MTN Overview (printable overview FY '09)

The Missouri Telehealth Network exists to enhance access to care to underserved areas of Missouri, to provide educational opportunities for health care providers, to further homeland security efforts related to disaster preparedness, to be available in the event of a disaster and to provide research opportunities to clinicians wanting to study via telehealth.

MTN has a 2 gigabit (2G) backbone infrastructure on the MOREnet network.  This is a robust, reliable and secure network.  This network connects to the Internet via a high-speed intrastate network consisting of six major circuits connecting several major population centers in the state.  The six major circuits form the network backbone, which functions like an interstate highway.  All MTN sites use the backbone to connect to each other. 

Missouri Telehealth Network began in 1994 as one of the nation's first public-private partnerships in telehealth. A ten site network was initially developed with federal support coming from the Health Resource and Services Administration's Office of Rural Health Policy and private support coming from telecommunication companies, as well as each telehealth site. Today, the Missouri Telehealth Network has over 175 endpoints in 51 Missouri counties. In 2010 this number will be 200 endpoints in 56 counties. The network is funded with federal, state and institutional dollars. This continues to include financial support from Missouri Telehealth Network sites.

The Missouri Telehealth Network has provided services in many different medical specialties, with a majority of the work coming from radiology, mental health, dermatology and cardiology. To date, more than 29,900 interactive video encounters and over 124,000 teleradiology exams have been conducted by current network participants.  This usage brings specialized care to underserved, rural areas of Missouri in a manner that is convenient to both patient and provider. In fiscal year 2010 over 60 medical professionals in 31 specialties conducted over 6,900 encounters via video on the Missouri Telehealth Network.

The Missouri Telehealth Network has the experience and expertise to train start up telemedicine programs in all crucial areas: clinical, technical, operational, legal and regulatory, manage existing and new sites, and increase access to heath care via telehealth services for rural Missourians.  Currently Missouri Telehealth Network oversees the entire network which consists of hospitals, Federally Qualified Health Centers, Community Mental Health Centers, a State Habilitation Center, Critical Access Hospitals, Community Hospitals, Rural Health Clinics and a host of other types of health care facilities. 

Besides training start up telemedicine programs MTN also has experience in the following areas:

• providing technical assistance to other telehealth networks;
• business and strategic planning;
• evaluation of satisfaction, cost analysis, concordance in diagnosis and treatment of various telehealth modalities;
• telehealth policy activities;
• educational outreach; and
• information dissemination

The Missouri Telehealth Network as a leader of telehealth medicine

As an existing and well-established telehealth network, the Missouri Telehealth Network currently assists other organizations requesting information regarding telehealth.  Another vital component of the success of Missouri Telehealth Network is the integration of telehealth activities into the clinical and educational processes of the organization.  Missouri Telehealth Network staff work diligently to integrate telehealth into the clinical processes at the University of Missouri Health Care.  Telehealth must mirror how care is provided face-to-face in order to be successful in a clinic setting.  This is accomplished at Missouri Telehealth Network by customizing the billing and scheduling software and working closely with various departments including Integrated Technology Services, University Physicians, Patient Accounts and clinical specialty staff to integrate telehealth into these existing systems.  This is especially important in training and advising other networks or new telehealth programs who are trying to accomplish this goal.  The processes developed and implemented by Missouri Telehealth Network can and are being replicated by other telehealth networks.    

Impact of Telehealth

Telehealth Saves Missourians Time & Money
Data from payor sources was collected to reveal that utilization of telehealth saved Missourians significant travel time and dollars. In FY2008, nearly 3,000 round trips from rural areas of Missouri to specialists' clinics in Columbia and Kirksville were avoided resulting in saved fuel costs of over $300,000. The average savings per trip was $116. (These calculations use the federal mileage reimbursement rate of 58.5¢ per mile) Over 575,000 miles of travel were avoided because of the availability of telehealth to these rural communities.

In FY2009 these numbers increased dramatically. There were 4,106 patient encounters completed at MTN's 53 clinical sites, saving 1,008,510 miles round-trip in patient travel. MTN patient cost savings in FY2009 was $554,680. In FY2010 a total of 6,703 trips were avoided totalling 245,608 miles with cost savings of $662,285.

Continuing Medical Education
Satisfaction data was collected on Continuing Medical Education (CME) activities that were viewed utilizing the telehealth equipment. During FY2008, 91 CME activities were broadcast out to 214 professionals, ranging from Physicians and Nurse Practitioners to Community Support Specialists and School Counselors. In FY2009, the number of professionals increased to 312. During FY2010, 276 CME activities were broadcast via telehealth to over 800 professionals, ranging from physicians and nurse practitioners to community support specialists, chaplains, social workers and public health staff. The chart below represents the satisfaction of the professionals who utilized the telehealth equipment to participate in the CME activities.

Missouri Habilitation Center
In 2004, MTN placed equipment at the Marshall Habilitation Center (MHC) in Marshall, Missouri.  MHC is a long term residential facility, located on 388 acres in Marshall and it is operated by the Missouri Department of Mental Health.  MHC has slightly fewer than 400 residents, who are severely and permanently disabled.

The addition of MHC to the network was started in an effort to reduce the costs associated with transporting patients from MHC to the University of Missouri Health Care, but more importantly it was started as a mechanism to improve access to care.

