The California Telehealth Network: A Resource to Support InnovationA Resource to Support Innovation

Thomas Nesbitt, M.D., M.P.H.Associate Vice Chancellor, Strategic Technologies and Alliances

Director, Center for Health and TechnologyChief Scientist CITRISChief Scientist, CITRIS

University of California, Davis

There is a growing expectation that There is a growing expectation that g g padvanced information technology

will transform our health care

g g padvanced information technology

will transform our health carewill transform our health care system.

will transform our health care system.

One of the problems is that we are applying new technology toOne of the problems is that we are applying new technology toare applying new technology to a broken model of care instead are applying new technology to a broken model of care instead of using technology to facilitate

h i th d l fof using technology to facilitate

h i th d l fa change in the model of carea change in the model of care

Th t h l i h lTh t h l i h lThese technologies can help facilitate a new, more efficientThese technologies can help facilitate a new, more efficientfacilitate a new, more efficient

model of care across the i d hi

facilitate a new, more efficient model of care across the

i d hieconomic and geographic spectrum

economic and geographic spectrumspectrum.spectrum.

Requirements for a sustainable Statewidetechnology enabled healthcare system

Requirements for a sustainable Statewidetechnology enabled healthcare systemgy ygy y

• A ubiquitous, broadband networks with guaranteed quality of service (for TM)

• Broad distribution of hardware and software in the fieldfield

• Standards for HIE, telemedicine, etc. • Organizations focused on policy and regulatory• Organizations focused on policy and regulatory

changes that facilitate new models of care • A technology competent health care workforceA technology competent health care workforce • Research and development programs for device

development and service delivery models

One of the essential requirements for an One of the essential requirements for an optimally functioning technology enabled

health care system and research network is optimally functioning technology enabled

health care system and research network is widely distributed broadband connectivity

which is reliable, with explicit quality of widely distributed broadband connectivity

which is reliable, with explicit quality of service (QOS), security, privacy service (QOS), security, privacy

FCC Rural Health Care Pilot ProgramFCC Rural Health Care Pilot Program• Dedicated over $417

million for 69 pilot t kprogram networks

• Encourages regional broadband health carebroadband health care networks with connections to national backbones UPDATE!

Sites included in RHCPPSites included in RHCPP

Commissioner Martin Presentation to AHIC, Nov 13, 2007

Th C lif i T l h lth N t kThe California Telehealth Network:A digital health care highwayg g y

Consortium MembersConsortium Members• The Office of the Governor • California Business, Transportation and Housing Agency (BTH)• The California Emerging Technology Fund (CETF)g g gy ( )• The California Public Utilities Commission (CPUC)• The California Department of Managed Health Care (DMHC)• The California Telemedicine & eHealth Center (CTEC)

R l T l h lth N t k• Rural Telehealth Networks• The UC Office of the President • University of California Davis Health System• The Office of Statewide Health Planning and Development (OSHPD)The Office of Statewide Health Planning and Development (OSHPD) • California Health & Human Services Agency (CHHSA)• The Corporation for Education Network Initiatives in California• The California Office of Emergency Services (OES)• The California Institute for Telecommunications and Information Technology • The California Hospital Association (CHA) • 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)

FCC Rural Health Care Pilot Program: California’s Goals Summarized

FCC Rural Health Care Pilot Program: California’s Goals Summarized

• Goal 1: Create statewide broadband network dedicated• Goal 1: Create statewide broadband network dedicated to health care with explicit QOS, privacy and security

• Goal 2: Link the California Telehealth Network (CTN) to ( )a national backbone

• Goal 3: Leverage and build upon recent investments in telehealthtelehealth

• Goal 4: Utilize CTN for ongoing disaster preparedness trainingg

Technical GoalsTechnical Goals• Extend broadband

connections to 300+ rural health carerural health care providers in 3 years

• Facilitate use of state-of-the-art telehealth servicesservices– Telemedicine– Continuing Medical

