Telehealth AETC Appalachian Project

1. Telehealth AETC Appalachian Project Principal Investigator and Executive DirectorTelehealth AETC Appalachian Project Linda Frank, PhD, MSN, ACRN, FAAN Associate Professor, Department of Infectious Diseases Graduate School of Public Health, Community and Health Systems, School of Nursing and Clinical and Translational Science Institute, School of Medicine

2. TAAP Goals • Clinical consultation which may include the use of case presentations and patient co-management (though it is not intended to supplant patient referral to an expert when needed); • Other education and training modalities that result in a continuum of longitudinal learning opportunities for trainees; and • Development of an informed support system for trainees.

3. Organizational Chart Project DirectorDr. Linda Frank Education Coordinator Jeanette Southerly Evaluation Consultant Janet Meyers Clinical DirectorsDrs. Rashida Khakoo, David Wheeler, Pamposh Kaul, Jane Cecil, Bruce Gilliam Outreach Tech SupportDavid Hoover Data ManagementDavid Korman NCCCDr. Ronald Goldschmidt Technology CoordinatorMatthew Garofalo FiscalLissa Foster Clinical ConsultantsPharmacy, Subspecialist, Psychiatry, Nursing & Substance Abuse

4. TAAP Cores

7. Telehealth AETC Appalachian Project:Selecting WebEx Web Conferencing Technology Matthew Garofalo Telehealth Coordinator

8. TAAP Goals • Clinical consultation which may include the use of case presentations and patient co-management (though it is not intended to supplant patient referral to an expert when needed); • Other education and training modalities that result in a continuum of longitudinal learning opportunities for trainees; and • Development of an informed support system for trainees.

9. Technology System Marketing Concept Patient receives primary care and specialty services Provider Patient in need of clinical services Interact with provider Implement treatment plan Treatment Support Materials Develop a treatment plan Answers Questions Technology as a medium to interact with resources Specialist Consultations Clinical Practice Portal (Resources, scheduling, tracking, etc.) Peer Learning

10. Project Goals Technological Support

11. Technology Support Design Technology Coordinator Technical support

12. Technology System Concept Targeted Clinicians: physicians, dentists, nurse practitioners, advanced practice nurses, pharmacists, physician assistants • Intervention needed: • Assessment • Prevention • Clinical management • Decision making Patient • Telehealth Intervention • Ongoing interactive training events • Problem-based learning, case studies • Regular clinical consultation • Ongoing technical assistance events Clinical Practice Portal • Resources • Literature: print, online • Guidelines • Best practices • Performance indicators • Peer Learning • Group discussions • Peer to peer input • Store & Forward • consultations • case studies • training • Clinical expert consultation • Weekly, bi-weekly based on needs assessments • Evaluation of outcomes • Resource utilization tracking • Surveys, questionnaire results • Summary of key informant interviews • Capacity building documentation • Longitudinal training outcomes: practice, policy changes; patient clinical outcomes

13. Targets for Technological Support • Low volume health care providers in Appalachia community health centers • Project clinical directors who provide consultation • Project team

14. Project Goals Technological Support

15. Web Conferencing Options: WebEx • Polycom • Adobe Connect • GotoMeeting • WebEx WebEx

16. What is WebEx? • WebEx is an Application Program Interface (API) • Uses Https (S stands for SSL or secure socket layers) • 128 bit HIPAA compliant encryption • Password protected scheduling, archival and webcasts • Works across platforms (Mac, PC, Unix, and Linux)

17. Advantages of WebEx • Packaged product- features don’t change • Infrequent updates • Provides a free secure video server • Quick to set up • Minimum CPU and software requirements to run • Works with standard webcams • Host controlled synchronization

18. Rural Health Technology A number of criteria have been promoted for a systemic approach to telecommunications for rural health, including: • Interoperability (ability to exchange information with other systems) • Scalability (elements that work equally well in small or large settings) • Flexibility in approach and in tools used • Use of low-end and more readily available “off-the-shelf” technologies • Recognition of the different starting points of most programs • Broad consideration of various technological approaches without bias or preference for any particular technology and appreciation of the situational and cost needs of host communities and institutions • Designing systems that are secure and promote patient confidentiality (Neuberger, Payne, & Wakefield, 2001) Neuberger, N., Payne, M. E., & Wakefield, M. (2001). Rural Health Care and the Internet: Issues and Opportunities for Using Interactive Communications to Improve Rural Health Care Services. VA: Health Tech Strategies, LLC.

19. Low-End & Readily Available Technologies The Telehealth Training Center’s approach to technology must be neither “high tech,” nor “low tech,” but “appropriate tech.” Just as consultation and education services must be tailored for the specific needs of the provider and patient, so must the communication medium. Rural areas often have less access to technology and training resources. (Meit, 2004) Meit, M. (2004). Rural Public Health Preparedness: The Rural Public Health Research Agenda. Pittsburgh, PA: University of Pittsburgh, Center for Rural Health Practice.

20. Standard WebEx Features • Invite and remind participants - invite participants to an online meeting that has already started via email, voice conference, or instant messenger, and send reminders about your upcoming meeting. • Use integrated WebEx audio – create a more productive meeting experience with integrated WebEx audio. • Record your meeting - record your actions during your meeting so you can review the discussion at a later time, or send to colleagues who couldn’t attend. • Share content - get everyone on the same page. Open any document or application and discuss it in real time with other participants. • Pass the ball - let other participants share and present documents from their computers and assign privileges to individual participants. • Transfer files - avoid sending emails back and forth by exchanging files – no matter how large – in your meeting quickly, easily, and securely. • Interact within a meeting - use polling and chat, and learn how to integrate webcams into your meeting for a more personal experience.

21. Questions