Beam me in, Scotty: Telemedicine in Education, Clinical Medicine and Research

1. Center for Translational Neuroscience Seminar Series Tuesday, October 14, 2008, 12 noon Rayford Auditorium, Biomed II Bldg. Beam me in, Scotty: Telemedicine in Education, Clinical Medicine and Research Richard Whit Hall, M.D. Department of Pediatrics, Section of Neonatology, UAMS

2. Introduction. Practicing clinicians, especially in rural areas, are often isolated from learning opportunities and interaction with subspecialty providers. Telemedicine can enhance communication to provide education, improve clinical outcomes and expand research into the community. A Pediatric Physician Learning and Collaborative Education (Peds PLACE) program was developed to address education; telenursery was established to improve clinical outcomes through guidelines and regionalization; and research was undertaken to evaluate this program. Methods. Peds PLACE was assessed using two evaluation forms collected from October 2007 to May 2008. One of them was completed by 221 attendees from the University of Arkansas for Medical Sciences (UAMS) and 193 from remote sites. Another form was completed by 131 participants from Arkansas Children’s Hospital (ACH), an academic free standing children’s hospital. All used Likert evaluation scales. Clinical outcomes were compared using mortality and intraventricular hemorrhage rates of very low birthweight babies and place of delivery using a linked Medicaid database before and after institution of telecommunication with outlying intensive care nurseries. Funding, publication and dissemination of translational research to the community were assessed. Results. Education. Ninety-five per cent of Peds PLACE participants agreed that the presentations related to their professional needs, 98% agreed that it increased their subject matter knowledge, 81% evaluated the presentations as some of the best they have attended, and 93% agreed that the information would translate into professional practice, enhancing patient care. Comments were generally positive and correlated with Likert scale data. Clinical. Regionalization was improved after telenursery was established which resulted in improved clinical outcomes. Of neonates <1000 grams, 24% were transferred to UAMS for delivery before telenursery while 33% were transferred after telemedicine (p<0.001); the delivery place of larger neonates was unaffected (p ns). Survival of all VLBW neonates delivered at UAMS was 91%, while survival of VLBW neonates delivered elsewhere was 85% (p<0.01). Early neonatal mortality decreased after telemedicine was instituted from 1.73% to 1.46% at UAMS and from 0.63% to 0.35% in small NICU’s. Research. There have been 10 abstracts, 3 publications, and almost $3,000,000 in federal funding related to telemedicine projects. The translational research portion of Peds PLACE resulted in 95% of clinicians finding it relevant to their practice. Conclusions. Participants reported being highly satisfied with Peds PLACE and considered it an effective way to address the continuing education needs of practitioners. Clinical outcomes of VLBW neonates have improved after telecommunication, likely as a result of regionalization. Research has been enhanced by telemedicine as evidenced by publications and funding. Supported by USPHS Grant RR20146, AR Medicaid and ANGELS