11/26/2009
Northeast health insurer MVP Health Care will begin reimbursing its network of more than 22,000 physicians for Web-based consultations with patients covered through most of its benefit plans. The Schenectady, N.Y.-based payer covers more than 750,000 members in New York, Vermont and New Hampshire. The company is working with Mohawk Valley Medical Associates, an independent physician association in Schenectady, to identify 200 early adopter physicians in its service area. MPV Health Care also is seeking at least 50 additional early adopters in other markets.
The insurer will use the webVisit consultation software of the RelayHealth division of McKesson Corp., San Francisco. Further details, including the amount of reimbursement for online consultations, were not immediately disclosed.
(Source: Health Data Management, October 20, 2009)9/11/2009
by Michael Edwards, Maine Telemedicine Service News, Sept. 11, 2009
Both Maine and New Hampshire in the Summer of 2009 passed and obtained Governor signatures for laws which require insurance companies to pay for services delivered by telemedicine. Along with Oregon earlier this year, this brings the total to 12 for states with similar statutes (joining California, Colorado, Georgia, Hawaii, Kansas, Kentucky, Louisiana, Texas, and Oklahoma - see the
Telemedicine Information Exchange). In the case of Maine, the new law supplements Medicaid reimbursement for telemedicine services delivered by interactive video sessions, whereas in New Hampshire, Medicaid does not cover telemedicine except in selected pilot waiver programs.
For the benefit of other states who may ponder such a step, we cover here some details about the similarities and differences in the laws and discuss some of what we know about how these laws got through the state legislatures.
Process Leading to Maine Law
The Maine Legislature passed the bill LD 1073, "An Act to Provide for Insurance Coverage of Telemedicine Services" on May 12, and Governor Baldacci signed it into law on June 11th. The law, Chapter 169 MRSA 4316, contains the following provisions:
- Definition. For the purposes of this section, "telemedicine," as it pertains to the delivery of health care services, means the use of interactive audio, video or other electronic media for the purpose of diagnosis, consultation or treatment. "Telemedicine" does not include the use of audio-only telephone, facsimile machine or e-mail.
- Coverage of telemedicine services. A carrier offering a health plan in this State may not deny coverage on the basis that the coverage is provided through telemedicine if the health care service would be covered were it provided through in-person consultation between the covered person and a health care provider. Coverage for health care services provided through telemedicine must be determined in a manner consistent with coverage for health care services provided through in-person consultation. A carrier may offer a health plan containing a provision for a deductible, copayment or coinsurance requirement for a health care service provided through telemedicine as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to an in-person consultation.'
The Governor's office included this statement of support in a
press release after a signing ceremony:
"Telemedicine offers opportunities to increase the accessibility of health care, ensure that appropriate medical information is available, reduces medical errors and reduces health care costs," Governor Baldacci said. "This bill makes sense and I am pleased to sign it."
The sponsor of the bill was Rep. Anne Perry, a Family Nurse Practitioner in Washington County. Co-sponsors included Rep. Hannah Pingree, Linda Sanborn, Meredith Strang Burgess, and Sharon Anglin Treat. Surprisingly, the final bill passed in the House on May 7th with a 136 to zero roll-call support; the Senate passed the bill "in concurrence" on May 12th. During the committee review process, hearings, and sub-committee sessions, the bill received major support from the Maine Hospital Association and major hospital corporations with active telemedicine programs, including
Eastern Maine Healthcare and
Maine Health. Major health insurance providers opposed the bill. At the final hearing, a presentation by Tom Key, Director of
Maine Telemedicine Services and the Northeast Telehealth Resource Center, made three major points: 1) the law would promote the use of telemedicine, 2) substantial evidence supports the benefits of telemedicine on the efficiency and efficacy of health care delivery, and 3) the improvements in timeliness and rural access for services acts to enhance the quality of health care.
