November 2015 

It has already been a busy November for NETRC! We were excited to present and exhibit at the American Public Health Association's (APHA) Annual Meeting, where there were many opportunities to increase awareness of telehealth and the potential benefits for public health. Although the Consortium of Telehealth Resource Centers were the only telehealth specific exhibitors, we found there were many more sessions that included telehealth components (out of the 1,000+ available) this year as compared to last year.

Following APHA, we presented and exhibited at the New England Rural Health Conference. Many attendees were hungry to learn more about outcomes and lessons learned from model telehealth programs in our region. Among the many conference highlights was a keynote speech from Alan Morgan, Chief Executive Officer of the National Rural Health Association. Mr. Morgan referenced telehealth as an integral component in the shift towards value-based care and underscored the importance of supporting policies that advance telehealth (including pending legislation to expand Medicare reimbursement). We also heard from our friends at the Massachusetts Department of Public Health about how they are using telehealth to replicate and expand the impact of their evidence-based Sexual Assault Nurse Examiner (SANE) program to partners across the nation!

Last week, we were fortunate to attend the Center for Telehealth and e-Health Law's (CTeL) Executive Telehealth Summit. Among the topics discussed were:
  • Updates on evidence-based telemedicine (including a new secret shopper study on direct-to-consumer telemedicine soon-to-be published)
  • Updates on reimbursement (including Oregon's new parity law that allows payers to reimburse for telehealth services at lower rates than in-person services in hopes to achieve cost savings)
  • Comments from the much-talked-about Texas Medical Board and their current telemedicine policy (including that their policy allows for a "face-to-face" telemedicine visit without an in-person visit prior to prescribing medication, but also requires a telepresenter in most cases)
  • A presentation from the National Council of State Boards of Nursing (including their strong support of telehealth, but concerns in maintaining the appropriate standard of care/scope of practice)
  • A discussion on malpractice and the need for clear protocols, guidelines, and documentation (including the need to talk with your insurer about any new telehealth services and that although no one has identified malpractice litigation related to telehealth in court to date, it is likely to change quickly) 
In policy news, we are excited to share that MaineCare (Maine's Medicaid program) has proposed an updated reimbursement rule for telehealth to address several barriers to utilization. Proposed changes include removing the pre-approval requirement and the addition of an "originating site fee." A public hearing on the proposed rule will be held on December 7. 

Please see below for a variety of available funding opportunities, a few webinars, and our monthly collection of news articles and published resources.

Happy Thanksgiving to you and your family!


The NETRC Team

Funding Opportunities

This funding opportunity hopes to:  (1) identify promising innovations to improve health being implemented in low-resource communities; (2) evaluate whether the innovations improve health care quality and health without increasing costs; and (3) disseminate these innovations as examples for other communities to implement.
Proposal Deadline: December 10, 2015
Sponsor: Robert Wood Johnson Foundation

Helps small rural hospitals of 49 beds or less, do any or all of the following: 1) enable the purchase of equipment and/or training to help hospitals attain value-based purchasing provision in the Patient Protection and Affordable Care Act (ACA); 2) aid small rural hospitals in joining or becoming accountable care organizations, or create shared savings programs per the ACA; and 3) enable small rural hospitals to purchase health information technology, equipment, and/or training to comply with meaningful use, ICD-10 standards, and payment bundling.
Application Deadline: December 15, 2015
Sponsor: Health Resources and Services Administration

Provides up to $5,000 to support the development and deployment of innovative broadband-enabled solutions to support, among other things, rural health care. The successful applicant(s) will demonstrate how the broadband-enabled technology will generate improvements to community strength and growth consistent with the goals of this program.
Application Deadline: December 31, 2015
Sponsor: National Telecommunications Cooperative Association - Rural Broadband Association

Intended to support telemedicine adoption for long term and post-acute providers through creative, innovative, and scalable services as essential tools in the shift towards pay-for-quality.
Letter of Intent Deadline: December 31, 2015
Sponsor: LG CNS

