Host: Office of Telemedicine, Virginia Commonwealth University, Richmond, Virginia
Moderator: Cynthia Barrigan, RN, MPH, President/CEO, Telehealth Strategies, LLC, Centreville, VA
Attending: Dr. Vladimir Lavrentyev, Virginia Commonwealth University; Gene Sullivan, University of Virginia Health System
Attending Remotely: Jean-Pierre Auffret, George Mason University; Howard Chapman, Southwest Virginia Community Health Systems, Inc; Michael King, Northrop Grumman; Ted Kummer, Virginia College of Osteopathic Medicine; Goodlett McDaniel, Associate Dean, Finance, Marketing, Practice Development, George Mason University; Dr. Karen Rheuban, University of Virginia Health System; Chris Riha, Carilion Health System; Dr. Dixie Tooke-Rawlins, Dean, Virginia College of Osteopathic Medicine; Dr. Jan Willcox, Virginia College of Osteopathic Medicine; Kathy Wibberly, Virginia Department of Health; Jane Woods, Driftwood Consulting.
Total Attending: 14
New Members since last meeting: 4
Meeting was convened at 1:00pm EST with a roll call and review of the agenda. The general purpose of the working group was also presented for new members.
Thirteen separate hand-outs were sent as read-aheads for the meeting which consisted of: 1) 10 GIS maps depicting different state-wide views of the location of Community Health Centers and Rural Hospitals and their relationships to Primary Care, Dental and Mental Health HPSAs, Dermatology Specialty Shortage Areas, Poverty Levels etc.; 2) a Powerpoint slide showing a high level short-term project plan for VTN; and 3) a Powerpoint Presentation of the Rural Health Pilot program given at the ATA’s Industry Advisory Board Meeting December 2006 by the FCC and 4) a revised OWG Charter.
Moderator Cynthia Barrigan, TeleHealth Strategies, advised that she was awarded a contract by VDH on a part-time basis to formally lead VTN efforts. She indicated that this reflected VDH’s commitment to moving VTN forward.
Ms. Barrigan began the discussions by indicating that the FCC topic would be moved from the last agenda item to the first agenda item given certain participants were there to aid in that part of the discussion and had to depart early, and because there was much in the way of “breaking news” for the group on this topic.
The following are highlights of the FCC discussion which lasted for approximately one hour.
Ms Barrigan presented information she received from Bill England at the FCC regarding whether or not a portion of the Commonwealth’s $240M Network Transformation investment could meet the 15% match requirement for the RHC pilot program.
The previous week, Northrop Grumman (NG) had contacted Kathy Wibberly at the urging of the Secretary of Technology (Chopra) to coordinate network development efforts. NG presented information on their $240M 10- year contract with VITA (awarded in 2006), and plans to upgrade the core network infrastructure to an MPLS network in 2007. The idea was that the $20M allotted for this particular portion of the enhancement to the core network—a vital link for VTN users--could be leveraged to meet the match requirements for the RHC Pilot Program.
Bill England interpreted the FCC guidance in relation to the question concerning the match. He indicated that he did NOT believe the $20M could be applied towards the 15% match for the following reasons:
The NG contract “pre-dates” the FCC order. Therefore, those funds/plans were not allocated with the rural health pilot in mind.
The match would need to be “cash” and “new money” meaning that funds would need to be applied AFTER the upload of FCC Forms which follows at some period after the announcement of selected applicants.
Mr. England said that the NG effort was an important part of the VTN story and would strengthen the overall proposal.
Dr. Karen Rheuban reported speaking with the Secretary Chopra (at his request) earlier today about a range of issues, one of which was the FCC pilot. Dr. Rheuban said UVA received “marching orders” to partner with Northrop Grumman, Accenture, IBM, etc. Apparently, Virginia had lost other proposal efforts in the past due to a lack of collaboration. She reported to him that VTN had been in discussions with NG. He was very pleased.
Based on Ms. Barrigan’s feedback, the group discussed various strategies for meeting the match requirements. Several ideas were put forward; approach the legislature and try to amend language; explore Tobacco monies; try to apply annual operating costs to the match; explore ARC; try to apply Universal Services monies (question as to whether USF is federal or “consumer” funds) etc.
The issue regarding the fact that all proposals will be placed on the FCC website was a concern in terms of the risk of exposing any proprietary information and/or strategy to other entities.
There has been no known response to the National LambdaRail petition by the FCC.
Mr. King suggested that the VTN contact Lem Stuart, Virginia CIO for general coordination, and Steve Marzolf, VITA Voice Services Group, for info on E911.
