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Please stand by for realtime captions >> Karen Rheuban Thank you for being here. I am, the
professor of the address at the University of Virginia and the director for the Center
of Telehealth. Telehealth programs have served as a innovative tool for the delivery of care
All the while navigating specialty workforce shortages.
Through an explosion of advanced technologies and the significant federal investment in
Telehealth programs and Rod brand infrastructure, many lives of Americans and likewise patients
around the world now benefit from care provided through Telehealth.
Telehealth programs are entirely aligned with a -- the aims of CMS -- better care, better
health, and lower-cost.
With the passage of recent affirmation of the affordable care act, we are now at a strategic
inflection point in our efforts to further integrate Telehealth into mainstream everyday
Over the next two days, we hope to further delineated evidence base for Telehealth and
highlight special applications for rural and underserved populations, but also for all
patients regardless of location.
We will discussion actions to be undertaken by HHS, the state, and the payers and also
hear from consumers.
This is our opportunity to identify issues that warrant further study by the Institute
of medicine.
I would like to thank the colleagues here -- Dr. Wakefield, Dr. Morris, and [indiscernible]
for their leadership role in advancing this program nationwide. And for funding this workshop.
A special thanks goes to the planning committee -- Dr. Tom Nesbit,, the doctor at partners
healthcare, Dr. Spero Manson, and Dr. Pruitt, the office of Telehealth.
In addition, I want to thank Dr. Tracy lusted who coordinated this and for colleague, Samantha
[last name indiscernible] . >> Our schedule is tight this morning and we encourage people
to move about if they need to. When the time comes for questions and answers, flip the
switch on the microphone and we encourage audience participation.
No food or drinks are allowed in the auditorium since it is brand-new and renovated. These
turn off your cell phones and pagers. Now, it gives me great leisure to introduced Cheryl
Lynn Pruitt -- she will introduce her colleague, Dr. Mary Wakefield Dr. >> Thank you, Karen.
I am honored to introduced the next speaker, Dr. Mary Wakefield. When I saw her this morning,
I asked how she went to be introduced. She said keep it short and leave more time for
content. I will honor her request. Before I do, I want to tell a story. I joined the
office in 2006 and I intended a meeting of the rural health information network. This
meeting was led by Dr. Wakefield. I saw her and I thought who is that lady? She hasn't
so much energy and enthusiasm. She is bright and she can control the room. I was very impressed
by her. When I heard she was going to be the administrator here, we were all excited. She
knows Telehealth and rural health and anybody who is interested in rural communities and
the medically underserved populations, we are blessed to have her as the administrator.
I would like to introduce our administrator and IOM member, Dr. Mary Wakefield Dr.
Thank you very much. As you can tell, Cheryl Lynn is associated with the office and they
are a bit of a [indiscernible] group. They pretend that they take direction from me,
but they go and do what she does. They not and say yes and they go off and do what they
should be doing which is great -- paid no attention to the administrator. I am just
joking, of course. The health resources and services administration has a set of programs.
It is a delight for me because of where I come from to deal with the Terrell office
of rural health policy. I have a long standing history with Tom Moore 17 there. We have fabulous
employees across the entire agency. These are certainly some of the best. And to all
of you with [indiscernible] -- Steve Hirsch is also here and will speak later.. Thank
you Karen for your willingness to serve in helping to coordinate and lead this particular
meeting. We go way back -- she is from the University of Virginia and I have spent some
time myself in some of the university infrastructure of the state of her gender. I appreciate the
opportunity to talk with all of you today about what I think is an incredibly important
topic for the meeting -- focusing on how we can for the meeting -- focusing on how We
Can Dr., Telehealth technology in an even more robust fashion to improve patient outcomes,
especially for people in isolated geographic areas across the United States. And how we
can harness telehealth technology to expand the reach of what our scarce health resources
in rural America are. At HR as they and across HHS, we have been looking forward to this
meeting for quite some time with the hope of a report that will provide us with your
great thinking about how we can really catalyze this agenda going forward.
The six members of the planning committee -- a special shout out to each of you who
are willing to dissipate in the meeting. Also you will be participating in terms of helping
to Perl the content together on the back and with the IOM. It is nice to see familiar faces
in the audience. I know we are broadcasting this as well and that it will be available
archived. For those of you here and why no, we have worked collectively a number of bus
in this rural landscape for now decade. The issues that we are talking about today we'll
he -- really resonate with me today. I am a resident of the state of North Dakota. I
commute for my job. It is still home for me. Obviously, you don't have to look to too many
states that are more rural than the state of North Dakota. These issues we are talking
about -- ensuring access to healthcare resources -- play a way for me and family members who
reside in rural parts of that state. And, Frank, for as long as I have been in healthcare
for decades -- rural issues have been a part of what I have focused on. In that context,
I see a promise and potential impact and also some of the challenges that we have had in
deploying Telehealth -- not just in North Dakota, but in other parts of the United States.