EducationEducation

Technical HighlightsTechnical Highlights1. Persistent, IP-Based connection, no dial-up2. Dedicated End-to-End Connection, no Internet3. Explicit Quality of Service (QOS)4. Bandwidth exceed current needs

• Expandable5 “Interoperable ” peer-to-peer Any-to-Any5. Interoperable, peer-to-peer, Any to Any6. 24 x 7 x 365 Monitoring7 Secure Private Network7. Secure, Private Network8. Access to UC’s, CSU’s, other academic centers9 Access to Internet 29. Access to Internet 2

Current Status of the CTNCurrent Status of the CTN• Award of $22.1M from FCC• California Emerging Technology Fund (CETF)

providing $3 6M for 15% match and start upproviding $3.6M for 15% match and start-up funds

• $5M commitment from United Health Care $• Letter of Agency process (completed)

• Original goal was 319O 1000 l ti t d i th i d• Over 1000 locations represented in the received letters of agency

• USAC has qualified over 860 sites• RFP has been posted on the USAC RHCPP

web-site• An award should be made in the next 60 days• An award should be made in the next 60 days

FY 2007FY 2007Sites

Pil t 2009Pilot 2009Sites

4 to 14

3 to 4

2 to 3

1 to 2

1

Current ModelCurrent Model

California California Telehealth Network

Telehealth NetworkNetworkNetwork

California California Telehealth Network

Telehealth NetworkNetworkNetwork

Two proposals were submitted on August 17, 2009

Two proposals were submitted on August 17, 2009,,

• Title: The CTN Expansion and Enhancement InitiativeEnhancement Initiative

• NTIA Infrastructure (Middle Mile)NTIA S t i bl Ad ti P• NTIA Sustainable Adoption Program

• Expand CTN to 2000 sites over 2 years, support eHealth adoption programs, fund CTN operations to ensure sustainability

• TOTAL PROJECT = $55.4 million

NTIA Infrastructure ProposalNTIA Infrastructure Proposal

• Federal request of $29.6 with $7.4 match (Total $37M)$ )– United Healthcare ($4.4M)– California Healthcare Foundation ($2M)

$– California Emerging Technologies Fund ($1M)• Leverage the CTN as “shovel ready” adding

1137 sites1137 sites• Provide medical grade bandwidth, firewall

protection, and telecommunications equipment p , q pat the site to connect to CTN

• Enhanced funding at existing CTN sites

NTIA Infrastructure Proposal (con’t)NTIA Infrastructure Proposal (con’t)

• CTN grant staff identified over 30,000 potential sites:potential sites:– Clinics, hospitals, skilled nursing facilities,

pharmacies, physician offices, county mentalpharmacies, physician offices, county mental health facilities, county managed care plans, senior centers, school-based health clinics, cancer centers, tumor registries, group homes for developmentally disabled persons, county EMSEMS

NTIA Sustainable Adoption ProposalNTIA Sustainable Adoption Proposal• Federal request of $13.2 M with match of $4.6M

– University of California, Proposition 1D ($2M)National Coalition for Health Integration ($2M)– National Coalition for Health Integration ($2M)

– United HealthCare ($600K)• Fund 26 FTE including 18 FTE to support CTN g pp

operations and 8 eHealth educators to advance the adoption of eHealth– Develop and implement a 90-hour eHealth educatorDevelop and implement a 90 hour eHealth educator

training “certificate” consisting of 30 hours of on-site education and 60 hours of on-line training

– Develop 20 hours of on-line coursework “IntroductionDevelop 20 hours of on line coursework Introduction to eHealth Implementation” to prepare eHealth site coordinators (in coordination with HITECH efforts)

– Create 2 hours of on-line CTN orientation for all CTN sites

NTIA Sustainable Adoption Proposal (con’t)NTIA Sustainable Adoption Proposal (con’t)

• Enhance sustainability and management of the y gCTN through a Customer Management Application

• Distribute $2 6M in training scholarships to 200Distribute $2.6M in training scholarships to 200 individuals to become community eHealth educatorsDi t ib t $5M t t 200 H lth• Distribute $5M to support 200 eHealth Implementation Coordinators ($25K stipend)

• Distribute $2M in equipment to community sites st bute $ equ p e t to co u ty s tes(up to $20K)

• Support the transition of the CTN to a non-profit corporationcorporation

Proposition 1DProposition 1D

• Proposition 1D: K-University Public p yEducation Facilities Bond Act of 2006– “ the amount of $200 million shall be used…the amount of $200 million shall be used

for capital improvements that expand and enhance medical education programs with an p gemphasis on telemedicine aimed at developing high-tech approaches to health

”care.”

