|Vision for California||5|
|Mission Statement and Goals||6|
|Goals and Objectives||7|
|Initial Action Plan||12|
|Findings and Recommendations of Consultant Charles Turcan||14|
|Organizations Coordinating and Preparing the Strategic Plan||A-2|
|Potential Funding Services||A-3|
Project Funding Provided by
Approved May 24, 1995
The Coordination Project was established to support the emergence of Telehealth/Telemedicine (TH/TM) technologies in California as they apply to the delivery of the full spectrum of health care services. Providing public and preventive healthcare education and information through computer and electronic-information transfer technologies is referred to as Telehealth. Providing computer and electronic-information transfer technologies for medical care is referred to as Telemedicine. (Full definitions of these terms can be found in Appendix I of this Strategic Plan.)
Primary to its purpose, the Planning Committee focused its initial efforts on the development of a strategic plan to identify and coordinate use of the technology for improving access to care and promoting efficient delivery of cost-effective, quality healthcare.
The technology, systems, and resources needed to establish TH/TM networks often require significant capital investments. When computers were first introduced, many healthcare providers made sizable investments in systems that very quickly became outmoded and that proved to be less than adequate for their needs. Without careful planning, the danger of wasting precious technological and financial resources does exist.
Further, while financial resources for TH/TM networks are available through the federal government and other major funding sources, none of these dollars are currently flowing into California.
It is the premise of the Planning Committee that through a planning process involving a broadly representative consortium of stakeholders, and through the implementation of a master plan for the state of California:
To this end, the broadly based Planning Committee was established to provide direction and guidance to the Coordination Project. The Planning Committee serves as a representative stakeholder consortium ensuring that the Coordination Project is in a position to be most effective expanding the use of TH/TM for the benefit of all Californians.
The Planning Committee membership is a mix of interests from inside and outside the healthcare "community." Representation includes university medical centers, community hospitals, public health, research and planning, state government, libraries, prisons, clinics, payers, physicians, educators, associations, private foundations, and vendors. Other members will be added to the Planning Committee as new issues develop or additional expertise is needed.
To facilitate the rational implementation and expansion of TH/TM in California, the Planning Committee is working to identify opportunities as well as "critical components" in the makeup of a dynamic evaluation strategy. For example, a first step will be the development of a survey to determine the current deployment of TH/TM technologies already in use in the state that are of interest to agencies and providers, potential funding sources, obstacles in establishing TH/TM capability, and other important issues.
On February 7 and 8, 1995, the Planning Committee held a retreat to develop the Coordination Project Strategic Plan. Charles Turcan, specialist in healthcare telecommunications and medical computing, and Lauren Lund, facilitator and trainer, were retained by the Sierra Health Foundation to help guide the Planning Committee through the strategic planning process.
At the retreat, a mission statement, goals and objectives, and initial action plan for the Coordination Project were developed. Also, it was determined that initial implementation efforts of the Coordination Project would focus on rural areas of the state - assessing needed and appropriate applications of the technology, developing strategies to attract financial resources to support the technology, fostering a supportive regulatory/legislative environment, and targeting specific communities for implementation.
The Planning Committee determined the initial focus of its work would be on underserved areas of the state with the immediate emphasis on rural communities for two key reasons. First, research suggests that "telemedicine appears to be an effective mechanism for bringing medical care to the underserved, and its proliferation will certainly benefit the rural areas of the country." Second, although these areas and populations may benefit most from telemedicine, they are the least likely to be able to secure the resources to develop and operate telemedicine programs and networks. Later efforts will focus on the broader underserved populations throughout the state in urban as well as rural areas.
TH/TM Consultant's Report
Following presentation of the Coordination Project Strategic Plan, the TH/TM Consultant's report presents findings and recommendations for the future, both short- and long-term, and lay out some broad operational and policy issues for the Planning Committee to consider in coming months.
As the reader will see, the TH/TM Consultant's report also validates the work of the Planning Committee and supports the Coordination Project Strategic Plan.
Advances in computer technology and electronic-information transfer, including telecommunication and teleconferencing, are happening at an astounding rate. Quantum improvements in the quality, size, and speed of computer hardware, software, and communication network capabilities have delivered a tremendous variety of powerful applications and resulted in broad and eager acceptance of the new technologies. Now a current initiative of the federal government to modify many state-of-the-art defense technologies for application in the private sector has added to the rapid development of emerging technologies. The healthcare field has been targeted as one of the key beneficiaries for these applications.