The strategic role played by Rep. Perry in devising and shepherding the bill through and the Governor's readiness to sign it into law was founded on extensive prior planning efforts. As a member of the Board for the Regional Medical Center at Lubec, Perry was well attuned over the years to the promise of telemedicine in Maine and advised by the health center's Maine Telemedicine Services and project staff of its Northeast Telehealth Resource Center. She was "kept in the loop" during the 2007 review proceedings of the Governor's Telehealth Workgroup, and she participated in the development of a plan for rural health that included strategies to advance telemedicine solutions.
Both planning efforts recognized reimbursement as a major barrier for widespread development of telehealth services in Maine. Whereas the Telehealth Workgroup proposed group efforts to produce more convincing documentation of telehealth benefits, the Rural Health Work Group called more directly for action to address reimbursement issues. Under the mandate of the 2006-2007 Maine State Health Plan, the Telehealth Workgroup involved many stakeholders to "to develop strategies to help Maine achieve an appropriately-developed, utilized and reimbursed telemedicine infrastructure that serves the best interest of patients". The effort was coordinated by Peter Kraut of the Governor's Office of Health Policy and Finance and Kim Crichton of the Maine Health Access Foundation. Also commissioned by the Governor under recommendation of the State Health Plan, the 14 member Rural Health Work Group, in teamwork with the Maine Office of Rural Health and Primary Care and Center and Maine Center for Disease Control and Prevention, had a broader mission to "to assess the capacity of Maine's rural health system to deliver essential health services necessary to promote and preserve the health of Maine's rural citizens.
The April 2008
"Report of Maine's 2006-2007 State Health Plan Telemedicine Workgroup"[pdf] found that three major Maine insurance providers (Cigna, Aetna, and Harvard Pilgrim) had policies not to pay for patient visits with providers using distance technology, while one (Anthem) did reimburse for some telehealth services. The insurance providers participating in the workgroup's meetings argued that there is neither sufficient demand from patients, providers, and employers, nor sufficient data on the quality and effectiveness of telemedicine services, for them to modify their reimbursement policies. Citing
reviews from Agency for Healthcare Research and Quality, the report agreed there was not sufficient data to make any conclusions about outcomes, leading to a recommendation in the
Maine 2008-2009 State Health Plan [pdf] that the State Office of Rural Health and Primary Care lead a discussion forum with a goal of "creating an evidence-base (which services telemedicine is used for; what the outcomes, costs and benefits are, etc.) to establish the business-case for telemedicine and share this information with insurers, providers, and employers." The Feb. 2008 report of the Rural Health Work Group,
"A Plan for Improving Rural Health in Maine" [pdf], commended the efforts of the Telehealth Workgroup, but recommended more explicitly that "commercial insurers should address reimbursement issues, especially adequate reimbursement for host site transmissions" and that both they and the State Medicaid program, MaineCare, "explore the use and reimbursement of store and forward services; and establish reimbursement for tele-home health services".
Process Leading to New Hampshire Law
The New Hampshire Legislature passed the bill, SB 138, on June 13th, and Governor Lynch signed it into law on July 16th. The
New Hampshire Telehealth Act, Chapter 259, specifies that:
- It is the intent of the general court to recognize the application of telemedicine for covered services provided within the scope of practice of a physician or other health care provider as a method of delivery of medical care by which an individual shall receive medical services from a health care provider without in-person contact with the provider.
- An insurer offering a health plan in this state may not deny coverage on the sole basis that the coverage is provided through telemedicine if the health care service would be covered if it were provided through in-person consultation between the covered person and a health care provider.
- Nothing in this section shall be construed to prohibit an insurer from providing coverage for only those services that are medically necessary and subject to the terms and conditions of the covered person's policy.
