AFHCAN Project Telemedicine in Alaska

1
AFHCAN ProjectTelemedicine in Alaska
Stewart Ferguson, Ph.D Associate Project
Director Director of Technology Darren Coolidge,
MCSE Senior Software Analyst Kari Lundgren,
PA-C Telemedicine Coordinator, SEARHC AFHCAN
Project Office Alaska Native Tribal Health
Consortium 907-729-2260 www.afhcan.org
2
Alaska Telemedicine Testbed Project (ATTP)

• Funded by NLM Contract N01-LM-6-3540
• University of Alaska Anchorage (UAA)
• Fred Pearce, Ph.D. Principal Investigator
• 4 Regional Health Corporations
• 26 Village clinics
• Evaluate the impact of low-bandwidth telemedicine
  systems on costs, professional isolation and
  provider/patient satisfaction
• 3,000 cases 9,000 images in 2 years

3
Ear Disease

• Ear disease accounts for
• 31 of clinics visits for those under the age of
  five
• 59 of the antibiotic prescriptions for those
  under the age of seven

4
NLM Project - Software

• Windows NT Workstation

MS Outlook 98
Custom Form/ Leverage2K
Snapins
5
AFHCAN VISION 235 federal and state sites health
care sites in Alaska linked in a telehealth
network Create needs based solutions Build
flexible systems Ensure sustainability Evaluate
solutions Coordinate with all telehealth in Alaska
AFHCAN MISSION To improve access to health care
for federal beneficiaries in Alaska through
sustainable telehealth systems
AFHCAN Project is managed by the Alaska Native
Tribal Health Consortium (ANTHC)
AFHCAN Project is a project of the Alaska
Federal Health Care Partnership
6
Referral Patterns
ANMC (Specialist)
Elm. AFB (Specialist)
AFHCP
Region (MD)
USCG (MD)
RMT
PRIVATE (Non-Federal)
Village (CHA)
7
AFHCAN Partners

• IHS - 194 sites - 97,000 beneficiaries
• VA - 1 site - 65,000 beneficiaries
• US Army, US Air Force - 9 sites - 47,000 military
  and dependents
• USCG - 4 sites - 3,000 beneficiaries
• Alaska PHN - 26 sites

8
AFHCAN Sites
9
Organizational Issues

• 235 Sites
• 38 Organizations
• 32 Native Non-profit Health Corporations
• Designed as a four-year project (1999-2002) with
  a 30 million dollar budget
• Multiple Federal funding sources (DHHS, HIS, DoT,
  DoD )

10
Subregional Center
Initial Entry
Both Initial Secondary
Secondary Care
Secondary Tertiary Outsourced Care
Harborview ANMC Providence AK API Private
MD/Dental
(Limited Entry) Petersburg Wrangall Skagway Ketchi
kan
The SEARHC Clinical System
11
Walk before running approach
What is the use of running when we are not on the
right road? Old Saying
12
OrganizationalChartCommunications
TELEHEALTH Team
EXECUTIVE BOARD CEO / Commanders ANMC, VA, USCG,
3MDG, BACH, 354 MDG
STEERING BOARD AFHCP Planning Board Chairman,
AFHCP Project Officer, AFHCP Business
Office Director, ANMC Data Manager, and Clinical
and Tribal Representatives
AFHCAN Partners
Clinical
Training
APO
Technology
Business
Informatics
13
Wanted Simple Solution.Needed Orthogonal Design

• 38 Autonomous organizations
• Many server platforms - Unix, Linux, WinXX
• Many client platforms and browser
• Many servers apps - web, database
• Multiple HIS
• Distributed / Disconnected servers - (SF between
  servers)

14
AFHCAN Technology
15
AFHCAN Referrals
16
AFHCAN Technologies
17
Cart
18
Equipment
19
Details
20
Touchscreen
21
Video Otoscope
22
Digital Camera
23
Digital Camera - LCD
Image Quality
Better
Ease of Use
Worse
Sony FD90
Nikon 990
24
AFHCAN Software - Design Goals
25
1b) Make it Medical before Telemedical.

• Single, intelligent interface to all devices
• Rapid access to medical devices
• Smooth / accurate display
• Color accuracy, compression factors

26
A properly designed system can improve the
quality of health care delivery without saving or
sending a single byte.
27
Simplified User Interface

• Darren Coolidge

28
Make it Easy to Use

• Can and will be used by a diverse user population
  - 67 of sites staffed by Community Health Aides,
  21 staffed by Nurses or P.A.s (Initial
  Providers)
• Roughly 10 of sites staffed by MDs (Specialists)

29
Two Basic Types of Users

• Initial provider?
• Ease of acquisition more important
• Specialist?
• Ease of acquisition less important
• Data more important

30
Make it Robust

• Accept poor (unreliable) connectivity
• Accept low bandwidth limitations
• Function over satellite connectivity

31
State Machine
32
drinks
Software
The web is a stateless system.
33
(No Transcript)
34
10 Soda
35
(No Transcript)
36
Patient ID
Patient ID
37
State Machine

• Reusable Code
• Independent testing of modules (machines)
• Robust - State info stored on server
• Scaleable
• Customizable - by machine or in wiring
• Standards-based data exchange

38
Web-based Programming Considerations
39
Distributed Architecture

• 38 Autonomous organizations
• Many server platforms - Unix, Linux, WinXX
• Many client platforms and browser
• Many servers apps - web, database
• Multiple HIS
• Distributed / Disconnected servers - (SF between
  servers)

40
(No Transcript)
41
Satellites

• Add 0.6 seconds to roundtrip delay
• Cause web pages to load in 5 - 40 seconds
• Solutions
• Remove need for frame sets
• Caching locally
• TCP/IP registry tweaks
• No HTTP/Redirects

42
Technology Used
43
Technology
44
ACKNOWLEDGEMENTS
Technical Expertise and Design Tom Bohn Jim
Rogina David Young Chris Patricoski, MD AFHCAN
Statewide Committees Funding Sources DHHS -
OAT VA U.S. Army IHS Legacy NLM / UAA
45
(No Transcript)