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    [PowerPoint] [PowerPoint] Presentation Transcript

    • AFHCAN Project Stewart Ferguson, Ph.D Associate Project Director Director of Technology AFHCAN Project Office Alaska Native Tribal Health Consortium 907-729-2260 www.afhcan.org
    • AFHCAN Sites
    • AFHCAN Partners
      • IHS - 194 sites - 97,000 beneficiaries
      • VA - 1 site - 65,000 beneficiaries
      • US Army, US Air Force - 9 sites - 47,000 military and dependents
      • USCG - 4 sites - 3,000 beneficiaries
      • Alaska PHN - 26 sites
    • “Remoteness” by Access
    • Cost of Travel
    • “Types of Sites” by Staffing
    • NLM - Maniilaq Data
      • 11 Village clinics
      • Begin: 1/26/1999
      • Gather: 1/15/2001
      • 2863 Cases
      • 8594 Images
        • 3393 Video otoscope (40%)
        • 5061 Digital camera (60%)
    • Lessons Learned from NLM...
      • Software too difficult
        • “ If you don’t use it regularly, then you will forget how to use it”
      • Radio Medical Traffic
        • “ 20 cases in 30 minutes”
    • Radio Medical Traffic
      • Daily telephone calls
      • 90 seconds / consult
      • Telemedicine facilitates this process
    • What is Telemedicine? “ Telemedicine involves the transfer of health data over a telecommunications system.” Ask-a-Doc Home Health Store & Forward RMT Radio/Phone/Fax Remote RPMS VideoConference Remote Surgery Single Provider Multiple Providers
    • Workload Distribution
    • What are your key organizational goals for telehealth applications? Please rank in order of importance to your organization:
      • Access to care
      • Patient Satisfaction
      • Quality of Care
      • Information Transfer
      • Costs/Economics
      • Continuity of Care
      • Other
    •  
    • AFHCAN Referrals
    •  
    • AFHCANet
      • Alaska Native Medical Center (1)
      • Veterans Administration Medical Center (1)
      • Maniilaq Health Corporation (13)
      • SouthEast Regional Health Consortium (12)
      • Kodiak Area Native Association (6)
      • Eastern Aleutian Tribes (8)
      • Norton Sound Health Corporation (15)
      • Public Health Nursing (?)
      • Yukon Kuskokwim Health Corporation (47)
      • Bristol Bay Area Health Corporation (30)
      • Dialup connectivity (up to 23)
      • Commissioned - EAFB (1)
    •  
    •  
    • VoIP - Anchorage Dial Tone
      • Provide 24 dial tones in Anchorage
      • Integrate T1 into PBX at sites:
        • SEARHC, KANA, NSHC, MHC
      • Least cost routing
      • Monitor traffic and cost savings:
        • NSHC spends >$2000/mo
        • T1 cost ~$900/mo
        • 24 dial tones ~$25/mo each
    • CLINIC NETWORK AFHCAN SYSTEM CART Otoscope ECG Scanner Touchscreen CPU UPS LAN Access Point Hub PRINTER Print Server Printer SERVER AFHCAN Cold Fusion SQL Server Web Server O/S CPU BASIC COMPUTER Monitor CPU WAN Router AFHCANet
    • AFHCANet POTS/WAN Facility “C” CHA #3 CHA #4 Router C Facility “B” CHA #1 CHA #2 Server B Facility “A” M.D. #1 M.D. #2 Server A HTTPS/XML
      • CLIENT
      • Operating System
        • Win95/98/NT/2000
        • (Unix/XWindows)
      • Browser
        • IE v4.01/v5
      • Acquisition Hardware
      • Frame Grabber
      • Biometrics
      • SERVER
      • Operating System
        • WinNT/2000
        • (Unix/Linux)
      • Web Server
        • IIS, Apache
      • Cold Fusion
      • Database Server
        • SQL, Access
      • Archive hardware
    • Sustainability
      • Organization owns equipment
      • Training provided on:
        • Assembly, testing, burnin
        • Software installation / management
        • Clinical design
        • Clinical usage
    • 1) Keep it Simple.
      • 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
    • 2) Make it Sustainable and Supportable.
      • Easily maintained
        • Open source design (.CFM)
        • State Machine
      • Centralize “Point of update” or “Point of Code”
        • Web solution - NO custom clients
        • remote upgrades
      • Minimize initial and recurring costs
        • No ongoing licenses
    • So many organizations … so many software issues!
      • >1000 Workstations
      • >100 Servers
      • WinNT, Win2000, Unix, Linux
      • IE3, IE4, IE5, Netscape, Xwindows
      • POTS to T1 connectivity
      • Different patient encounter forms
      • RPMS / CHCS / VISTA / Meditech
      • Funds disappear in 2 more years
    • A properly designed system can improve the quality of health care delivery without saving or sending a single byte.
    • Satellites
      • Add 0.6 seconds to roundtrip delay
      • Cause web pages to load in 5 - 40 seconds
      • Solutions:
        • Remove need for frame sets
        • Caching locally
        • TCP/IP registry tweaks
        • Different IP stack
        • IE (http) registry tweaks
        • 3rd party software (e.g. Flash Networks) - mostly proxy/spoofing techniques
        • 3rd party hardware
    •  
    • Effect of Proxy / SSL
    • Alaska Federal Health Data Sharing Planned Project Relationships What the AFHCAN software is not ... VISTA CHCS T2P2 ? GCPR MFI Telerad AFHCAN PACS Integrator HIS Telehealth CPRS ANMC 1/02-6/03, field start 9/03 CPRS Phase I deploy 7/00 RPMS Alpha 3/01-7/01 Beta 7/01-12/01 Phase III 2/02 RAHALL 4/00 version4 ANMC billing 6/00-10/00 Adding lab & meds Adding 10 yr data existing planned possible Going to CHCSII NPIRS/ ORYX
    • AFHCAN Evaluation
      • Usage - all
      • Evaluation questions - all
      • Voice over IP - SEARHC, KANA, NSHC, MHC
      • PE Tube Followup - MHC
      • Video Conferencing - SEARHC
      • Ear Disease - YKHC
      • FAS Clinic - SCF
    • FAS Clinic (SCF)
      • Team Approach - based on University of Washington’s nationally recognized model
        • Pediatrician
        • Pediatric Psychologist
        • Physical Therapist
        • Speech and Language Therapist
        • Social Worker
        • Parent Navigator / Advocate
        • Clerk
        • Coordinator
    • FAS Clinic (SCF)
      • Purpose - Develop diagnosis and treatment plan for FAS
      • Method - Interviews with parent and child
      • Technology
        • VtC (digital one way mirror)
        • Nikon 990 (dysmorphology)
      • Future - travel team, travel equipment
    • PE Tubes
    • PE Tube Followup
      • National standard - 4 month followups
      • Reality - 8 month or longer
      • Expect up to 90% of followups can be accomplished with reverse telemedicine
      • Is an image as good as an “on site” visit?
        • Two independent “on site, in person” assessments. Take images
        • 6 and 12 weeks later, conduct assessments from images alone.
        • Compare inter-provider variability, “on site” versus “image” assessment and treatment plans
    • 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 www.hss.state.ak.us/atac Core Principles Alaska Telehealth Advisory Council - Technical Standards Workgroup
    • ACKNOWLEDGEMENTS
      • Technical Expertise and Design
        • Tom Bohn
        • Jim Rogina
        • Chris Patricoski, MD
        • AFHCAN Statewide Committees
      • Funding Sources
        • DHHS - OAT
        • VA
        • U.S. Army
        • IHS
      • Legacy
        • NLM / UAA