Conversations about telehealth are happening all over the region. NETRC was thrilled to participate in several events in June, including presenting on telehealth and the resources we offer at the National Organization of State Offices of Rural Health Regional Meeting in Portsmouth, NH, and the Massachusetts Hospital Assiocation's The Promise of Telemedicine Conference in Burlington, MA. 

A few of the conferences we are attending this fall include:
Stay tuned for an official Save the Date for the next NETRC Regional Telehealth Conference. We are currently exploring options for late spring, 2017.

Have a happy and safe 4th!


The NETRC Team
Telehealth Regulation: Medical Boards

Do you know your state medical board rules on telehealth?

State telehealth regulations are continually evolving to address the standards of practice for what many still consider a "new" type of care (see New York's proposed updates to their Telepsychiatry Regulations). 

Similar to reimbursement laws, every state is addressing their regulations a bit differently. Of particular note, medical boards continue to consider best practices for telehealth and/or telemedicine in their state (the Federation of State Medical Boards released a  Model Policy in 2014). Some of these rules may limit certain practices and have even resulted in a lawsuit (see Texas). 

The Maine Board of Licensure in Medicine and the Board of Osteopathic Licensure recently released a proposed joint rule governing the use of telemedicineThe proposed rule defines terms and sets forth practice guidelines, including provisions regarding establishing a physician-patient relationship in the telemedicine setting, technology requirements for physicians using electronic communications, and maintaining privacy and security. Public comments will be accepted on the rule until Friday, July 15.

Several other states in the northeast have similar guidelines readily available online, including Rhode Island and Vermont , while New York   provides Statements on Telemedicine that were developed in 2000. Some states include comments on internet prescribing or other practices in their regulations, but have not developed these more comprehensive guideline documents.

In addition to medical board rules,  telehealth standards and practice guidelines may be part of state law,  such as those in  Connecticut  and New Hampshire.

Of course, we can't mention practice standards and guidelines without highlighting the recent  news about the American Medical Association's new ethical guidelines for telemedicine. 

Career Opportunities

Now hiring: Telehealth Network Director

Location: CHNCT Holding, Inc., Wallingford, CT

Responsibilities of this role include: 
  • The Director will report to the Holdings Board, which represents seven Federally Qualified Health Centers (FQHCs), serving patients and families throughout Connecticut.
  • The Director is responsible for proactively leading the growth of telehealth programs and services, and for facilitating collaborations across the network of clinical sites. 
  • This role directs all clinical, technical, business and regulatory activities around the telehealth program, as well as developing and implementing operational and business plans for telehealth program expansion. 
  • This position will serve as the liaison between participating medical staff, Information Services and operational personnel among FQHC sites. 
  • The Director develops, manages and implements program plans, as well as identifying and tracking performance metrics to inform program sustainability and growth.
  • Bachelor's degree in a Clinical area, Engineering, Business or Information Systems from an accredited college or university required, with a minimum of five (5) years' experience in healthcare operations or relevant support services.
  • Annual Salary Range: $120,000 - $140,000 
Interested candidates may apply by forwarding resumes and cover letters to their website at Click on the Careers tab, then click the CHNCT Career Center tab. This will bring you the Candidate Self Service website. Follow the on-line instructions on how to register and apply or fax to 203.949.6007.

Now hiring: Telehealth Program Manager

Location: University of Vermont Medical Center, Burlington, VT

Responsibilities of this role include: 
  • Provide leadership for program and business operations for telehealth programs and/or services. 
  • Manage all clinical, technical, business and regulatory activities around the Telehealth program. 
  • Work with the Medical Director of Telehealth, medical staff, and operational leaders to develop and implement new areas of clinical utilization for Telehealth activities and participate in the development of business plans for new Telehealth opportunities. 
  • Serve as the liaison between participating medical staff, Information Technology Services, Enterprise Applications and other necessary departments to support success of telehealth programs.
  • Responsible for developing and managing project plans, identifying key deliverables and resource requirements, and develop project implementation plans.
  • Master's degree in business administration, finance, nursing, health administration, or a related field required. Minimum of five years' experience in healthcare, healthcare operations, or information technology, to include familiarity with health information technology and related regulatory requirements required. Minimum of two years direct supervisory experience required. 4-5 years related experience in Telehealth Project management experience preferred. Experience with process improvement preferred. Clinical management or supervisory experience preferred.
  • Salary Range: $37.30 per hour - $55.96 per hour

Do you have a telehealth job opening? Email and we'll add it to our next newsletter!

