Medical Disaster Resources Network (MD.RN)

1. 2008 ATALACC Meeting Panama City, Panama Medical Disaster Resources Network (MD.RN)

2. Medical Missions for ChildrenMission Statement • Provides medical diagnoses and treatment via telemedicine to children and mothers • Facilitates medical knowledge transfer from its source to healthcare providers worldwide • Delivers health related resources to underserved hospitals • Supports applied medical research utilizing communications infrastructure

3. MMC Facts • Founded in 1999 at St. Joseph’s Children’s Hospital, MMC is a not-for-profit charity supported entirely by grant and donations • MMC net worth in excess of $10 M (donated services, equipment, satellite time) • >30,000 children helped

4. MMC History • Founded by Frank and Peg Brady • First Milestone: Hospital del Nino in Panama City, Panama

5. First Child Helped • Yordano, 11 years old with cranial deformity resulting in mild retardation, only one eye, and difficulty swallowing • Poster child for handicapped children for Panama • Family of six with a healthy twin brother • Using telemedicine to collect measurements, a computer model was reproduced. His skull was reshaped with computer imaging to correct the problems. Implants of titanium and harvested bone were created. • First surgery took place (in this case) back at St. Joseph’s, the 10 hour phase one operation to change the shape of Yordano’s skull and create an eye socket for prosthetic eye. • In conclusion, MMC’s Telemedicine and Teaching network was used to review the entire procedure with approximately 50 physicians in Panama as a “forum for learning.” Yordano and Dr. Ephros

6. Early Timeline • 1999 • MMC founded by Frank and Peg Brady • 2000 • United Nations (UNOPS) agrees to support MMC effort • Pilot program established with Hospital del Nino in Panama City • 2001 • World Bank and USAID partner • MMC wins Polycom contest for best use of videoconferencing • 2002 • Certificate of recognition from US Congress • DOD agreement with MMC to provide telemed in eastern Europe • Wins 14th Annual Federal Award • 2003 • Intelsat, Ltd partnership formed • US AID Grant • 22 mentoring hospitals • 2004 • St. Joe’s provides MMC headquarters, satellite teleport, studio digital NOC • Internet2 • MBC

7. Giggles Children’s Theater • Live performances 3 days a week • Puppet shows, celebrity performers, magicians • Transports patients to places such as Panama Rain Forest, Bronx Zoo, NASA or diving with sharks • Archived Performances broadcast daily

8. Media Production

9. Telemedicine Outreach Program • Two-way interactive video via IP • TOP sessions are recorded and broadcast on MBC • Consultations scheduled via MMC Help Desk • 24 Mentoring Hospitals

10. Medical Broadcasting Channel (MBC) • US FCC license as a global satellite broadcaster • Multi-cast streaming via Internet2 • Satellite time donated by Intelsat, Ltd. • 9 M physicians, 14 M nurses, 89K hospitals, 16 K major universities, plus 110K institutions (I2) globally

11. MBC Schedule

12. MBC Content by Category Physician Education 23% Medical Science 13% Prevention and Public Health 22% Family Health 14% Nursing Education 19% Patient Education 9%

13. Global Video Library of Medicine • Electronically stores processed digital content to feed MBC • Content supplied by highly credentialed tier-one hospitals, federal agencies, research centers, & global organizations

14. GVLM Content Partners (125) Massachusetts Medical Society Miami Hand Center, Badia Clinic National Library of Medicine National Institutes of Health Partners Healthcare SLP 3D, OR Live Southern Nevada Health Network St. Joseph’s Regional Medical Center St. Jude Cure4Kids St. Petersburg College St. Vincent Healthcare Sutter Health System University of Albany, School of Public Health University of Maryland Medical Center World Health Congress World Health Organization Alabama Dept of Public Health Montefiore Medical Center American Cancer Society California Distance Learning and Health Network Capital Media Group Children’s Heartlink Children’s Hospital Boston Operation Smile Center for Disease Control Children’s Hospital of Wisconsin Children’s Hospital of Omaha Deaconess Clinic Food and Drug Administration Howard Hughes Medical Institute Johns Hopkins Medical Center Kaiser Family Foundation Lifestar

15. Global Video Library of Medicine • GVLM is positioned to become the single largest repository of medical education video in the world

16. MD.RN • Medical Resources Disaster Network • Up to date inventory of telemedicine hub networks used to provide care coordination and services in response to large scale disasters • Long term goal: develop telemedicine response that can increase long term surge capacity

17. What We Know • No nationally coordinated telemedicine network in place to respond to large-scale disasters • With the very real threat of biological outbreaks or terrorist attacks, there is a need for a coordinated national response network • Existing telemedicine infrastructure is well positioned to provide essential links between local, regional and national resources in a mass disaster • Utilization of telemedicine resources requires access to a documented network of willing telemedicine providers

