Transforming Health Care in West Virginia through Telehealth

and Broadband Access

David Campbell, CEO andJack L. Shaffer, Jr.

Chief Information Officer

Community Health Network of WV

• Nineteen community health centers formed the Community Health Network of West Virginia (formerly West Virginia Primary Care Network) to use shared technology and integrated resources to attack the health challenges facing West Virginia’s rural communities.

• The Network member sites collectively provide services to over 100,000 patients in 28 of West Virginia’s 55 counties each year, with nearly 400,000 patient encounters annually.  Our member health centers provided over $40 million in health care services last year, with 70% of this care to Medicare, Medicaid and uninsured patients. 

West Virginia is a rural state:

• Sixty-four percent of the state’s population lives in a rural area.

• Forty-five of West Virginia’s fifty-five counties are designated as rural.

• Fifty counties have some portion of the county designated as a medically underserved area and thirty-seven counties have some portion designated as a health professional shortage area.

Sixty-four percent of the State’s population lives in a rural area

Most of the rural areas are medically underserved

Many rural areas are also health professional shortage areas

Health status in rural areas:According to an AHRQ study, rural residents

are at a health disadvantage:• Compared with their urban counterparts, rural residents are

more likely to be: elderly, poor, in fair or poor health, to have chronic conditions, and to die from heart disease.

• Rural residents are less likely to receive recommended

preventive services and report, on average, fewer visits to health care providers.

• Although 20% of Americans live in rural areas, only 9% of physicians in America practice in those areas. There are 3 times more specialists in urban areas than in rural areas.

Source:http://www.qualitytools.ahrq.gov/disparitiesreport/2005

A number of rural areas lack access to mental health services

Access to dental health is also an issue in many rural areas

Health care applications of technology:

• Telehealth for access to specialty services;

• Shared digital diagnostic devices;• Shared clinical resources and health

education through distance learning;• Remote, in-home monitoring;• Integration of electronic health records to

assure portability of health information and interoperability;

Telehealth: A tool for aging in place.The need in West Virginia:

•The growth of the number of elderly in rural communities will require changes in the delivery of health care. While less than ten percent of those age 65 to 74 are disabled, nearly two-thirds of those over 85 are disabled.

•The difference in the prevalence of Alzheimer’s for these two age groups is dramatic: the rate is approximately 3% in the 65 to 75 age bracket and 50% of those over 85. Individuals with Alzheimer’s live up to 20 years after onset and the average lifetime cost for care is nearly $175,000 (even though most personal care is provided by family members).

The need for care coordination:

• The average Medicare beneficiary has 15 ambulatory care visits annually, with 6.4 distinct providers and 20 active prescriptions.

• A Medicare beneficiary with 5 or more chronic conditions has 37 visits annually, with 13.8 distinct providers and 49 active prescriptions.

Connectivity is essential for Health Information Exchange and

Care CoordinationHospital

PatientAssisted Living

Skilled nursingPrimary Care Physician

Specialist

Laboratories

Radiology

Hospice

payer

Pharmacy

Home care

Find the patient record.

Barriers to Telehealth and Health Information Exchange:

Many rural communities don't have broadband networks. But even those communities that have the necessary infrastructure face additional barriers: the costs associated with the use of telecommunications lines as well as regulatory and payment environments that limit the use of information and communications technology.

From: "Rural Health in the Digital Age: The Role of Information and Telecommunications Technologies in the Future of Rural Health," as adapted for use in a 2004 Institute of Medicine (IOM) report on the future of rural health care.

Medically Underserved Areas are also underserved with Broadband

Telemedicine Benefits

• Better access• Lower Costs• Higher Quality of life

– Over the next 25 years, approximately 78 million Baby Boomers will retire, dramatically changing the demands on both government and private resources.

– Economic gains from expedited broadband rollout can be a potential solution to alleviate these strains.

– WV is a microcosm of what the US will look like in the future.

Telemedicine BenefitsSavings from broadband are potentially enormous.

Robert Litan – vice president for research and policy at the Kauffman Foundation and also a senior fellow in the economic studies program at the Brookings Institution – identified up to $927 billion in cost savings and output benefits from “business as usual” broadband deployment and an additional $532 billion - $847 billion in economic benefits from accelerated broadband deployment that can be available to help ease America’s transition to an older society.

