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Commissioned Officers Association

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Engineers Enhance Healthcare Delivery though Telemedicine and Teleradiology Commissioned Officers Association Annual Meeting-2001 Mark R. Thomas, P.E. – PowerPoint PPT presentation

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Title: Commissioned Officers Association


1
Making It Work
Engineers Enhance Healthcare Delivery though
Telemedicine and Teleradiology
  • Commissioned Officers Association
  • Annual Meeting-2001
  • Mark R. Thomas, P.E.
  • Prinicpal Clinical Engineer
  • Alaska Area Native Health Service

2
The Indian Health Service
  • Who we are
  • The challenge facing us
  • The telemedicine/teleradiology solution

3
A health care system for the first Americans
4
49 Hospitals in 14 Locations
Mescalero, NM
Acomita-Canoncito-Laguna, NM
Alaska Native Medical Center Anchorage Alaska
Owyhee Tribal Hospital, Nevada
Hu Hu Kam, Sacaton Az.
5
IHS mission, goal, and foundation
-raise the health status of Indian people -ensure
medical community services to Indian
people -uphold treaty obligations to Indian
people
6
Most IHS locations are
7
The Alaska Challenge Geography
  • Insert Picture of US dispersion of programs

8
Alaska-Partnering to take on the Challenge
  • IHS - 194 sites - 97,000 beneficiaries
  • VA - 1 site - 65,000 beneficiaries
  • DOD - 9 sites - 47,000 military and dependents
  • USCG - 4 sites - 3,000 beneficiaries
  • Alaska DPHN - 26 sites

9
The Challenge Geography
  • Insert Picture of US dispersion of programs

10
Village Health Clinics
  • 168 Remote Locations
  • Staff 450 CHA/Ps
  • 300,000 OPE/Yr
  • 3M Equipment

11
Patient Transportation
  • 90,000 Med-Evacs/Yr
  • gt 40 M / Yr

12
New Technologies-Handheld Examination Deivces
13
New Technologies-Imaging Devices
14
New Technologies
15
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16
Telemedicine Workstation Assembly Line
17
Alaska Native Health System
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  • Alaska Native Medical Center
  • 7 Regional Hospitals
  • 5 Physician-Based
  • Health Centers
  • 22 Physician
  • Assistant
  • Health Centers
  • 168 Rural Village
  • Health Stations

18
Alaska Native Medical Center
  • 150 Bed
  • 5,000
  • Disch/Yr
  • 225,000
  • OPE/Yr
  • 50,000
  • Radiology Studies/Yr

19
Existing Telecom Infrastructure
  • Satellite Only (Low-Bandwidth)
  • POTS Modem 9600 bps
  • Frame Relay 56Kbps

20
PHASE I - TELEMED BASELINE RESEARCH
  • Phase I - Needs Assessment
  • Phase I II - Evaluation Methodology put in
    place (Phase I) performed (Phase II) by
    University of Alaska - Anchorage (UAA)
  • Funded through National Library of Medicine
  • Contract N01-LM-6-3540
  • 3 Million, Over 3 Years
  • 25 Villages

21
PART B - TELERAD PILOT PROJECT
  • Phase I - Teleradiology Pilot Project
    (Dillingham) with Connection to ANMC PACS
    (Anchorage) Image Compression, Transfer,
    Storage, and Display
  • Funded through Indian Health Service
  • 450,000 Lease/Purchase
  • Shared Maintenance Plan
  • Compatible with other
  • Alaska Federal Healthcare Partnership sites

22
PHASE II -
  • Needs Assessment yields need for treatment of
    Ear Pathology

23
PHASE II - TELEMEDICINE COUNTRY
  • Phase II - NLM Contract
  • Demonstration Project Locations
  • Anchorage Hub
  • Demonstrations in 5 villages and 1 regional hub
    in 5 geographical regions
  • Bristol Bay South Central
  • Kotzebue Yukon-Kuskokwim
  • Norton Sound

24
PHASE II - LOW-BANDWIDTH TELEMED SITE
COMPONENTS
  • Equipment Cart
  • Computer w/
  • Frame Grab SW,
  • Store--Forward
  • E-Mail type SW
  • Video Otoscope,
  • Video Monitor,
  • Other Assessories Digital Camera, Flat-Bed
    Scanner, Color Printer, Power Conditioner/UPS
  • POTS Modem Connectivity

25
PHASE II - BI-DIRECTIONAL TELERADIOLOGY With
WAVELETTE COMPRESSION ON-THE-FLY
  • Phase II - Bi-directional Teleradiology
    Connectivity via between PACS and 10
    Physician-Provider Sites
  • Funded through Project AKAMAI and the
  • Alaska Federal Healthcare Partnership
  • 1.4 Million, One-Time Appropriation
  • Self Maintenance Plan
  • Compatible with other AFHP sites

