Maine Nursing Home Telehealth Network

3. Sunbeam Telehealth Room Telemedicine Equipment with otoscope, hand-held camera and stethoscope. Able to do: blood draws (has centrifuge), strep tests, pregnancy tests, pulse oximetry. Fully equipped for dressing changes� etc.

4. Sunbeam V

5. Frenchboro Island

6. Maine Seacoast Mission& History of the Sunbeam Sunbeam V is latest ship in 100 history of service to mid-coast islands by the non-denominational ministry Makes 2-day rounds of the four islands bi-monthly Regular crew includes minister, captain, steward, engineer, and nurse (Capt. Allen and Steward/wife Betty in 33rd year) Health services addition in 2001 to the spiritual and social services mission of the Sunbeam revives tradition of the past Nurse Sharon Daley, though not a clinic employee, carries out health promotion/screenings and WIC (20 clients) Vital signs, skin lesion checks, and blood tests for diabetes, lipid profiles, prostate cancer, thyroid disease Tetanus shots and flu and pneumonia vaccinations Facilitates health education sessions by others--e.g. speech therapist visits; occupational health program for lobstermen

8. Background on State Health Statistics High rates for lung disease and cancer--�99-02 mortality rates ranked 6th and 4th among states Relatively high accident and suicide mortality rates--15% and 17% higher than for U.S. High rates of asthma--6th among states for �03 Relatively high diabetes rates--7.4% vs. 7.2% U.S. High rates of disability--12th among states High ER utilization rates--5th among states Substantial rural vs. urban health disparities linked to economics and health care access

9. Sunbeam Island Telehealth Sites

11. Maine Telemedicine Network Primarily ISDN 128-384 kbps Open-architecture IP-based hospital use w/ISDN gateway

14. Development of Boat-Based Mobile Telemedicine Services Start-up funded by OAT grant to HealthWays in 2001-3 Polycom 512 unit purchased (RUS funds) and installed on Sunbeam Dockside ISDN ports established at island harbor piers Units installed at sites of PCPs Island Community Medical Center (Vinalhaven) Islesboro Health Care (Islesboro) Southwest Harbor Clinic/Mount Desert Island Hospital (Bar Harbor) Southwest Harbor Maine Coast Memorial Hospital North Haven Clinic (North Haven) Unit placed in ER of regional hospital, Penobscot Bay Med. Center (Rockport)

15. Development of Mobile Telemedicine Services (continued) Identifying and training Site Coordinators Addressing challenge of non-Verizon telco for 1 island Developing primary care protocols Solving scheduling and communications challenges for multiple PCP sites, tight docking schedules, tide issues Adapting protocols for available specialty care services, such as wound care, psychiatry, pediatrics, genetic counseling

16. Telemedicine Successes and Challenges During 2nd and 3rd year of OAT project, about 8 clinical telehealth uses per month were achieved Most have been PCP check-ups and ancillary care services--flexibility and creativity at play Refreshing that credentialing and privileging are no barrier for primary care telehealth Most effective uses are screenings that prompt timely referrals for diagnostic testing and treatment Twice a month services leads to interest in permanent land-based equipment Limitation of not being able to supply medications--new State law required for boat to be designated a clinic. Meications delivered as they have historically been provied (lobster boat, mail boat, mail plane.)

17. Sustaining Telehealth Services Services sustained through about $100,000 per year fund-raising efforts (salary, fuel, supplies) Services from 3 PCP sites were sustained and one was not. PCP turnover is a major factor; in one case, lack of support by office staff was the major barrier Services were provided briefly by a PCP at another hospital, which rescinded support; however, funds were raised to buy unit for doctor�s home Emergency medical situations lead to concentrated efforts to transport to mainland hospital, not telehealth linkage to Penn-Bay Hospital Recent planning grant project led to detailed needs assessments and resident oversight committees

18. Telehealth Reimbursement Medicare Reimburses provider as if a face-to-face visit. Medicaid (Mainecare) Reimburses provider as if a face-to-face visit. Private Insurers Reimbursement received from most.

19. Educational Telehealth Approaches Diabetes education Lyme Disease trainings Alcoholics Anonymous sessions

20. Clinical Service Provided to Date Primary Care Psychiatry Mental Health Counseling Endocrinology Genetics Surgical Follow-Up

21. Examples of Mobile Telehealth Sessions Man with chest pain was reticent to travel to doctor for check-up (assumed was heartburn). Telehealth visit prompted admission to hospital for in-depth assessment which is believed to have prevented major heart attack. Man with cough and hoarseness of 2 mos. duration received lung auscultation by telemedicine, prompting referral for X-ray which led to lung cancer diagnosis. Man with a skin lesion was examined by telemedicine, leading to biopsy and melanoma excision; later seen by IVC for post-surgical follow-up Woman with mental illness presented in telehealth session with severe infection of hand from a cat bite. An antibiotic was prescribed, which was delivered by airplane. (Less urgent deliveries make use of daily mailboat or calls to other resident returning by ferry)

22. Mobile Boat-Based Telehealth Small rurally remote populations can achieve improved health care access through a mobile telehealth system--analogies with telehealth vans tried elsewhere Telemedicine for primary care is easier than specialty care with respect to credentialing and privileging problems However, it is more difficult for scheduling and set-up due to residents of seeing different PCPs and using different clinics