The legislative process accelerated when an earlier version of the bill was amended and passed by the Senate in March (with a 17-5 vote). It was championed by sponsor Senators Kathy Sgambati and Peter Burling, and sizable set of co-sponsors: Senators Debbie Reynolds, Matthew Houde and John Gallus and Representatives Liz Merry, Sharon Nordgren, James Aguiar, Thomas Donovan, Alida Millham, and Peter Batula. The New Hampshire Telehealth Program, a consortium led by Director Louis Kazal, M.D. and Co- Director David Price, helped write both the bill and the amendment. The New Hampshire Hospital Association and New Hampshire Medical Society both have noted on their Websites the support they provided for the bill during its review by the legislature (
NHHA,
NHMS), while major health insurance providers in the state opposed the bill, as did the New Hampshire House Republican Alliance (
NHRA) [pdf]. As reported in the
New Hampshire Business Review, supporters argued that passage would reduce health care costs and enhance rural patient access to specialty care services. Opponents expressed the view that passage would drive up health care premiums and foster unsupervised experimental medicine.
As a precursor to the development of the bill, the
New Hampshire Telehealth Program engaged many health care stakeholders in 2007-2008 during their strategic planning for a statewide telehealth network. Maine Telemedicine Services of the Regional Medical Center at Lubec was contracted to facilitate the discussions and help draft the report. The report and prior needs assessment work in 2006 explicitly highlighted the barrier that limited reimbursement plays in implementation of telemedicine services in the state, setting the stage for the legislative efforts.
The amendment to the bill made by the House in June involved revising the definition of telemedicine services to be subject to reimbursement. Dr. Kazal favored the original definition, which was meant to include clinical services delivered by e-mail data exchange (termed "store-and-forward", as common in teleradiology and teledermatology practice). In part influenced by the wording in the Maine bill and that used in Medicare provisions for telemedicine coverage, Kazal reports that some legislators favored a definition that sanctioned only interactive video sessions as reimbursable. The compromise definition finally adopted does leave open store-and-forward services:
"Telemedicine," as it pertains to the delivery of health care services, means the use of audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment. Telemedicine does not include the use of audio-only telephone or facsimile.
According to the NH Hospital Association, before the new law goes into effect (Oct. 14th), providers, carriers and the NH Insurance Department will meet to work on the carriers' guidance to providers.
Summary
The success of these two states in enacting laws to mandate private insurance reimbursement was founded on a prolonged period of planning. In both cases, hospitals and provider groups were supportive and insurance providers were not. Concern for the evidence base for telemedicine is often raised as an issue, but the prospects of enhanced access and cost savings from more timely care seemed to motivate passage of the bills with very few legislators voting against them. The resulting laws are similar, except that the New Hampshire version is more open to store-and-forward applications.
About the Author
Michael Edwards, PhD, is Director of Research and Evaluation at the Regional Medical Center at Lubec, Maine, where his work includes 12 years of service with its division Maine Telemedicine Services and recent OAT-funded project Northeast Telehealth Resource Center.
(Source: Author Submission, September 11, 2009)8/28/2009
GPs at The Orchard Medical Centre in Bristol,
UK have reported on the success of telehealth in improving care for patients with chronic heart failure (CHF), keeping them independent and out of emergency care, and promoting greater self-management.
The Bristol-based practice has successfully integrated telehealth into its CHF service, to provide more preventative support within the community setting, help avoid hospital admissions and reduce some of the burden on secondary care providers whilst providing a cost-effective model of care for the management of the condition.
GPs at the Orchard Medical Centre have liberated valuable additional resource and have reported reduced hospital admissions for some of the CHF patients since deploying the telehealth solutions.
In the case of one patient who had severe heart failure and a history of poor medication compliance, the telehealth monitor enabled GPs to view the direct link between poor medication compliance, weight gain and low oxygen saturation. This was remedied with the aid of telehealth as the patient could see for herself the importance of taking her medication. Telehealth also resulted in a dramatic improvement in another patient with severe heart failure who has not had to use out-of-hours health services in the 18 months since using the monitoring equipment, where previously she had been in and out of hospital four times in a nine-month period.
