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Learning From Alaska’s Telehealth Experience
 

Learning From Alaska’s Telehealth Experience

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Stewart Ferguson, PhD ...

Stewart Ferguson, PhD
Acting CIO, Alaska Native Tribal Health Consortium and Director, Alaska Federal Health Care Access Network (AFHCAN)

John Kokesh, MD
Medical Director, Department of Otolaryngology, Alaska Native Medical Center

(2/11/10, Workshop 3, 12.30)

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    Learning From Alaska’s Telehealth Experience Learning From Alaska’s Telehealth Experience Presentation Transcript

    • Learning From Alaska’s Telehealth Experience Stewart Ferguson, PhD John Kokesh, MD
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    • Stewart Ferguson Ph.D. is Acting CIO for the Alaska Native Tribal Health Consortium and Director of the Alaska Federal Health Care Access Network (AFHCAN). He currently serves as Vice President of the American Telemedicine Association. He has been involved in development for CT scanners, the forward and inverse problems in biomagnetism, and imaging techniques for cardiac activity. He holds M.S. and Ph.D. degrees both in Biomedical Engineering, and B.S. degrees in both Mathematics and Electrical Engineering. John Kokesh, MD is Medical Director of the Department of Otolaryngology at the Alaska Native Medical Center where has has worked for the past 17 years. His a full time clinician whose focus in telehealth is developing clinical applications, clinical outcomes research, education and business processes for store and forward telemedicine. He received his M.D. degree, residency training and head and neck oncology fellowship training at the University of Washington. He holds clinical faculty appointments at the University of Washington, Loyola University of Chicago and Central Michigan University. He is a fellow of the American Board of 5 Otolaryngology.
    • Cases Created per Year  10 year Operational History ◦ 20,000 cases / year 25,000 ◦ 14,000 Alaska Natives served/year 20,000 Cases Created 15,000 10,000 ◦ 900 Active providers / year 5,000  Whole Product Solution 0 ◦ Design  Manufacturing  Installation  Training  Support  Marketing 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 (Proj) 16,000 Annual Patient Involvement  Alaska: 248 sites, 44 organizations 14,000 ◦ 37 Tribal organizations ◦ US Army sites (6) & US Air Force 12,000 # Patients 10,000 8,000 6,000 bases (3) 4,000 2,000 ◦ State of Alaska Public Health 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Nursing (26) (Proj) ◦ Community Health Centers  Other states and countries 6
    • When one has finished building one’s house, one suddenly realizes that in the process one has learned something one really needed to know in the worst way – before one began Nietzsche, 1886 7
    • PLEASE NOTE: Outcomes will be presented on Thursday in a separate session. 8
    •  TheAFHCAN Story … from a Program perspective.  The AFHCAN Story … from a Clinician’s perspective.  Skeletonsin the Closet … what we learned, and what we did right and wrong.  Where to next?
    •  Theseare our experiences. ◦ Actual mileage may vary.  Some of these issues only apply to large scale systems. ◦ E.g. Apportionment, centralization.
