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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 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 Offer Community Needs-Based Services Centralized Tech Support & Scheduling Call Center 24/7 Telemedicine Network & Infrastructure Evaluation and Quality Improvement Case Coordination & Evidence-Based Guidelines/Protocols ANGELS Sites Batesville Batesville Blytheville Camden Clarksville Clarksville Conway Conway Crossett DeQueen Dumas El Dorado El Dorado Fayetteville Fayetteville Fayetteville Fort Smith Fort Smith Fort Smith Fort Smith Harrison Helena Helena Hope Hot Springs Hot Springs Johnson Jonesboro Jonesboro Lake Village Little Rock Little Rock Little Rock Mena Mountain Home Newport Paragould Pine Bluff Pine Bluff Rogers Russellville Russellville Russellville Searcy Texarkana Texarkana Texarkana, TX Independence County Health Department White River Medical Center Great River Medical Center Ouachita County Medical Center Johnson County Health Department Johnson Regional Medical Center Conway Health Department Conway Regional Health System Ashley County Medical Center Sevier County Health Department Delta Memorial Hospital Medical Center of South Arkansas AHEC South Arkansas Northwest AHEC Washington Regional Med Center Willow Creek Fort Smith AHEC St. Edward’s Mercy Medical Sebastian County Health Department Sparks Health System North Arkansas Regional Medical Center Delta AHEC Helena Regional Med Center Hempstead LHU National Park Medical Center St. Joseph’s Mercy Health Center Willow Creek Women’s Center Northeast AHEC St. Bernard’s Medical Center Chicot Memorial Hospital Arkansas Children’s Hospital St. Vincent’s Medical Center UAMS Mena Medical Center Baxter Regional Hospital Harris Hospital Arkansas Methodist Medical Center AHEC Pine Bluff Jefferson Regional Medical Center Mercy Medical Center Millard-Henry Clinic Pope County Health Department Saint Mary’s Regional Medical Center White County Medical Center Miller County Health Department Southwest AHEC Wadley Regional Medical Fayetteville Jonesboro Mana Northwest Arkansas Pediatric Clinic Children’s Clinic Triage Call Center Facilitates Acute telemedicine Coordinates Transports Communicates to Providers & Patients 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 ANGELS Telemedicine Program TelemedicineConsults Guidelines • 203 guidelines for best practices in Obstetrics, Neonatology, & Pediatrics www.angelsguidelines.com 4,254 visits from 25 countries in 2013 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/e vents.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 ANGELS Spinoff Programs Following Baby Back Home Colposcopy Arkansas Fetal Diagnosis and Management OB Psychiatry Newborn Screening Center for Distance Health Programs That Create Access 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 subspecialty expertise. Average Age of Stroke 100 92 90 86 80 72 71 70 70 68 68 66 65 64 63 Age 60 50 40 30 20 10 0 Female Male Based on Annual Data 2008 2009 2010 2011 2012 2013 69 Overall Performance 700 611 600 576 500 464 Minutes 400 300 267 180 200 139 114 109 100 70 7 2 29 17 15 26 23 24 29 3 13 19 30 0 Total Consults Activase % Activase Based on Annual Data 2008 2009 2010 2011 2012 2013 Total Sites 40 40 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 Telemedicine Consults in Arkansas Emergency Departments Trauma and Hand Sites 2014 Image Repository Trauma Images can move between hospitals for trauma patient HAND Patient Arkansas Trauma Hand Specialist BURN 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 Evolution of UAMS Telehealth Programs (2003-2014) (ONE) Team 2013 4,566 OB patient visits Obstetrical Neonatal Exchange CE for Nurses FAIM 2003 2004 ANGELS 24-hr Call Center Service (Clinic) TOUCH Telemedicine $102M BTOP Grant Award Collaborative Healthcare Completion of BTOP Grant Connecting 410+ Healthcare Sites (Neonatal Census Rounds) 2006 2007 New Clinical Services: • Diabetes • Colposcopy • Residentfacilitated HROB Clinic Spanish Translation Interpretation Services Tele-Nursery Fetal Echo CME for Outreach MDs Utilizing High-Risk OB & Neonatal Guidelines Triumph Tele-Rehab Spinal Cord Commission 2008 2009 Telehealth KIDS FY 2013: 594 consults, (tPA to151 patients) 2010 2011 2012 Stroke Assistance thru Virtual Emergency Support Federal Communications Commission Rural Health Care Pilot Program Health Education Assessment Research Telehealth 2013 Adult Sickle Cell (Clinic) 2014 Hand Trauma Guideline Smartphone Application Postpartum Hypertensio n Project BTOP Broadband Technology Opportunities Program (BTOP) Awarded in 2010 BTOP Sites BTOP Benefits in Arkansas Healthcare Higher Education/Libraries Public Safety Research & Clinical Trials Year 4: After Grant Funding Ends Current Healthcare Examples ANGELS Home Health Arkansas SAVES eICU Trauma Network Telenursery 3-1-2011 Year 4: After Grant Funding Ends Current Education Examples Coursework Sciences Health Training Information Tech. Workforce Training Research 3-1-2011 Telemedicine Broadband and Equipment Overview Organization Broadband Provided or Enhanced IAV Equipment Stethoscope Jed Med DigiCam Public PC 5 8 8 9 8 109 118 95 95 0 AHECs 9 11 10 11 11 Clinics 82 87 87 87 78 Hospitals 75 140 1 137 81 Mental Health Clinics 67 66 0 0 52 Therapy Centers 11 11 0 0 11 Libraries 0 8 0 0 8 Human Development Centers 6 6 5 5 0 Pathfinder 4 11 0 0 4 KIDS First 8 9 9 9 9 376 475 215 353 262 Area Aging Institutes Arkansas Dept of Health 405 454 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 UAMS-Where Telemedicine Lives!