Clearly from this example telehealth has the potential to reduce costs, which is even more compelling when CHF is becoming an increasing burden in an aging population, and the annual cost to the NHS is 600m pounds. According to the British Heart Foundation, inpatient care accounts for 60% of heart failure care; with average admissions approaching two weeks, and so keeping patients out of hospital and supporting them within the home environment through telehealth has the potential to deliver significant resource and budgetary savings.
Telehealth has proven valuable in identifying trends such as change in body weight at an early stage to enable early intervention, and also in providing support to patients who find it difficult to visit the surgery. Patients have found the solutions easy to use, resulting in increased medication compliance and a resulting improvement in quality of life.
According to Dr Richard Berkley, clinical lead on the telehealth project: "Telehealth keeps people where they want to be, and that's at home with their family. Patient acceptance of telehealth is high; daily monitoring has enabled more accurate titration of patient medication, and also gives patients valuable reassurance, keeping them calm and reducing the risks of exacerbation and of hospital admission.
"Clinical contact with the district nursing team has actually increased as a result with patients taking greater interest and increased responsibility for their condition. The reassurance of self-monitoring has also helped to boost medication compliance, which in turn is thought to have helped to avoid unplanned emergency admissions and has helped to keep patients safe and well within the home environment."
The positive results reported by The Orchard Medical Centre reflect the growing acceptance of telehealth as a means of enabling trusts to support a greater number of patients, improving outcomes and making the best use of available resources.
The telehealth project was a joint venture between NHS South Gloucestershire and South Gloucestershire Council community care & housing department, and was funded by a technology grant from the council together with three years project support from Takeda UK Ltd. As a result of the success of the project, the Orchard Medical Centre is looking to expand the use of telehealth within Gloucestershire, through closer involvement and collaboration with other local GP practices.
(Source: eHealth News EU, August 21, 2009)
The
German Medical Technology Association, BVMED, has published a ten point plan for advanced medical technology in patient care. The plan aims to provide a basis for health policy discussions in the run-up to the German general election this autumn.
The plan emphasizes the increasing need for telehealth and telecare across Germany, arguing that patients should not only have access to products but to comprehensive homecare treatment.
�Telehealth should be a part of regular care,� the plan says. �E-health, telemedicine and telemonitoring by means of medical technologies lead to better, safer, optimized and most cost effective care and must therefore become part of standard care.�
(Source: eHealth Europe, August 26, 2009)
8/28/2009
The Health and Human Services Department recently indicated that it received no applications to operate the National Telehealth Resource Center. Because no one applied, HHS said it is extending funding for the existing operator of the National Telehealth Resource Center, the Center for Telehealth & E-Health Law (CTeL) until a new competition can be held in 2010, according to a Federal Register notice published Aug. 26. HHS is providing $225,000 in noncompetitive supplemental grants to the existing center for the year ending Aug. 31, 2010.
HHS' Health Resources and Services Administration (HRSA) is releasing the supplemental funding to the CTeL, which serves as the current National Telehealth Resource Center, so it can continue to provide technical assistance services to regional telehealth centers, the department said.
"HRSA received no applications for the National Telehealth Resource Center," the Federal Register notice states. "Since no organization applied to serve in the capacity as a NTRC, it is urgent that the Center for Telehealth & E-Health Law continue to provide its services until next year without disruption when HRSA can conduct a new competition for the provision of these services."
The Center for Telehealth and e-Health Law has been operating since 1995. It was selected as the National Telehealth Resource Center in 2006.
(Source: Federal Computer Week, August 27, 2009)
8/28/2009
Universal coverage could clog the healthcare system unless new care-delivery models are created, such as telehealth and online doctor appointments, according to a survey from PricewaterhouseCoopers. Fifty percent of consumers surveyed said they would be willing to seek healthcare through the internet or other computer technology instead of face-to-face, non-emergency visits. E-mail consultation was the top choice (76 percent), followed by telehealth, question-answer consults and an online forum monitored by a doctor.
The second alternative to access was retail and worksite clinics for patients. Of consumers surveyed, 37 percent said they would likely use a worksite clinic, and 36 percent said they would use a retail health clinic.