26
PHASE II - TELERADIOLOGY COUNTRY
  • Phase II - Wide-Area PACS




    Bi-directional Connectivity
  • Locations
  • Barrow Ketchikan
  • Bethel Kodiak
  • Dillingham Kotzebue
  • Fairbanks Nome
  • Juneau Sitka

27
PHASE II - TELERAD SITE COMPONENTS
  • X-Ray Film Digitizer
  • Digitizer Compression
  • Send Unit
  • Frame Grabber
  • Compression Send Unit
  • DICOM Bridge
  • Compression Send Unit
  • Medium Resolution Dual-Monitor Reading Station
  • Frame-Relay (56kbps) WAN Connectivity

28
Evaluation of System
ALASKA TELEMEDICINE PROJECT
____

- Human Factors Analyses - Staff
Turnover/Retention Analyses - Provider/Customer
Satisfaction - Utilization Review Analyses -
Cost-Benefit/Sustainability Analyses - Profile /
Cluster Analyses
NEEDS STUDY WHAT HAPPENS
EVALUATION ASSESSMENT PUBLISH FINDINGS
PROCESS
29
Conclusions
  • Nearly 50 of telemed workstations built and
    being delivered to villages
  • Teleradiology systems in place
  • Evaluations will begin soon
  • Provider
  • Patient
  • Clinical efficacy
  • Business case

30
Questions?
31
Show 3- Minute Video Now Please
32
Referral Paradigm
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  • HUB
  • SPOKE
  • NEEDLE

33
Clinical Technical Issues - TELEMEDICINE (
N E E D L E P E R S P E C T I V E )
34
TELEMED NEEDLE Certified Health Aide
/ Professional (CHA/P) at Village Health Clinic
  • PERSPECTIVE
  • Convinced Telemed is an Important Tool
  • Excited
  • Overwhelmed
  • Want Hub, Spoke Needle Contacts
  • Want Call Coverage
  • CONCERNS
  • Not be Taken for Granted or Left Out
  • Rather See Resources Spent on Other Things
  • Worried about Fewer Med-Evacs
  • Some Acute Cases

35
TELEMED NEEDLE Mid-Level Provider (PAs or CNPs)
at Sub-Regional Clinic
  • PERSPECTIVE
  • Motivated
  • Want Hub, Spoke, Needle Contacts
  • Improve Communication
  • Diagnostic Tool
  • Management Tool
  • CONCERNS
  • Adequate Training
  • Electronic Forms Capability
  • Call Coverage
  • Technical Support

36
Clinical Technical Issues - TELEMEDICINE
TELERADIOLOGY ( S P O K E P E R S P E C T I V
E )
37
TELEMED SPOKE Physician Provider at Regional
Hospital
  • PERSPECTIVE
  • 50/50 Acceptance
  • Want Hub Contacts to Specialists
  • Access to Competition
  • Training Tool
  • Want Regional Support
  • CONCERNS
  • Call-Back Nuisance
  • Changing Referral Patterns
  • Bypassing Present System
  • Protocols

38
TELERAD SPOKE Rad Technologist at Regional
Hospital
  • PERSPECTIVE
  • Motivated
  • Like Original Films to Stay in Department
  • Emergency Reports-1H
  • Report Time doesnt Depend on Mail - 24 Hr
  • CONCERNS
  • More Clerical Work
  • Computer Phobia
  • Loss of Data / Glitches
  • Slow Transmission Times
  • Technical Support

39
TELERAD SPOKE Physician at Regional Hospital
  • PERSPECTIVE
  • Interested / Skeptical
  • Want Clinical Quality - Medium Resolution
  • Emergency Reports-1H
  • Interpretation - 24 Hr
  • Permits Pulling Previous Exams
  • CONCERNS
  • Easy User Interface
  • Still Like Looking at Film
  • Fast Send Rates - Compression
  • Technical Support

40
Clinical Technical Issues - TELEMEDICINE
TELERADIOLOGY ( H U B P E R S P E C T I V E )
41
TELEMED HUB Physician Specialist at Referral
Hospital
  • PERSPECTIVE
  • Reluctance
  • Follow-Up Tool
  • Prefer High-Bandwidth Technology
  • Lower-48 Contact with Specialists
  • CONCERNS
  • Call-Back Nuisance
  • Changing Referral Patterns
  • Bypassing Present System
  • Protocols

