America’s health care “safety net” provides primary care to low-income and uninsured patients through a collection of community clinics, health centers, and hospitals. However, it does not offer access to specialty care; rather, patients are referred to specialists who may be far away, have a long waitlist, or do not accept uninsured patients. A demonstration project, the Specialty Care Safety Net Initiative (SCSNI), enlisted telemedicine (videoconferencing and telecommunications) to address the need for specialty care in the safety net.

The initiative connected safety-net clinics across California with specialists at University of California Schools of Medicine at Davis, Irvine, Los Angeles, San Diego, and San Francisco to provide remote specialist consultations to low-income and underserved patients. SCSNI covered six key medical specialties: dermatology, endocrinology, hepatology, neurology, orthopedics, and psychiatry.

Launched in 2010 by the Center for Connected Health Policy (CCHP), and funded by the California HealthCare Foundation, the initiative benefited from the participation of 43 clinics — both urban and rural — and provided 2,301 specialty consultations connecting medical professionals as far as 600 miles away.

Through three years of intensive statewide efforts, CCHP identified these 10 keys to establishing, integrating, and using telehealth:

1. Secure the support of executive leadership
2. Perform a comprehensive needs and site readiness assessment
3. Designate a dedicated telehealth services coordinator
4. Standardize processes associated with telehealth
5. Build understanding and appreciation of telehealth technology
6. Secure active involvement of participating providers
7. Be selective in contracting for specialty care services
8. Anticipate and respond constructively to disruption
9. Expand the roles of mid-level practitioners
10. Demystify telehealth

For a full report (July 2013) and an executive summary (May 2013), as well as details on providers and the initiative, see the CCHP website through the External Link below.