Content compiled by Michael Edwards, NETRC Consultant
Telehealth Policy News

Boston Business Journal, June 28, 2016
Starting July 1, the state's second largest commercial insurer will cover telehealth, offering the video chat service through California-based Doctor On Demand and from doctors in the  Harvard Pilgrim network that offer telehealth. Blue Cross Blue Shield began offering a similar service on January 1.

Federal Telemedicine News, June 26, 2016
Legislation called the "Rural Health Care Connectivity Act of 2016" was recently signed into law. The Act aids rural skilled nursing facilities by giving them access to funding within the Universal Service Fund. Access to the funding will help enable skilled nursing facilities to use telemedicine by upgrading broadband access in rural areas.

Fierce Healthcare, June 14, 2016
Recent policy changes by the Centers for Medicare and Medicaid Services are favorable for telehealth service expansion, including Medicaid managed care regulations that recommend telehealth as a possible solution to assure network adequacy standards for clinical access to care and inclusion of telehealth adoption in strategies for high scores under the proposed Merit-Based Incentive Payment System. Telehealth coverage under private insurance plans is growing as a result of a doubling of states with parity laws in the past three years.
CCHP News, June 14, 2016
The bill SB 7953 was recently introduced in the New York legislature to add the requirement for payment parity to supplement the states telehealth parity law, which was passed in 2015. CCHP notes that without such provisions in law the insurance provider Excellus is within its rights to offer lower payment rates for telehealth vs. in-person treatment services. Unfortunately, the current legislative session in New York has ended without this bill advancing, but we anticipate a similar bill will be introduced during the next session.
mHealth Intelligence, June 14, 2016
The American Medical Association recently approved at its annual meeting in June a set of practice standards for physicians using telehealth that calls for exercise of discretion and adequate safeguards of informed consent, particularly when used for conducting a diagnostic evaluation or prescribing therapy. The AMA's CEO later criticized how many vendors of inadequately researched products are the  equivalent of "snake oil salesmen" in today's healthcare landscape.
This is a broad summary of telemedicine reimbursement issues, policies, and initiatives which is supplemented with examples of recent telehealth service expansion by the Cleveland Clinic, Brigham and Women's Hospital, Veterans Health Administration, and Independence Blue Cross. Whether state parity coverage laws relating to telehealth should call for payment equal to in-person visits is under debate, with the CEO of Anthem's LiveHealth Online opposing the trend.
ATA News, May 26, 2016
This story reviews to range of telehealth-related legislation that have been passed this year and await signature by state governors, including bills in Connecticut, Massachusetts, and New York in the northeast. Other significant bills were passed in Missouri, Arkasas, Arizona, Louisiana, and Hawaii.
Federal Telemedicine News, May 25, 2016
The Rhode Island House of Representatives has passed legislation to create the Telemedicine Coverage Act, which would require health insurance policies to include provisions for the reimbursement of telemedicine services the same as if the services are provided through in-person consultations or contact.  The bill now heads to the Senate.
Healthcare Dive May 12, 2016
Researchers from Harvard Medical School, RAND Corporation, and McLean Hospital analyzed trends in telemedicine use in Medicare from 2004 to 2013 using claims from a random sample of Medicare beneficiaries in a study published in JAMA.  Utilization rates rose substantially over this period, yet only 0.7% of rural beneficiaries received Medicare coverage for a telemedicine visit in 2013. 
mHealth Intelligence, May 9, 2016
In response to care access deficiencies highlighted by the CMS and GAO, the federal Indian Health Service proposes to build a connected care platform in the Great Plains states tor the nearly  130,000 Native Americans residing there.  Recently, IHS has put out the call for telehealth proposals to serve a seven-hospital region covering Iowa, Nebraska, and the Dakotas. 

News on the Practice of Telemedicine

Forbes, June 30, 2016
Telemedicine companies that have been landing a flurry of new contracts with employers and insurers to provide less expensive and more convenient medical consultations with physicians are now adding mental health services for their customers.

The Wall Street Journal, June 26, 2016
The authors note that, after years of big promises, telemedicine is finally living up to its potential. Driven by faster internet connections, ubiquitous smartphones and changing insurance standards, more health providers are turning to electronic communications to do their jobs-and it's upending the delivery of health care.

