NETRC Facilitates a string network outlining what a telehealth network could look like for the Maine Rural Health Collaborative.
MRHC members make connections and map a mock telehealth network using yarn.
Spring is in full bloom, as is telehealth activity across the region. The NETRC team has been busy, from presenting at the New Jersey Rural Health Symposium and the American Telemedicine Association Conference, to helping the Maine Rural Health Collaborative (MRHC) visualize a mock telehealth network using a little "old school" yarn.

Did you hear that the NIHCM Foundation has requested Letters of Inquiry (due July 11) to fund innovative research projects to enhance healthcare financing, delivery, management, and/or policy? If you are looking to fund a small telehealth pilot study, this could be a great start.

Some highlights in this month's newsletter include s elect Regional Updates (be sure to read about New York's telehealth parity struggle), a special honor for a  NETRC Telehealth Champion, and a unique Q&A session during the upcoming National Telehealth Webinar.

We hope you enjoy a beautiful Memorial Day weekend, and many thanks to our colleagues, friends, and families who serve, or have served our country!


The NETRC Team
ReRegionalUpdatesgional Updates
Here's a quick look at some of what we are following:
  • New York's Excellus BlueCross BlueShield recently notified providers that, starting August 1, 2016, they will reimburse telemedicine services at 50% of the rate payable when these services are performed in-person. Although NY passed a telehealth parity bill last year (AB 2552), the language only addressed coverage parity and not payment parity. Read more about this distinction from the Center for Connected Health Policy. Would you like to join the conversation in New York? Register for the New York Telehealth Learning Collaborative monthly calls hosted by the New York Telehealth Partnership.
  • New Hampshire officially became the first state in the northeast to join the Interstate Medical Licensure Compact when Governor Hassan signed HB 1665. NH joins 15 other states who are already in the process of finalizing and implementing what is intended to be an expedited and more streamlined licensing process. Vermont and Rhode Island have also introduced similar legislation.
  • Vermont became one of the first states in the country to mandate Medicaid reimbursement for primary care services provided via telemedicine to beneficiaries located outside of a healthcare facility when they passed SB 139 last year. Green Mountain Care has since established an application process for providers wishing to develop these types of services for internal medicine, pediatrics, family medicine, or obstetrics and gynecology.
  • Rhode Island's House of Representatives passed HB 7160A (An Act Relating to Insurance - The Telemedicine Coverage Act) earlier this month. If this bill passes the Senate and is signed by the Governor, it would require private payers to cover telehealth services. However, similar to the New York law, this bill does not currently include language to require payment at the same rate as in-person services.
  • Massachusetts stakeholders continue to push for coverage and payment parity legislation. Join the conversation at the Massachusetts Hospital Association's The Promise of Telemedicine Conference on June 22.
  • Maine's Medicaid program, MaineCare, recently adopted a new telehealth rule. As we highlighted last month, significant changes include removing the prior approval process and adding telemonitoring services. Unfortunately, NETRC has heard from some organizations that language now preventing rural health clinics and federally qualified health centers from covering telehealth under their encounter rate may significantly discourage telehealth utilization at these sites.
Did we miss something? We would love to hear from you!
RecogChampionnizing a Telehealth Champion!
terry head shot

Each year, the American Telemedicine Association (ATA) elects members of distinction as new ATA Fellows.  Election to the College of Fellows is a high honor that highlights significant achievements in telemedicine, service to the general telemedicine community, and service to ATA. We are thrilled to announce that  NETRC's own, Dr. Terry Rabinowitz, MD, DDS, has received this recognition! 

Dr. Rabinowitz is a Professor of Psychiatry and Family Medicine at the University of Vermont College of Medicine, and has been Medical Director of the Psychiatry Consultation Service at University of Vermont Medical Center (formerly Fletcher Allen Health Care) since 1996. He designed the state's first Telepsychiatry consultation service in 2001. He was appointed Medical Director of telemedicine services at UVMMC in 2005, and has worked to develop and implement telehealth initiatives with the American Telemedicine Association and HRSA's Office for the Advancement of Telehealth. He is the founding and current Chair of the Telepsychiatry Special Interest Group of the Academy of Psychosomatic Medicine and serves as the  Principal Investigator for the NETRC.

We are very fortunate to have Dr. Rabinowitz on the NETRC team, and exceptionally proud of his accomplishmentPlease join us in congratulating him on this pivotal achievement!