    • … from a Program Perspective
    • ATA Defining Telemedicine http://www.americantelemed.org/news/definition.html 12
    • 1990-2002 Store & Live Forward VtC Remote Monitoring
    •  Asynchronous.  Low bandwidth requirements  Can create a case  Static data – e.g. Vital signs “on the run.” Doctor can respond Static Images   when available. ◦ Digital camera (megapixel)  Many consults are ◦ Scans not critical. ◦ Captured video images  It is needed as a (ENT, Dental, Opthal., Naso.) communication  Video Clips – esp. from video tool. devices  Fits with present  Temporal Data: model. ECG, stethoscope, tympanomet  Minimal onsite technical support is er needed.  Textual: ◦ Health summaries 14
    •  1st in land mass ◦ 1,420 miles (N-S) ◦ 2,400 miles (E-W)  33,900 miles of shoreline ◦ More than all of the contiguous states combined. National Travel and • 47th in road miles Safety Board (NTSB) – 75% Alaskan communities unconnected by reported 436 a road to a hospital. commuter aircraft – 25 of these have no airport. accidents in Alaska – 25% Alaskans (46% of Alaskan Natives) from1990-2004 (2.8 live in communities of less than 1000 accidents a month) - people. accounting for 36% of all commuter • Population density is 1.1 persons/mile2 aircraft accidents in – 70 times smaller than the national average. the US. 15
    •  49% of all physicians in Alaska are primary care physicians (2002 data). U.S. average is 28%  Alaska is 48th in “doctors to residents” ratio ◦ 65% are located in Anchorage ◦ Shortages in many specialties ◦ 579 Community Health Aides in 200 villages provide nearly ½ million encounters each year. AI/AN U.S. Gap DISPARITIES: MD 73.9 220.6 66% Lower Health Staff per DD 24.0 61.8 61% Lower 100,000 people Nurse 229.0 849.9 73% Lower 16
    •  180 Small Village Health Centers 550 Community Health Aides/Practitioners 125 Behavioral Health Aides 20 Dental Health Aides/ 12 Therapists 100 Home health/personal care Average Alaska village attendants  350 Residents 17
    •  Radio ’60’s  Telephone 70’s  Fax 80’s  X-ray transmission 80’s  Computer 90’s  2 way video 90’s  Universal Services Fund (USF) – broadband connectivity - 1999
    • GOAL: Evaluate the impact of low-bandwidth telemedicine systems on costs, professional isolation and provider/patient satisfaction  Funded by NLM (National Library of Medicine) Contract #N01-LM-6-3540 ◦ University of Alaska Anchorage (UAA)  Fred Pearce, Ph.D. Principal Investigator  4 Regional Health Corporations ◦ 26 Village clinics,  3,000 cases 9,000 images
    •  Email-Based Software  Basic Cart with video otoscope and camera  Shipped in small boxes and flown to clinic  Assembled by local high school students
    •  The solution need not be sophisticated or complex to be clinically effective …  … as long as providers are able to gain value. 23
    • 40% 35% Provider Experience 30% Telemedicine Cases 25% 20% 15% 10% 5% 0% 0-4 5-9 10-14 15-19 20-24 25-29 30-34 Provider Years of Experience Clinical experience of health aides had no impact on utilization.
    •  It’s NOT about the technology – it’s about the value proposition.  Experienced health aides saw the value – e.g. it let them convince the new doc that they really were seeing an infected ear.  Think … “communication tool”
    •  Non-clinical factors will often drive usage and usage patterns … perhaps more than clinical factors.  A note about evaluation – be careful! Notice Hawthorn effect (or top ten ways to kill telehealth usage)
    • Usage 100% 80% will grow Telehealth Cases faster Linear Predictor than the 60% Good Predictor 40% number of sites 20% involved 0% Maniilaq (11 of 11) NSHC (5 of 14) BBAHC (5 of 28) YKHC (5 of 46) Organization (# clinics involved)
    •  Partial participation will results in less than partial results: We’re either all in or it’s not worth doing.  Full participation and organization support is the only approach to gain desired utilization.  Pilots may not tell you about larger systemic issues and may not be predictors of usage.
    • Cases Created per Year (by Role) 6,000 5,000 Cases Created 4,000 3,000 2,000 1,000 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 (Proj) Primary Care Specialty Care 30
    • Source: YKHC Policy PF_O52_PC “Telemedicine Cart Use”
    •  “I will fire anyone that does not do telemedicine” – Janet Shackles.  Policies work.