The third alternative was the use of telehealth technologies. This method could expand access to specialty physicians for patients in remote and underserved areas. Seventy-three percent of consumers said they would use biometric electronic remote monitoring services to track their condition and vital signs.
A fourth alternative is shared medical appointments (SMAs). Of consumers surveyed, 28 percent said they would be willing to participate in a shared medical appointment. This would consist of a 60- to 90-minute session that includes a private or personal exam, integrated with patient education and discussion with a group of 10-to-15 people. Instituting SMAs could increase patient access and a physician�s productivity by an additional six patients during a four-hour clinic session, according to PricewaterhouseCoopers.
(Source: Modern Medicine, August 27, 2009)
5/7/2009
Christian Hageseth , the former Colorado physician who prescribed an antidepressant over the Internet to a Stanford student who later committed suicide was recently sentenced to nine months in county jail. He faced up to a year in jail after pleading no contest in February to a single felony count of practicing medicine without a license.
His case is one of the first criminal prosecutions of a practitioner for using telehealth without having a license in the patient's state. More information about the Hageseth case can be found
here and
here.
San Mateo County Superior Court Judge James Ellis said he would allow Hageseth to serve his sentence in Colorado as he recovers from heart surgery and ordered him to pay $4,200 to the California medical board, which investigated the case. Chief Deputy District Attorney Steve Wagstaffe said prosecutors would insist Hageseth stay behind bars for the entire sentence and not be allowed to serve the time in a work program or some other kind of release.
Hageseth's lawyer, Carleton Briggs, who had tried to get an appellate court to dismiss the charge, said Friday that the case would hurt the practice of medicine.
"Telemedicine is now dead," he said. "No doctor in his or her right mind would now pursue telemedicine unless licensed in all 50 states," which would be prohibitively expensive.
But Deputy District Attorney Jennifer Ow said the prosecution was targeted at an illegal practitioner who "was not licensed in any state to do what he did."
(Sources: San Francisco Chronicle, April 17th, 2009; San Jose Mercury News, April 18, 2009)4/30/2009
Doctors already involved in
Australia's embryonic telemedicine sector, which allows patients to consult specialists hundreds or thousands of kilometers away, say the Government's plans to build a $43 billion national fiber-optic network is a good first step to encourage further roll-out of such hi-tech services. But they say the full potential of telemedicine will only be realized when governments make it easier. Currently, only face-to-face consultations qualify for Medicare rebates, a disincentive for GPs and other private doctors to get involved.
Mark Coulthard, a pediatric intensive care specialist at Brisbane's Royal Children's Hospital, often participates in long-distance consultations using equipment that allows two-way communication with a studio set up in regional towns.
Instead of traveling to the state capital for a specialist consultation, patients travel to the studio in their town, where the specialist can see and hear them, and see their scans and other information.
Coulthard says once complete, the planned national fiber-optic network would allow doctors to devise "creative ways of delivering health services, and also directly into the home". "It will give us a mechanism to make headway in areas that are normally difficult to reach," he says.
But educating staff in how to use the new systems would also be vital. While telemedicine consultations between Brisbane and Mackay were a regular event, similar equipment in nearby Rockhampton was underused because staff there were undertrained and uncomfortable with using it.
Anthony Smith, deputy director of the Centre for Online Health at the University of Queensland, says the proposed new infrastructure is "an important piece of the puzzle, but not the most important piece". "It's really important that to have telemedicine accepted as a mainstream service, that it's funded appropriately," he says.
Marianne Vonau, executive director of critical care at the Royal Brisbane and Women's Hospital, and the first Australian-trained female neurosurgeon, recently conducted a telemedicine clinic in Brisbane in which she reviewed the progress of a four-year-old child in Mackay.
The child, Grace Druery, had had a shunt implanted in her head to drain fluid that had built up in her skull due to a congenital condition. Without the telemedicine facility, Grace and her mother Leanne would have had to fly the 800km from Mackay to Brisbane.