California’s Proposition 1D PassesCalifornia’s Proposition 1D Passes

“With Proposition 1D we will be able to connect our best hospitals and our best medical schoolsour best medical schools with clinics in remote areas all over the state ofareas all over the state of California.”

Governor Arnold Schwarzeneggergg10/27/2006 UC Davis Pediatric Telehealth Colloquium

Telemedicine Resource Center & Rural PRIME Facility

Project Scope

• Four-story addition to UC Davis School of Medicine EducationMedicine Education Building

52 141 gross square• 52,141 gross square feet

T t l j t t f• Total project cost of $36,000,000 (includes approximately $6M forapproximately $6M for equipment)

Telemedicine Resource Center & Rural PRIME FacilityFacility

View from the CourtyardView from the Courtyard

Telemedicine Resource Center & Rural PRIME Facility

Project Goals

§ Provide a training resource for entire UC system and partner organizations

§ Enhance learning opportunities for all medical students and other members of the healthcare team at UC Davisteam at UC Davis

§ Facilitate implementation of Rural PRIME ProgramTraining the next generation of medical students and residents how to incorporate telemedicine into their

practice

CTN l tf f hCTN as a platform for research and developmentp

What if you could use this entire network as your research andnetwork as your research and

development laboratory?

The Value of the CTN for R&DThe Value of the CTN for R&D• Represents 900 to 2000 health care anchor

institutions that have already self-identified as ybeing interested in technology solutions to health care

• Managed network, single point of contact, data collection and management on uses of broadbandbroadband

• Subsidized broadband connectivity, expandable bandwidth on demandbandwidth on demand

• With ARRA, RECs and Prop 1D funding, equipment and training resourcesequipment and training resources

Using CTN to facilitate technology trials, and service model development

Using CTN to facilitate technology trials, and service model development

• Recruit and/or follow up with health care providers• Recruit and/or follow-up with health care providers through video conferencing – Identify sites /assess interested in studyIdentify sites /assess interested in study– Interview potential subjects and/or families for

possible inclusion in studies/ provide informed consent

– Follow-up with participants over distance during studystudy

– Educate providers regarding new technologies and associated services modelsand associated services models

Using the CTN to Facilitate Technology TrialsUsing the CTN to Facilitate Technology Trials

• Deliver study interventions or services to remote communities via videocommunities via video– Administer an evaluation from the expert over video– Provide support services for studyProvide support services for study

• Training individuals in remote sites to conduct studyTraining individuals in remote sites to conduct study protocols and collect data– Training remote professionals over video– Video mentoring early in process – Video monitoring of research at distant site

• Quickly evaluate adverse events at remote site

How this all comes togetherHow this all comes togetherAll i h i “ di l h ” i h• All patients have a primary “medical home”, with EHRsD t f EHR fl i t ibl d t• Data from EHRs flow into accessible data repositoriesAll health providers academic health systems and• All health providers, academic health systems and technology development researchers are able to exchange health information and connect viaexchange health information and connect via videoconferencing via a secure network with explicit QOS

• New technologies are developed and implemented under new services models

SummarySummary• Advanced information and

telecommunications technologies have a central role to play in transforming ourcentral role to play in transforming our health care system

• Currently there is an unprecedentedCurrently there is an unprecedented financial and political investment in this approach

• The CTN can serve as a laboratory for clinicians, University researchers, industry and government to development newand government to development new technologies and service models that improve access and quality while p q ydecreasing costs of care