Funds the use of technology, including web-based services, smart phones, and behavioral health electronic applications (e-apps) to expand and/or enhance the ability of providers to effectively communicate with persons in treatment and to track and manage their health to ensure treatment and services are available where and when needed.
Application Deadline: January 4, 2016
Sponsor: Substance Abuse & Mental Health Services Administration

The Network Planning program promotes the planning and development of healthcare networks in order to: (i) achieve efficiencies; (ii) expand access to, coordinate, and improve the quality of essential health care services; and (iii) strengthen the rural health care system as a whole. Telehealth may be used to meet these goals.
Application Deadline: January 8, 2016
Sponsor: Health Resources and Services Administration

Develops  and validates a research infrastructure that has the capacity to integrate data across different projects, incorporates existing technologies, and can accommodate future technologies, designed to assess and intervene across a variety of observational and clinical research studies and settings, and for a range of measures, diseases and populations
Application Deadline: January 12, 2016
Sponsor: National Institutes of Health
Provides a 65 percent discount on eligible expenses related to broadband connectivity to both individual rural health care providers (HCPs) and consortia, which can include non-rural HCPs.
Applications accepted on an ongoing basis
Sponsor: Universal Service Administrative Company

National Telehealth Webinar Series
Presenters: Southwest Telehealth Resource Center with Kimberly Shae, PhD, RN, University of Arizona, College of Nursing
TOMORROW, Thursday, November 19, 2015, 2:00 - 3:00 PM EST

Health Resources and Services Administration
Wednesday, December 2, 2015, 2:00 - 3:00 PM EST

Maine Public Health Association
Presenters: Danielle Louder and Andrew Solomon, MPH, Northeast Telehealth Resource Center
Monday, December 14, 2015, 10:00 - 11:00 AM EST

Content compiled by Michael Edwards, NETRC Consultant
Telehealth Policy News

Foley & Lardner LLP News, November 16, 2015
Five trends that will drive telemedicine's continued growth and transformation of health care delivery in 2016: 1.) Expanding Reimbursement and Payment Opportunities; 2.)  Uptick in International Arrangements; 3.) Continued Momentum at the State Level; 4.) Retail Clinics and Employer Onsite Health Centers on the Rise; and 5.) More ACOs Using Technology to Improve Care and Cut Costs. 

Modern Healthcare, November 16, 2015
The American Medical Association House of Delegates decided Monday that proposed recommendations for  ethical practices  in telemedicine did not clearly address medical liability concerns and sent them back to the authors for more work.

ATA News, November 4, 2015
On October 30, the Obama administration issued its final rule for the 2016 Medicare Physician Fee Schedule, including several IT provisions that will positively impact the telehealth industry. Six new procedure codes for telehealth use include ones for end-stage renal disease related services and for prolonged service in the inpatient or observational setting.
National Law Review, October 26, 2015
A legal expert in telemedicine provides an overview of  recent policy changes in New Hampshire and renders practical advice in how best to take advantage of the changes to improve patient access to services.
Health Care Law Today, October 19, 2015
New York's recent statute mandating private insurance coverage for telemedicine services as of Jan. 1, 2016 has been revised by an amendment signed by the Governor. A legal telemedicine expert summarizes these changes, such as remote monitoring provisions, and provides advice to health care organizations pursuing telemedicine solutions.
mHealth News, October 6, 2015
The Office of Civil Rights recently launched a website designed to help app makers maneuver through the HIPAA landscape. The sties invites app developers to ask questions about HIPAA health information privacy, security and breach notification rules.
News on the Practice of Telemedicine

URAC News, November 11, 2015
URAC, the independent leader in health care accreditation, is now offering an accreditation program to recognize the quality of telehealth providers. URAC's telehealth accreditation is said to focus on critical service quality aspects of health care such as safety, risk management, and performance improvement that will positively impact delivery of care by telehealth providers.