Read more about Dr. Rabinowitz's work serving rural nursing homes in New York State from the Rural Health Information Hub and check out the recent article in Psychiatric Times and National Telehealth Webinar Presentation, both featuring Dr. Rabinowitz with Dr. Don Hilty, MD.

National TeleheWebinaralth Webinar
Presented by the National Consortium of Telehealth Resource Centers

Thursday, June 16, 2016

2:00 PM EDT

This webinar will feature a panel of Telehealth Resource Center experts from around the country discussing the top questions they received during the 2016 American Telemedicine Association Conference. Join us as we explore the hottest issues and your most burning questions!

Participants are also encouraged to submit questions when registering.

To register for this webinar:

Content compiled by Michael Edwards, NETRC Consultant
Telehealth Policy News

The National Law Review, May 12, 2016
The US Federal Trade Commission submitted public comments regarding provisions of a proposed state bill in Alaska. The FTC continues to focus on health care competition and general discouragement of anti-competitive conduct in health care markets, with a renewed interest and focus on telehealth.

mHealth Intelligence,  May 03, 2016
The Centers for Medicare & Medicaid Services recently granted approval for the Connecticut Medicaid program to reimburse for electronic provider-to-provider consults. The announcement comes after a year-long pilot in which primary care providers at clinics of Community Health Center, Inc., used an online platform to consult with cardiologists, dermatologists and other specialists, achieving turnarounds of 1-2 days compared to several months using conventional referrals.
HIPAA Journal News, April 29, 2016
The ban on independent practitioner use of text messaging with patients due to security risks has recently been lifted when assurances can be provided of use of: secure sign-on process; end-to-end message encryption; read and delivery receipts; date and time stamps for messages. Other requirements relate to tracking of authorized users and control of message retention time frames.
Fierce Health IT, April 27, 2016 
In a recent policy brief the American Hospital Association advocates that t he Centers for Medicare & Medicaid Services include telehealth in all value-based payment models and lift geographic restrictions on its use. In support of excessive caution in the restrictions included in the initial authorization of Medicare reimbursement, the brief cites the underestimates by the Congressional Budget Office in utilization and payouts for the five years after 2001.
MobiHealth News, April 26, 2016
In the recent update to managed care rules, the Center for Medicare and Medicaid Services seeks to modernize how states purchase managed care for beneficiaries, advances patient-centered aspects, and strengthens consumer protections. Within the massive document are provisions that encourage states to employ telehealth solutions to assure "network adequacy" for access to services by Medicaid beneficiaries.
Federal Telemedicine News, April 17, 2016
A new study by researchers at Georgetown University, based on interviews with officials in six states, reveals how little private and public insurance programs are attending to telehealth solutions to meet standards for provider network adequacy. Key barriers include lack of support in state insurance regulations and opposition from clinicians who see telehealth as a threat for patient loss to distant providers..
MobiHealth News, April 14, 2016
This overview for the first quarter of 2016 highlights the most significant payer-related news on digital health in the areas of: public payers; private payers; Blue Cross programs; employer programs, and survey studies on trends.
mHealth Intelligence,  April 08, 2016
The American Hospital Association has launched an online resource on local, state and national telehealth programs. This move reflects the organization's efforts to garner support for policies, platforms and reimbursement for telehealth as vital to the nation's healthcare system.

News on the Practice of Telemedicine

The State University of New York received a $7 million grant to test the effectiveness of telemedicine in treating certain patients with hepatitis C. A five-year project will be conducted at 12 methadone clinics throughout the state to compare treatment in-person vs. video.

mobihealthnews, May 16, 2016
Researchers submitted 62 simulated dermatologic patient cases to 16 direct to consumer telemedicine websites that offered services to California residents. Just 26 percent of the services disclosed information to patients about clinician licensure. Some of these services even used a physician based outside the US who didn't have a California license. Some 23 percent of the services collected the name of the user's primary care physician and even fewer, 10 percent, offered to send records to the user's primary care physician.

