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TeleHealthNews

Vol. 1 No. 2 October 1997 PART 1

Welcome to the TeleHealthNews, an Internet resource for health professionals. Please feel free to pass this newsletter onto your friends and colleagues. Subscribing/unsubscribing information is at the bottom. If you would like more information than found here, check out our website at: CyberTowers Professional Center

This issue is brought to you through the sponsorship of the University of Vermont, hosts of the Oct. 12 - 15 How to Build a Telemedicine Program Conference. For more information visit their website @: http://uvmce.uvm.edu:443/profprog.htm

Table of Contents

PART 1
1. Report of an Active Telehealth Project
2. Politics and Policy
3. The Human Side of using Telehealth Tools
PART 2
4. Internet Resources
5. Telehealth Articles, Books, Journals, Reports
6. Conference and Education
7. Organizations & Companies
12. Subscribing and Unsubscribing

FEATURE ARTICLE: Report of an Active Telehealth Project
Kentucky Advances Mental Health Services Through Kentucky TeleCare and the State Mental Health Network by Deborah C. Burton, M.A.

Citizens of the Commonwealth of Kentucky will have greater access to mental health services through the telecommunications infrastructure from two networks: a) Kentucky TeleCare Network and b). The State Mental Health network.

The Kentucky Telehealth Network is a coalition of primary, secondary, tertiary and regional care partners. The network is based on dedicated T-1 communication lines operating at 768 kbs with a V-Tel platform. The University of Kentucky Chandler Medical Center (UKMC) has offered regular scheduled weekly Grand Rounds, including Psychiatry Telehealth Clinics, monthly Psychiatry Grand Rounds, & remote education.

From 12/20/95 to 7/23/97 the Kentucky TeleCare Network has served 255 patients. Child & adult psychiatrists at the Psychiatry consults contributed 48% of the total patients reported above, 11% adult psychiatry and 37% child psychiatry. Grand rounds are transmitted from the Hospital Auditorium. The presenter, local and remote health professionals may interact using a multipoint link and participants receive one hour of CME credit per session. Additionally, Dr. Otto Kaak has conducted a 14 month Child Psychiatry class for allied health professionals at remote sites. Colleagues from the Department of Psychiatry have assisted Dr. Kaak by teaching modules in their specialty.

The Mental Health Network is also based on dedicated T-1 communication lines operating at 768 kbs with a VTel platform, to facilitate network linkage to the Telecare Network. Elizabeth Wachtel, the Commissioner of Mental Health Services, has authorized two million dollars to create this statewide system to expand access to telepsychiatry services.

The state of Kentucky is divided into four state mental health districts. The Mental Health Network will start in the Eastern District, which serves eight MHMR facilities, and expand into the other districts.

Based upon the experience of the Kentucky TeleCare network, Commissioner Wachtel expects network utilization to revolve around Clinical, Educational and Administrative applications. Wachtel said, "As we become more comfortable with the use of the technology, we will discover new opportunities for utilization, such as greater facilitation of discharge planning from the state hospital to the community MHMR facility." Wachtel hopes to create links to the State Mental Health Network from all 120 counties, to help ensure that citizens and health professionals have access to convenient, cost effective clinical and educational mental health services, and more efficient administrative collaboration.

If you have a project you would like included or reviewed in the next issue please e-mail us: telehealthnews@cybertowers.com

POLITICS & POLICY

I. American Telemedicine Association (ATA)
The ATA Technology Task Force has been charged by the ATA to develop comprehensive technology strategies to establish adaptation and compliance standards for universal, accessible telemedicine systems. Input from these discussions will be included in a formal recommendation document that will be presented to the members at the 1998 A.T.A. Meeting.

II. AERA Standards for Telecommunications Activities
The purpose of the AERA Standards is to insure the accuracy of the information AERA disseminates over the internet, to provide for the efficient and economical delivery of such information, and to protect the image and reputation of the Association while allowing reasonable discretion to groups and individuals: http://aera.net/about/standards.html

III. Congress Approves Limited Medicare Reimbursement For Telehealth Services
A significant victory was achieved for advocates of Telehealth when Congress agreed to include reimbursement for telehealth consultations for rural Health Provider Shortage Areas (HPSAs). Acting on legislation introduced by Senator Kent Conrad (D-ND), the House and Senate conferees agreed to a smaller version of the original bill. Under the agreed upon provisions, reimbursement will be established for all eligible Part B Medicare services at normal co-pay rates, no facility fees or transmission costs will be eligible for reimbursement. It is estimated that this will yield $100 to $200 million per year for telemedicine reimbursement starting January 1, 1999. For the actual language of the Act, see S.B. 2151 (the Balanced Budget Act of 1997), SEC. 4206. MEDICARE REIMBURSEMENT FOR TELEHEALTH SERVICES.

