disaster health, large scale emergency responsehealth, large scale emergency response
Telemedicine in the Outpatient Telemedicine in the Outpatient SettingSetting
Telemedicine brings the expertise of a Telemedicine brings the expertise of a specialist to the point of care and allows that specialist to the point of care and allows that expertise to be customized to that patientexpertise to be customized to that patient
Interactive healthcare Interactive healthcare over distance using over distance using technologytechnology
Medical PeripheralsMedical Peripherals
General Exam Camera
Otoscope
Nasopharyngoscope
Electronic stethoscope
Telemedicine in the Hospital Telemedicine in the Hospital SettingSetting
Reducing Costs and Improving Reducing Costs and Improving Quality in the HospitalQuality in the Hospital
Hospitalized patients are much sicker than Hospitalized patients are much sicker than in the pastin the past
Having the right information at the point of Having the right information at the point of care 24/7 is essentialcare 24/7 is essential
Electronic Medical Records (EMRs) are Electronic Medical Records (EMRs) are reducing errors made from not having reducing errors made from not having correct patient related information, right correct patient related information, right dose of drug, etc.dose of drug, etc.
Need the right medical science at the Need the right medical science at the bedside at the right timebedside at the right time
Emergency Room TelemedicineEmergency Room Telemedicine
Neonatal and Pediatric Intensive Care funded in part by Neonatal and Pediatric Intensive Care funded in part by William Randolph Hearst FoundationWilliam Randolph Hearst Foundation
Neonatal and Pediatric Intensive Care funded in part by Neonatal and Pediatric Intensive Care funded in part by William Randolph Hearst FoundationWilliam Randolph Hearst Foundation
Redistributing Expertise in the Redistributing Expertise in the Inpatient SettingInpatient Setting
What is the Future of What is the Future of Telemedicine in California?Telemedicine in California?
Current Investments in Current Investments in Telemedicine in CaliforniaTelemedicine in California
Foundation Support – TCE, CETF, CHCF, Foundation Support – TCE, CETF, CHCF, Blue Shield FoundationBlue Shield Foundation
Government Efforts to Increase Government Efforts to Increase TelemedicineTelemedicine• California Prop 1D and Broadband InitiativeCalifornia Prop 1D and Broadband Initiative• FCC grant programFCC grant program• California Advanced Services Fund California Advanced Services Fund
Executive Order for Health ITExecutive Order for Health IT•Statewide eHealth Forum October 12, 2006Statewide eHealth Forum October 12, 2006•Encourage Telemedicine and Health ITEncourage Telemedicine and Health IT
Proposition 1D: K-University Public Education Proposition 1D: K-University Public Education Facilities Bond Act of 2006Facilities Bond Act of 2006• “…“…the amount of $200 million shall be used for the amount of $200 million shall be used for
capital improvements that expand and enhance capital improvements that expand and enhance medical education programs with an emphasis on medical education programs with an emphasis on telemedicine aimed at developing high-tech telemedicine aimed at developing high-tech approaches to health care.”approaches to health care.”
Governor Schwarzenegger Governor Schwarzenegger Executive Order for Health IT Executive Order for Health IT
and Proposition 1Dand Proposition 1D
California’s Proposition 1D PassesCalifornia’s Proposition 1D Passes
““With Proposition 1D With Proposition 1D we will be able to we will be able to connect our best connect our best hospitals and our best hospitals and our best medical schools with medical schools with clinics in remote areas clinics in remote areas all over the state of all over the state of California.”California.”
Governor Arnold Governor Arnold Schwarzenegger Schwarzenegger
UC Davis Pediatric Telehealth Colloquium
FCC Rural Health Care Pilot FCC Rural Health Care Pilot ProgramProgram
Dedicated over Dedicated over $417 million for 69 $417 million for 69 pilot program pilot program networksnetworks
Pays flat 85% of Pays flat 85% of telecommunication telecommunication related expensesrelated expenses
Encourages Encourages regional broadband regional broadband health care health care networks with networks with connections to connections to national backbonesnational backbones
UPDATE!
Consortium MembersConsortium Members
The Office of the Governor The Office of the Governor California Business, Transportation and Housing Agency (BTH)California Business, Transportation and Housing Agency (BTH)
The California Emerging Technology Fund (CETF)The California Emerging Technology Fund (CETF)The California Public Utilities Commission (CPUC)The California Public Utilities Commission (CPUC)
The California Department of Managed Health Care (DMHC)The California Department of Managed Health Care (DMHC)The California Telemedicine & eHealth Center (CTEC)The California Telemedicine & eHealth Center (CTEC)
Rural Telehealth NetworksRural Telehealth NetworksThe UC Office of the PresidentThe UC Office of the President
University of California Davis Health SystemUniversity of California Davis Health System
Other PartnersOther PartnersThe Office of Statewide Health Planning and Development (OSHPD) The Office of Statewide Health Planning and Development (OSHPD)
California Health & Human Services Agency (CHHSA)California Health & Human Services Agency (CHHSA)The Corporation for Education Network Initiatives in CaliforniaThe Corporation for Education Network Initiatives in California
The California Office of Emergency Services (OES) The California Office of Emergency Services (OES) The California Institute for Telecommunications and Information Technology The California Institute for Telecommunications and Information Technology
The California Hospital Association (CHA) The California Hospital Association (CHA) The California Health Foundation and Trust (CHFT) The California Health Foundation and Trust (CHFT)
The California State Rural Health Association (CSRHA) The California State Rural Health Association (CSRHA) The California Primary Care Association (CPCA)The California Primary Care Association (CPCA)
ProposedProposedNetworkNetworkDesignDesign
Up to $22.1M Up to $22.1M
California Emerging California Emerging Technology Fund Technology Fund (CETF) providing 15% (CETF) providing 15% match and start-up match and start-up funds $3.6Mfunds $3.6M
Technical GoalsTechnical Goals Extend broadband Extend broadband
connections to connections to 300+ rural health 300+ rural health care providers in 3 care providers in 3 yearsyears
Address technical Address technical and cost and cost constraintsconstraints
Facilitate use of Facilitate use of state-of-the-art state-of-the-art telehealth servicestelehealth services• TelemedicineTelemedicine• Continuing Medical Continuing Medical
EducationEducation
California Advanced Service FundCalifornia Advanced Service Fund
$100 Million funding for infrastructure build-$100 Million funding for infrastructure build-out to bring broadband to unserved and out to bring broadband to unserved and underserved areas of the Stateunderserved areas of the State
Funded by 0.25% surcharge on phone end Funded by 0.25% surcharge on phone end users’ bills by CPUCusers’ bills by CPUC
40% match for infrastructure build-out 40% match for infrastructure build-out projectsprojects
Awards based on scoring criteriaAwards based on scoring criteria There is significant potential synergy with the There is significant potential synergy with the
CTNCTN
How will all of this benefit How will all of this benefit Californians?Californians?
SummarySummary Medical science that can significantly improve Medical science that can significantly improve
the health of people with access to it is the health of people with access to it is increasing increasing
Advanced information and telecommunications Advanced information and telecommunications technologies have a central role to play in technologies have a central role to play in bringing health care expertise to the point of bringing health care expertise to the point of needneed
Unprecedented resources are being invested in Unprecedented resources are being invested in telemedicine infrastructure and equipmenttelemedicine infrastructure and equipment
Resources to support the operational transition Resources to support the operational transition to this new model of care will still be necessary to this new model of care will still be necessary if we are to take full advantage of the if we are to take full advantage of the investments already committedinvestments already committed