Telehealth Network Inches Nearer to Reality

These are heady days for Eric Brown. He’s the executive director for the California Telehealth Network, an organization partially funded by the Federal Communications Commission and run by UC-Davis that plans to use video feeds to eventually link medical specialists to more than 800 rural and underserved health care facilities across the state.

CTN recently announced that 25 medical facilities now are hooked up to a broadband network, bringing the futuristic vision of telehealth closer to reality in California.

“It’s a very exciting time,” Brown said. “It’s good to be making progress. About 25 sites now have active circuits, and full functionality will come in the next week or two. We’re shooting for the first week of February.”

Having active circuits means the 25 sites can talk to each other, but not yet to consulting specialists at University of California medical centers. That will happen once CTN sets up computer equipment at the central facility to establish the firewall and enable a secure connection outside of the current network. Then, staff at the 25 sites will be able to consult via video chat in real time with specialist physicians from the eight UC medical centers, as well as a few private hospitals, such as Stanford University and the University of Southern California, Brown said.

“The vision is that the CTN eventually would be made available ubiquitously around the state — whether you’re urban or rural, nonprofit clinics or for-profit hospitals, you would have access to the CTN, to provide services or to receive services,” Brown said. “Right now, our initial funding and focus is on these medically underserved areas to start with.”

More than 850 medical facilities in rural and underserved areas across California are eligible to be part of the telehealth network, Brown said. Most of those sites are rural, with about 30% to 35% of them in non-rural areas, and that’s roughly the breakdown of the 25 sites that are launching the project, he said. Places that qualify range from a clinic in San Francisco’s Chinatown to a hospital in Ukiah to a family health center in western Santa Barbara County.

Another Month, Another Project

In addition to going fully operational at the start of February, the CTN has two other initiatives it’s about to set into motion.

“CTN and UC-Davis recently received a broadband grant that’s going to kick off in the next 60 days,” Brown said. The project idea is to find “communities” of facilities that have started to use health information technology and help them band together to create something new and innovative, he said.

“We’re looking for a collection of sites united by a common approach to using technology,” Brown said. “We want to partner with those sites that are embracing technology and bringing technology more deeply into the community, and we want to see if we can accelerate that by providing broadband to these areas.”

For instance, he said, there are a number of federally qualified health centers, or FQHCs, that have school-based clinics in the community. “If we were able to set up a kiosk at these clinics, patients could see videos on lifestyle and nutrition there.” Or, he said, there could be a system where people go to a public library or community center to have their vital signs checked and then have that information sent along to their primary care physician through a secure network.

“Those are the kinds of concepts that these communities are being urged to put together,” Brown said.

The other project is more internal: setting up a business plan to determine where future efforts and resources will go. Brown said funding for a business plan consultant will be provided by the California HealthCare Foundation, which is represented on the CTN board of directors.  CHCF publishes California Healthline.

“Obviously, there are so many things you could do,” Brown said. “How do you decide what to do first? And how do you ensure sustainability over the long run?”

Brown said a request for proposals for both projects will go out around the first week of February. The model community project probably will be chosen in February and is expected to be up and running by July, he said.

Next Steps for Telemedicine

Establishing a broadband connection for isolated or underserved communities is the culmination of a long effort, yet it also is just the start of the telemedicine project.

One criticism of the project is that there is no standard for transmission of electronic health records. Physicians using the telemedicine network are not yet able to transfer patient charts.

“We haven’t gotten to that point yet,” Brown said. “That has to be an agreement between two sites doing a consultation on a patient. They’re left to their own to figure out the transmission of medical information securely.”

In a way, physicians do this now, by consulting with other health care providers on the phone. The video component of the CTN allows consulting physicians to see a patient’s symptoms and view any scans, and the complete health record is not always necessary, Brown said.

“It’s open platform,” he said, “so that’s one of our challenges. There certainly are a lot of vendors trying to solve that with health information exchange platforms.”

In some cases, just having the broadband connection could help sites find health record systems that are compatible with various other sites, and to pool information and buying power to get the best EHR system. “What the CTN can do is help facilitate a telemedicine session or teleconferencing system to share that information,” Brown said.

The “first focus is to just get the network launched,” Brown said. “Then we pivot to figure out what applications are in highest demand, and where do we want to expand the network.”

Expanding the Network

The goal of the CTN is to bring specialty care to areas of California that don’t have it.

To do that, the Center for Connected Health Policy started the Specialty Care Safety Net Initiative. The idea is to connect safety-net patients with physicians in six medical specialties, and over time, to evaluate which areas and which specialties have the greatest demands.

“That will be one of our early indicators [to see where to expand effort],” Brown said. “Our mission is to use broadband to efficiently utilize those specialty services. Again, that’s just in the early stages. But that’s the vision.”

Hooking up the wires is a great start, but Brown wants to go a few steps further to make sure participants get full use out of the system.

“We need to see how we can facilitate or broker services with those who need it,” he said.

With the expansion of health care coverage coming in 2014 as part of national health care reform, the demand for specialty services could rise, particularly in underserved areas, he said.

“My sense is, if you look where the specialists are located, it’s not always matched up with heaviest patient loads,” Brown said. “If you look at the long-term future, it is clear there will be more people entering the system, and specialty care will not keep pace with that.”

So the future is now, Brown said with a smile — but it’s also in the future.

“That’s the daunting challenge of this. There is so much still to be done,” he said.

“It’s a little scary at first, but it’s fun, too. You have to be prepared to learn as you go,” he said. “Because what we’re doing, a lot of these things haven’t been done before.”

When you look at innovations in medicine such as EHRs, Brown said, “it’s already starting to look different in medicine. Right now. It’s a very different environment than it was a few years ago, even. It’s not a 10-year window, it’s closer to two years, or five years,” he said, before the face of medicine changes dramatically.

“It’s already started, the technology is increasingly pervasive,” Brown said. “We want to make sure that the rural and the underserved aren’t left out of that. We want to make sure we find a way to include everybody.”

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