PR Newswire, May 04, 2016
A new program launched by neurologists at University of Rochester Medical Center will expand access to care and serve as a national model for the management of Parkinson's disease and other chronic illnesses using remote telehealth assessment and monitoring technologies. The director, Dr. Kevin Biglan, expects the program of free virtual house calls will break down the barriers of geography and deliver care directly to patients in their homes, many of whom have never seen a specialist.
Business Wire, April 26, 2016
HomeHealth Visiting Nurses of Southern Maine determined that the 30-day rate for hospital readmissions for  chronic disease patients cared for using a remote monitoring system, the HRS Patient Connect Platform was marked low for 2015: 4.2% compared to a statewide average estimate of 16.6%. High rates of compliance were observed for patient use of the integrated wireless system for recording and reviewing vital signs, self-management education, and problem-solving video calls with nurses.
WXXI News (Rochester, NY), April 21, 2016
Dr. Kenneth McConnochie, a pediatrician with University of Rochester Medicine, presented on his innovative school-based telemedicine program at a U.S. Senate briefing, providing research evidence that delivery of onsite care by remote doctors saves both time and money. The Health-e-Access Connected Care model he developed, when implemented for inner-city child care centers was associated with a 64% drop in absences and 22% fewer visits to an emergency department.
Fierce Health IT, April 5, 2016
In a recent study published in JAMA Internal Medicine, researchers from the University of California, San Francisco, assessed the quality of telehealth care delivered by eight commercial online healthcare companies for simulated patient presentations of six common acute illnesses. They concluded that one in four patients got an incorrect or no diagnosis from the virtual visits, and that adequacy of patient histories and exams ranged from 50 to 80%.
The cHealth Blog, March 28, 2016
In this blog post by telehealth leader Dr. Joe Kvedar, he discusses possible reasons for lack of significant outcome benefits in two recent published studies, one on benefits of personal health tracking devices on self-management of chronic disease patients and the other on the ability of remote monitoring in heart failure patients to reduce rehospitalization rates. He suggests that factors such as levels of health coaching and engagement of patients in adherence to the intervention can be critical to achieving good outcomes with telehealth.

Telemedicine Technology News

Fierce Mobile Healthcare, May 9, 2016
Researchers at the University of Washington recently reported that their smartphone-based system called SpiroCall was rated well on ease of use and produced assessment data of lung function approaching the accuracy of professional medical spirometers. Patients call a 1-800 number, then exhale into a breath recording device linked to a mobile phone, thus allowing physicians to monitor status of chronic lung diseases from asthma to cystic fibrosis
MobiHealth News, May 03, 2016
Hacking Medicine Institute, a nonprofit organization spun out of Massachusetts Institute of Technology last year, recently launched its health app review platform, called Ranked Health. The initiative, led by expert medical specialists in the Boston area aims to provide patients and clinicians guidance for decisions on their choices for selecting healthcare-focused mobile apps.
Time, April 28, 2016
iPhone maker Apple hopes to jumpstart development of effective health care and self-management apps for its smartphone with its new programming toolkit CareKit. It includes modules that helps users track how often they take medication or complete physical therapy routines, a tool for tracking symptomssuch as fevers and other ailments, a dashboard for comparing symptoms against recorded health metrics, and a function for sharing that information with doctors, caregivers, or family members.  

Wainhouse Research Blog,  April 15, 2016
Recently plans have been enacted for a leading vendor of videoconferencing and telemedicine systems, Polycom, to be acquired by Mitel, a unified communications and telephony service and product vendor. Polycom will retain its brand and operate as an independent division within Mitel, and in the journalist's view both will benefit from the merger.
MobiHealth News, April 14, 2016
This overview highlights significant news so far in 2016, including innovative activities at Apple and at Harvard and Stanford Universities, government moves in health IT, use of Fitbit and related devices to harness patient-generated health data, and digital health solutions to foster more patient engagement.  

MobiHealth News, March 16, 2016
A search of the U.S. clinical trials database yielded a substantial number of research trials in progress that employ the Fitbit device for health care. Among the trials profiled are ones that address chronic
health conditions of diabetes, cancer, cystic fibrosis, and arthritis.

