PS3-28: Telemedicine Specialty Consultation in a Medically Underserved Community

Abstract

Background and Aims: During the current national health care reform discussions, health information technologies (HIT) are receiving a lot of attention as means of lowering health care costs, improving access to health care, reducing errors during the delivery of healthcare, and improving health outcomes. Patients in rural or medically underserved areas find it difficult to obtain and maintain adequate access to health care. Telemedicine (TM) services can exchange video and audio information between healthcare providers and patients in different locations. For individuals in rural communities TM may improve access to care through the use of novel care delivery models. We are conducting a proof of concept (POC) study to evaluate the use of TM consultation between a primary care clinic in a medically underserved region of southern Colorado and a specialty care (endocrinology) clinic in Denver. Methods: This is a prospective health services POC study. We are taking advantage of a “natural experiment,” the expansion of primary care services into a medically underserved area of southern Colorado, to examine the requirements for establishing TM services between a rural primary care clinic and metropolitan based specialists. Results: Technical requirements included establishing network capabilities (512 kbps ISDN, H.320), 2 Mbps IP (H.323 or SIP), wirelss LAN connection, encryption embedded transmissions (H.235 and IEEE 802.1 x authentication); and remote monitoring equipment (exam camera, ENT/otoscope, electronic digital audio stethoscope (frequency: 40 Hz–2000 Hz, response: 45 Hz–1.6 KHz). Legal requirements involved the review of both federal and state statutes governing the use of TM for patient care and geographical/population requirements. Billing and regulatory requirements entail ensuring the use of the correct CPT and modifiers codes for TM and making sure these are operational within the medical record. Establishing criteria to ensure patients are appropriate for TM, the contents for TM informed consent, rules governing the use of TM for Medicare/Medicaid and non-Medicare/Medicaid patients. Establish clinical workflows for TM between the primary care and specialty care clinics. Conclusions: Invovle legal counsel early to review state statutes and develop TM patient/provider consent forms. Coordinate services with IT department. Coordinate documentation requirements with the billing and coding department. Work with clinic staff to incorporate TM into the clinic and admnistrative workflow. Define roles and responsibilites. Early planning and inter-department coordination is essential for a successful TM project.