Broadband is a Must

“Broadband is not a technology that simply delivers more movies, videos, sports, and other forms of instant gratification. As Robert Litan shows, it can improve the lives of the elderly who account for a large and growing share of the population,” Dr. Robert W. Crandall of the Brookings Institute said in a statement.

Source: Information Week – December 2005

Telemedicine BenefitsIn profiling advances in telemedicine, Technology Daily described a "ruraltelestroke clinical network" developed by the Medical College of Georgia.The program, which treats patients who experience cluster strokes, usesmobile carts in emergency departments in the state's rural hospitals to allowphysicians to remotely evaluate patients online, examine brain images andperform medical examinations.The acute ischemic stroke system is capable of handling video streams butnot voice streams because of low bandwidth, so physicians must speak onthe phone while specialists examine patients online. Currently, specialistsprovide their services at no cost to the eight hospitals connected to theMedical College because the Medicare reimbursement requirements fortelehealth require both video and voice streams, which rural areas are notcapable of due to the limited bandwidths.Physicians have a three-hour window to perform exams and prescribemedicine to reverse the impact of a stroke, said Max Stachura, director ofthe Medical College and president of APT. The low bandwidth increases thetime needed to load the images, narrowing that window, TechnologyDailyreports.

Broadband is a Must

Rep. John Dingell (D-Mich.), the House Energy and Commerce Committee's ranking Democrat, on Thursday said that broadband technology can have a "leveling effect" on access to health care, TechnologyDaily reports.The lack of high-speed online service in remote and rural areas restricts the use of advances in telemedicine, supporters of high-speed Internet deployment said at an event sponsored by the Alliance for Public Technology.

Source: iHealthBeat – July 2005

Broadband is a Must

• Must have broadband– Transmission of large amounts of data and video

• Advanced Broadband– DSL/Cable not good for telemedicine– Asymmetric bandwidth – geared towards download– Upload speed more important

• Wireless– Allows for more advanced monitoring– Allows for more mobility– Location based services for patient

Barriers• Many states fund pilot programs to

demonstrate telemedicine's effectiveness. But to make these data-rich options more available to patients, states generally must solve two problems.

Barriers• First, insurance companies in most states

do not reimburse doctors for telemedicine services. However, several states such as Louisiana and California have passed laws requiring that insurance companies cover telemedicine expenses, and other states have modified their Medicaid programs to cover telemedicine.

Barriers• Secondly, though doctors can easily practice

telemedicine across state lines, many states require doctors to obtain an instate medical license, and in the past few years several states have passed statutes applying very restrictive licensure requirement to telemedicine. Alabama, Oregon, and California, however, have passed reciprocal licensing laws allowing doctors in any of the three states to practice in the others via telemedicine. Other states permit their medical boards to grant telemedicine licenses automatically to licensed physicians from other states, or allow out-of-state doctors to apply for special telemedicine permits.

BarriersCurrent U.S. laws also run counter to the technology. For instance, Americans can't use Asian equipmentthat allows diabetics to use cell phones fitted with blood testing kits. The reason? A cell phone is not anapproved medical device.Medical licensing laws also don't allow a specialist in certain states to monitor the health of a patient inanother state, shutting off some patients from a specialist.In addition, the technology is so new that most insurers won't reimburse hospitals for the costs, so mosthealth providers absorb it as a cost of doing business -- at least for now.

BarriersEven so, barriers remain that slow telemedicine's growth, said Russell Bodoff, executive director of theCenter For Aging Services Technologies, which last month made a presentation at a White Houseconference.

One major barrier is that only 40 percent of Americans have access to broadband. That compares with75 percent in Japan and South Korea. The United States ranks 18th in the world in broadband access."It's absolutely essential to get broadband to more citizens," Bodoff said.

Barriers

• Broadband deployment– Consistent State driven policy

• Reimbursement• State and Federal laws and regulations

– e-Prescribing– Cross state licensing of physicians

• Human Attitudes– Physician Participation– Patient Perception and Reluctance

For More Information:Call 304-201-5700

Or visit us on the web:www.chnwv.org