Telehealth

Authorizing Legislation: Section 330I of the Public Health Service Act; as amended by Public Law 107-251, and 330L of the Public Health Service Act; as amended by Public Law 108-163.

Program Description and Accomplishments
Telehealth is the use of electronic information and telecommunications technologies to support clinical health care, patient and professional health-related education, public health, and health administration. Telemedicine, a subset of telehealth technologies is defined as the use of telecommunications and information technologies to provide or support long-distance clinical care. Telemedicine and other telehealth technologies are not things or ends in themselves, but the means to provide services at a distance. Information may be in various forms -- audio, video, data, or text.

In FY 2006, Congress expanded HRSA’s telehealth programs beyond its Telehealth Network Grant Program (TNGP) that provides grants to health care networks to develop and evaluate the use of Telehealth technologies to improve access to underserved communities. The new funding allowed HRSA to add grants for: (a) pilot projects examining the cost impact and value added of tele-home care and tele-monitoring services (Telehealth Networks-Telehomecare); (b) telehealth resource centers to improve technical assistance to communities wishing to establish telehealth services (Telehealth Resource Center Grant Program); and (c) demonstrations to provide incentives for licensure coordination among states (Licensure Portability Grant Program). At the end of FY 2006, 24 three-year grants were awarded as follows: sixteen (16) grants for telehealth networks and telehomecare networks, six (6) Telehealth Resource Center grants, and two (2) grants to improve licensure coordination among states. In FY 2007, funds were appropriated to support continuation of these grants for their second year.

A Program Assessment Rating Tool (PART) review of the Telehealth Network Grant Program (TNGP) was conducted in 2006. The program received a rating of “Moderately Effective”, being cited for its success in expanding access to services in underserved rural communities. The assessment noted however that the impact on clinical outcomes is unknown. The Office of Telehealth has developed new annual performance measures and is tracking performance against benchmarks. The program has started collecting data on a new long-term measure to assess the program’s impact on clinical outcomes in diabetic patients served by the grantees of the TNGP program, targeting control of hemoglobin A1C levels in patients. As of August of 2007, TNGP grantees used telehealth technologies to provide 39 different types of clinical services, representing a total number of 150 clinical services, across 339 sites in underserved rural communities for a total of 489 sites and services. For the baseline reporting period (FY 2005 funding), 101 communities had access to Pediatric and 72 had access to Adult Mental Health services that otherwise would not have had access in the absence of the Telehealth grant. Data for FY 2006 and FY 2007 are anticipated to be available in March 2008 and March 2009, respectively, as grantees complete their activities for those funding years. These data will be cumulative.

HRSA’s Office for the Advancement of Telehealth (OAT) has started collecting data on a new long-term care measure to assess the program’s impact on clinical outcomes in diabetic patients served by the grantees of the TNGP program, targeting control of hemoglobin A1C levels in patients. For the majority of TNGP grantees, OAT continues to track performance against benchmarks mental health services, expansion of sites and services, and sustainability.

To evaluate the performance of its tele-homecare/monitoring grantees, OAT has developed common metrics and data analysis strategies, based on data routinely collected through the OASIS system, which is a nationally recognized standardized data collection system of performance measures. The measures focus on the impact of these grants on the cost and effectiveness of the services provided. Common metrics have been agreed upon and a draft data analysis plan has been implemented. Data are being collected and aggregated from all the programs, with a report of the findings available at the end of the 3-year grant cycle.

HRSA is also tracking performance of the Licensure Portability Grant Program (LPGP) grantees. In FY 2006, the Federation of State Medical Boards (FSMB) was awarded a 3-year grant to reduce the legal and administrative barriers to states sharing licensure information. In its first year, FSMB established pilot projects in two regions of the country to develop and maintain a centralized interactive data management system. FSMB also compiled state profiles of the technical capabilities to electronically share licensure data for each of the 14 states in the pilot regions, as well as a policy analysis of each to determine legislative and regulatory barriers to sharing data. A comprehensive policy review of the 9 states that have specific telemedicine licenses/registration programs also has been completed.

The National Council of State Boards of Nursing (NCSBN) was awarded the second LPGP grant to identify and implement enhancements to its current program for cross-state recognition of licenses for nurses -- the Nurse Licensure Compact (NLC) and to support states that are in the process of or considering adoption of the NLC. In the first year, NCSBN developed a cost analysis tool as a reference tool for States to address misconceptions regarding the cost of adoption of the NLC. To date, 23 states have implemented a NLC. A summit of all nurse state licensing boards was held to clearly identify the barriers to further expansion of the NLC and selected states received funds to improve their criminal background check systems, a significant barrier to states implementing the NLC.

In FY 2006, six grants were awarded under the Telehealth Resource Center (TRC) grant program. During their first year, TRC’s provided individualized technical assistance to groups developing Telehealth services and have created web based tools to provide technical assistance in the 24 states that they cover, including US-Affiliated Pacific Islands.

Funding includes costs associated with grant reviews, processing of grants through the Grants Administration Tracking and Evaluation System (GATES) and HRSA’s electronic handbook, and follow-up performance reviews.

Funding History

Budget Request
The FY 2009 Budget Request will facilitate a competition for a new 3-year cycle of these grants at the FY 2007 level of activity. The FY 2009 Budget Request is $6,819,000, an increase above the FY 2008 Enacted. The funds requested will allow a new competition of the current Telehealth Network Grant Program that supports consortia of health providers to deploy telehealth technologies that: (a) provide access to, coordinate, and improve the quality of health care services; (b) improve the training of health care providers; (c) improve the quality of health information available to health care providers, patients, and their families; and (d) evaluate the impact of tele-home care and tele-monitoring services.

For 2009, HRSA has established a number of performance targets for this program:

a) Increasing the proportion of diabetic patients enrolled in a telehealth diabetes case management program that have achieved ideal glycemic control to 14.5% from a baseline of 10%;

b) Expanding the number of telehealth services (e.g., dermatology, cardiology) and the number of sites where services are available as a result of the TNGP program to 1,371 from 968 in 2008;

c) Increasing the number of communities that have access to pediatric and adolescent, and adult mental health services where access did not exist in the community prior to the TNGP grant as a result of the TNGP program to 207 for pediatric and 175 for adult mental health services; and

d) Expanding the number of services and/or sites that provide access to health care as a result of the TNGP program per federal program dollar expended to 106 per million federal dollars expended.

These funds will also support a new competition for licensure portability grants that will allow:
(a) states to implement their plans for reducing the barriers to cross state practice, and (2) HRSA to expand licensure portability throughout the United States and evaluate lessons learned from these grants. The funds will also support a new competition for the Telehealth Resource Center Grant Program, which will allow the establishment of additional centers of excellence in under served areas not presently served with the resource centers funded in the 2006 - 2008, three -year grant cycle. This funding will further allow HRSA to evaluate the effectiveness of providing technical assistance and outreach services through these additional regional centers. More specifically, the funds will support 3 grant programs: 1) The Telehealth Network Grant Program (including grants to specifically examine the cost-effectiveness of telehomecare and telemonitoring services) – $3,932,000; 2) The Telehealth Resource Center Grant Program – $1,800,000; and 3) The Licensure Portability Grant Program – $700,000, as well as associated evaluation activities. The remainder of FY 2009 appropriated funds ($387,000) will support: (a) the mandatory administrative costs of the grant competition, (2) evaluation of the progress of these grants, and (3) other purposes to fulfill the objectives of the telehealth programs, including specialized technical assistance for grantees that is unavailable from the resource centers, and implementation of a uniform, electronic performance assessment system that is consistent with the Department's evolving Information Technology requirements.