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PACMEDTek - 1998 Clinical Applications Denver Allen Lodge, M.E., CCE Chief Biomedical/Clinical Engineer Alaska Area Native Health Service Making It Work:

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Presentation on theme: "PACMEDTek - 1998 Clinical Applications Denver Allen Lodge, M.E., CCE Chief Biomedical/Clinical Engineer Alaska Area Native Health Service Making It Work:"— Presentation transcript:

1 PACMEDTek Clinical Applications Denver Allen Lodge, M.E., CCE Chief Biomedical/Clinical Engineer Alaska Area Native Health Service Making It Work: Clinical and Technical Issues in Low-Bandwidth Telemedicine and Teleradiology

2 I need to I need text Alaska Native Health System Alaska Native Medical CenterAlaska Native Medical Center 7 Regional Hospitals7 Regional Hospitals 5 Physician-Based5 Physician-Based Health Centers Health Centers 22 Physician22 Physician Assistant Assistant Health Centers Health Centers 168 Rural Village168 Rural Village Health Stations Health Stations

3 Village Health Clinics emote Locations168 Remote Locations 450 CHA/PsStaff: 450 CHA/Ps 00 OPE/Yr300,000 OPE/Yr quipment$3M Equipment

4 Alaska Native Medical Center 150 Bed 5,000 Disch/Yr 225,000 OPE/Yr 50,000 Radiology Studies/Yr

5 Patient Transportation ed-Evacs/Yr90,000 Med-Evacs/Yr Yr> $40 M / Yr

6 Telecommunications Infrastructure Satellite Only (Low-Bandwidth) POTS Modem 9600 bps Frame Relay 56Kbps

7 ____}{ PHASE 1 PHASE 1 A LASKA T ELEMEDICINE P ROJECT NEEDS EVALU- ASSESSMENT ATION PHASE I - TELEMEDICINE

8 ____} - Full-Motion Video Teleconference - Narrow-Bandwidth VTC - Store & Forward Voice & Video - Telemetry & Teleradiology - Tele-Health Informatics - for every Health Provider { PHASE 1 PHASE 2 PHASE 1 A LASKA T ELEMEDICINE P ROJECT NEEDS DEMONSTRATIONS... EVALU- ASSESSMENT ATION PHASE IIa - TELEMEDICINE

9 ____} - Human Factors Analyses - Staff Turnover/Retention Analyses - Provider/Customer Satisfaction - Utilization Review Analyses - Cost-Benefit/Sustainability Analyses - Profile / Cluster Analyses { PHASE 1 PHASE 2 PHASE 2 A LASKA T ELEMEDICINE P ROJECT NEEDS STUDY WHAT HAPPENS EVALUATION ASSESSMENT & PUBLISH FINDINGS PROCESS PHASE IIb - TELEMEDICINE

10 ____} - Full-Motion Video Teleconference - Narrow-Bandwidth VTC - Store & Forward Voice & Video - Telemetry & Teleradiology - Tele-Health Informatics - for every Health Provider { PHASE 1 PHASE 2 PHASE 1 PHASE 3 A LASKA T ELEMEDICINE P ROJECT NEEDS DEMONSTRATIONS... EVALU- IMPLEMEN- ASSESSMENT ATION TATION $ PHASE III - TELEMEDICINE

11 Phase I - Needs Assessment performed by Alaska Native Health Board (ANHB) Phase I & II - Evaluation Methodology put in place (Phase I) & performed (Phase II) by University of Alaska - Anchorage (UAA) $ Funded through National Library of Medicine Contract N01-LM $3 Million, Over 3 Years 25 Villages PHASE I - TELEMED BASELINE RESEARCH

12 Phase I - Teleradiology Pilot Project (Dillingham) with Connection to ANMC PACS (Anchorage): Image Compression, Transfer, Storage, and Display $ Funded through Indian Health Service $450,000 Lease/Purchase Shared Maintenance Plan Compatible with other Alaska Federal Healthcare Partnership sites PHASE I - TELERAD PILOT PROJECT