Overall, the group expressed frustration regarding the FCC pilot in terms of its requirements, timeline and ambiguity, and felt that it would be helpful to raise our concerns with Secretary Chopra, Congressman Boucher and others. Dr. Rheuban agreed to schedule a follow-up meeting with Secretary Chopra to report back on the latest development regarding our inability to leverage any portion of the $20M from the NG contract and to seek guidance on other possible strategies to meet the match requirement and strengthen our overall ability to respond.
Ms. Barrigan proceeded with the next agenda item---exploring the “fit” for VTN with the existing health system.
Ms. Barrigan presented a wide array of GIS maps to illustrate to the group the data that VDH collects, and how it can be leveraged to get different views of health care needs. This type of information will be used in the coming weeks to identify and prioritize areas which could benefit from telehealth.
In follow-up to the previous OWG meeting concerning the desire to link VTN strategies with existing health initiatives the following was discussed;
Ms Barrigan reported back that efforts are still underway to explore the Healthy Virginians Initiative. She indicated that this program is divided into three separate programs: 1) Healthy Families- focused on Medicaid Beneficiaries, 2) School Health and 3) Employee Health. Each of these focus areas have separate coordinators under different government organizations. Further efforts will need to be made to fully understand where each of these programs is headed.
Mr. Chapman described the Health Disparities Collaborative and talked about Southwest’s involvement in this activity and ways he envisioned telehealth supporting the CHCS in obtaining the goals and objectives of this initiative. Specifically, he mentioned the value of health education and access to nutritionists and others than can support chronic disease management. http://www.healthdisparities.net/hdc/html/home.aspxDr. Rawlins expressed VCOM’s interest in addressing clinical guidelines. VCOM is very active in distance learning and in July will be education sessions for patient groups at remote hospital sites.
Ms. Barrigan highlighted opportunities to network with CHCs at the upcoming VPCA conference 21 Feb in Richmond, and the National Association of CHCs held 15-21 March in Washington, DC.
The meeting continued with a focus on better organizing the activities of the OWG and/or larger VTN over the next 90-120 days.
Ms. Barrigan presented a “Ways and Means” slide which divided high-level VTN tasks into 3 areas: 1) Organizational, 2) Clinical/Business and 3) Technical/Infrastructure. Most of the near-term tasks focus on activities for the Operations and Infra Work Group in preparing for a response to the FCC pilot. In terms of the overall VTN efforts, she discussed activities underway to establish the VTN as a 501C3.
Professor Auffret recommended that VTN put together an abstract, and/or a “package” that describes VTN and outlines potential benefits of telehealth using personas/use cases etc to help health care providers understand VTN’s vision/mission. He also suggested that a project plan be put in place.
Note: VCOM/Ted Kummer relayed additional comments pertaining to this topic via email following the meeting. I have inserted them here for the record. “One idea was to integrate, coordinate and capitalize on the strengths of the major players, state-wide, to reduce reinvention of the wheel and perhaps jump-start the VTN concept. For example, UVA and VCU in clinical telemedicine, UVA, VCU, and VCOM in graduate and continuing medical education, others in other health care services.
Overall, a majority of the meeting focused on the FCC pilot. Therefore, other agenda items were not covered in depth. The following describes what was accomplished and identifies further actions/next steps.
FCC Pilot
Continue to explore the feasibility of VTN responding to the FCC Pilot. UVA remains committed to responding on behalf of the VTN, if the membership so desires. Meetings will be scheduled to further vet the issues with leaders and gain feedback on possible strategies. At this time, it is not readily apparent whether or not VTN will be able to respond. Many are struggling with an approach that meets requirements in the given timeframe. It is also unclear as to whether efforts to apply for the pilot will yield a beneficial gain or simply divert limited resources away from the larger VTN effort. Members remain skeptical regarding working with the FCC due to past experiences with the RHC program.
VTN Planning
Efforts will continue on actions identified in the subsequent meeting and today relative to making progress on defining and understanding the “as is” health system, conducting needs assessments, identifying potential telehealth applications and exploring links to existing health care initiatives.
Specifically at today’s meeting, the need to do more definitional work on VTN, develop a comprehensive project plan, further solidify VTN Strategy and develop educational materials was identified.
Work Group Form and Function
While a revised Charter was provided time did not allow for its review. This will be covered at the next meeting.
Ms. Barrigan closed the meeting indicating that future meetings would be held at locations throughout the state and that she would provide meeting minutes. The group continues to agree to work primarily by email and phone, and hold the next in-person meeting in the coming weeks at a location to be determined.
Meeting adjourned at 2:50 pm EST.
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