BRIDGING THE DIGITAL DIVIDE: INFORMATICS FOR DIABETES AND EDUCATION TELEMEDICINE IDEATel PROJECT AMI

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BRIDGING THE DIGITAL DIVIDE INFORMATICS FOR
DIABETES AND EDUCATION TELEMEDICINE (IDEATel)
PROJECTAMIA5/29/03Steven Shea, M.D.
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IDEATelInformatics for Diabetes Education and
Telemedicine

• CMS Sponsorship
• Columbia University
• NewYork-Presbyterian Hospital
• SUNY Upstate Medical University
• Verizon
• American Telecare, Inc.
• American Diabetes Association

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GOALS

• Feasibility
• Acceptability
• HIPAA Compliance
• State-wide Tele-health Network
• Bridging the Digital Divide
• Age, Education, Culture, Language, Rural
• Isolation
• Effectiveness
• Diabetes Control, Blood Pressure, Cholesterol
• Cost-effectiveness

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Rationale CMS does not reimburse providers for
electronically delivered health care
services Design Randomized Controlled
Trial Target Pop. Medicare Beneficiaries,
Diabetes, Medically Underserved Enrollment
NYC 775 Upstate 890
Total 1,667 Follow-up 2 years for each
participant
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INTERVENTIONHome Telemedicine Unit

• 2-Way Video/Voice Conferencing
• Electronic Device Port
• Glucose Meter
• Blood Pressure Device
• Web Browser
• Clinical Data Display
• Electronic Clinical Communication (E-mail)
• Tailored Educational Material

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Home Telemedicine Unit (HTU)

• Proven Technology
• Low Maintenance
• Simple to Use

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NYC IDEATel Network
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Upstate IDEATel Network
A. L. Lee Memorial Hospital, Fulton, NY Anthony
L. Jordon Health Center, Rochester, NY Arnot
Ogden Medical Center, Elmira, NY Bassett
Healthcare, Cooperstown, NY Family Health
Network, Cortland, NY Guthrie Healthcare System,
Sayre, PA Hudson Headwaters Health Network, Glens
Falls, NY Lourdes Hospital, Binghamton, NY Olean
General Hospital, Olean, NY Samaritan Medical
Center, Watertown, NY SUNY Upstate Medical
University, Syracuse, NY United Health Services,
Binghamton, NY University at Buffalo, SUNY,
Buffalo, NY Woodward Health Center, Rochester,
NY and several hundred private practices
stretching from Lake Erie to the Hudson River
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BRIDGING THE DIGITAL DIVIDEDEMOGRAPHICS
Upstate N () White, NH 812 (91) Black,
NH 63 (7) Hispanic 12 (1) Other
1 (lt1) Total 888 NYC White, NH
8 (1) Black, NH 185 (24)
Hispanic 573 (74) Other 7 (1)
Total 773
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BRIDGING THE DIGITAL DIVIDE DO YOU KNOW HOW TO
USE A COMPUTER?
Upstate No () Yes () White, NH 520
(64) 280 (35) Black, NH 54 (86) 9
(14) Hispanic 11 - 1 - Other
0 - 1 - Total 585 (67) 291 (33) NYC
White, NH 4 - 4 - Black,
NH 166 (91) 16 (9) Hispanic 555 (97)
16 (3) Other 2 - 5 -
Total 727 (95) 41 (5)
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CLINICAL VIGNETTES
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EVALUATION STUDY
Projected Completion - 10/31/03 Upstate NYC
Total Visit 1 (Baseline) 890 775
1,665 Visit 2 720 671 1,391 Visit
3 481 482 963
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EVALUATION STUDY
Completed Evaluation Visits - 03/31/03
Upstate NYC Total Visit 1 (Baseline) 890
775 1,665 Visit 2 586 679
1,265 Visit 3 88 60 148
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EVALUATION STUDY
Service Utilization Interview telephone, Q 3
months 5,369 completed interviews
613 refused or not reached after 10
attempts Provider Satisfaction Survey mail and
telephone Qualitative Study of Patient
Perspective Questionnaire Study of Patient
Perspective Cost Analysis Independent
Evaluation by Mathematica
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PRIMARY CARE PROVIDER ACCEPTABILITY
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This research was supported by Cooperative
Agreement Centers for Medicare and Medicaid
Services (95-C-90998). We are grateful to all the
participants who graciously gave of their time to
participate in the study. In addition to the
authors, the IDEATel Research Consortium includes
the following Columbia University and
NewYork-Presbyterian Hospital (NYC) S. Shea, J.
Starren, W. Palmas, L. Field, R. Lantigua, MD, G.
Hripcsak, S. Sengupta, E. Shortliffe, D. Kaufman,
V. Patel, M. Ashraf, S. Mota, C. Tuck, P.
Kringas, J. Rivera, R. Bachmann Harlem Hospital
Center (NYC) L. Capps, MD St. Lukes-Roosevelt
Hospital Center A. Prigollini Hebrew Home for
the Aged at Riverdale (Bronx, NY) D. Holmes, J.
Teresi, S. Silver, J. Kong, E. Petkova, L.
Orzechowska, J.P. Eimicke SUNY Upstate Medical
University at Syracuse (Syracuse, NY) R.S.
Weinstock, R. Izquierdo, P.E. Knudson, L.T.
Wolff, S. Meyer, S.M. Carusone, F.G. Tudiver,
T.J. Wagner, C. Lagua, S. Fox, S. West, J. Shupe,
D.R. Roller, J. Ziemba, D.P. Thomson, M. Malone,
K. Duncan, W. VanRiper, S. Doolittle, J. Kearns,
D. Bowerman, P.T. Bazen, P. Suddaby, K.M.
Brindak, F. Benson A. L. Lee Memorial Hospital,
Inc. (Fulton, NY) S. Seabury Arnot-Ogden
Medical Center (Elmira, NY) J.F. Carroll, F. P.
Skinner, T.L. Ennis Bassett Healthcare
(Cooperstown, NY) K. Sellers, B. Leo, E. Haus,
C. Cooney Delaware Valley Hospital (Walton,
NY) M.J. Freeman Family Health Network of
Central New York, Inc. (Cortland, NY) S. Ulrich,
Guthrie Healthcare System (Sayre, PA) B.D.
Cassetta, Hudson Headwaters Health Network (Glens
Falls, NY) P. Auer, W.E. Hammond, C.L. Young,
M.M. Beadnell Lourdes Hospital (Binghamton,
NY) T.C. Howland Olean General Hospital (Olean,
NY) R. Catalano, G. Anderson, T.N. Kolasinski
Samaritan Medical Center (Watertown, NY) A.
Shah, K.R. Fraczek, T. Flynt State University of
New York at Buffalo (Buffalo, NY) J. Taylor,
L.R. Tumiel, M. Shilling, C. Fox United Health
Services (Binghamton, NY) D. Kwiatkowski
American Telecare, Inc. (Eden Prairie, MN) C.R.
Abbruscato, K. Boril. Deceased. Current
address E. Tennessee State University (Johnson
City, TN).
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