In the past, the federal government has provided demonstration grants for telehealth projects and reimbursement in several limited projects to assess the effectiveness and efficacy of telehealth. However, this is the first time the federal government has approved reimbursement of federal funds for regular, on-going healthcare consultations.

The conference report included language directing the Department of Health and Human Services (HHS) to make payments for professional consultations via telecommunications systems with a practitioner furnishing eligible services for patients residing in designated rural HPSAs. The payments shall be shared between the referring and consulting health professionals and not be greater than the current fee schedule for the health services provided. In addition, HHS will submit a report to Congress by January 1, 1999 evaluating the use, quality, and cost effectiveness of telehealth. It also directed the Department to report on expanding reimbursement for telehealth services to other potential beneficiaries.

The Health Care Financing Administration is now working to identify eligible areas, and over the next year will be drafting regulations covering implementation: http://www.atmeda.org

IV. FCC--Universal Service Provisions to Rural Health Providers
The FCC recently formed a subsidiary corporation to handle the development of protocols, standards, and applications for the $400 million in reduced telecommunications charges that will be made available to eligible rural health care providers as of January 1, 1998. While some details remain, the FCC appears to be on schedule to make the first discounts available immediately after the start of the new year. For more information, go to call 888-CALL-FCC or go to: http://www.fcc.gov/healthnet

THE HUMAN SIDE OF USING TELHEALTH TOOLS

Birth of Telehealth Applications: One Example in Development
By Deborah C. Burton, M.A.

As Telehealth networks evolve, it is interesting to witness the process of utilization and development of applications. I'd like to share with you one example of a developing Telehealth application which initiated from the old adage, "necessity is the mother of invention."

In his preschool years, my son was diagnosed with ADHD, Tourette's Syndrome and Obsessive Compulsive Disorder and in third grade was identified for the Gifted program. This sent me to the library shelves and prompted many conversations with social workers, psychiatrists, psychologists, physicians and other allied health personnel so that I could become educated and learn skills to cope with my son's behavior.

The process of trying different medications and their timing and dosages during seemingly continual growth spurts, which also affected my son's behavior, also prompted many conversations with teachers, school counselors and principals. I found myself year after year, a single parent in educational conferences passing along articles to teachers, wringing their hands in despair and asking me what to do with my son. There were a lot of misinterpretation of behavior and misconceptions about the disorders and I knew that there were many other parents having similar conversations in schools statewide, especially in rural areas of our state where few clinicians exist, resources are scarce, and geographical barriers are intimidating.

At the University of Kentucky Chandler Medical Center (UKMC) had already demonstrated success in Telehealth consultations via the Kentucky TeleCare network. Many patients seen by Department of Psychiatry Child Psychiatrists were children with ADHD who were referred for recommendations on medication management. I had learned that medication was only one part of the process and behavior modification was a necessary ingredient in the approach to helping these children lead happy, productive lives. However, treating the child is just one part of the puzzle. It seemed that greater success could be achieved in a multidisciplinary approach whereby primary care physicians, educators, family members and caregivers were educated about the disorders, the role of medication, and taught skills to consistently and collaboratively manage the behavioral aspect of the treatment.

I contacted an M.S.W. in the Department of Psychiatry who had developed a training module with video tape for teachers, and the TeleCare Network Education subcommittee, to see if they would be interested in a pilot project to conduct training sessions via the TeleCare network. Positive responses from both directions sparked continued motivation.

Input and interest from a former school psychologist who was also the Director of a summer camp for ADHD children, and a mother of an ADHD child, prompted the idea of organizing a focus group to help identify needs and action plans for family's with ADHD children. Letters and invitations for focus group participation were sent to eighty education and allied health professionals in the state. Recently twenty-five respondents from eight counties, including the Ashland Independent school district and the Erlanger-Elsmere schools, met at the Kentucky Clinic South site.

Participants included school superintendents, directors of special education, school nurses, representatives from Kentucky Education Association, Division of Exceptional Children Services, Division of Learning Disabilities, the Learning Disabilities. Association, Kentucky Speech-Language-Hearing Association, school psychologists, a parent representative who was also director of C.R.I.S.E.S. and a representative of C.H.A.D.D., the M.S.W. and the Director of the ADHD camp from UKMC Department of Psychiatry, UK Division of Communication Disorders, the Director of Kentucky TeleCare and the Senior Telemedicine Associate, Kentucky TeleCare. This meeting included an introduction to the Telehealth network, and focused on four areas: 1) perceived problems associated with children with ADHD, 2) current actions to address these problems, 3) possible solutions and 4) recommended action plans.

It was amazing that many of the professionals at the meeting also were parents of children with ADHD and associated disorders. With this type of personal experience as a driving force, the breadth of collaborative professional experience as a platform for action, and technological innovation as a multidimensional vehicle, this project is poised for success as a catalyst for change. Change because we want to; change because we have to; and change because it's the most logical course of action.

