History of Telemedicine in Vermont

1960s - 1980s: the beginning

Vermont's experience with two-way interactive videoconferencing began in 1968 with the advent of the INTERACT network. This microwave system linked nine hospitals in Vermont and New Hampshire at its highpoint in the late seventies. This included: the Medical Center Hospital of Vermont in Burlington (now called Fletcher Allen Health Care), Central Vermont Hospital in Berlin, Rockingham Memorial Hospital in Bellows Falls (now defunct), the White River VA Hospital in White River Junction, the St. Albans Correctional Facility, the Brattleboro Retreat, Claremont Hospital in NH, and Dartmouth-Hitchcock Medical Center in Hanover, NH.

Like many programs of its time, when the grant money ran out for the project in about 1980, the subscribing organizations attempted to run it on their own with limited success. The end finally came in 1985. INTERACT joined the other sixteen or so pilot programs in the United States that died when soft money dried up.

1990s: one of the first statewide systems

The next serious effort to establish a telemedicine network began in 1993 when the Director of the Dana Medical Library at the University of Vermont (UVM), and the, Associate Dean of the UVM College of Medicine, established VTMEDNET. VTMEDNET was a text-based statewide system that actually began serious operations in 1995. All providers in the State of the Vermont had access to e-mail, text-based web browsing, MEDLINE searches, and other clinical information.

It was one of the first, if not the first, statewide systems in the country. This was expanded to another attempt at two-way interactive video in 1994 when a small Pathology network was formed linking Rutland Regional Medical Center, Central Vermont Hospital, and Fletcher Allen via T-1 lines with room-based systems. Microscope-mounted video cameras transmitted slide images from the remote pathologist as he moved the microscope stage as directed by the Fletcher Allen consulting physician. Rigorous evaluation indicated very good diagnostic accuracy and physician satisfaction. However these telecom systems were complicated to use and had inadequate reliability.

At the same time, the Media Services department at Fletcher Allen was experimenting with desktop videoconferencing using a single ISDN line. The following year the decision was made to use the triple ISDN (384 kbps) solution and form a network of nine distant hospital sites (different from INTERACT's nine sites) to test out the effectiveness of desktop videoconferencing on a large scale. Fletcher Allen installed a multipoint bridge capable of handling six multipoint or simultaneous video calls. Each external site designated a telemedicine site coordinator who was responsible for arranging their site's teleconsults, coordinating the system’s continuing medical education (CME) for their local staff, and assuring the equipment was in working order. This project put Fletcher Allen at the forefront of telemedicine systems nationwide, and placed Vermont squarely in the future  of this technology.

Honors and recognition

The Fletcher Allen/UVM Telemedicine Program was honored as one of the nation's top telemedicine programs as the first selection in Telemedicine and Telehealth Network magazine's Hall of Fame. This followed selection two years in a row as a Top Ten Telemedicine Program in December 1996, and again in December 1997. Selection was based upon demonstrated organizational support, sustainable funding, provider acceptance, fulfillment of regional needs, and the monitoring of results. In addition, on October 8, 1996, the Fletcher Allen Telemedicine Project was featured on the CBS Evening News with Dan Rather in a special segment by Health Correspondent, Dr. Bob Arnot.

In 1998, Fletcher Allen's Telemedicine Program and the University of Vermont co-sponsored the "Information Connection" in Burlington, a conference that featured multiple specialty presentations and a full day of continuous telemedicine demonstrations from Fletcher Allen as well as a video link to a US Navy vessel patrolling in the Persian Gulf. For the next several years, under the leadership of both the Medical Director of Telemedicine and also the Director of Information Systems for UVM College of Medicine /Telemedicine Operations Director, the Fletcher Allen Telemedicine Program expanded significantly to other area rural hospitals, clinics, and dialysis centers. With federal grant funding it also developed a cutting-edge feasibility project, FAST STAR (Fletcher Allen Specialized Telemedicine for Supporting Transport And Rescue), which tested the use of interactive video from a moving ambulance. This allowed the hospital’s Level 1 Trauma Center specialists to consult with emergency medical technicians and paramedics in a specially equipped ambulance enroute to the hospital. From 1997 through 2005 a series of "How To Build" telemedicine and teletrauma training symposiums  were produced and hosted locally to teach and provide hands-on demonstrations to national and international attendees.

Current - providing training and support

The current Medical Director of Telemedicine and of FAHC’s Division of Consultation Psychiatry and Psychosomatic Medicine, Terry Rabinowitz, M.D.,  designed and implemented the first telepsychiatry service in Vermont. For several years FAHC has provided telepsychiatry consultations to rural nursing home facilities in VT and upstate New York and trained others to do the same. There are established technical connections and videoconferencing equipment at most of VT’s hospitals, some satellite clinics, and many of its Federally Qualified Health Centers.  These connections are used for access to Grand Rounds, tumor boards, distance learning conferences, administrative meetings, employment interviews, etc.

Currently, UVM/Fletcher Allen serves as the clinical partner on the Northeast Telehealth Resource Center (NETRC) grant project, funded by HRSA’s Office for the Advancement of Telehealth (OAT).  NETRC is one of several regional telemedicine centers whose principal mission is to improve access and quality of healthcare by assisting healthcare providers to implement or expand telehealth services to rural and underserved areas and populations throughout New England and New York. 

The project provides technical assistance, training, and support to a range of healthcare entities that provide or will provide telehealth services. NETRC disseminates information and research findings related to telehealth services. The NETRC team provides expert consultation on telemedicine issues such as how to: 

  • Conduct needs assessments
  • Obtain funding
  • Design  and implement protocols
  • Select and use various telehealth technologies
  • Evaluate your program
  • Conduct strategic or business planning
  • Obtain third-party reimbursement for telehealth services
  • Overcome related licensure and credentialing barriers

Reimbursement for Telemedicine in Vermont

In October, 2012 VT Act 107, An Act Relating to Telemedicine, went into effect. This law requires all health insurance plans in VT (including Medicaid and other public health care assistance programs) to provide coverage for health care services provided through live, interactive telemedicine to the same extent that the services would be covered if they were provided in-person at a health care facility.

Due in part to Dr. Rabinowitz’s  expert witness testimony at the Vermont Statehouse, the act also allows health insurance plans, at their discretion, to reimburse health care providers for teledermatology and teleopthalmology services provided by asynchronous (i.e., Store and Forward) means. Furthermore, a health care provider licensed in the state “may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations to a patient after having performed an appropriate examination of the patient either in person or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically.”