Elizabeth Krupinski, PhD, Ana Maria Lopez, MD, Ronald Weinstein, MD Presented at

1. The Arizona Telemedicine Program: Two Years’ Experience With a University-Based Telemedicine Program Elizabeth Krupinski, PhD, Ana Maria Lopez, MD, Ronald Weinstein, MD Presented at The American Telemedicine Association Conference April 18-21, 1999 Salt Lake City, UT

2. Goal • To assess the Arizona Telemedicine Program (ATP) in terms of patterns of use, patient demographics and general satisfaction with the program. • Periodic and consistent assessment is a long-term and on-going component of the ATP.

3. Rationale I • Continuous assessment of our Telemedicine Program provides a measure of Quality Control (QC) and Quality Assessment (QA). • We can track progress of the program and changes in usage over time.

4. Rationale II • By assessing patterns of use of the Telemedicine Program at each of the remote sites, we can better determine what their individual needs are and how we can best meet those needs.

5. Tuba City Ganado Kingman Cottonwood AHSC Hub Telemedicine Payson Springerville Telepathology DOC - Phoenix Teleradiology Whiteriver DOC - Yuma AHSC Kino Tucson VA Patagonia Nogales Douglas ATP Telemedicine Sites

6. Methods • Detailed medical records are kept for each telemedicine patient. • These records are analyzed on a monthly basis to track various aspects of the program. • Statistics are compiled for the program as a whole and for each individual site. • This poster only reports on telemedicine, not teleradiology cases

7. Record Compilation • The Site Coordinator at each remote location gathers the necessary patient information for the consult. • The Telemedicine Coordinator at the AHSC hub site establishes a new patient record once the information has been received and a consult requested.

8. Record Contents • Patient consent • ATP required forms • Diagnostic information • Written patient records • Still photos • Radiographs & radiology reports • Lab test results (e.g., autochem printout) • EKG, EEG printouts • Other relevant materials

9. Required Forms • Patient consent form • Patient demographics form • Patient history form • Internal medicine • Non-internal medicine • Cardiology • Initial psychiatric • Follow-up psychiatric • Billing/insurance form

10. Case Volume • We have conducted over 900 telemedicine and 1500 teleradiology sessions to date • We have been averaging about 60 telemedicine cases per month • 56% are store-forward; 44% are real-time • 76% are initial consults; 24% are follow-up consults

11. Quarterly Case Volume

12. Health Care Providers • 70 clinicians at the AHSC ATP hub site have served as telemedicine consultants. • 116 health care providers at the remote spoke sites have referred patients to AHSC for a telemedicine consultation.

13. Referring Clinician Degrees

14. Sub-Specialties Covered Cardiology Ophthalmology Peds. Orthopedics Dental Orthoped. Surg. Peds. Psychiatry Dermatology Orthopedics Peds. Pulmonology Endocrinology Otorhinology Peds. Rheumatology Fam. & Comm. Med. Pain Clinic Peds. Urology Gastroenterology Pathology Psychiatry Genetics Peds. Cardiology Radiology Hematology/Oncology Peds. Dermatology Reprod/Infertility Infectious Disease Peds. Endocrinology Rheumatology Internal Medicine Peds. Gastroenterology Surgery Medicine Peds. Hem/Onc Surgical Oncology Nephrology Peds. Infec. Disease Toxicology Neurology Peds. Nephrology Urology Ob/Gyn Peds. Neurology

15. Patient Age Groups

16. Patient Race

17. Patient Employment

18. Patient Insurance

19. Case Turn-Around Time

20. Types of Service

21. Patient Information * Other than required forms (e.g., growth chart)

22. Program Satisfaction • Both referring and consulting clinicians have been quite satisfied with the quality of services they have been able to provide with telemedicine. • Patients are also quite satisfied, especially with the travel time that they have been able to avoid by not going to see a specialist in person.

23. Patient Benefits • For the existing telemedicine sites, patients would have to travel on average about 165 miles to get to Tucson to see a specialist (min = 60 miles; max 300 miles approx.) • Travel cuts into work time and wages, and for many requires child care, animal care, making special plans, missing school and dealing with parking.

24. Discussion • The ATP is successfully using both real-time and store-forward technologies for a variety of sub-specialty consults. • Regularly scheduled clinics have been set up for the more voluminous specialties.

25. Discussion • Including teleradiology, telepathology, administrative and CE broadcasts, the ATP has held nearly 3000 sessions since beginning operation two years ago. • Efforts are underway to expand our services to other sites and to develop and maintain a self-sustaining, state-wide health care network.