    • The Alaska Native Health Board The Alaska Native Tribal Health Consortium The Alaska Federal Health Care Partnership The Alaska Telehealth Advisory Council 33
    •  Veterans Affairs  DoD (Army & Air Force)  DHS - (USCG)  Indian Health Service (IHS):  Alaska Native Tribal Healthcare Consortium (ANTHC) 34
    • A formal, voluntary, Underling Philosophy interagency relationship  Learning Organization between the DoD, DHS,  Patient centered IHS and VA working  Health care as close to together by the sharing home as possible of each other’s  Long term resources, talents, and relationships experience to improve  Respectful of individual patient care throughout cultures the state of Alaska  Evolving process  Inclusive not exclusive 35
    • Alaska State Population: 626,932 DoD Federal/ Tribal Population Other DHS DoD/DHS 72,950 VA 63,000 IHS/Tribal 115,000 VA Total 250,950 Note: Total Federal/Tribal Population includes both “dual” and “triple” beneficiaries IHS & Tribal *2000 Census Figures
    •  Alaska Native Tribal Health Consortium (ANTHC) ◦ Management structure and support ◦ AFHCAN funds were centralized in ANTHC  Appropriations may be used as multi-year funds AFHCAN MISSION: To improve access to health care for federal beneficiaries in Alaska through sustainable telehealth systems
    • AFHCAN MISSION To improve access to health care for federal beneficiaries in Alaska through sustainable telehealth systems Alaska Federal Health Care Access Network
    •  Leverage existing RELATIONSHIPS and collaborative groups.  Leverage their contacts.
    • EXECUTIVE BOARD TELEHEALTH CEO / Commanders ANMC, VA, USCG, 3MDG, BACH, 354 MDG Team 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 AFHCAN Project Technology Office Business Informatics
    •  Project Proposal with defined bylaws  Autonomy of organizations  Ownership of equipment  Maintenance of referral patterns
    •  … for developing mission, intent, and funding  … for overall design: Partner  … for making it happen: Dedicated, committed work unit with staff, equipment, offices, funds, rol es and responsibilities.  … for making it work: Partners plus office 42
    • ATAC members provide direction, ATAC leadership and coordination of Statewide telehealth efforts Telehealth throughout Alaska. Issues ANTHC AFHCP Funded and Operating Supported AFHCAN AFHCAN 43
    •  More steering, less rowing.  There is a role and need to involve partners not directly involved in the project  Chance to involve payers, other systems, address issues of standards and interoperability, look to the future, share in successes.  Created a buzz – and a sense of ownership beyond the project. 44
    • Primary Care Kasan Primary Care Alicia Clinic SEARHC Juneau Roberts Medical Center Medical Center Subregional Center Dental Dental Primary Care Initial Entry Hydaburg Clinic Dental Both Initial & Secondary Specialty Secondary Care Clinics SEARHC Sitka Acute Care Clinics Secondary Eye Care Pelican Emergency MEH &Tertiary Diagnostic Outsourced Clinic Services Care Services Mental Health Therapy Harborview Haines Medical ANMC Center Dental Planned Providence Angoon Clinic Primary Care AK (MLP) API Klukwan Kake (Limited Entry) Private Clinic MD/Dental Tenahee Clinic Petersburg Clinic (MLP) Wrangall Skagway The Clinical System Ketchikan
    • What are your key organizational goals for telehealth applications? Quality of Care Access to Care Patient Satisfaction Continuity of Care Information Transfer Cost of Care/Saving 1 2 3 4 5 6 Low Priority Average Priority High Priority 46
    •  May not tell you what you need to know.  May not tell you where telehealth can impact clinical care.  Might not be asking the right questions.
    •  Ear Disease ◦ Audiometer, Tympanometer, Video Otoscope  Heart Disease ◦ ECG & Vital Signs Monitor  Respiratory Illness ◦ Spirometer & Vital Signs Monitor  Trauma, Skin & Wound ◦ Digital Camera  Dental Problems ◦ Dental Camera  General ◦ Scanner & Forms 50
    •  Base Cart include: ◦ Metal Frame ◦ Isolated Power System ◦ CPU and LCD Touchscreen ◦ Expansion Ports for USB, RS232, Video In/Out, External Display  Currently Supported Peripherals include: ◦ Video Otoscope ◦ Digital Camera ◦ Scanner ◦ Video Conferencing ◦ ECG ◦ Spirometer ◦ Tympanometer ◦ Audiometer ◦ Dental Camera ◦ Vital Signs Monitor ◦ Stethoscope
    • National Telehealth Technology Assessment Center Providing a variety of resources to the NTTAC telehealth community • Device assessment toolkits – five this year • Technical support to Regional Telehealth Resource Centers • News and information on technologies and clinical applications A robust online community for sharing and learning • Includes full access to toolkits and forums • Hosts and records webinars • Helps select technologies for assessment • Will have free membership through 2010 www.TelehealthTAC.org Made possible through support from HRSA and IHS
    •  Do NOT underestimate the value of a well designed SYSTEM (not just a collection of devices).  The devil is truly in the details. This is where you need the detail people involved.  Know the conditions you are designing for.  Involve clinicians early and often in equipment review, and design.  Decide if YOU want to become a manufacturer.