The incentive of federal funding, coupled with the momentum of growing acceptance of the technology, has resulted in an unheralded variety of new medical applications, vendor designs, and potential networks under proposal. As a result, many groups and individuals are looking toward medical technological advances as new resources for providing greater preventive healthcare education and for solving many existing problems of access to medical care, efficient delivery, and the cost of medical care.
Providing public and preventive healthcare education and information through computer and electronic-information transfer technologies is referred to as Telehealth. Providing computer and electronic-information transfer technologies for medical care is referred to as Telemedicine. Telehealth/Telemedicine technologies may include everything from the use of a telephone; to the use of voice, data, and interactive video communications with libraries, medical research institutions and state or federal agencies; to the use of satellite up-links for teleconferencing; or to the basic use of information storage/retrieval capabilities of computer technology to the tremendous opportunities that may be realized through Local Area Networks (LANs) and statewide or nationwide computer network systems. Telehealth/Telemedicine technologies may also include anything from a simple fax machine to a highly complex information-transmission system for sending digitized images through video monitors.
To be successful, Telehealth/Telemedicine (TH/TM) network systems require the design, construction, and/or coordination of compatible, sufficient infrastructures, equipment, networks, and operator capabilities. Throughout the United States, medical network systems are now being designed, developed, and pilot tested. Such projects include the HealthNet project in Pennsylvania, the Iowa Communications Network, the Oklahoma Telemedicine Network, the Louisiana TELEMED Project, the Georgia Telemedicine Network, the Western New York Health Networking Project, and a project in West Virginia which is receiving support from the Office of Rural Health Policy, among others.
In each case, it was found that critical steps were overlooked or not anticipated, which later posed significant challenges to the success of the projects. In one instance, medical professionals were not initially included in the planning process. In another, the end users were not sufficiently identified so the system developed was limited in its applicability upon implementation. Other projects are currently challenged by managerial problems related to various issues like scheduling, staffing, physician incentives, etc.
Cognizant of the potential for oversights in the design, development, use, and coordination of resources and implementation of Telehealth/Telemedicine network systems, in late 1994, the concept for the formation of the California Telehealth/Telemedicine Coordination Project (Coordination Project) began to take shape. The initial idea (which later was broadened) was to establish a forum through which key stakeholder groups in the field of telemedicine could be brought together for the purpose of planning the development and deployment of this technology throughout the state of California. It was hoped that, through such a forum, many of the pitfalls being experienced by other projects could be avoided.
Thomas S. Nesbitt, M.P.H., M.D., Assistant Professor, UCDMC - Department of Family Practice, served as the initial "visionary." The California Health Collaborative, a nonprofit affiliate of the Hospital Council of Northern and Central California, took the lead in convening an initial planning committee for the project and serving as the neutral facilitator for managing the project. An initial core group of individuals was formed from the California Office of Statewide Health Planning and Development, the California Department of Health Services, the Association of California Hospital Districts, the California Association of Hospitals and Health Systems, and the Hospital Council of Northern and Central California. Soon after, the Sierra Health Foundation became a partner and member of the Planning Committee, providing in-kind support to the project. Through funding provided by the Sierra Health Foundation, on February 7 and 8, 1995, this core planning group, now the California Telehealth/Telemedicine Coordination Project Planning Committee (Planning Committee), participated in a retreat for the development of a strategic plan to assist the emergence of Telehealth/Telemedicine in California. Charles Turcan of Turcan-Wingard Associates, a specialist in healthcare telecommunications and medical computing, and Lauren Lund, a facilitator and trainer from California State University Sacramento Foundation, were retained by the Sierra Health Foundation to guide the Planning Committee through the strategic planning process.
The results of that retreat and subsequent work of the Coordination Project Interim Steering Committee (Steering Committee) resulted in the creation of this strategic planning document. It has been designed to serve both as a working document for the Planning Committee and to provide structure and focus in communicating with funding groups, the legislature, and other key stakeholder groups.
The use of TH/TM technologies, from fairly simple electronic "e-mail" networks to highly complex technological applications, offers the promise of greatly enhancing access to healthcare services. This promise is of particular value in areas where specialty and tertiary diagnostic services are in limited supply. Further, application of TH/TM technologies will augment opportunities for consultation and medical education, increase efficiency, and lower the cost of care delivered by providing a means for rapid electronic transmissions of information.
The vision of the Coordination Project is to see the most efficient and effective TH/TM network system possible developed and coordinated throughout the state of California providing optimal health-education opportunities and medical care for all our citizens.
The officers and members of the Planning Committee know that this vision can be realized through careful planning, statewide collaboration of efforts, rational implementation and deployment of TH/TM applications, and a commitment to continuously improve and maximize accessibility and coordination of TH/TM technologies.
