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The State of Telemedicine and Telehealth in Texas

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The State of Telemedicine and Telehealth in Texas The State of TeleMedicine and TeleHealth in Texas A Special Report of the Texas Statewide Health Coordinating Council and Recommendations for Ensuring a Strong Telemedicine/Telehealth System in Texas Texas Statewide Health Coordinating Council A Collaborative Effort With the Texas State Telemedicine/Telehealth Workgroup Statement of the Chairman In the 2001-2002 Texas State Health Plan Update, the Statewide Health Coordinating Council (SHCC) briefly examined the potential impact of telemedicine and telehealth (TMTH) in addressing the maldistribution of health professionals and improving access to health care in medically underserved areas in Texas. However, on November 9, 2000, at the request of numerous stakeholders from within the TMTH community, the SHCC convened the first of four TMTH stakeholder workgroup meetings to discuss the current efforts and future opportunities for collaboration on TMTH. Fourteen months, numerous meetings, and thousands of work hours later, the SHCC presents the final product of this process. The State of Telemedicine and Telehealth in Texas: A Special Report of the Texas Statewide Health Coordinating Council and Recommendations for Ensuring a Strong Telemedicine/Telehealth System in Texas represents the combined efforts of over 100 experts and stakeholders in the field of TMTH. The SHCC has reviewed the work of this group and believes that the resulting report and its recommendations provide an important first step in improving the health of all Texans through the rapidly expanding, ever evolving TMTH technologies. Additionally, the SHCC believes that the report will provide a sound basis for state policy makers as they approach future decisions. The SHCC recognizes that these expanding technologies offer new portals for access to and delivery of medical care and provide powerful tools for health care professionals. However, the SHCC would emphasize that the technology provides a tool to enhance the care delivered to patients, rather than being an end in itself. Without a quality health care workforce in place, especially in urban and rural medically underserved areas, all the potential benefits of advanced technology will be for naught. Access to quality health care providers must remain the primary focus of health workforce planners and decision makers. The SHCC would like to recognize and express sincere appreciation for the hard work and commitment that each member of the TMTH workgroup brought to this project. Their service was invaluable. i Next, I would personally like to thank each of the members of the SHCC TMTH Committee, who remained dedicated and diligent throughout the lengthy process. Without their hard work, this special report would not be a reality. And finally, we want to give special recognition to the staff from the Texas Department of Health, Office of Strategic Health Planning. These individuals remained committed and enthusiastic throughout the project and we sincerely appreciate their contribution. The SHCC looks forward to working with the Legislature and with state and community leaders to ensure a quality of health care for all Texans. We believe that Texas is on the right track in preparing our state and its people for a future in which every individual is informed, is productive, and enjoys equal and full access to quality health care and optimal health status. ______________________ Ben G. Raimer, M.D., Chairman Texas Statewide Health Coordinating Council The State of Telemedicine and Telehealth in Texas ii STATEWIDE HEALTH COORDINATING COUNCIL A VISION We envision a Texas in which all are able to achieve their maximum health potential - A Texas in which: * Prevention and education are the primary approaches for achieving optimal health. * All have equal access to quality health care. * Local communities are empowered to plan and direct interventions that have the greatest impact on the health of all. * We, and future generations, are healthy, productive and able to make informed decisions. A Healthy Texas is a Productive Texas iii The State of Telemedicine and Telehealth in Texas iv Texas Statewide Health Coordinating Council February 2002 Name/City Representing Officers: Ben G. Raimer, M.D. University Representative Chair, Galveston James A. Endicott, Jr. * Public Member 1st Vice Chair, Harker Heights David A. Valdez, M.D. * HMO Representative 2nd Vice Chair, San Antonio Susan M. Scott-Galindo, M.Ed. Health Care Professional CCC/SLP Secretary, Bryan Laura Prendergast Gordon Public Member Parliamentarian, El Paso Members: Joan Wood Biggerstaff * Public Member Plano Adena Williams Loston, Ph.D. Community College Houston Representative Vacant Hospital Representative Charles