    •  Simplicity is key for Case Creation  Minimize need for keyboard skills  Touchscreen  Color coded 56
    •  Rich Web Interface for Specialists  Zero software footprint 57
    •  Minimal computer skills: Touchscreens  High turnover rates (re- training): Few choices per screen, color coded  Language barriers: Very selective word choice  Disparate educational levels: Reduce complexity to few components
    •  Specialist? Ease of acquisition less important  Primary Care Provider? Ease of acquisition more important
    •  More than hardware – the software design is NEVER done.  Get a solution out quick.  Know your users – and involve them heavily in design decisions.  Do NOT let your developers add every “good” idea. Mandate clinical governance in software design decisions.  Again - decide if YOU want to become a software developer.
    • Response Rate to Evaluation Questions 2010 (Proj) (n=20,004) 2009 (n=14,542) 2008 (n=11,030) 2007 (n=11,137)  Clinical 2006 (n=8,817) Committee 2005 (n=7,771) supported 1 2004 (n=7,058) question per 2003 (n=5,058) case session 2002 (n=3,431) 2001 (n=921)  Configurable 0% 10% 20% 30% 40% 50% 60% Response Rate (%) 70% 80% 90% 100% questions Consultant Responses Initiator Responses ATHS (Alaska Tribal Health System) (1/1/2001 to 8/31/2010) 61
    •  Build in from the start  Involve stakeholders in design  Remember Hawthorn
    • Noatak Health Clinic Maniilaq Health Center Satellite Satellite Alaska Native Medical Center (ANMC) 63
    •  Solution must support the workflow  Do not change workflows to support the solution.  Workflows change. This requires a flexible system
    •  A massive shift in the plan allowed for design and Original Plan Actual Plan testing phases. Oct 1998  A “multiphased” Deploy 40% NLM Deploy approach provided confidence for the Oct 1999 rapid deployment Deploy 40% Equipment of a basic solution. Support 40% selected Oct 2000 Deploy 20% Deployment Support 40% Begins Oct 2001 Support 20% 250th Cart Server-to-Server Oct 2002 65
    •  Allow significant time for design and development – it will pay dividends.  Plan for delays and problems – contingency plans for clinical care, problem resolution, design changes, …
    • Provides project oversight, coordination and centralized management  Planning  Informatics and data  Contractual and needs Legal/regulatory  Clinical Program Design  Recruitment of providers  Ongoing SLA Monitoring  Needs and Site  Purchasing Assessments  Deployment / Config.  Technology Assessment  Support and Training  Marketing  Evaluation 67
    • Budget Budget % Budget Lvl Description (Installation) (Support) per Site A1 Tertiary Care Native Medical Center $1,535,200 $191,800 5.6360% A2 Tertiary Care Military Medical Center $1,375,520 $171,840 5.0498% B1 Hospital - Very high workload $696,800 $87,000 2.5579% B2 Hospital - High workload $625,120 $78,040 2.2947% B3 Hospital - Medium high workload $590,560 $73,720 2.1679% B4 Hospital - Low high workload $397,520 $49,590 1.4591% B5 Hospital - workload < 35,000 $354,560 $44,220 1.3014% C1 MD Health Center - Fairbanks $497,280 $62,060 1.8254% C2 MD Health Center - VA $425,600 $53,100 1.5622% C3 MD Health Center - Native Primary Care Ctr $313,360 $39,070 1.1501% C4 MD Health Center - workload 20,000-50,000 $262,800 $32,750 0.9645% C5 MD Health Center - workload 10,000-20,000 $145,840 $18,130 0.5351% C6 MD Health Center - workload < 10,000 $103,360 $12,820 0.3791% D1 PA Health Center workload > 4000 $107,280 $13,310 0.3935% D2 PA Health Center workload < 4000 $93,120 $11,540 0.3416% E1 CHA Health Center workload > 4000 $100,240 $12,430 0.3677% E2 CHA Health Center workload < 4000 $82,580 $10,260 0.3030% F1 PHN Health Center workload > 4000 $79,600 $9,850 0.2919% F2 PHN Health Center workload < 4000 $46,720 $5,740 0.1712% 68