In my home state, though, Telehealth technology and its hardest thing has been a key player
I think that is the ability to capitalize on technology, especially from and through
a rural lands, probably gets its start in a rural communities that are often shy of
a full array of resources. In places like North Dakota, I like to think about those
communities -- rural healthcare leaders -- that really do necessity is the mother of innovation.
When I think of innovation and our ability to better meet these needs in our rural and
frontier parts of the country, I certainly buy into that thinking more effective deployment
of Telehealth technology.
Prior to my current position, I served on the Commonwealth commissions find. This was
on a high performing healthcare system. I brought the commission people from across
the United States -- I brought them to North Dakota to look at innovation in healthcare.
Central to the conversation was the deployment of Telehealth technology. That state, in particular,
we were talking about tele-pharmacy were you do not have a arm assist in every single rural
community and yet you have a lot of people who are relying on the knowledge and availability
-- of pharmacy. I am well aware of the important where role that technology can play in rural
frontier states and even through that tele-pharmacy project is well underway there.
When I came to HRSA, I became more aware of the importance of oral health. As Karen indicated,
any isolated communities. The point would be that some of our most isolated communities
in some respects are actually in some of our urban inner-city areas. I know that because
I've seen it in my current capacity as recently as a week and a half ago. I visited an incredibly
medically underserved part of this District of Columbia -- a stone's throw from -- a stone's
throw from the nation's capital.
So, that is the orientation that we bring to this set of issues around really alighting
on the promise and opportunity of Telehealth technology with an obvious recognition of
than right now for us to be focusing in on this conversation. It's about the role that
Telehealth can play in what is really a rapidly evolving healthcare environment. The importance
of Telehealth and its potential will, I believe, and many of you believe it too, the importance
of this will continue to grow, especially as more and more people in rural and isolated
areas across the United States are able to seek a full complement of healthcare services.
In no small part part this will be a part of the affordable care act including provisions
lies like health insurance exchangeable reach out the availability of access to health insurance
coverage. Also, the availability without co-pay of preventive healthcare services. Without
out-of-pocket costs. Another set of services that individuals will not have caused barriers
to in terms of accessing as well as some of the new Medicare and Medicaid payment models.
We have a lot of new opportunity that we can take advantage of and I think Telehealth technology
is a key player when we think about these isolated populations.
communities and the older. An older population. We know that rural communities tend to have
people with lower incomes and we know that in sharp contrast to some of the myths that
we have higher rates of three -- certain chronic diseases in rural areas. Because of this,
chronic disease, low in, -- low income, and this creates additional barriers to our helping
individuals to obtain healthcare services in real-time.
We also know that in rural areas we have challenges with attracting and retaining healthcare providers.
Physicians, pharmacists, physical therapists, nurses, and others. That can be for many of
the rural communities a difficult challenge. We know that a lot of the for a lot of the
health-care industry, particularly some of the smallest hospitals, today they are operating
on the thinnest of margins. We have a lot of challenges, but I would say also opportunities
of which Telehealth technology applications can be a part, not entirely, but part of the
solution.
So, at HHS we are addressing these issues as we think about the future of health care
across the United States and we are paying attention -- paying attention to healthcare
challenges -- some that I mentioned and others too numerous to mention. Rural communities
would say while it is not an initiative, from my perspective, one of the most important
and periodically I am summoned to talk about this -- one of the most important steps that
I think the president has taken that helps advance for rural America's agenda is by naming
the secretary that he named to head the US Department of health and human services -- Secretary.
needs in the rural communities that she was responsible for helping to govern across the
I've ever been a part of with her has lost sight of some of the unique challenges and
president created the White House rural Council -- the first Council of its type -- focusing
This is a Council that HHS interfaces with in no small part to the federal offices in
very much a dancing health care issues, too. Then, coming on the heels of that we have
and benefits from our vantage point to rural populations, too. Starting to help the rural
play specific to the rural communities in a positive way. So, for example, expanding
not find it -- individuals that go without insurance or are underinsured is not uncommon
The affordable care act also focuses on improving healthcare quality through team-based patient
if you will, of this focus on Telehealth and how we engage more fiber link the full skill
set that teams bring to care of individuals and communities. In addition, the affordable
but praise to benefit rural areas. It focuses on -- sharply -- and we own a lot of work
in this area -- focuses on increasing the numbers and deployment of healthcare providers.
Much of this occurs in rural communities going forward. As a result of the Affordable Care
Act, we have 16 million Americans living in rural areas that a longer days like time limits
on -- in terms of dollar amounts -- on their health benefits. About half of all of the
already started to play an even more important role in what for us is clearly evolving landscape
exist right now. In that context, some of the opportunities have already become fairly
They all provide mental health services including crisis intervention and detection of posttraumatic
way and opportunities put directly in front of us that we can capitalize on.
