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The “Appliance” Approach to Creating a Simplified Telemedicine Acquisition System for Alaska

The “Appliance” Approach to Creating a Simplified Telemedicine Acquisition System for Alaska. A. Stewart Ferguson, Ph.D. Herbert L. Sivitz, M.S. Darren Coolidge Alaska Federal Health Care Access Network (AFHCAN). Outline. NOW (AFHCAN, ATAC) AND THEN … (NLM Project) Key Design Issues

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The “Appliance” Approach to Creating a Simplified Telemedicine Acquisition System for Alaska

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  1. The “Appliance” Approach to Creating a Simplified Telemedicine Acquisition System for Alaska A. Stewart Ferguson, Ph.D. Herbert L. Sivitz, M.S. Darren Coolidge Alaska Federal Health Care Access Network (AFHCAN)

  2. Outline • NOW (AFHCAN, ATAC) • AND THEN … (NLM Project) • Key Design Issues • (1) “Providers want to use it” • (2) “Providers use it correctly” • (3) “Providers continue to use it” • (4) “Providers can interact as needed”

  3. AFHCAN MISSION To improve access to health care for federal beneficiaries in Alaska through sustainable telehealth systems

  4. AFHCAN Partners • 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

  5. AFHCAN Sites

  6. EXECUTIVE BOARD OrganizationalChart“Communications” CEO/COMMANDERS ANMC, VA, USCG, 3MDG, BACH, 354 MDG STEERING BOARD AFHCP Planning Board Chairman, AFHCP Project Officer, AFHCP Business Office Director, ANMC Data Manager, and Clinical and Tribal Representatives AFHCAN Partners Clinical Training APO Technology Business Informatics

  7. AFHCAN Toolset • Low Bandwidth Store and Forward • Low and High Bandwidth Video Conferencing • Patient Education Kiosk • Statewide Network

  8. Multiphase Project FY00 FY01 FY02 • Design/Needs - Build - Design/Evaluate …. • Rapid continuous deployment • Constant feedback loop / Regional variability Phase 1 - Most Sites Design Deploy Support Phase 2 - Most Sites Design Deploy Support Phase 2 - Some Sites Design Deploy Support

  9. Clinically Driven ... • NOW (AFHCAN, ATAC) • AND THEN … (NLM Project) • Key Design Issues • (1) “Providers want to use it” • (2) “Providers use it correctly” • (3) “Providers continue to use it” • (4) “Providers can interact as needed”

  10. Alaska Telemedicine Testbed ProjectNLM Contract #N01-LM-6-3540

  11. Village Clinic (Noatak) • One of 184 Village Health Clinics • 600 ft2 • 0 beds • 4 CHPs

  12. (1) “Providers want to use it” • Meet a critical health need • Improve the quality of care • Improve efficiency • Reduce workload • Simple and effective

  13. Ear Disease • Each village clinic averages: • 203 encounters /month (or 2430 yearly) • 23 ear cases (or 274 yearly) • 14 ear cases that go via RMT (or 163 yearly) • Each month, 190 Alaskan villages have 38,500 encounters of which 4,340 are ear cases, and 2,576 would be included in RMT.

  14. NLM - Maniilaq Data • 11 Village clinics • Begin: 1/26/1999 • Gather: 4/14/2000 • 486 Days (319 workdays) • 1715 Cases • 5233 Images • 2340 Video otoscope • 2753 Digital camera

  15. Improve the quality of care • Improved diagnosis • Improve access to care • Distance learning • NLM Project: Decreased antibiotic use with telemedicine • CDC: Decreased antibiotic use without telemedicine

  16. (2) “Provider uses it correctly” • Regular use (not intermittent) • “Software too difficult … if you don’t use it regularly, then you will forget how to use it” • Continuous quality control • Ongoing training

  17. Telemedicine Cart

  18. “Telemedical” versus “Medical”

  19. Refine Equipment • Ergonomics • e.g. hand / foot / remote triggers • mounting devices • Clinical • e.g. barrel redesign • Technical • e.g. Color correction, ballooning, RadioLan

  20. (3) “Provider continues to use it” • Support plan (technical / logistical) • Design for remote update - 235 web servers • Statewide support for 1 year through ACES • Localize training - clinical and technical • Non-obsolescence • Design and equipment selection • ATAC Technical Standards

  21. Alaska Telehealth Advisory Council - Technical Standards Workgroup Core Principles Develop standards to … ENHANCE the interoperability of disparate telehealth systems and applications. IMPROVE the sustainability and usability of such systems in future years. Provide a mechanism for meeting current and projected FUTURE needs for data security

  22. ATAC Technical Standards

  23. (4) “Providers can interact ...” • Inter-operability with other systems • IHS / DOD / PHN / USCG / VA • ATAC Technical Standards • Active involvement of receiver • Identify recipients needs

  24. Identify recipient’s needs • RMT - Short intensive interaction • e.g. ENT, Derm • Triage • Direct surgical referral • Post-surgical follow-up • e.g. PE Tube Follow-up • More complete/accurate patient record • e.g. PEF

  25. Acknowledgements • The Health Aides, Physicians, and all the staff of Maniilaq Association. Special thanks to Eugene Smith and Dr. Shackles. • Fred Pearce and the UAA telemed team. • Denise Statz and ANHB staff. • AFHCAN Project Office. • The National Library of Medicine.

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