    • Project Plan $30,685,640 5 Year Actuals (FY99-FY03)* $27,456,279 * Five Year Actuals are $28,332,505 including ATAC Project Plan Expenditures (FY99-FY03) Equipment (Phase 1) Site Funds and Equipment (Phase 2) Software Development Project Design and Management Deployment Unfunded Requirements (e.g. ATAC) 0% 5% 10% 15% 20% 25% 30% 35% Percent of Budget or Actuals 69
    •  Agree early on where the funds sit (central … or not)  Agree on apportionment process  Portion for cash, equipment, support, …  Portion to remain centralized
    • … from a Clinician’s Perspective
    •  Find and develop interest  Establish acceptance  Promote usage  Build programs  Integrate telehealth into the standard way you deliver care
    • One question: Do we have a problem we need to solve?
    • ENT Clinic Demand, Supply and Activity (Jan 2002 - May 2003) 60 50 Patient Appointments 40 Avg Demand 30 Avg Supply Avg Activity 20 10 0 Monday Tuesday Wednesday Thursday Friday 74
    •  If there is no perception of a problem, look elsewhere  If they don’t think it is broken, you can’t fix it
    • Put the technology in their hands Make sure it works Let them play Support, support, support Go for the easy win Talk about it
    • How satisfied were you with the use Willing to have a telemedicine of the telemedicine technology? exam for follow-up? 25 30 20 15 20 10 10 5 0 0 No Yes Poor Fair GoodVery Good Overall Satisfaction How well did the telemedicine technology With This Visit help you understand your problem? 25 30 20 15 20 10 10 5 0 0 PoorFair ood G Very Poor Fair Good Very Good Good 79
    • “I was able to see the problem - then the repaired normal condition … and discussed my problem - very informative!” “I liked to see with my own eyes the inside of my ear!”
    •  Let your customers (patients) create your buzz.
    •  For clinicians, you have to prove it works  There must be a value proposition • Better? • More efficient? • You can do what you otherwise can’t do • More profitable?
    •  254 sets of tubes placed at ANMC in 2000  1,000 follow up appointments needed in 12 month period  Many of these patients from remote areas 83
    •  To determine if video otoscope still images (640 x 480 pixel resolution) of the tympanic membrane following surgical placement of tympanostomy tubes are comparable to an in-person microscopic examination.
    • % CONCORDANCE ON PHYSICAL EXAM 100% 99% 99% 99% 97% 96% 95% 94% 90% 90% InterProvider (Exam0) 85% 80% IntraProvider using all images (Exam0 vs Review1,2) 75% 70% IntraProvider using "good" images 65% (Exam0 vs Review1,2) % Concordance 60% 55% High level of agreement  Correlation between in person 50% 45% exam and telemedicine exam 40% good to excellent 35% 30%  Telemedicine can be used to do 25% 20% routine ear tube follow up 15%  Make available several hundred 10% 5% appointments per year 0% Tube In Tube Drainage Perforation Granulation Middle ear Retracted Patent fluid Physical Exam Descriptors Kokesh J, Ferguson AS, Patricoski C, Koller K, Zwack G, Provost E, Holck P. “Digital images for postsurgical follow-up of tympanostomy tubes in remote Alaska”. Otolaryngology-Head and Neck Surgery, 139:87-93, 2008. Patricoski C, Kokesh J, Ferguson AS, Koller K, Zwack G, Provost E, Holck P. “A Comparison of In-Person Examination and Video Otoscope Imaging for Tympanostomy Tube Follow-Up”. Telemedicine Journal and e-Health, 9(4):331-344, 2003.