42
TELERAD HUB Radiologist at Referral Hospital
  • PERSPECTIVE
  • Interested / Skeptical
  • Want Diagnostic Quality - Hi-Res, Hi-Bw without
    Compression Losses
  • Pre/Post Fetch Capability
  • CONCERNS
  • Too Much Work
  • Up-Time
  • Easy User Interface
  • Competition Bypass
  • No Two Radiologists Reading Same Study
  • Buy-In at All Levels

43
PHASE III - TELERADIOLOGY NEEDLES
  • Phase III - Teleradiology




    Unidirectional Connectivity via
    Teleradiology to 27



    Mid-Level
    Provider Sites
  • Funding ???
  • 2-3 Million, One-Time Appropriation
  • Self Maintenance Plan
  • Compatible with other AFHP sites

44
PHASE III - SITE COMPONENTS
  • X-Ray Film Digitizer
  • Digitizer Compression Send Unit
  • POTS Modem Connection

45
Alaska Federal Healthcare Partnership
PACS/Teleradiology Plan
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46
PHASE III - TAKING LOW-BANDWIDTH
TELEMEDICINE STATE-WIDE
  • Phase III - Telemedicine Implementation




    Plan for 235 Sites
  • Alaska Federal Health Care Access Network -
  • (AFHCAN Project )
  • Major portion of Funded by special
    appropriation from Congress, through the Indian
    Health Service
  • 30 Million over 4 Years
  • Self Maintenance Plan
  • Compatible with other NLM sites

47
PHASE III - AFHCAN TELEMED SITE COMPONENTS
  • 688 Telemed Workstations
  • NLM-Compatible Stations
  • Full Compliment of Scopes
  • Otoscope/Ophthalmoscope
  • Dental Scope
  • Derm Scope
  • Culposcope
  • 254 Telehealth Information Kiosks
  • Satellite WAN Connectivity

48
AFHCAN PROJECT - ORGANIZATION/IMPLEMENTATION
COMMITTEE MODEL
49
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Alaska Federal Healthcare Partnership AFHCAN
Project Telemedicine Sites
  • Phase III Vision
  • Useful,
  • Compatible
  • Telemedicine
  • Technology
  • for Every
  • Provider
  • Improved
  • Access to
  • Quality
  • Care for
  • Every
  • Patient

50
- THE END - Credits for making this presentation
possible go to the following individuals
  • Paul Sherry, CEO - ANHC
  • Richard Madsager, MD - ANMC Director
  • Russell Pittman, CIO - ANMC ITS
  • Rich Hall - ANMC ITS
  • Fred Pearce, PhD - UAA
  • Rob Rauls, PO - ANHB
  • Stuart Ferguson, PhD - ANHB
  • Denise Statz, PA - ANHB
  • Chuck Borg - AFHCP
  • Susan Yeager - AFHCP
  • Victorie Heart - CHA/P
  • John Midthun, MD - ANMC Imaging Services
  • Gwen Obermiller, RN - ANMC
    Administration
  • Eugene Smith - Maniilaq
  • Cheryl Booth, CHP - Noatak
  • Ralph Schaber, RT - Dillingham

51
PHASE I - TELEMEDICINE
ALASKA TELEMEDICINE PROJECT
PHASE 1 PHASE 1
____

NEEDS EVALU- ASSESSMENT

ATION
52
PHASE IIa - TELEMEDICINE
ALASKA TELEMEDICINE PROJECT
PHASE 1 PHASE 2
PHASE 1
____

- Full-Motion Video Teleconference -
Narrow-Bandwidth VTC - Store Forward Voice
Video - Telemetry Teleradiology - Tele-Health
Informatics - E-Mail for every Health Provider
NEEDS DEMONSTRATIONS...
EVALU- ASSESSMENT
ATION

53
PHASE IIb - TELEMEDICINE
ALASKA TELEMEDICINE PROJECT
PHASE 1 PHASE 2
PHASE 2
____

- Human Factors Analyses - Staff
Turnover/Retention Analyses - Provider/Customer
Satisfaction - Utilization Review Analyses -
Cost-Benefit/Sustainability Analyses - Profile /
Cluster Analyses
NEEDS STUDY WHAT HAPPENS
EVALUATION ASSESSMENT PUBLISH FINDINGS
PROCESS
54
PHASE III - TELEMEDICINE
ALASKA TELEMEDICINE PROJECT
PHASE 1 PHASE 2
PHASE 1
PHASE 3
____


- Full-Motion Video Teleconference -
Narrow-Bandwidth VTC - Store Forward Voice
Video - Telemetry Teleradiology - Tele-Health
Informatics - E-Mail for every Health Provider
NEEDS DEMONSTRATIONS...
EVALU- IMPLEMEN- ASSESSMENT

ATION TATION
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