13 Phase II - ANHB Needs Assessment yields NLM / UAA Evaluation Focus on Telemedicine Treatment of Ear Pathology $ Phase II also Funded by NLM Contract PHASE II - SCOPE OF TELEMED EVALUATION

14 Phase II - NLM Contract Demonstration Project Locations Anchorage Hub Demonstrations in 5 villages and 1 regional hub in 5 geographical regions: –Bristol Bay– South Central –Kotzebue– Yukon-Kuskokwim –Norton Sound PHASE II - TELEMEDICINE COUNTRY

15 PHASE II - LOW-BANDWIDTH TELEMED SITE COMPONENTS Equipment Cart Computer w/ Frame Grab SW, Store-&-Forward type SW Video Otoscope, & Video Monitor, Other Assessories: Digital Camera, Flat-Bed Scanner, & Color Printer, Power Conditioner/UPS POTS Modem Connectivity

16 Phase II - Bi-directional Teleradiology Connectivity via between PACS and ~10 Physician-Provider Sites $ Funded through Project AKAMAI and the Alaska Federal Healthcare Partnership $1.4 Million, One-Time Appropriation Self Maintenance Plan Compatible with other AFHP sites PHASE II - BI-DIRECTIONAL TELERADIOLOGY With WAVELETTE COMPRESSION ON-THE-FLY

17 Phase II - Wide-Area PACS Bi-directional Connectivity Locations: Barrow– Ketchikan Bethel– Kodiak Dillingham– Kotzebue Fairbanks– Nome Juneau– Sitka PHASE II - TELERADIOLOGY COUNTRY

18 PHASE II - TELERAD SITE COMPONENTS X-Ray Film Digitizer Digitizer Compression Send Unit Frame Grabber Compression Send Unit DICOM Bridge Compression Send Unit Medium Resolution Dual-Monitor Reading Station Frame-Relay (56kbps) WAN Connectivity

19 Show 3- Minute Video Now Please

20 I need to I need text Referral Paradigm HUBHUB SPOKESPOKE NEEDLENEEDLE

21 Needle Spoke Hub TELEMEDICINE ( N E E D L E P E R S P E C T I V E ) Clinical & Technical Issues - TELEMEDICINE ( N E E D L E P E R S P E C T I V E )

22 PERSPECTIVE: Convinced Telemed is an Important Tool Excited Overwhelmed Want Hub, Spoke & Needle Contacts Want Call Coverage CONCERNS: Not be Taken for Granted or Left Out Rather See Resources Spent on Other Things Worried about Fewer Med-Evacs Some Acute Cases TELEMED NEEDLE: Certified Health Aide / Professional (CHA/P) at Village Health Clinic

23 PERSPECTIVE: Motivated Want Hub, Spoke, & Needle Contacts Improve Communication Diagnostic Tool Management Tool CONCERNS: Adequate Training Electronic Forms Capability Call Coverage Technical Support TELEMED NEEDLE: Mid-Level Provider (PAs or CNPs) at Sub-Regional Clinic

24 TELEMEDICINE & TELERADIOLOGY ( S P O K E P E R S P E C T I V E ) Clinical & Technical Issues - TELEMEDICINE & TELERADIOLOGY ( S P O K E P E R S P E C T I V E ) Needle Spoke Hub

25 PERSPECTIVE: 50%/50% Acceptance Want Hub Contacts to Specialists Access to Competition Training Tool Want Regional Support CONCERNS: Call-Back Nuisance Changing Referral Patterns Bypassing Present System Protocols TELEMED SPOKE: Physician Provider at Regional Hospital

26 PERSPECTIVE: Motivated Like Original Films to Stay in Department Emergency Reports-1H Report Time doesn’t Depend on Mail - 24 Hr CONCERNS: More Clerical Work Computer Phobia Loss of Data / Glitches Slow Transmission Times Technical Support TELERAD SPOKE: Rad Technologist at Regional Hospital