    •  “Waiting time for a field clinic appointment has gone from 4-5 months a year ago to 1- 2 months now. I've probably got 100 stories of patients or parents who were pleased with the quicker, easier access to ENT services they Kokesh J, Ferguson AS, Patricoski C. received either through “Preoperative planning for ear surgery using store-and-forward telemed or direct referral.” telemedicine”. Otolaryngology-Head Mike Comerford, Audiologist, and Neck Surgery, 143:253- 257, 2010. Yukon Kuskokwim Health Corporation
    •  Low hanging fruit is still fruit.  Take it  Talk about it 87
    •  If you often say “There must be a better way” there probably is  Look for these in terms of telemedicine 88
    • Take your best ideas and build on them. 89
    • Traveling a Provider to Promote Efficiency and Rapid Delivery of ENT Care Through Telemedicine Kokesh J, Ferguson AS, Patricoski C, LeMaster B. “Traveling an Audiologist to Provide Otolaryngology Care Using Store-and-Forward Telemedicine”. Telemedicine and e-Health, 15(8):758-763, 2009.
    • Patient Cost Visits Traveling Audiologist Program 1,987 ($175,000) Patient Travel Prevented 1,726 $697,090 Based on Outcomes of: • Did patient still need to travel to field clinic? Assumptions: Note: 1,153 • Only travel to hub is being saved. • Escort required if patient less than 18 years old less than • No lodging / per diem calculated 18 yrs old Net Savings in Travel Costs $522,090 Realized by Program (300% ROI)
    •  Proven technology  High unmet need  No other good solutions 96
    •  Evolve successes to predictable levels of clinical service  Find and support (but don’t solely rely on) your clinical champions  Clinical protocols matter  But it’s all about RELATIONSHIPS 97
    • Champion Service Model  Can  Guarantee of performance ◦ See potential  Agreed upon expectations ◦ Create  Sustainable and scalable ◦ Innovate ◦ Nurture  Accountable  Can’t  Independent of ◦ Sustain individuals ◦ Grow to large scale  Requires support ◦ Leave something behind structure 98
    •  Multi-provider, multi-region, multi- organization, multi-jurisdiction, patient participant….  Focus on integrating with the way providers work and formalizing relationships and mutual responsibilities: ◦ Who accepts referrals? ◦ Do they have specific data requirements? ◦ How fast must they answer? ◦ How do you track what is happening? ◦ How is everyone paid? ◦ Who gets notified and must respond when the patients telemetry data tanks? 99
    •  Software can help drive clinical protocols  Essential for program development 100
    • 2.6 cases/month 7.9 cases/month Almost 10 250 more Avg Monthly Caseload 8 patients 6 are being 4 seen per 2 year, a 0 savings in -48 -36 -24 -12 0 12 24 80 man- years of TIME Relative to CME/Training (months) Before CME After CME waiting time. AVG (Before) AVG (After) 101
    • Misunderstanding incentives The workload / capacity mismatch “In addition to” versus “Instead of” trap 102
    • 103
    •  Know the incentives for behavior within your system, and make sure that they on in alignment with what you are trying to accomplish  If they are not, change the incentives or move on to a different project.
    • You may be “too successful” System usage may grow faster than you can grow capacity Have contingency plans – short and long term
    • Frame telemedicine 12  Median Time per Case (min) as a better way to 10 8 do existing work, 6 not just additional 4 work 2 Provide appropriate 0  Sep-02 Sep-03 Sep-04 Sep-05 Sep-06 incentives  Don’t reward work well done with more work
    •  If you are not a clinician, “Live a day” with your clinician(s)  Knowing the work, the workflow, the systems within which they work will provide you a huge advantage  Build trust, understanding, rapport 108
    • … what we learned, and what we did right and wrong.