18. Infectious Disease ScenarioWhat Can 80 Sick People On A Plane Cause • If an infectious agent such as smallpox they can reach 64,079 people in 9 days. • Of which 4673 will be hospitalized within 15 days not counting the 5766 worried well that will show up at the hospital • Requiring on a bad day- 8,000,000 gloves, 3,000,000 HEPA masks and 16,000 extra doctors and nurses. Source: CDC

19. Infectious Disease ScenarioOr if the 80 Simply Touch 800 • Assuming a pneumonic plague and early containment, providers will still need 20,000 sets of gloves, 9,000 HEPA masks (per day), 67 nurses, 49 doctors and 1298 volunteers (without Telemedicine)‏

20. Driving Factors • Improved Containment Measures • Resource Coordination • Biological, Radiological, Pandemic Disasters • Just in time training, education, treatment protocols • Access to highly specialized clinical expertise • Can’t always move the patient to the doc or the doc to the patient

21. Questions to Think About • When is the movement of information more valuable than the movement of people? • What role can telehealth play in disaster response? • How do we integrate telehealth into existing disaster plans?

22. Existing Telemedicine Database • 200 Networks identified • 3000 Telemedicine sites • Not filtered for disaster preparedness • Not tested for connectivity • Currently includes: • Hub Networks • Medical Call centers • Home Telehealth • Remote Monitoring • Outsourced Clinical Services

23. ATA EPR SIG TDRN Goals • Define essential fields for the Database • Create the inventory/direct and determine collection methodology • Create specialized collaborative web based tools to share information and promote dialogue on emerging health threats and infectious disease outbreaks • Identify target users (medical, EMS, federal, and state agencies, public health, NGO’s, military and private sector entities)‏ • Develop dialogue and opportunities to educate target users • Create appropriate use policies—who gets what data • Define activation protocols—do exercises, add technical details to database • Qualify technical and clinical capabilities of disaster TM sites

24. State/Region Volunteer Coordinator North Carolina, Texas, Virginia Lori Balch Colorado, Arizona, New Mexico, Nevada Randy Roberson Florida, Georgia, South Carolina, Alabama Susan Dimmick, Lori Balch Pennsylvania, West Virginia, New Jersey, Delaware, Maryland Diane Castelli Wisconsin, Illinois, Ohio, Kentucky, Tennessee Brett McPherson, Ron Holk, Karla Lavin Oklahoma, Missouri, Arkansas, Louisiana, Mississippi, Hawaii Jana Lindsey Iowa, Minnesota, Nebraska, North Dakota, South Dakota Julie Kann Michigan, Indiana, Kansas Rose Young Maine, New Hamshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York Ken Topel, Michael Edwards, Alaska, Idaho, Oregon, Montana, Washington, Utah, Wyoming Denny Lordan, Brian Hoots, District of Columbia John Dobson California Christine Martin, Steve Fowler TDRN Volunteer Coordinators

25. TDRN Participation Form • Network or Program Name • # of Sites: • Program URL: • 24/7 Point of Contact: • Title, Organization, Address, City, • State, Zip, Phone, Cell, Pager, Email • Clinical Resources (Yes or No): • Infectious Disease Tropical Medicine • Pulmonary Medicine • Nuclear Medicine • Pediatric Burn • Notes: • Alternative POC • Specialized resources

26. New TDRN Telemedicine Database • 55 disaster networks identified • 5 Time Zones • 1700 TM sites ready to respond • Infectious Disease (21)‏ • Pulmonary (23)‏ • Nuclear (17)‏ • Peds Burn (18)‏

28. Next Steps for MD.RN Work • Qualify technical and clinical capabilities of MD.RN listings • Test and exercise the MD.RN sites to refine activation protocols • Identify sites that are most useful for specific disaster situations • Make information on volunteer network providers useful and available to federal, state, and local response agencies, while respecting permissions for such use • Integrate telemedicine networks into local and state emergency communications systems • Use MD.RN to complement and build upon other existing efforts related to public health, emergency response and threat detection, such as CDC’s Health Alert Network and Emergency Medical Operation Centers (EMOCs)‏ • Dialogue with FEMA regarding reimbursement for network costs in disasters • Dialogue with ASPR regarding a virtual DMAT type team or an NDMS adjunct resource • Dialogue with state Medicaid programs about reimbursement in disasters • Seek funding to support these activities

29. Acknowledgements • American Telemedicine Association (ATA) and the Emergency Preparedness & Response Special Interest Group (EPR SIG • Volunteer Coordinators • Participating Programs • Medical Mission for Children • 24/7 POCs

30. For additional MD.RN information: LoriBalch lbalch@mmissions.org 252.917.1520 David Balch, EPR SIG Chair dbalch@mmissions.org 252.917.4412

31. Thank you. Restoring Hope through Technology