27 PERSPECTIVE: Interested / Skeptical Want Clinical Quality - Medium Resolution Emergency Reports-1H Interpretation - 24 Hr Permits Pulling Previous Exams CONCERNS: Easy User Interface Still Like Looking at Film Fast Send Rates - Compression Technical Support TELERAD SPOKE: Physician at Regional Hospital

28 Needle Spoke Hub TELEMEDICINE & TELERADIOLOGY ( H U B P E R S P E C T I V E ) Clinical & Technical Issues - TELEMEDICINE & TELERADIOLOGY ( H U B P E R S P E C T I V E )

29 PERSPECTIVE: Reluctance Follow-Up Tool Prefer High- Bandwidth Technology “Lower-48” Contact with Specialists CONCERNS: Call-Back Nuisance Changing Referral Patterns Bypassing Present System Protocols TELEMED HUB: Physician Specialist at Referral Hospital

30 PERSPECTIVE: Interested / Skeptical Want Diagnostic Quality - Hi-Res, Hi-Bw without Compression Losses Pre/Post Fetch Capability CONCERNS: Too Much Work Up-Time Easy User Interface Competition Bypass No Two Radiologists Reading Same Study Buy-In at All Levels TELERAD HUB: Radiologist at Referral Hospital

31 Phase III - Teleradiology Unidirectional Connectivity via Teleradiology to ~27 Mid-Level Provider Sites $ Funding ??? $2-3 Million, One-Time Appropriation Self Maintenance Plan Compatible with other AFHP sites PHASE III - TELERADIOLOGY NEEDLES

32 X-Ray Film Digitizer Digitizer Compression Send Unit POTS Modem Connection PHASE III - SITE COMPONENTS

33 I need text here Alaska Federal Healthcare Partnership PACS/Teleradiology Plan

34 Phase III - Telemedicine Implementation Plan for ~235 Sites: Alaska Federal Health Care Access Network - (AFHCAN Project ) Major portion of $ Funded by special appropriation from Congress, through the Indian Health Service $30 Million over 4 Years Self Maintenance Plan Compatible with other NLM sites PHASE III - TAKING LOW-BANDWIDTH TELEMEDICINE STATE-WIDE

35 PHASE III - AFHCAN TELEMED SITE COMPONENTS ~688 Telemed Workstations NLM-Compatible Stations Full Compliment of Scopes: »Otoscope/Ophthalmoscope »Dental Scope »Derm Scope »Culposcope ~254 Telehealth Information Kiosks Satellite WAN Connectivity

36 AFHCAN PROJECT - ORGANIZATION/IMPLEMENTATION COMMITTEE MODEL: JOINT STEERING BOARD TECHNICAL TRAINING PROJECT OFFICE INFORMATION CLINICAL LEGAL BUSINESS

37 I need text to cover up Alaska Federal Healthcare Partnership Alaska Federal Healthcare Partnership AFHCAN Project Telemedicine Sites Phase III Vision: Useful, Compatible Telemedicine Technology for Every Provider Improved Access to Quality Care for Every Patient

38 - THE END - - THE END - Credits for making this presentation possible go to the following individuals: Paul Sherry, CEO - ANHC Richard Madsager, MD - ANMC Director Russell Pittman, CIO - ANMC ITS Rich Hall - ANMC ITS Fred Pearce, PhD - UAA Rob Rauls, PO - ANHB Stuart Ferguson, PhD - ANHB Denise Statz, PA - ANHB Chuck Borg - AFHCP Susan Yeager - AFHCP Victorie Heart - CHA/P John Midthun, MD - ANMC Imaging Services Gwen Obermiller, RN - ANMC Administration Eugene Smith - Maniilaq Cheryl Booth, CHP - Noatak Ralph Schaber, RT - Dillingham


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