It is estimated that each transport to MU from MHC costs the state funded MHC more than $500 per patient. Equipment was placed at MHC in 2004, and through July 2007, 582 trips have been avoided, resulting in approximately $60,000 annual savings to Missouri taxpayers. In FY2008 the result was $61,000 and in FY2009 it was $68,000 surpassing the projected annual savings to taxpayers. Savings are significant, but equally important is the improved quality of care as a result of the direct contact between the physician and the patient's care providers at the time of the visit. Similar potential for savings exists at other state funded sites.

Phelps Regional Home Care
In late 2004 the University of Missouri Health Care, the Missouri Telehealth Network and Phelps Regional Home Care (PRHC) in Rolla, Missouri began collaborating on a residential telehealth program to meet the needs of those living at home with a chronic disease.  Patient monitoring equipment is placed in select homes and patients are monitored on a daily basis by having their blood pressure, pulse oxygen saturation rate, weight, etc., sent to PRHC.  That information is stored in a central database at PRHC.  Alerts are generated to the PRHC staff whenever a patient’s vital sign values are outside of the norm and a call to the patient’s home is then generated.

Narrative: This study evaluated the impact of remote monitoring on clinical outcomes and health care costs for patients with chronic disease. The telehomecare equipment used was specifically designed for remote home monitoring without video conferencing. Outcome data regarding unscheduled visits and hospitalizations, provider activities, and costs were analyzed. Home health staff selected clients for remote monitoring who they felt would benefit, otherwise groups were randomized to each group. Descriptive statistics were used to analyze demographics, diagnosis, and utilization of services, provider activity, and costs between the intervention and control groups of clients. Demographics of the two groups were similar other than diagnoses of surgery aftercare (43% v 27%) and infection (19% v 4%), which were more frequent in non-telehealth clients; diagnoses of congestive heart failure (38% v 19 %) and COPD (15% v 2%) were more common in the telehomecare group. Quantitative data from this study (see table) suggest that remote telehealth monitoring is cost effective, reduces hospitalization, and decreases total service expense.

 Variable                              Remote Monitoring          No Remote Monitoring
(*p=.028)
(† Equipment costs included=$20,300)

Funding Source:  Office of Rural Health Programs, Missouri Telehealth                                        Resource Center University of Missouri-Columbia

N = 39 tele-monitored, 47 non-monitored

Network Description

Sites:  The Missouri Telehealth Network uses a semi private network using the Internet Protocol (IP) to deliver two way interactive audio and video for clinical encounters, and data transfer for teleradiology and other store and forward services.

• 18 Community Mental Health Centers
• 2 Mental Health Hospitals
• 27 Federally Qualified Health Care Centers
• 2 Urgent Care Clinics
• 10 Critical Access Hospitals
• 40 Hospitals
• 23 Rural Health Clinics
• 14 Specialty Medical Clinics
• 1 Home Health Agency
• 2 Rehabilitation Hospitals
• 1 Outpatient Cancer Center
• 1 Army Hospital
• 2 Nursing Home
• 1 State Habilitation Center
• 2 Schools of Medicine
• 1 School of Nursing
• 1 School of Health Professions

Telecommunications:  The Missouri Telehealth Network uses T1 (Frame Relay) connections to each site. These connections provide dynamic bandwidth allocation for voice, video and data. MTN sites have the flexibility to call any other MTN site directly in this configuration.

Services:  On average, MTN currently provides the following services per month:

• 340 Interactive Telehealth Encounters
• 720 Teleradiology Exams
  

Clinical Specialties:  Adolescent Specialties (eating disorders), Autism Clinic, Burn Clinic, Child Health, Children with Special Needs, Dermatology, Endocrinology, Genetics Follow-up, Geriatric Consultations, Hip & Knee, Internal Medicine, Neurology, Orthopaedics, Physical Medicine & Rehabilitation, Psychiatry, Radiology, Rheumatology, Spine, and Surgical Follow-up.

Network Partners

Below is a list of MTN partners in Missouri. Each organization has played an integral part in the development of the network.

MOREnet - MOREnet provides the network backbone for MTN and with their next generation network will provide MTN with a 2 gigabit dedicated healthcare backbone for MTN.

Federal Communications Commissions - MTN is the recipient of the Rural Health Care Telehealth Pilot Program that discounts expansion costs.

Missouri Department of Social Services - DSS has a Rural Health Clinic Telehealth Pilot that will add 25 rural clinics to the network.

Missouri Department of Health and Senior Services - Partner since 2004 for bioterrorism preparedness and response.

Missouri Department of Mental Health - Funding DMH sites to save taxpayers money on patient transportation. DMH has telehealth in two facilities currently (Marshall Habilitation Center and Fulton State Hospital).

Missouri Hospital Association - Partner and liaison for 40 hospital telehealth sites.

Missouri Primary Care Association - Partner & liaison for 27 Federally Qualified Health Care Centers.

Missouri Telehealth Roundtable - a recently formed group of stakeholders from around the state interested in furthering the use of telehealth in Missouri.

Language Access Metro Project & Missouri Foundation for Health - MTN has partnered with LAMP and MFH to provide free video interpretative services in 32 languages to all telehealth sites for two years.