It is with confidence in the value, importance, and practicality of this vision that the Planning Committee now offers this initial TH/TM Strategic Plan.
The mission of the California Telehealth/Telemedicine Coordination Project Planning Committee is to support the emergence of Telehealth/Telemedicine networks to benefit Californians.
Honoring this mission, the California Telehealth/Telemedicine Coordination Project Planning Committee commits to the following goals:
I. To create an environment which will facilitate Telehealth/Telemedicine programs
II. To assess the current environment and needs for TH/TM networks in California
III. To produce, promote and distribute a report for TH/TM network development in California
IV. To implement new Telehealth/Telemedicine programs and improve and expand current programs
V. To assess program outcomes and recommend and implement changes in the Telehealth/Telemedicine environment
A. Possible funding summit.
B. Possible users/applicants summit.
6. Become educated on available TH/TM technology and relative costs involved.
7. Create educational and planning opportunities for communities and users (including hospitals, clinics, and physicians) that will address both technical information as well as promote acceptance of the use of the technology.
8. Cultivate an effective working relationship with the California Congressional delegation, California Legislature, other elected officials, as well as state/federal funding and administrative agencies.
9. Link with other interested planning groups at either county or statewide level.
10. Promote interaction with other states and other nations (Mexico) to learn and apply experience.
Creating an environment that will facilitate TH/TM programs, invites the exploration of a variety of ways to interest and involve a wide segment of health professionals and other key individuals from the public and private sector. Symposia and workshops may support many of the above objectives. Continuing to produce and share written reports of activities and findings will support all the goals.
A. Conduct infrastructure analysis.
3. Assess current barriers to implementation.
4. Identify health resources and available funding sources for network development.
5. Identify individuals key to coordinating TH/TM relationships.
6. Identify cost-effective applications of TH/TM technologies.
7. Publish written reports.
Primary elements in this goal -- to assess the current environment and needs for TH/TM networks in California -- are the determination, in all efforts, to be mindful of the dignity and diversity of all people, to identify and develop opportunities, and to provide written reports of findings for the greater benefit of all involved.
By addressing these objectives, the Planning Committee endeavors to ensure that this Goal -- to produce, promote, and distribute a report for TH/TM network development in California -- becomes a functional source of information and a tool for those involved (currently and in the future) in TH/TM technology, and that paramount is the applicability of this technology.
Taken as a whole, the goals and objectives represent dynamic processes that interface with each other continuously. This is particularly evident at the stage of implementing new TH/TM programs and improving and expanding current programs. The elements of evaluation and modification, identifying opportunities, exploring the use of symposia and workshops, and providing written reports converge at implementation and lead on to the assessment of outcomes.
A. Conduct infrastructure analysis
B. Identify new cost-effective applications and think in new ways
5.Assess community TH/TM education processes and programs.
6.Appraise current, and identify new, cost-effective applications.
7.Conduct ongoing assessments of regulatory environments.
8.Assess the environment for needed modifications to encourage original research in TH/TM.
9.Create ways to encourage original research in TH/TM.
10.Publish reports of findings and recommendations.
Initial assessments for understanding the environment and needs for TH/TM networks in California provide the baseline for assessing outcomes and recommending modifications to TH/TM programs and networks. In all cases, assessment processes function to identify barriers, aid the discovery of new opportunities and applications, and facilitate understanding and sensitivity to market forces. The use of symposia and workshops will continue to offer rich opportunities to involve and draw on the expertise of health professionals and public and private sector representatives statewide. Collaboration, communication, and continuous improvement will be key factors in successfully "supporting the emergence of TH/TM networks to benefit Californians."
Action planning is an ongoing process. Working groups have been and will continue to be established to focus on specific strategic plan objectives and to work on action plans. At the February retreat, certain activities were identified for immediate attention.
The Planning Committee determined that the most critical objectives for the near future would be those that had to do with attracting the attention and receiving the support of new members, financial support, and developing governance guidelines. As these objectives are addressed, the Planning Committee will then be able to focus its full attention and energy on all the other objectives and issues it has identified.
Initial Action Plan Activities
Timelines for the specific goals and objectives of the Planning Committee are currently being established through a number of working groups that have been formed. All work included in the Initial Action Plan is targeted for completion by July 1, 1995, with the exception of the "Demonstration of Telehealth" in practice, which is targeted for completion by December 31, 1995.
