Final
Overview of Telemedicine
HEALTH CARE TASK FORCE
Votes:
Action Taken:
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9:13 AM -- Overview of Telemedicine
The meeting was called to order. Chairman Frangas announced that today's Health Care Task Force meeting will focus on telemedicine. Staff distributed a memorandum entitled "Current Colorado Law Addressing Telemedicine" (Attachment A). [A copy of most of the materials provided at today's hearing are available on the Health Care Task Force web page at:
http://www.state.co.us/gov_dir/leg_dir/lcsstaff/2005/comsched/05HealthCareTFsched.htm
].
Dr. Flo Raitano, CEO, Rural Development Specialists, introduced herself, and asked that Mr. Bryan Nation, with Banner Health System and representing the High Plains Rural Health Network, and Mr. Mike Riggio, with Poudre Valley Hospital also come to the table. She distributed a copy of their PowerPoint presentation (Attachment B). Dr. Raitano explained the difference between telehealth and telemedicine. While telemedicine focuses on specific disciplines and technology like tele-radiology, telehealth focuses on the application of technology for patient needs including health records, disease management, remote monitoring and patient compliance. Dr. Raitano gave a basic definition of telemedicine as the use of advanced telecommunication and information technologies to exchange health information and provide health care services across geographic, time, social and cultural barriers.
Dr. Raitano, Mr. Riggio, and Mr. Nation discussed the history of telemedicine in Colorado. Dr. Raitano described Colorado's activities in telemedicine including the multi-use network (MNT), a fiber "backbone" connecting each county seat in Colorado. The MNT is a local network designed for use by local governments, education, and health care, and was built by Qwest. She added that the health care sector has not fully utilized the MNT. Mr. Nation described some of the issues delaying the use of the MNT by the health care industry including HIPAA requirements, connectivity response time, and network expansion beyond the county seat.
Dr. Raitano explained some of the benefits of telemedicine including: decreased travel for patients, providers, and staff; increased access to specialty consults and second opinions; decreased information processing time; increased efficiency of care; and lowered costs of patient care.
Representative McCluskey asked about who pays for the initial investments and ongoing costs of telehealth. Mr. Nation responded that additional services are required to utilize telemedicine, and he views them as a cost of doing business like radiology or other tools used in providing health care. Mr. Riggio added that providers are leveraging resources to minimize costs, and indicated that the High Plains Rural Health Network is facilitating collaboration in this area.
Dr. Raitano described the Docking Institute Study completed in Nebraska which reviewed patient satisfaction with telemedicine. The study found that non-doctor related costs and total health care costs were lower in the treatment group than in control groups, and patient satisfaction was higher among the treatment group.
Mr. Riggio described Poudre Valley Health System's use of telemedicine. Cardiology is the primary area. Another major use is in radiology, with over 700 patients served each month. He identified a key to success as integrating the technology with the regular workflow of providers.
9:41 AM
Dr. Raitano described some of the challenges related to telemedicine. She stated that the lack of a robust rural infrastructure is still an issue for facilities outside of the county seat and in rural areas. Mr. Riggio explained that insurance reimbursement is also a concern particularly when providers must use equipment located outside of their normal workplace and/or network. Mr. Nation stated that work is continuing to establish standards to allow integration of systems across networks. Dr. Raitano commented on additional issues including security, connectivity, equipment costs, maintenance costs, transmission costs, and federal and state regulation. Mr. Nation stated that regulations through HIPAA, JCAHO, and the FDA determine how telemedicine can be implemented. Dr. Raitano discussed SB05-244 stating that she is concerned that it may have put telemedicine in a box and may hamper future uses. Instead, she thinks of telemedicine as a tool for the health care industry.
Representative Clapp asked if a definition of telemedicine is available at the federal level and is one necessary at the state level. (A definition exists in Section 12-36-106, C.R.S., see Attachment A.) Mr. Nation responded that there are some definitions at the federal level. Dr. Raitano expressed the potential need for definitions for insurance purposes. Representative Clapp asked if the presenters have had trouble collecting from insurance companies. Mr. Nation stated that Banner has not had trouble in this area. Representative Frangas asked if the definitions provided in SB05-244 have hampered efforts to receive grants. The presenters responded that they are not aware of problems in this area. Representative Butcher stated that a definition of telemedicine is important to protect consumers.
Dr. Raitano commented on SB05-152 in that it may be problematic for certain rural areas of the state without broadband access. She then shared some resources for further information on telemedicine. Representative Frangas asked the presenters to provide some follow-up information on HIPAA compliance, system reliability, Medicare and Medicaid compliance, cost neutrality and MNT uses.
Representative Butcher asked for clarification of the concept of patient compliance. Mr. Riggio explained that when a patient can go to a local provider's office for follow-up care with a telemedicine speciality consultation, the patient may be more likely to correctly follow care instructions. Dr. Raitano gave an example in the area of physical therapy, and responded to additional questions on the billing and payment of expenses by explaining that the patient would be referred to the physical therapist in the normal way. Then, the therapist would bill for time as usual, and technology expenses would also be incurred and billed.