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November 2017    
HTRC's monthly telehealth bulletin
Public health meets telehealth

For the second year, National Telehealth Resource Centers, which includes HTRC, exhibited at the American Public Health Association Conference - this year in Atlanta. HTRC Project Director Janine Gracy reflected on the use of telehealth in the public health realm.

"Public health professionals are very creative problem solvers and we are here to put our heads together," said Gracy. "With decreased budgets of local public health agencies there is a growing need to innovate. Telehealth can save money on travel and improve efficiency."

To illustrate the linkages between public health and telehealth, we've listed the 10 essential services of public health below and provided examples or calls to action for each.

Ten essential services of public health
Monitor health status to identify community health problems.

Telehealth-based antibiotic stewardship programs have been used to monitor the effects of  prescribing practices to prevent spread of infectious disease.

Diagnose and investigate health problems and health hazards in the community.

Telehealth has been used to diagnose and treat  Ebola cases, while protecting clinicians.

Inform, educate, and empower people about health issues.

CDC-recognized Diabetes Prevention Programs have been delivered remotely via telehealth.

Mobilize community partnerships to identify and solve health problems.

The Children's Advocacy Centers of Oklahoma's KidSafe project used telehealth to provide quality exams for sexual abuse victims and provide trainings to better preserve evidence for law enforcement.
Develop policies and plans that support individual and community health efforts.

One promising example is the Trump Administration's declaration on the opioid crisis, which could make it easier for opioid addiction medications to be prescribed via telehealth.

Enforce laws and regulations that protect health and ensure safety.

Increasing adherence to regulations can be aided through training, such as an online food-safety training course.

Link people to needed personal health services and assure the provision of health care when otherwise unavailable.

The Saline County Health Department in Kansas is among the local public health departments now using telehealth for case management.

Assure a competent public health and personal health care workforce.

A recent HTRC article highlighted the use of telesupervision in helping rural mental health professionals earn their credentials. 

Evaluate effectiveness, accessibility, and quality of personal and population-based health services.

The Project ECHO model emphasizes  program evaluation and is increasingly used among groups like community health workers.

Research for new insights and innovative solutions to health problems.

Public health professionals are known for their resourcefulness and we are excited to see what new uses for telehealth they identify in the coming years.

Jefferson City, Mo. 
February 1

The 2018 Missouri Telehealth Summit will focus on financial barriers and incentives for rural hospitals, successful Missouri telehealth projects, legislative updates and more. The keynote speaker will be Yulun Wang, Ph.D., founder and CIO of InTouch Health. 

For those who want a crash course in telehealth basics, a pre-summit Telehealth 101 Workshop will be held January 31, also at the Capitol Plaza Hotel in Jefferson City, Mo. 

ECHO schedule

Pain Management Ongoing Kansas
Airway  Ongoing Kansas
Child Behavioral Health Starts fall 2017 Kansas
Back-to-School Ongoing Kansas
Impact Asthma Next cohort starts January, 2018 Missouri
Year round Missouri
Healthcare Ethics Ongoing Missouri
Chronic Pain Management Ongoing Missouri
Dermatology Year round Missouri
Hep C Year round Missouri
Child Psych Ongoing Missouri
Community Health Worker
Opioid Use Disorder Ongoing Missouri
Addiction Medicine Ongoing Oklahoma
Obesity Medicine Ongoing Oklahoma
HIV/Viral Disorders Ongoing Oklahoma
Psychiatry Ongoing Oklahoma

CCHP report shows strengths and weaknesses of telehealth policy in Kan., Mo. and Okla.
An updated state-by-state report on telehealth laws, regulations and Medicaid policies released early this month highlights policy areas where Kansas, Missouri and Oklahoma shine, as well as where growth is needed.
According to the Center for Connected Health Policy, Missouri and Oklahoma are two of only 15 states that reimburse for store-and-forward services. Kansas, Missouri and Oklahoma are included in the 21 states that offer some type of remote patient monitoring (RPM) reimbursement. None of these three states have telehealth-specific licensing policies, but Kansas is part of the Interstate Medical Licensure Compact along with 21 other states.
Oklahoma has made significant progress in the past six months, according to the report. By adding policies for both store-and-forward services and RPM, Oklahoma earned its place alongside Missouri on the list of only 9 states that allows for reimbursement for live video, store-and-forward and RPM, though actual implementation of these policies has been delayed in some cases. Missouri also stands out as 1 of only 7 states that reimburse for teledentistry.
However, online prescribing policies are strict in all three states. Kansas and Missouri require providers to have a preexisting relationship with patients before prescribing medication via telehealth. In Oklahoma, a provider may prescribe without a preexisting relationship only in some situations.
In addition to Medicaid policy, some states have passed requirements for private payers. Both Oklahoma and Missouri require private payers to cover telehealth services, but Missouri does not require coverage for site origination fees and telehealth provision costs in some situations. Kansas telehealth advocates are moving forward with their effort to add telehealth parity to the books.
AAN teleneurology team develops curriculum to standardize practice   

An American Academy of Neurology team of researchers has pioneered a new teleneurology curriculum for providers, according to a release from the University of Missouri-Columbia. The curriculum's aim is to standardize training for teleneurology and increase its effectiveness.

"Unfortunately, teleneurology is akin to the Wild West," Raghav Govindarajan, MD, assistant professor of clinical neurology at the MU School of Medicine and lead author of the study, said in the release. "Many practitioners may be operating without the necessary skills and expertise to best care for patients."
The release said the team focused on five crucial knowledge areas with which providers must be familiar to provide effective teleneurology: 
  1. Technology basics and technical problem-solving 
  2. State licensure requirements and medical ethics  
  3. "Webside" manner in building relationships with patients 
  4. Patient privacy, informed consent and disclosure 
  5. The same clinical skills required for in-person neurological care

Project ECHO

Project ECHO is a program using telehealth to revolutionize medical education  and improve access to specialty care. Project ECHO, which was developed by the University of New Mexico School of Medicine, works by connecting primary care clinicians with specialist teams via videoconference. 

Each specialty area has its own ECHO, such as autism or chronic pain. ECHO teams meet regularly to collaborate with primary care providers.

Heartland Telehealth Resource Center | | 
 4330 Shawnee Mission Parkway   Fairway, KS 66205