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Telemedicine In Healthcare Rural Areas Specialty Coverage. Michael Manley, RN, MNSc Outreach and AR SAVES Director Center for Distance Health University of Arkansas for Medical Sciences. First e-ICU. Patients First. Utilizing Telemedicine Across the Healthcare Spectrum.
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Telemedicine In HealthcareRural Areas Specialty Coverage Michael Manley, RN, MNSc Outreach and AR SAVES Director Center for Distance Health University of Arkansas for Medical Sciences
Origins of ANGELS/CDH in AR • In 2002, DHS approached UAMS with high risk OB support concept • Innovative program was able to leverage federal dollars to increase access to care • UAMS provides state match portion, resulting in requirement of no state funds
Arkansas Telemedicine Model Education & Training for Providers Centralized Tech Support & Scheduling Call Center 24/7 Offer Community Needs-Based Services Telemedicine Network & Infrastructure Evaluation and Quality Improvement Case Coordination & Evidence-Based Guidelines/Protocols
Angels Call Center In 2013: Staffed by 6 appointment center specialists Handled 206,481 phone calls Processed 26,662 appointments 1824 Urgent care visits avoided by triaging
Guidelines • 203 guidelines for best practices in Obstetrics, Neonatology, & Pediatrics www.angelsguidelines.com
Interactive Video Conferences • High Risk OB • OB/GYN Grand Rounds • ONE Team nursing teleconference • Fetal Anomaly Interdisciplinary Management (FAIM) • Peds PLACE For a current listing and access information please go to - https://learnondemand.org/events.aspx
Education Courses • On-site and via Interactive Video • S.T.A.B.L.E. • AWHONN Fetal Heart Rate Monitoring Courses • NRP • Breastfeeding mini-course • Nurse Certification Courses • Inpatient OB • High Risk Newborn • Low Risk Newborn • Maternal/Infant
Online Education • Launched December 2013 • Over 100 modules • >1000 users • 65 of Arkansas’ 75 counties with users • ANGELS content free to Arkansas residents • Multidisciplinary • Continuing Medical Education • Continuing Nursing Education • Continuing Pharmacy Education
Patient Education Website • To launch Summer 2014 • Allows for private discussion groups (HIPAA compliant) • First educational initiatives will focus on maternal/infant education
Arkansas SAVES: Purpose • Increasing subspecialty access to rural stroke patients • Impacting stroke-related disability and mortality, and • Enhancing emergent stroke support by consulting on the administration of tPA medication to eligible patients.
Arkansas SAVES: Rationale • Rural hospitals without the support of a neurologist often forgo administration of tPA. • The time needed to affectively administer tPA is often lost when transporting patients. • Arkansas’ stroke patients are missing out on sub-specialty expertise.
Adult Sickle Cell Clinical Program • Program Background • Legislature support for Sickle Cell (2012) • UAMS given opportunity to develop program • 2013 Program development • Jan 2014 Adult Sickle Cell Clinical Program
Program Overview • Transition Clinic • Facilitate patient’s transition from ACH to adult care • Annual sub-specialty multi-disciplinary clinic • Inpatient Consult Service • Registry • Database collecting valuable information concerning Arkansas Sickle Cell patients • 24/7 Triage Call Center supporting program (providers, patients, and community) • Educational program • Best practices for sickle cell disease treatment • Sickle Cell Outreach to AR Providers and communities • Directory of Arkansas Healthcare Providers • that manage Sickle Cell patients
Telehealth and Sickle Cell • Current uses • 24/7 Triage Call Center Support for Providers, Patients and Community • Educating Healthcare Providers • Teleconference Presentations • Call Center encounters • Future Plans for Telemedicine • Building a Sickle Cell PCP Network through TM outreach • Telemedicine Clinic • Collaboration with PCPs • Consults for acute care treatment • Consults for best practices to use in daily practice • Follow-up with shared patients
Image Repository Trauma Images can move between hospitals for trauma patient
Patient HAND Arkansas Trauma Hand Specialist
TRIUMPH Tele-Rehabilitation Interventions through University-based Medicine for Prevention and Health
TRIUMPH • Education-Guideline development, presentation and promotion. • 24-7 Call Center 1-855-PMR-MYTE (767-6983) • Telemedicine appointments for Arkansans living with Spinal Cord Injury and Traumatic Brain Injury
Federal Communications Commission Rural Health Care Pilot Program Evolution of UAMS Telehealth Programs (2003-2014) (ONE) Team ObstetricalNeonatal Exchange CE for Nurses Triumph Tele-Rehab Spinal Cord Commission 20134,566 OB patient visits Fetal Echo (Clinic) TOUCH Telemedicine Outreach Utilizing Collaborative Healthcare(Neonatal Census Rounds) FAIM CME for MDs $102M BTOP Grant Award High-Risk OB & Neonatal Guidelines Completion of BTOP Grant Connecting 410+ Healthcare Sites 2003 2004 2006 2007 2008 2009 2010 2011 2012 2013 2014 • New Clinical Services: • Diabetes • Colposcopy • Resident-facilitated HROB Clinic • Spanish Translation Interpretation Services Telehealth KIDS Hand Trauma ANGELS 24-hr Call Center Service Stroke Assistance thru Virtual Emergency Support Adult Sickle Cell (Clinic) Guideline Smartphone Application Postpartum Hypertension Project HealthEducationAssessmentResearchTelehealth FY 2013: 594 consults, (tPA to151 patients) Tele-Nursery
BTOP Broadband Technology Opportunities Program (BTOP) Awarded in 2010
BTOP Benefits in Arkansas Healthcare Higher Education/Libraries Public Safety Research & Clinical Trials
Year 4: After Grant Funding Ends Current Healthcare Examples 3-1-2011
Year 4: After Grant Funding Ends Current Education Examples 3-1-2011
Telemedicine Broadband and Equipment Overview 454 sites total includes 33 colleges and universities, 15 home health sites and 1 public safety organization.
Conclusion “Where you live shouldn’t decide whether you live or whether you die.” Paul Hewson