This strategic planning document is considered just the beginning step in an ongoing and dynamic process of planning and coordination. Assuredly, new issues will be identified requiring the attention of the Planning Committee. New technologies and applications will be developed requiring more education/information and resulting in further critical planning and coordination activities, and new needs, problems, and solutions will surface for which TH/TM may be appropriate. As the project grows and evolves, this document will be refined, goals and objectives will be modified, and action plans and timelines will be expanded.
Some issues above and beyond those included in the goals and objectives and initial action plan already have been identified as requiring future attention of the Planning Committee. These issues will be assigned to existing or new working groups as the Coordination Project evolves.
The Planning Committee identified these additional issues:
The findings and recommendations contained in this section specifically reflect the counsel provided by Charles Turcan of Turcan/Wingard Associates, who served as the technical consultant during the February strategic planning session.
Turcan-Wingard Associates is a healthcare consulting firm specializing in Medical Information Networks and Applications. Charles F. Turcan, principal in the firm, is a specialist in healthcare telecommunications and medical computing, with over 16 years experience in these fields. Most recently, Mr. Turcan has chaired two national Telemedicine and Distance Learning conferences and was the lead healthcare consultant for the NTIA funded study of the healthcare infrastructure needs for the state of Nebraska. Turcan-Wingard Associates was retained by the Sierra Health Foundation to work with the California Telehealth/Telemedicine Coordination Project Planning Committee.
The following is an assessment of the efforts of the California Telehealth/Telemedicine Coordination Project Planning Committee (the Planning Committee) to date, and recommendations on where the Planning Committee should place its focus in the short-term and long-term.
The Planning Committee was convened to accomplish work that will prove to be critical to the success of the Telehealth/Telemedicine efforts in California. As will be discovered when research is completed on efforts that have been initiated throughout the US during the last 3-4 years, the integration of telecommunications technology with healthcare and educational program delivery is difficult at best. The lack of standards, issues regarding reimbursement, concerns about licensure and liability, funding efficacy, effectiveness, acceptance, availability, and more all plague these efforts. Those initiatives which are succeeding are doing so due to the efforts of groups like the California Telehealth/Telemedicine Coordination Project Planning Committee.
To be successful, the process must include careful consideration of regional and state needs, a thoughtful approach toward the standards and assessment, and development of resources that go beyond just dollars and cents (technical resources, training, measurement, education, etc). Only then will the implementation of Telehealth/Telemedicine projects become operating programs.
The efforts of the Planning Committee are on track toward these goals. While, at times, it will be difficult to find the motivation, energy, and necessary funding to move forward with this project, the Planning Committee is encouraged to pursue the course that has been undertaken.
The Planning Committee should consider the following recommendations:
Before settling on its name, the California Telehealth/Telemedicine Coordination Project Planning Committee spent considerable time discussing the terminology that would most clearly articulate the intended focus for the group's activities. The terms Telehealth and Telemedicine were chosen for inclusion to fully communicate that the group would focus on the uses of the technology for health promotion and disease prevention and for medical care, consultations, and education.
For purposes of this Strategic Plan, the following definitions are assumed for Telehealth/Telemedicine.
Telehealth is the use of electronic communication networks for the transmission of information and data focused on health promotion, disease prevention and the public's overall health including patient/community education and information, population based data collection and management as well as linkages for health care resources and referrals.
(Definition used by the Kansas Telemedicine Policy Group)
Telemedicine is the practice of healthcare delivery, diagnosis, consultation, treatment, transfer of medical data, and education using interactive audio, visual, and data communications.
(Definition used by the National Information Infrastructure Testbed)
Telemedicine uses low-speed to high-speed networks for the electronic transmission of everything from X-rays, MRI images, and CT scans and other computerized patient clinical and medical information, to interactive video for remote diagnosis, consulting or training.
This Strategic Plan document was prepared with input from all officers and members of the California Telehealth/Telemedicine Coordination Project Planning Committee. Two organizations provided specific services in the preparation and coordination of the plan.
Sierra Health Foundation
Sierra Health Foundation is a private, nonprofit, independent foundation that awards grants in support of health and health-related activities in 26 Northern California counties.
The perpetual funding base for Sierra Health Foundation's philanthropic efforts was provided by Foundation Health Plan and Foundation Health Corporation, formerly known as Americare Health Corporation. Sierra Health Foundation was incorporated on January 31, 1984, in conjunction with the conversion of Foundation Health Plan from nonprofit to for-profit corporate status. Foundation Health Plan contributed all of its common stock and $1,000,000 to Sierra Health Foundation upon its conversion to for-profit status.