Health Information Technology News

EHR Intelligence, May10, 2016
More than a year after the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) the Department of Health & Human Services has recently issued its notice of proposed rulemaking for MACRA implementation. This article clearly summarizes the complex provisions and proposed timeline for phasing in the Merit-based Incentive Payment System, Alternative Payment Models, and the role of documented clinical practice improvement activities (which can include telehealth).
Healthcare IT News, April 28, 2016
St. Joseph Hospital in Bangor, Maine, has been making use of data and analytics on the state's health information exchange, Health InfoNet, to help reduce readmissions. The system allows providers to access real-time data from all hospitals connected to the HIE and carry out proactive outreach and interventions before conditions warrant an ER visit, results included in a 2015 publication in the Journal of Medical Internet Research.
Fierce EMR, April 27, 2016
The editor of this news source praises the recent rules from Centers for Medicare & Medicaid Services in setting the agenda for Medicare and Medicaid managed care but criticizes its inadequacies for modernizing Meaningful Use and health information exchange (HIE). She predicts the consequence will be inconsistencies from state to state regarding EHRs and HIEs, poor interoperability, and, by extension, problems with coordination of care, population health management, and rising costs of treatment.
Fierce EMR, April 13, 2016
In an editorial, the author highlights some of the findings of a recent study on health information exchanges (HIEs), which reveals how providers and prayers are shifting away from public HIEs to commercial and private ones.  There were 277 sustainable private HIEs in 2015 compared to 152 in 2014, whereas 83% of the nation's 165 public HIEs are failing.

Recent Telehealth Resources

Ahn S, Corlette S, Lucia K.  Can telemedicine help address concerns with network adequacy? opportunities and challenges in six states.  Urban Institute, April 6, 2016 Link

American Hospital Association. Telehealth: Helping hospitals deliver cost-effective care.  AHA Issue Brief, April 2016 Link

Beste LA, Mattox EA, Pichler R, Young BA, et al.  Primary care team members report greater individual benefits from long- versus short-term specialty telemedicine mentorship.  Telemed. eHealth [epub before print], March 2016

de la Vega R, MirĂ³ J.  mHealth: a strategic field without a solid scientific soul. a systematic review of pain-related apps.  PLoS One 9(7):e101312, 2014 Link

Debes KL. Telehealth risk management and insurance considerations.  Alliant Insurance Services, 2016 Link

Dorsey ER, Achey MA, Beck CA, et al.  National randomized controlled trial of virtual house calls for people with Parkinson's disease: interest and barriers.  Telemed. eHealth [epub ahead of print], Feb. 2016 Link

Gregersen TL, Green A, Frausing E, et al.  Do telemedical interventions improve quality of life in patients with COPD? A systematic review.  Int. J. Chron. Obstruct. Pulmon. Dis. 11:809-822, 2016 Link

Haverhals LM, Sayre G, Helfrich CD, Battaglia C, Aron D, Stevenson LD, Kirsh S, Ho M, Lowery J.  E-consult implementation: lessons learned using consolidated framework for implementation research. Amer. J. Managed Care 21(12):e640-647, 2015 Link

McKoy J, Fitzner K, Margetts M, et al.  Are telehealth technologies for hypertension care and self-management effective or simply risky and costly?  Popul. Health Manag. 18(3):192-202, 2015 Link

Nocella JM, Dickson VV, Cleland CM, Melkus GD.  Structure, process, and outcomes of care in a telemonitoring program for patients with type 2 diabetes.  Patient Related Outcome Meas. 7:19-28, 2016 Link

Paul DL, McDaniel RR Jr.  Facilitating telemedicine project sustainability in medically underserved areas: a healthcare provider participant perspective.  BMC Health Serv. Res. 16(1):148, 2016  Link

Peng W, Yuan S, Holtz BE.  Exploring the challenges and opportunities of health mobile apps for individuals with type 2 diabetes living in rural communities.  Telemed. eHealth 22(9):1-6, 2016 Link

Pludwinski S, Ahmad F, Wayne N, Ritvo P.  Participant experiences in a smartphone-based healt h coaching intervention for type 2 diabetes: A qualitative inquiry.  J. Telemed. Telecare 22(3):172-178, 2016 Link

Rabinowitz T, Hilty D.  Telepsychiatry for vulnerable and underserved populations.  Psychiatric Times, April, 2016 Link

Salisbury C, O'Cathain A, Edwards L, et al.  Effectiveness of an integrated telehealth service for patients with depression: a pragmatic randomised controlled trial of a complex intervention. Lancet Psychiatry. [epub ahead of print] Aprtil, 2016 Link

van Houwelingen CT, Moerman AH, Ettema RG, Kort HS, Ten Cate O.  Competencies required for nursing telehealth activities: A Delphi-study.  Nurse Educ Today 39:50-62, 2016 Link

Weinstein IM, Litman S.  Evaluation of the Logitech GROUP solution.  Wainhouse Research, April 2016 Link