(Source: The Australian, April 10, 2009)
The first ever telemedicine center in
Cameroon recently became operational. Known as Genesis Telecare, it was inaugurated in the city of Yaounde by the Secretary General in the Ministry of Public Health, Professor Fru Angwafor III. The project is the fruit of a public-private sector partnership between the Genesis Futuristic Technologies and the Ministry of Public Health. Some 200 sites are expected to be connected to the network in the next two years.
Through the telemedicine center, patients in remote or rural areas can electronically get health care services including consultation and treatment without having to travel long distances.
With the aid of video conferences technology, patients can be consulted from the district hospital by a specialist doctor in Yaounde. The medical equipments used for the operation are computerized, making medical diagnosis to be exchanged instantaneously.
With the introduction of telemedicine, health care services are expected to be less expensive, faster and easily reachable.
Jacques Bonjawo, Director General of Genesis Futuristic Technologies said during the pilot phase of the project, hospitals in Yaounde and Douala will be connected to rural hospitals nationwide.
The Abong Mbang District Hospital, in the South region is the first rural hospital to be connected to the network and was used at the inauguration to consult a patient.
(Source: Africa News, April 23, 2009)
To address the shortage of medical specialists in the country with a population of 700,000,
Bhutan's Ministry of Health has launched two telemedicine projects, where an expert from India can diagnose and advise on a case of a critically ill Bhutanese patient�all via the internet and through videoconferencing.
Bhutan's Prime Minister Lyonchhoen Jigmi Y Thinley and the Indian ambassador to Bhutan, Sudhir Vyas, inaugurated the projects�SAARC (South Asian Association for Regional Cooperation) Telemedicine Network and Bhutan Rural Telemedicine�during the ministry's annual conference in Thimphu, Bhutan's capital.
The real-time video conferencing will require an internet bandwidth of 384 kbps, while the rural telemedicine will use the existing infrastructure of dial-up internet connectivity.
With this telemedicine innovation, the Health Ministry hopes to improve the accessibility and quality of healthcare by harnessing ICT. Apart from getting advices from India, this remote doctoring will also enable Bhutanese specialists to attend to patients in other parts of the country.
"Through telemedicine, doctors and specialists will be able to keep in touch with their peers and keep up with medical advancement in technologies," said Gaki Tshering, Head of the ICT Unit at the Ministry of Health.
(Source: FutureGov Magazine, April 23, 2009)
4/30/2009
Congressmen Mike Thompson, D-California recently introduced telemedicine legislation would provide $30 million in grants to help health facilities pay for telehealth equipment and expand telehealth support services. Currently about 80% of Americans do not have access to telemedicine because of restrictions that limit funding for these types of facilities to rural areas. The Medicare Telehealth Enhancement Act (House Resolution 2068) would expand Medicare reimbursement to urban and suburban areas and include more facilities, the press release states. It will also allow doctors to monitor patients remotely.
Co-authors include reps. Bart Stupak, D-Mich., Lee Terry, R-Neb., and Sam Johnson, R-Texas.
"As health care becomes more expensive, we need to use smart innovations such as telemedicine technology to help lower costs and expand access for all Americans," said Thompson in a release. "Allowing doctors to remotely monitor a patient who has congestive heart failure not only helps the patient stay healthy, it also reduces costly visits to the emergency room. The Obama Administration has indicated that telemedicine will be an important part of their health care reform agenda, and I look forward to working with them to expand access to this important technology."
Last July, Thompson and Stupak's provisions to expand the types of facilities authorized to provide telehealth care were passed into law as part of the Medicare Improvement for Patients and Providers Act. This bill will further expand the type of facilities that are eligible.
(Source: Eureka Times Standard, April 27, 2009)
3/26/2009
Health insurers would no longer be able to require that a doctor meet a patient face-to-face in order to be reimbursed under a bill passed recently by the New Hampshire Senate. Senate Bill 138, which defines telemedicine and requires its coverage, passed the Senate on a 17-5 roll call vote. The measure now goes to the House for approval.