Good morning. I am going to cover a lot of material in a short period of time first,
reductions in hospitalizations and reduction in bed days. They also showed some improvement
able to use these models of care? Again, although big systems can have disease management, how
it after telemedicine was introduced in the community. It showed that rural communities
and in 18% it had a major positive impact. These were just in time pathology cases.
This is a paper published in 2010 again at psychiatric your bird via tele-psychiatry.
care system. I think that evidence-based models facilitated by these technologies can improve
Mr. Linkous Mr. >> Thank you. By saying I have a longer time,
we are seeing huge groups coming in to work with that. Is a challenge and store us and
or a -- we talk about telemedicine, I can see their eyes glaze. They say here is another
has moved into the cease week. I had conversations over the last several months preparing this
If you want to use it wherever, that you should have that choice. Patient safety and quality.
think 3 ran million$ conservatively for multiple physician licenses. We have one company as
If you have a license in one state, just as your driver's license in one state, that's
New Mexico. You hear about some of those with some of the other speakers that effect not
Some of the main points, it would allow the apply to the primary program and the primary
provide adequate and affordable broadband. The threats are we will have incomplete product
Before 1950, the census actually defined urban as any population in a, in, in a core, incorporated
2500 people at the minimum amount for an urban ized population. The majority of the people
micro Paulten counties have nonmetro counties. So, we add them altogether and come up with
and looking at population data and have ZIP codes you can find out what their code is
Let me start out, thanks for your comments. Clearly all the things that we do whether
you're in or out, I just, no longer apply in, in a world that is very connected, 4G.
of, of physicians and other practitioners that we need to do everything that we can
play a huge role or FCC play as huge role in getting this country connected. So, I really
found food. The talk after lunch is going to be exciting and stimulating and everyone
center. This was grant funded and there were mission driven people not doing this to make
fewer bills, less than 30,000 from the originating site. You think that these would come in pairs.
you talk to a ecologist or cardiologist -- they made be able to bill hundred dollars in 10
We put all of these constraints around because we were trying to get the Congressional I
malpractice situation, as you know -- the affordable care act did not do much. We still
farmer from the story -- three hours away from Columbia in the middle of harvest season.
my hands and what I do with my brain and my eyes. Hopefully, we will see this change because
visit.
develop a network and try to find the providers ready to embrace this. The challenge from
IM, or I can write the prescription. If there is a clinician here that tells you they didn't
monitoring. Basically, the transportation -- transmission of information about and from
and can be paid for because of the way in which the entire set of instructions -- incentives
These new models are really very interesting and I think this gives us hope at the end
therapy what if we did it over Telehealth it would cost the system $56. We have done
Their job is to figure out how to deliver the best care with the amount of money they
when I drive to see Karen in Missouri for a problem, I relied on her credentialing privileges
work it -- let me know. You can do a lot with the technology that is better quality and
of that could be telemedicine. This gets around the trying to hit more units of service, but
the hospital to what you think is worth $20. That is the downside. We want the access there
they have with physicians and if telemedicine brings the care to them in their homes, that
in about 28 states so we have a number of projects going on. I wanted to show you this
over here but I'm lost in space in this magic in between about something that is going to
projects we have office visits go up. 1 to 100. An office visit costs 1% of what a hospitalization
themselves. We need to support telehealth with robust evaluations and that means research
to as our HIT bundle. He has access to the pack system. He has real time audio and video
to create a good one. If you study a bad one, your study would be inn -- I would be remiss
but based on your argument that you hope and will keep telestroke patients in the local
They learn through our presentations. They learn from each other and mostly they learn
20 diseases that account for most of the morbidity and mortality. If you do echos on that, you
it in this type of demonstration. It is obviously very powerful. I want to thank you for that.
$15 million. I want you to know that we were called in to do an analysis of that and it
knowledge and practice and the route to sustainability. I think Doctor Aurora you just highlighted
we have them narrow the scope of the practice and give them the mentorship they need to
at -- in Texas and compared it to El Paso with no better outcomes. He is talked about
absolutely and key coordination improves access, improves quality. In most cases it lowers
how much time they had, they would say I am more busy than I will was when I was working.
everybody else that we've removed ourselves from the discourse and the table and I would
the technology as an and in itself. We may have done, and I'm also guilty, two go out
are 18 plus years of experience written in at least two journals and there are five specialty
than sometime we have residents coming in. We find when early medical student comes into
Contact one of us because we would like to work with you and I think you can do that
even thought of that. I think even in -- even if we didn't say we were doing tele-medicine,
[ Event Concluded ]