    • … don’t get so caught up in the “doing” that you neglect to reflect, speak and write about what you have done so far.
    • Annual Provider Usage (by Experience) 1,000 800 # Providers 600 …early on and 400 forever. And over 200 and over again. 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 Return New
    • Don’t be afraid to pull and reallocate resources.
    • Make sure you have the expertise and tools you need at the outset
    • Goodwill eventually runs out.
    • Where does Telehealth fit into the “Health Information Exchange?”
    • WHAT IS HOT CONNECTED HEALTH AFHCAN’s success in the past has been by ourselves AFHCAN AFHCAN server server AFHCAN’s future success will be based on how well our system can work with others
    • The goal of HIE is to Health Information There VtC S&F ExchangeaccessTheand facilitate (HIE) to retrieval of clinical data to mobilization of healthcare provide safer, more information electronically Space timely, efficient, effective, e across organizations within a region, patient-centered quitable, community or care. hospital system. Here “Classic” EHR/ EMR Now Soon Time Future 117
    • 118 118
    • “Network of Networks” being developed to provide a secure, nationwide, interoperable health information infrastructure that will connect providers, consumers, and others involved in supporting health and healthcare HISPC Electronic Health Record (EHR) Laboratory Results Reporting IS 01: Policy The02: Biosurveillance IS Health Information Security and Privacy Empowerment IS 03: Consumer Collaboration IS 04: Emergency Responder Electronic Health Record (ER-EHR) HITSP Consumer Empowerment and Access to Clinical Information IS 05: Standards via Media Healthcare Information IS 06: Quality Technology Standards Panel IS 07: Medication Management IS 08: Personalized Healthcare CCHIT Consultations and Transfers of Care IS 09: Certification Certification Commission for IS 10: Immunizations and Response Management Healthcare Information IS 11: Public Health Case Reporting Technology IS 12: Patient – Provider Secure Messaging IS 77: Remote Monitoring
    • Samples: C32 – Summary Document Using HL7 CCD May include administrative (e.g., registration, demographics, insurance, et c.) and clinical (problem list, medication list, allergies, test results, etc) information C48 – Encounter Document AFHCAN will be Supports the process of sending patient going live with encounter data (excluding laboratory and radiology) C32 interfaces to EHRs statewide C74 – Remote Monitoring Observation Medical information collected by remote later in 2010. monitoring management systems from monitoring devices and/or device intermediaries C84 – Consult and History & physical note Support the exchange of information from a consulting provider to a referring provider; and may also be used to provide background information from a referring provider to a consulting provider 120
    • 2003-2009 Blending Specialties Store & Live Forward VtC Remote Monitoring
    • 2010  Technology Blending Store & Live Forward VtC Remote Monitoring
    • Traditional Devices + New Connectivity + New Messaging = NEW SOLUTIONS 124
    •  Recognize that needs and technologies will shift during the lifetime of your system.  Constantly re-assess your program.  Look for the next thing. 125
    •  Telehealth is a clinical mandate, not a technical initiative.  Provide a predictable level of service (with scarce clinical resources).  Support local planning and decision making.  Provide state/national coordination, planning and accountability.  Create efficiencies through centralized services.  Leverage existing expertise. 126
    • Thank You John Kokesh, MD Stewart Ferguson, PhD Department of Otolaryngology Alaska Federal Health Care Access Alaska Native Medical Center Network (AFHCAN) 4315 Diplomacy Drive Alaska Native Tribal Health Consortium Anchorage, AK 99508 4000 Ambassador Drive Anchorage, AK 99508 (907) 729-1416 jkokesh@anthc.org (907) 729-2262 sferguson@anthc.org AFHCAN, Alaska Native Tribal Health Consortium, Anchorage, AK