February 1, 2011
Attendees (phone and in-person):
- Mary Ring, Illinois Critical Access Hospital Network
- Kay Berdusis, Children's Memorial Hospital
- Mark Chudzinski, Office of Health Information Technology (OHIT)
- Sandy Anton, Iowa Foundation for Medical Care (IFMC-IL)
- Walter Rosenberg, Rush University Medical Center
- Mary McGinnis, OHIT
- Wes Valdes, OHIT/UIC
- Amy Tenagapalous, Joint Commission on Accreditation of Healthcare Organizations
- Judy Storfjell, UIC College of Nursing
- Deborah Seale, Community Member
- Julie Bonello, Access Community Health
- Laura Zaremba, OHIT
- Kathy Webster, Loyola University Medical Center
- Saroni Lasker, OHIT
Wes Valdez opened the meeting with roll call. The last Telehealth Work Group meeting was held in November 2010, because OHIT was working with the ONC to revise, and resubmit the Strategic and Operational Plan (SOP). Laura Zaremba explained the SOP was approved on December 21, 2010, and the main modification was the addition of the Direct Project that would establish a provider directory and Health Information Service Provider. Any eligible professionals or hospitals that do not have an option for secure exchange of data can use the Direct Project to meet one of the criteria for Stage 1 Meaningful Use.
Wes explained that the Work Group will focus its efforts on addressing Meaningful Use and state-specific issues for Telehealth. The Work Group will be reviewing issues such as credentialing, regulations, and study best practices and lessons learned from other states. This review and discussion will enable the Work Group to make recommendations to the HIE Authority Board.
Wes also mentioned that Sunil Hazaray was a Board member, who created the Illinois Members Forum (Forum) within the American Telemedicine Association. The Forum is designed to gather feedback, comments, and questions from Association members. Sunil is working on expanding the Forum feedback mechanism to the members of the public. Wes then opened the discussion for general comments and concerns.
Julie Bonello raised some questions about how to manage workflow, and documentation, for telehealth referrals. Kay Berdusis responded that, based on her experience, the documentation requirements for telehealth referrals are similar to those for hospital referrals. Hospitals generally capture the same information on requisition, including the face sheet of the patient record, the physician's contact information, etc. The referral then needs to have a documented approval in the electronic health record system, in order to extract the authorized information. When these steps are completed the contractual requirements between the provider site, and the site with the provider service, can be met.
Kathy Webster added some additional clarification regarding the workflow question. One way to look at it is - the "hub" provider is traveling to the "spoke" site. The "hub" maintains the patient record and the physician must be credentialed and privileged to provider care at both the "hub" and the "spoke" locations. Documentation in the patient record must occur at the site where the patient is physically located. Another issue that arises, is the process of physician credentialing and hospitals privileging. Depending on the number of referrals, physician credentialing can be a complex process.
Kay asked what happens when there is no relationship with the other provider, to which Deb Seale replied, "There is a process that needs to be followed." A physician must go through the local facility's credentialing process by completing the proper documents and submitting them to the internal review and approval process. This can be a cumbersome process, because there is not a standardized credentialing and hospital privileging process. Wes added the delay in waiting for the next committee meeting, and checking references, makes the process inefficient.
Laura asked if a robust provider directory would alleviate the situation. Wes replied that the provider directory would make it easier to keep all the pertinent information in one place. The data elements in the provider directory will make things easier and more efficient. Mark Chudzinski added that credentialing, and a provider data center, would make sense in a businesses and patient/payers' aspect. This will, however, involve inter-governmental agencies verifying credentials. The group went on to discuss how things, like valid licensing and accredited medical schools, can be verified, but other factors may be more difficult to verify. This will apply to all licensed providers including, but not limited to, nurses, dentists, pharmacists, and other specialties.
The group went on to discuss how the Medicaid Reform Bill will affect Telehealth. The reform bills' goal is to increase the percentage of medical assistance enrollees in managed and/or coordinated care organizations to 50 %. This strategy will significantly improve care coordination, and will incorporate the risk-based model by 2015. This discussion led the work group to identify other concerns and challenges for the existing Telehealth rules:
- The exclusion of nursing homes and home healthcare
- Federal Register is limited to hospital-to-hospital transactions only
- Rural area requirements
- Ambiguity of storing and forwarding applications. The group agreed that it is best to see where other states line up on this issu, and where they do not.
- Mental health requirement for two licensed professionals to be present during a patient interview. Having two professionals is a burden for the site, restricts good communications with the patient, and hinders patient privacy.
With all the concerns listed, the group agreed to proceed by first internally listing concerns and questions, then taking external concerns and questions, then submitting these concerns to Healthcare and Family Services.
Wes introduced the idea of mandating Telehealth coverage in Illinois, similar to the way other states have done. Although this is a complex task that requires new legislation, there are precedents and advantages to this approach. Kathy added there are many resources from the twelve other states that have done this, and that mandating Telehealth also brings in third-party payers. Mark said that if mandating Telehealth is in consideration, there is a proper timeline of events that need to take place. The legislative process needs to be aligned in the December and January timeframe. The group would have to draft the legislation, find a sponsor, and submit to the appropriate committees, in order to have a December 2011/January 2012 consideration.
Wes asked if there were any additional comments. There were no additional comments from the group or the public. The next meeting will be held March 1, 2011, from 10 - 11 a.m.