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