Headquartered in Sacramento, Sierra Health Foundation is one of the largest California philanthropic foundations concentrating on health. In addition to providing significant monetary support to local and regional health-related programs and services, the Foundation hopes to influence public health policy in a positive way and assist in the creation of major improvements to California's healthcare system
Qualified 501(c)(3) organizations and public agencies may apply for funding through Sierra Health Foundation's grants programs, the Health Grants program, and the Community Partnerships for Healthy Children Initiative. Sierra Health Foundation does not grant to individuals. Each grant proposal is researched by the Foundation's staff and consultants. Funding recommendations are then submitted to the Board of Directors for final approval and award.
Since its inception, Sierra Health Foundation has awarded more than $19 million through over 700 grants funding health programs that include services for families, youth, and the elderly; substance abuse education; mental health projects; facility acquisition; and volunteer recruitment.
Sierra Health Foundation strives to establish a collaborative relationship with its grantees, and with other funders and foundations, through an open dialogue. Sierra Health Foundation approaches each grant as a partnership, with opportunities for the grantee and grantor to work cooperatively to enhance the effectiveness of the grant project. This philosophy of partnership is also extended to other funders in an effort to stimulate co-funding of common interests.
Sierra Health Foundation has provided guidance in the initial development of the California Telehealth/Telemedicine Coordination Project as well as financial resources to support the development of the strategic plan.
Contact: Dorothy Meehan, Vice President (916) 922-4755
California Health Collaborative
The California Health Collaborative (Collaborative) consists of two 501(c)(3) public benefit foundations that provide innovative leadership in healthcare systems development and research statewide. The Collaborative is uniquely positioned to build coalitions and partnerships to solve problems, design projects, and improve the healthcare of individuals and communities.
The mission of the California Health Collaborative is to:
It is the premise of the Collaborative's multidisciplinary Board of Directors (a geographically dispersed Board that includes leaders in healthcare, public health, and medical education) that collaboration is one of the most effective approaches to developing solutions to existing problems in the healthcare system and maximizing available resources.
The Collaborative provides project management and facilitation for the California Telehealth/Telemedicine Project.
Contact: J. Cari Elliott, Executive Director (209) 221-6315
1. Office of Rural Health Policy
Health Resources and Services Administration
Room 9-05, Parklawn Building
5800 Fishers LaneRockville, MD 29857
Contact: Carol Mintzer
Phone: (800) 785-0345
2. Office of Rural Health
Health Resources and Services Administration
Room 9-05, Parklawn Building
5800 Fishers Lane Rockville, MD 29857
Contact: Jake Culp
Phone: (800) 785-0345
Additional information is available through the Rural Information Center
3. Rural Information Center
National Agricultural Library Room 304
Beltsville, MD 20705-2351
Phone: (800) 633-7701
4. Economic Development and Technical Services
Rural Electrification Administration
Room 4025, South Building Agriculture Department
14th Street and Independence Ave. SW Washington, DC 20250-1500
Contact: Larry Bryant
Phone: (202) 690-3594
5. National Telecommunications Information Administration (NTIA)
Contact: Laura Breedon
Phone: (202) 482-2048
6. Agency for Health Care Policy and Research (AHCPR)
Contact: Rita Koch
Phone: (301) 594-1435
7. Health Care Financing Administration
Contact: Cynthia Mason
Phone: (410) 966-6680
8. NIH Office of Rural Mental Health
Contact: Charles Windle, PhD
Phone: (301) 443-9001
9. National Institute of Aging, NIH
Contact: Huber Warner
Phone: (301) 496-6402
10. Integrated Advanced Information Management Systems
The National Library of Medicine
Bethesda, MD 20894
Contact: Richard West
Phone: (301) 496-3113
11. Sierra Health Foundation
1321 Garden Highway
Sacramento, CA 95833
Contact: Lisa Chesin
Phone: (916) 922-4755
12. California HealthCare Foundation
21555 Oxnard Street
Woodland Hills, CA 91367
Contact: Mariano Diaz
Phone: (818) 703-2872
13. State of California, Department of Transportation
Division of Traffic Operations
Office of Transportation Demand Management
P.O. Box 942874, Mail Station 80
Sacramento, CA 94274-0001
Contact: Michael Seaman
14. The James Irvine Foundation
Spear Tower, Suite 1715
San Francisco, CA 94105
Phone: (415) 777-2244
15. The California Wellness Foundation
6320 Canoga Avenue, Suite 1700
Woodland Hills, CA 91367
Phone: (818) 593-6600
The California Telehealth/Telemedicine Coordination Project
is being managed by the
California Health Collaborative
For Information ContactCalifornia Health Collaborative