T. Ku, D.D.S. Health Care Professional Lewisville * Members of the SHCC Telemedicine Telehealth Committee v Members (Continued): Name/City Representing Rebecca Uribe-Garza, M.D. Health Care Professional Laredo Judy Petty Wolf University Representative San Antonio P. J. Wright * Public Member Spring Branch/San Antonio Stacey Silverman Texas Higher Education Austin Coordinating Board James L. Smith * Texas Department of Mental Austin Health & Mental Retardation Jacinto P. Juarez, Ph.D * Texas Health Care Information Laredo Council Mark Guidry, M.D. Texas Department of Health Houston Nora Cox Taylor Texas Health & Human Austin Services Commission The State of Telemedicine and Telehealth in Texas vi Staff Supporting the Statewide Health Coordinating Council Office of Strategic Health Planning Texas Department of Health Director of Strategic Planning Rick Danko, Dr.P.H. Director, Health Professions Resource Center Bruce Gunn, Ph.D. Project Director Connie Turney, B.S., L.N.F.A. Nicholas Hoover, M.P.Aff. Renato Espinoza, Ph.D., M.P.H. B. Dennis Finuf, M.P. Admin Trish Taylor Anjum Khurshid, M.P.Aff. (Student Intern) Aditya Paul (Student Intern) Editorial Assistance: Wendy Francik, M.A. Gyl Kovalik, M.P.Aff. Jessica Marien, M.P.H. Mario R. Anzaldua, M.D. Eduardo Sanchez, M.D. Chair, Texas Board of Health Commissioner of Health This publication is issued by the Texas Department of Health for the Statewide Health Coordinating Council under the authority of Chapter 104, Health and Safety Code, and is financed by public funds appropriated by the Texas Legislature. This agency is committed to providing its programs, services, and employment opportunities in a nondiscriminatory manner. vii The State of Telemedicine and Telehealth in Texas viii Table of Contents Executive Summary ............................................................................................................................ 1 Section I: Background ...................................................................................................................... 11 Section II: Current Status of Telemedicine/Telehealth in Texas.................................................. 25 Section III: Maldistribution of Health Professionals through Telemedicine/Telehealth........... 45 Section IV: Licensing and Scope of Practice ................................................................................. 53 Section V: Infrastructure ................................................................................................................ 63 Section VI: Training and Technical Assistance ............................................................................. 85 Section VII: Telemedicine/Telehealth Reimbursement Issues ...................................................... 99 Section VIII: Project Planning and Accountability .................................................................... 113 Section IX: Privacy and Security ................................................................................................. 121 Section X: Future Trends and Recommendations ...................................................................... 141 Appendix I-A: Telemedicine Legislation - 77th Legislature ..................................................... 151 Appendix II-A: Survey Instruments ............................................................................................ 157 Appendix II-B: List of TIFB Public Health Grantees ................................................................ 165 Appendix II-C: TMTH Projects Contacted for SHCC Survey ................................................. 171 Appendix II-D: Summary of Survey Responses ......................................................................... 183 Appendix II-E: Explanation of TIFB Public Health Grant Types ............................................ 261 Appendix IV-A: Licensing and Scope of Practice Survey and Responses................................ 265 Appendix V-A: Telemedicine Infrastructure Basics ................................................................... 277 Appendix V-B: Senate 789 Draft Minimum Standards.............................................................. 287 Appendix VI-A & B: Proposed Curriulum Training and National Websites .......................... 299 Appendix VII-A: Medicaid Telemedicine Reimbursement by State ......................................... 305 Appendix X-A: Response to Public Comments........................................................................... 311 Appendix X-B: Public Comments ................................................................................................ 323 ix List of Tables and Figures Figure I-1: Definitions ..................................................................................................................... 14 Table I-1: State Agency
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