L.A. Times, November 7, 2015
A company called Mavern bills itself as a "digital clinic for women" based on its provision of access to video chat through its smartphone app with providers that include pediatricians, gynecologists, doulas, lactation consultants, and nutritionists around the country.  Another app called DermCheck allows users to take and send photos of their skin condition and get an opinion from a dermatologist for a flat fee.

Examiner, November 4, 2015
MGH provides an iPad to parents who cannot be present at rounds in the Pediatric Intensive Care Unit (PICU). They receive an e-mail with the URL and password to connect to a telemedicine station in the PICU. That station is mobile and can be moved from patient to patient.
Journal of Emergency Management Services , November 2, 2015
The Houston Fide Department EMS has been implementing an mHealth triage strategy to reduce unnecessary ER transports. The project called ETHAN (Emergency Telehealth and Navigation) involves use of 4G-enabled tablet to link low-acuity patients with an emergency physician via videoconferencing software who completes an assessment and referral linkages.
The National Law Review, November 2, 2015
This overview cites data on underuse of telehealth strategies for Accountable Care Organizations to achieve cost effective health care delivery of Medicare covered services. ACOs can share costs of telehealth and remote patient monitoring services among their hospitals, providers/suppliers, and other ACO participants, according to federal regulations under the recently revised Medicare Shared Savings Program fraud and abuse waivers.
Fierce Mobile Healthcare, November 1, 2015
A growing number of Delaware healthcare providers are using an iPad video solution to help determine whether pediatric respiratory patients require transport to another hospital for treatment or instead can be treated in the local emergency room.
Federal Telemedicine News, October 21, 2015
A CMS-funded study by the University of Southern California School of Pharmacy and the large Federally Qualified Health Center AltaMed Health nears completion in their goal to enable pharmacy teams to provide medication management services to at-risk underserved patients via video consultations. Preliminary findings suggest improved adherence with complex drug regimens and reduced hospital utilization.
Fierce Health IT, October 9, 2015
NATO is moving forward with a plan for creating a system across nations that can increase health access as well as survival rates during emergencies. In June leaders visited Avera Health's emergency telemedicine facilities in South Dakota, and in September NATO successfully completed a field exercise in Ukraine.
Healthcare IT News, October 6, 2015
Various leaders in healthcare have pointed out the neglect of integrated behavioral health by the large majority of Accountable Care Organizations. Models and standards mainly from Europe support the argument that telehealth strategies hold great promise for the integration of mental and physical health in ways that can help achieve the ACO triple aim of cost effective care.
Telemedicine Technology News
A program in Jacksonville, Florida, highlights a trend for health insurance plans of large employers to bring acute healthcare to the workplace through telemedicine. The Crowley Maritime Corp. recently worked with UnitedHealthcare to place an onsite telemedicine kiosk system which allows adult employees and their children to access providers at Nicklaus Children's Hospital by means of videoconferencing and digital medical devices for exams.
Wainhouse Research Blog, October 14, 2015
Six trends and developments in adaptation of videoconferencing technology to organizations are highlighted.  The capabilities of desktop and mobile devices are being expanded as expensive legacy room-based systems are in decline.
Health Information Technology News

EHR Intelligence, November 03, 2015
The American Medical Association and 111 medical societies have written Congress to address shortcomings in the Stage 3 Meaningful Use final rule. The request deferral and refocusing of the targets of the final stage of the EHR Incentive Programs.
iHealthBeat, October 23, 2015
A recent report on data from a 2014 American Hospital Association survey highlights the percentage of hospitals in each state that report the ability to exchange summary-of-care records and lab results with outside hospitals and other providers. While an average of only 64% of hospitals nationwide could exchange electronic  summary-of-care records with any provider, New Hampshire, North Dakota, and Virginia had the highest rates (85-88%).
FierceHealthIT, October 20, 2015
A recent study finds that a majority of health information exchanges do not use metrics for assessing ROI and do provide reports on quality measures, thus raising concerns about their sustainability in the face of the ending of HITECH funding.
FierceHealthIT, October 9, 2015
A recent report by the American Hospital Association points to gaps in the ability of hospitals to exchange and make use of electronic health information with other health care organizations and barriers to integration of information from separate software systems such as lab, pharmacy and imaging. A recent update to federal EHR certification criteria and an interoperability roadmap produced by Office of the National Coordinator for Health IT represent some progress to the challenges faced by hospitals.
Recent Telehealth Resources