Supporters maintain that the bill will both lower health-care costs and provide better care in rural areas.
"This is going on now," said Sen. Kathy Sgambati, D-Tilton. But she said that there is "confusion on how to bill" for such services that is preventing some providers from engaging in the practice.
"This is vastly going to reduce the costs of health care and help with early detection," said Sen. Debbie Reynolds, D-Plymouth. Telemedicine would help with early detection and "access to specialty care that would reduce the severity of diseases."
But opponents questioned whether the bill is yet another insurance mandate that would drive up premiums. Others worried that it would result in unsupervised experimental medicine, though proponents pointed to language that defines telemedicine as having to fit in the current scope of practice.
(Source: New Hampshire Business Review, March 19, 2009)3/26/2009
Telehealth is expanding in Wyoming and across the country. This month, the state passed a law giving the Wyoming Department of Health's rural health office the authority to work with other states and organizations to lay the groundwork for more telehealth exchange.
Telehealth is particularly valuable in Wyoming. The state's rural nature and sparse population make it more difficult to attract health professionals, and it reduces demand for highly specialized doctors. Many in the state's medical community see telehealth as a way to bring advanced care to the Wyoming's most remote settlements.
What excites many health experts is the prospect of a nationwide telehealth network that would allow a Wyoming patient to be treated by the country's finest hospitals without buying a plane ticket.
The federal stimulus package's strong support for health technology carries with it the expectation that states will work together to create a nationwide telehealth network, said Dr. James Bush of the Wyoming Department of Health. Bush is helping design a comprehensive telehealth network in the state.
Bush said medical licensing laws could be a roadblock to a national network. New rules enacted by the Wyoming Board of Medicine make it easier for out-of-state doctors to obtain licenses to practice telemedicine. Bush hopes medical officials in all states will agree to recognize each other's licenses, at least to some degree, to allow more unfettered exchange of medical expertise and treatment.
"We could have more access to super specialists all around the country who would otherwise need to get licenses in 50 different states," Bush said.
Kevin Bohnenblust, executive secretary of the Wyoming Board of Medicine, said the state licensing process shouldn't stand in the way of telehealth, but the board's first goal is to protect Wyoming citizens.
"We don't want that state line to be sort of a boundary," Bohnenblust said. "We want to be able to regulate (telehealth) without standing in the way of it."
Rex Gantenbein, director of the Center for Rural Health Research and Education at the University of Wyoming, said the technology for telehealth has been around since the 1990s, but a funding increase in the past few years has pushed the practice into Wyoming's medical mainstream.
"Since then there's been an increasing amount of interest in it to the point now where most of the hospitals in the state have some telehealth capacity," Gantenbein said.
In 2007, a $500,000 telehealth program linked 24 of Wyoming's 26 acute care hospitals to facilitate video conferencing. Currently, the majority of telehealth in the state provides educational courses and connects medical professionals. Hospitals use the system for meetings and to conveniently provide training for their employees.
For instance, the Cheyenne Regional Medical Center offered an eight-week nurse education course broadcast from the University of Washington -- something that would have been impossible without the hospitals' telehealth capacities.
Doctors say the next step for Wyoming is to treat patients remotely on a large scale, both within the state and across state lines. Telehealth can save hours of driving for patients living in rural areas for whom a specialist is hundreds of miles away.
"Things that we've seen the biggest need for in the state is the ability to provide specialty care," Gantenbein said. "Everything from dermatology, cardiology and stroke care."
In other states, telemedicine is being used to treat mentally ill patients, monitor the elderly in nursing homes and even evaluate incarcerated prisoners.
Dennis Ellis, executive director of the Wyoming Medical Society, said the networks cut costs and negate the need for what he calls "windshield" time. Ellis said Wyoming is well-suited for a comprehensive telehealth network.
"It's easier to get all of Wyoming all on the same page than to get Denver on the same page," Ellis said.
(Source: Casper Star Tribune, March 16, 2009)
