The FCC Rural Health Care Pilot Program:

Improving Access and Quality of Health Care throughout California

Thomas Nesbitt, M.D., M.P.H.Executive Associate Dean, School of Medicine

Director, Center for Health and TechnologyUniversity of California, Davis

The explosion of new knowledge and information in the health sciences is ironically creating greater disparities in the quality of health care services.

If we discover a cure for cancer, but only half the people have access to it, we have only discovered half the

cure for cancer.

Medical Science, no matter how good it is, is worthless if not

applied appropriately to patients who need it

Advances in telecommunications and

information technologies can help to redistribute health care

knowledge and expertise to where and when it is needed

These technologies can help facilitate a new, more efficient

model of care across the economic and geographic

spectrum.

The role of information and telecommunication technology in

health care

TelemedicineTelemedicine

• Interactive healthcare over distance using technology

• Telemedicine brings the expertise of a specialist to the point of care and allows that expertise to be customized to that patient

UC Davis Telemedicine ServicesUC Davis Telemedicine Services

• Pediatric Critical Care• Pediatric Sexual Abuse QA• OB/GYN• Pediatric Cardiology• Surgical Oncology• Allergy• Occupational Medicine• Child Development• Burn• Genetics• Transplant• Urology• Pediatric Rheumatology• Pulmonary• Plastic Surgery• Pediatric PM&R• Podiatry• Hematology• Pediatric Urology• Pediatric Gastroenterology• Oncology• Pediatric Hematology/Oncology• Surgery

• Cardiology• Pediatric Endocrinology• Pediatric Nephrology• Gastroenterology• Infectious Disease• Pediatric Neurology• Pain Management• Pediatric Genetics• Nephrology• Psychology• Rheumatology• Neurology• Hepatology• Otolaryngology• Pediatric Obesity• Orthopaedics• Nutrition• Endrocrinology• Psychiatry• Dermatology

Medical PeripheralsMedical Peripherals

General Exam Camera

Otoscope

Nasopharyngoscope

Electronic stethoscope

Outpatient Telemedicine Outpatient Telemedicine

Outpatient Telemedicine Outpatient Telemedicine

Telemedicine in the Hospital SettingTelemedicine in the Hospital Setting

• Hospitalized patients are much sicker than in the past

• Having the right expertise at the point of care 24/7 is essential

• Access to specialty expertise is a significant challenge for smaller hospitals

• Telemedicine can bring that expertise to the emergency room or to the inpatient bedside

Emergency Room TelemedicineEmergency Room Telemedicine

Redistributing Expertise in the Inpatient SettingRedistributing Expertise in the Inpatient Setting

Requirements for a successful statewide telehealth network

Requirements for a successful statewide telehealth network

• Broadband connectivity– Reliability– Quality of Service (QOS)– Security – Privacy

• Equipment– At specialty and remote sites

• A trained workforce

Proposition 1DProposition 1D

• Proposition 1D: K-University Public Education Facilities Bond Act of 2006

– “…the amount of $200 million shall be used for capital improvements that expand and enhance medical education programs with an emphasis 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 schools with clinics in remote areas all over the state of California.”

--Governor Arnold Schwarzenegger  UC Davis Pediatric Telehealth Colloquium

The California Telehealth Network:A digital health care highway

Current StateCurrent State

FCC Rural Health Care Pilot ProgramFCC Rural Health Care Pilot Program

• Dedicated over $417 million for 69 pilot program networks

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

Consortium MembersConsortium Members• The Office of the Governor • California Business, Transportation and Housing Agency (BTH)• The California Emerging Technology Fund (CETF)• The California Public Utilities Commission (CPUC)• The California Department of Managed Health Care (DMHC)• The California Telemedicine & eHealth Center (CTEC)• Rural Telehealth Networks• The UC Office of the President • University of California Davis Health System• 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 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 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 telehealth

• Goal 4: Utilize CTN for ongoing disaster preparedness training

Technical GoalsTechnical Goals• Extend broadband

connections to 300+ rural health care providers in 3 years

• Address technical and cost constraints

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

Education

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-up funds • Letter of Agency process (completed)

• Original goal was 319• Nearly 1000 locations represented in the received

letters of agency

• USAC has qualified over 730 sites• RFP has been submitted for posting on the USAC

RHCPP web-site

Current StateCurrent State

TAHOE-FORESTHEALTH SYSTEM

FREMONT-RIDEOUTCANCER CENTER

UCDAVISHEALTH SYSTEM

MAYERS MEMORIAL HOSPITAL

ROUND VALLEYINDIAN HEALTH CENTER

Current ModelCurrent Model

California Telehealth

Network

California Telehealth

Network

California Telehealth

Network

California Telehealth

Network

This effort has not only led to the next generation of telecommunication for under served areas but has also led to a new focus on telehealth in the

State as well as a new level of collaboration among stakeholders

How will all of this benefit Californians?

The FCC Rural Health Care Pilot Program:

Improving Access and Quality of Health Care throughout California

Thomas Nesbitt, M.D., M.P.H.Executive Associate Dean, School of Medicine

Director, Center for Health and TechnologyUniversity of California, Davis