Arora S, Venkataraman V, Zhan A, Donohue S, Biglan KM, Dorsey ER, Little MA.  Detecting and monitoring the symptoms of Parkinson's disease using smartphones: A pilot study.  Parkinsonism Related Disorders  21(6):650-653, 2015 Link
Bashshur RL, Shannon GW, Smith BR, Woodward MA.  The empirical evidence for the telemedicine intervention in diabetes management.  Telemed. eHealth 21(5):321-354, 2015 Link
Brunton L, Bower P, Sanders C.  The contradictions of telehealth user experience in chronic obstructive pulmonary disease (COPD): a qualitative meta-synthesis.  PLoS One 10(10):e0139561, 2015 Link
eVisit Telehealth Solution, Inc. How to get reimbursed for telehealth. eVisit, 2015  Link
Hunter TB, Weinstein RS, Krupinski EA.  State medical licensure for telemedicine and teleradiology.  Telemed. eHealth 21(4):315-318, 2015 Link
Jalil S, Myers T, Atkinson I.  A meta-synthesis of behavioral outcomes from telemedicine clinical trials for type 2 diabetes and the Clinical User-Experience Evaluation (CUE).  J. Med. Syst. 39(3):28, 2015 Link
Jhaveri D, Larkins S, Kelly J, Sabesan S.  Remote chemotherapy supervision model for rural cancer care: perspectives of health professionals. Eur. J. Cancer Care  [Epub ahead of print] Apr 14, 2015 Link
McConnochie KM, Ronis SD, Wood NE, Ng PK.  Effectiveness and safety of acute care telemedicine for children with regular and special healthcare needs.  Telemed. eHealth 21(8):611-621, 2015 Link
Mobasheri MH, Johnston M, Syed UM, King D, Darzi A.  The uses of smartphones and tablet devices in surgery: A systematic review of the literature. Surgery 158(5):1352-1371, 2015 Link
Singh J, Badr MS, Diebert W, Epstein L, Hwang D, Karres V, Khosla S, Mims KN, Shamim-Uzzaman A, Kirsch D, Heald JL, McCann K.  American Academy of Sleep Medicine (AASM) Position paper for the use of telemedicine for the diagnosis and treatment of sleep disorders.  J. Clin. Sleep Med. 11(10):1187-1198, 2015 Link
Switzer JA, Singh R, Mathiassen L, Waller JL, Adams RJ, Hess DC.  Telestroke: variations in intravenous thrombolysis by spoke hospitals.  J. Stroke Cerebrovasc. Dis. 24(4):739-744, 2015 Link
Wayne N, Perez DF, Kaplan DM, Ritvo P.  Health coaching reduces HbA1c in type 2 diabetic patients from a lower-socioeconomic status community: a randomized controlled trial.  J. Med. Internet Res. 17(10):e224, 2015  Link
Whited JD.  Summary of the status of teledermatology research.  Teledermatology Special Interest Group, American Telemedicine Association, 2015  Link
Yang NH, Dharmar M, Yoo BK, Leigh JP, Kuppermann N, Romano PS, Nesbitt TS, Marcin JP.  Economic evaluation of pediatric telemedicine consultations to rural emergency departments.  Med. Decis. Making,  [epub ahead of print], May 2015 Link