Watertown Daily Times, June 23, 2016
Through a partnership with Upstate University Hospital in Syracuse, Samaritan Medical Center, Carthage Area Hospital, River Hospital in Alexandria Bay and Ogdensburg's Claxton-Hepburn Medical Center have all begun using telemedicine to rapidly treat stroke sufferers that arrive in their emergency departments.

Fierce Healthcare, June 16, 2016
In a recent announcement, the American Medical Association urges that telemedicine training become a standard part of medical school curricula, at both the undergraduate and graduate levels. The past AMA president Robert Wah argues instruction in telemedicine's capabilities and limitations at all levels of physician education will be essential to harnessing its potential.
Medical Economics, June 15, 2016
A recent survey by HealthMine finds that nearly 40% of consumer respondents had not heard of telemedicine and only one-third reported that their health plan offers telehealth as an option. Examples are providers of healthcare organizations trying to change that by developing apps and other technology to enhance patient engagement through more convenient access to clinical providers between appointments.
mHealth Intelligence, June 14, 2016
Two recent publications in journals of the American Medical Association raised questions about the quality of acute medical care delivered by commercial direct-to-consumer health platforms. This editorial criticizes the studies for limitations in methodology and design flaws that affect the potential veracity, replicability and generalizability of the reported outcomes. 
Boston Globe, June 4, 2016
A recent study by researchers at Beth Israel Deaconess Medical Center concludes that telehealth visits between nursing home staff and geriatric care specialists can significantly reduce the frequency of use powerful antipsychotic medications to treat dementia patient behavior, treatment which is known to have dangerous side effects.   
mHealth Intelligence,  June 1, 2016
This story highlights the need for and growth of telepharmcy networks to extend the services of a pharmacist to rural hospitals and clinics.  The program of Dartmouth-Hitchcock Medical Center in New Hampshire is profiled, which uses telehealth to provide on-demand decision support to clinicians at six hospitals in New England by linkage to an expert pharmacist.
mHealth Intelligence, May 19, 2016
American Well announced at American Telemedicine Association conference in May that its new entrpise platform The Exchange will give health care systems an online storefront for their branded services and allow consumers the option to link to services regardless of where they're located. Early adopters include Anthem Blue Cross Blue Shield, the Cleveland Clinic, and Florida's Nemours Children's Hospital.
MedCity News, May 24, 2016
The South Dakota healthcare organization Avera Health recently presented a webinar and a white paper on their strategies and methods for adding acute direct-to-consumer virtual health care for patients its conventional multistate practice. Avera, a leader in telehealth implementation, chose to work with consumer telehealth vendor American Well on the solution which they estimate is saving them about $48 per visit in health care costs.
Federal Telemedicine News, May 22, 2016
At the American Telemedicine Association annual conference an administrator with the Veterans Health Administration announced that five VA Mental Health Telehealth Clinical Resource Centers are being established to provide enhanced mental health access and services to veterans in remote locations. The facility already operational in West Haven, CT will serve as a specialty care hub focused on the most severe and complex mental health issues, such as chronic depression and bipolar disorder.
mHealth Intelligence, May 19, 2016
A recent report by telehealth vendor Avizia and Modern Healthcare based on a survey of healthcare executives concludes that today's provider-facing telehealth platforms will soon be replaced by mHealth efforts targeting the consumer. About 30-40% of respondent organizations were implementing telehealth services for stroke, behavioral health, and/or staff education, but their plans focused on strategies for patient engagement, patient education, remote patient monitoring, and expanded primary care services, often by mHealth solutions.

Telemedicine Technology News

Mobihealth News June 13, 2016
The annual conference of the American Diabetes Association in June proved to be a showcase of promising new technology for patient self-management of diabetes and telehealth solutions for provider monitoring and decision-support.
mHealth Intelligence, June 6, 2016
This article provides highlights from Minnesota, Maine, and Alaska where lack of broadband access in rural communities is hindering expansion of telehealth services. A discussion forum held by Senator Angus King last summer addressed the lack of adequate broadband in 25% of Maine's geograpjhy, a situation being addressed nationally by initiatives of the Connect America Fund of the Federal Communications Commission.
mHealth Intelligence, May 26, 2016
This story focuses on recent efforts to integrate speech recognition capabilities into mobile health platforms in order to enhance provider completion of clinical documentation, real-time language translation, and the medication reconciliation process. Examples from researchers at Boston Children's Hosptial and George Washington University Medical Center are highlighted.  
Fierce Healthcare, May 24, 2016
In response to a study by researchers at California State Polytechnic University that concluded Fitbit wristband trackers are often inaccurate in heart rate monitoring, Fitbit executives have recently criticized the methodology of this study.  Meanwhile, a number of clinical studies that employ Fitbit for monitoring patient conditions are proceeding. 
Federal Telemedicine News. May.15, 2016
AMC Health has recently integrated its CareConsole Mobile telehealth solution for managing chronic disease with the Kubi tablet stand device from Revolve Robotics, which allows a remote provider to control the orientation of a tablet camera in videoconferenced care visits. 