Deborah C. Burton, M.A.
Senior Telemedicine Associate
U. of Kentucky Chandler Medical Center, Kentucky TeleCare
e-mail: daburt00@pop.uky.edu

Internet Resources

CyberTowers Professional Center

Distance learning Software
http://www.ctt.bc.ca/landurl/oedahome.html
http://www.uiowa.edu:80/~itsisdg/index.html (U of Iowa)

Internet for the Family Physician by: Gilberto Lacchia. Comments and suggestions are welcome.

HOSTnotes
A brief update on our activities, notices of meetings, and other information of interest. For questions or membership information:
202-434-4771, or
444 N. Capitol St. NW, Suite 200 Washington, D.C.,

Loop-Back
By calling our site, users can test their video teleconferencing equipment. Our site is available 7 days a week, 24 hours a day. $1/min/call 1-900-255-LOOP(5667)

PharmInfoBYTES
Published by VirSci Corporation, and issued corresponding to updates to PharmInfoNet

Technology Registry for Mental Health

Web Conferencing

CONFERENCES & EDUCATION

Nursing and Health Informatics Conferences

The Organizational Behavior department of Phillips Graduate Institute is offering a new course over the Internet entitled *The Wired Organization: Business Research and Communication in the Age of the Internet.* For details contact Mark Stover at mstover@pgi.edu or

Association of Telemedicine Service Providers Oct 12 & 13 Portland, OR:

How to Build a Telemedicine Program
Sunday, October 12, 1997 - Wednesday, October 15, 1997 A Professional Program in Healthcare Presented by U. of Vermont & Fletcher Allen Health Care Learn how to improve your facility's ability to deliver quality healthcare through the establishment of a telemedicine program. E-mail: mbaggs@zoo.uvm.edu, phone 800-639-3188

Is Healthcare Ready for the Internet?
November 13-14, 1997 Washington Dulles Airport Hilton Sponsored by HOST This program will focus on the issues important to the continued development of healthcare on the Internet, and explore how these issues have affected their current projects. e-mail meeting@hostnet.org

TeleMed International Conference on Telemedicine & Telecare
November 26 & 27, 1997 at the Holiday Inn Crowne Plaza, Heathrow, London England. Contact Lisa Spicer, Events coordinator at the Royal Society of medicine: Events@roysocmed.ac.uk

4th Internet World Congress on Biomedical Sciences 97 in University of Occupational & Environmental Health, Japan December 8 to 19, 1997 (Official Language: English).
If you wish to present a poster at the Congress, please complete and submit ABSTRACT and REGISTRATION FORM by September 30, 1997. Click *Call for Abstract*

Third Annual Information Connection Healthcare Technology Series
*Implementing Effective Technologies in Healthcare* January 28-30, 1998 in Burlington, Vermont USA. Participants interact with creators of the leading informatics and telemedicine programs; discuss ways of integrating the two technologies

American Telemedicine Association Annual Meeting April, 1998

Telemedicine: Charting the Future, Forging New Alliances Telemedicine & Distributed Medical Intelligence Conference March 8-10, 1998 in Lake Tahoe, CA. Hosted by the East Carolina University Telemedicine Program. This conference will explore cutting-edge innovations and changes in the developing global telemedicine environment:

The Department of Defense and the American Telemedicine Association have joined forces to host this event, next year in Orlando, FL. Abstracts are now being accepted

TELEHEALTH ARTICLES, BOOKS, JOURNAL, REPORTS

webSight news digest for psycOH!

Clinton Would Ease Access to Private Medical Records
Copyright 1997 The New York Times Company
By ROBERT PEAR
**EXERPT** WASHINGTON -- Bowing to federal and state law-enforcement authorities, Clinton administration officials will soon propose legislation that would allow police officers to gain broad access to patients medical records, with hardly any restrictions on use or redisclosure of the data.

CyberKnife on MSNBC
MSNBC s The Site, broadcast a segment on the CyberKnife System, August 20,1997. Copies available from various sources. The CyberKnife allows doctors to target brain tumors with directed high-powered x-rays.

Government Accounting Office [GAO] (1997). Telemedicine: Federal Strategy is Needed to Guide Investments (GAO Publication [On-line].

U.S. Department of Health and Human Services (1997). Exploratory Evaluation of Rural Applications of Telemedicine (HHS Publication [On-line]..

A Searchable index of nearly 3000 Telemedicine abstracts is available

U.S. Department of Commerce (1997). *Telemedicine Report to Congress* by the JWGT

SPONSORSHIPS

TelehealthNews is proud to be sponsored by companies offering telehealth communication tools. To learn more about how you can become a sponsor for this newsletter, please write to Marlene Maheu at

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