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    Document Summary
    - Report Published -

    Report Document No. 28

    Document Title
    Report to the Virginia Department of Health on Improvements Needed in Current Telemedicine Initiatives and Opportunities to Enhance Access and Quality

    George Mason University; Department of Health

    Enabling Authority

    Executive Summary
    Pursuant to 32.1-19.1 of the Code of Virginia (Appendix A), the Virginia Department of Health (VDH) contracted with George Mason University's Center for Health Policy, Research and Ethics to conduct an analysis of federal and state practices related to the management, evaluation and oversight of public Telemedicine/Telehealth (TM/TH) Services in Virginia. This report builds on previous reports of TM/TH services in the Commonwealth and addresses items (iii) and (iv) of the statute:

    (iii) Recommendations regarding improvements needed in current telemedicine initiatives; and (iv) Identification of additional opportunities for use of telemedicine to improve access to quality health care and to health professional education for citizens of the Commonwealth.

    Specifically, this report methodology involved a number of strategies to identify relevant background issues and questions informing telecommunications and telemedicine/telehealth These approaches included: critical reviews of prior TM/TH studies conducted on behalf of the Commonwealth of Virginia since 1996 (*1) and analyses of the literature and influential public policy reports on privacy, liability and evaluation (including cost-effectiveness) pertaining to the authorizing legislation (*2). In addition, we explored current and emerging approaches to the evaluation of TM/TH programs based on available data from other states including legislative and strategic planning efforts. At the request of VDH, this report also includes information on recent national, regional and state efforts to increase public health infrastructure and capacity including telecommunication infrastructure. Specifically, the report highlights core public health functions that serve, in part, as a component of the critical infrastructure in support of the Commonwealth's emergency preparedness response capacity. Indeed, the VDH's central role in ensuring core public health functions through its own infrastructure capacity has been recently expanded, in part, in response to its designation on the Southern Governor's Association (SGA) Telehealth/Homeland Security Task Force. Emerging TM/TH challenges include regionalization of public health and service delivery capacity. Regionalization includes new demands that state departments of health including VDH demonstrate their capacity to rapidly leverage existing public health infrastructure including telecommunication and TM/TH to the extent practicable.

    Currently, state and local collaboration is evolving to secure critical infrastructure -- including TM/TH networking capacity -- as a fundamental component of essential public health services. (*3) Secure networks are vital to the support of public health preparedness (*4) especially in the face of natural and other disasters including potential biological (viruses, bacteria, or their toxins) or chemical (hazardous materials or other agents) attacks. Assuring network capacity is also basic to public health data collection, analysis and reporting that underlie the core public health functions (*5) (assessment, policy development, and assurance).

    Finally, this report discusses legislative initiatives to assure the growth of telemedicine and telehealth services and to assure comprehensive evaluation efforts in Virginia in the future. To this end, the first step towards reframing policy to support a well-developed and accountable TM/TH infrastructure capacity is a comprehensive strategic planning process. In the face of shifts in national policy and public health goals, the planning process should include leadership representation from each state agency and leverage existing systems including the public health infrastructure to ensure efficient, effective access for public health surveillance as well as preventive and primary health care for the citizens of the Commonwealth of Virginia. Building on recommendations from previous Telemedicine reports (under Governors Allen and Gilmore) and based upon state and national trends, recommendations for Virginia moving forward are as follows:

    • Implement a comprehensive and integrated statewide telemedicine/telehealth (TM/TH) infrastructure strategic planning process,

    • Establish and communicate specific authorities and particular roles for state agencies, committees, commissions, and work groups with respect to the:

    * physical infrastructure (existing telecommunications and health care resources within the state) and,

    * functional infrastructure (administrative, bureaucratic, programmatic and political).

    • Establish collaborative systems to ensure interoperability and operations among entities with authority and responsibility to process data and information,

    • Coordinate processes for data and information collection, management, reporting and dissemination using standardized frameworks and tools appropriate to the task for policy and program planning within each agency, and

    • Create a framework for evaluation of future telemedicine/telehealth activities in the Commonwealth using the mechanisms and elements drawn from prior evaluation frameworks described within the current study.
    (*1) See Appendix B. Table Summary of Telemedicine and Telehealth Studies in Virginia 1996-2001.
    (*2) See Appendix A. Authorizing Legislation House Joint Resolution (HJR) 210 of the 1998 Session of the General Assembly.
    (*3) Public Health Functions Steering Committee, http://www.health.gov/phfunctions/public.htm; accessed September 5, 2002.
    (*4) Core Public Health Functions and Department of Health and Human Services (Draft) Strategic Plan Fiscal Years 2003-2008. http://aspe.hhs.govlhhsplan/draft accessed September 4, 2002.
    (*5) Institutes of Medicine, Future of Public Health. National Academy Press, Washington, D.C. p.141-142.