Health Information Technology News

Virtual care within the EHR may be a 'game-changer'
eHealth Intelligence, June 9, 2016
The Medical University of South Carolina recently launched a virtual care solution that connects seamlessly with the health system's Epic EHR platform, thereby enhancing provider workflow with automated features with respect to integration of scheduling, billing, and medical record charting of telehealth sessions. Consumers seeking to connect with a clinician via video can use the EHR's patient portal, which features a real-time virtual visit platform from Vidyo.
Federal Telemedicine News. May 31, 2016
The General Accountability Office recently released the report "Information Technology: OMB and Agencies Need to Focus Continued Attention on Implementing Reform Law". The report concludes that much of the federal investment in health IT infrastructure in the past has either "failed, incurred cost overruns, schedule slippages, or contributed little to mission-related outcomes," and it proposes a series of initiatives to enhance the effectiveness of health IT development support in the future.

Recent Telehealth Resources

Buhrman M, Gordh T, Andersson G. Internet interventions for chronic pain including headache: A systematic review.   Internet Interventions 4(1): 17-34, 2016  Link

Canadian Agency for Drugs and Technologies in Health. Telehealth assessment of patients being retained for emergent mental health reasons: clinical-effectiveness and guidelines.  CADTH Rapid Response Reports, March 2016  Link

Chow N, Shearer D, Aydin Plaa J, et al.  Blood glucose self-monitoring and internet diabetes management on A1C outcomes in patients with type 2 diabetes.   BMJ Open Diabetes Res. Care 4(1):e000134, 2016  Link

Compare Business Products, Inc.  The Ultimate Videoconferencing Buyers Guide, June 2016  Link

Dubin RE, Flannery J, Taenzer, P, et al.  ECHO Ontario chronic pain & opioid stewardship: providing access and building capacity for primary care providers in underserviced, rural, and remote communities.  Chap. 2 in: Global Telehealth 2015: Integrating Technology and Information for Better Healthcare. IOS Press, 2015  Link

Fortney JC, Pyne JM, Kimbrell TA, Hudson TJ, Robinson DE, Schneider R, et al. Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial.  JAMA Psychiatry 72(1):58-67, 2015  Link

Kruse CS, Bouffard S, Dougherty M, Parro JS.  Telemedicine use in rural Native American communities in the era of the ACA: a systematic literature review.  J . Med. Syst.40(6):145, 2016  Link

Lindgren S, Wacker D, Suess A, et al.  Telehealth and autism: treating challenging behavior at lower cost.  Pediatrics 137(Suppl 2):S167-175, 2016  Link

Matthew-Maich N, Harris L, Ploeg J, et al. Designing, implementing, and evaluating mobile health technologies for managing chronic conditions in older adults: a scoping review  JMIR Mhealth Uhealth 4(2):e29, 2016  Link

Roth D, Zekovic-Roth S, Yasutake M, Richardson M.  Telehealth @ Home: A guidebook for people who will receive home-based telehealth services.  Mind & Body Works, Inc., 2016  Link

Salisbury C, O'Cathain A, Thomas C, et al.  Telehealth for patients at high risk of cardiovascular disease: pragmatic randomised controlled trial.  Brit. Med. J. 353:i2647, 2016  Link

Schneider R, Dorsey ER, Biglan K.  Telemedicine care for nursing home residents with Parkinsonism.   J. Amer. Geriatr. Soc. 64(1):218-220, 2016  Link

Tensen E, van der Heijden JP, Jaspers MW, Witkamp L.  Two decades of teledermatology: current status and integration in national healthcare systems.   Curr. Dermatol. Rep. 5:96-104, 2016  Link

Thilakanathan D, Calvo RA, Chen S, Nepal S, Glozier N.  Facilitating secure sharing of personal health data in the cloud.   JMIR Med. Inform. 4(2):e15, 2016  Link

Whitehead L, Seaton P.  The effectiveness of self-management mobile phone and tablet apps in long-term condition management: a systematic review.   J. Med. Internet Res. 18(5):e97, 2016  Link