Telemedicine

ISSN 1530-5627Telemedicineand e-HealthAbstracts fromThe American Telemedicine AssociationEighteenth AnnualInternational Meeting and ExpositionMay 5–7, 2013—Austin, TexasAn Official Journal of thewww.liebertpub.com/tmjAmericanTelemedicineAssociationCanadian Telehealth ForumForum canadien de la télésantéInternationalSociety forTelemedicine& eHealth

Abstracts fromThe American Telemedicine AssociationEighteenth Annual InternationalMeeting and ExpositionATA 2013 is held in cooperation with:. American Academy of Pediatrics. Fed-Tel. Four Corners Telehealth Consortium. Journal of Telemedicine & Telecare. Telemedicine & e-Health. Texas e-Health Alliance. TexLa Telehealth Resource Center. Universal Service Administrative Company (USAC)Jointly sponsored byMay 5–7, 2013Austin Convention CenterAustin, TXDOI: 10.1089/tmj.2013.9994 ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-1

Concurrent Oral PresentationsAbstract IndexThe American Telemedicine Association EighteenthAnnual International Meeting and ExpositionMay 5–7, 2013 Austin, TXSUNDAY, MAY 5, 201312:00 pm–1:00 pm Sunday, May 5, 2013HOW-TO PANELSession Number: 073Session Title: 447 KEYNOTE AND TELEMEDICINE TOOLKIT: THE FOUNDATION FOR STARTING A TELEMEDICINEPROGRAMTrack: Pediatrics Telehealth ColloquiumMeeting Room 12 A/BPRESENTERS AND CONTRIBUTING AUTHORS:Stephen D. Minton, MD, Medical Director 1 , Bryan Burke, MD, Associate Professor and Director of Term Nursery 2 , Terri Imus, RN, LNC, ANGELSOutreach Nurse 2 .1 Urban South Region Newborn Services, Intermountain Healthcare, Provo, UT, USA, 2 University of Arkansas for Medical Sciences, Little Rock, AR, USA.SUNDAY, MAY 5, 20131:00 pm–2:00 pm Sunday, May 5, 2013DISCUSSION PANELSession Number: 074Session Title: 715 SPEED ROUNDS: MEET THE EXPERTS IN PEDIATRIC TELEMEDICINETrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BMODERATOR: Neil E. Herendeen, MD, MBA, Director, Health-e-Access.University of Rochester Medical Center, Rochester, NY, USA.PRESENTERS AND CONTRIBUTING AUTHORS:James P. Marcin, MD, MPH, Professor of Pediatric Critical Care 1 , Madan Dharmar, PhD, Assistant Professor of Research 1 , Bryan Burke, MD, AssociateProfessor of Neonatology 2 , Julie Hall-Barrow, EdD, Director of Education for the Center for Distance 21 UC Davis, Sacramento, NY, USA, 2 University of Arkansas for Medical Sciences, Little Rock, AR, USA.SUNDAY, MAY 5, 20132:00 pm–3:00 pm Sunday, May 5, 2013DISCUSSION PANELSession Number: 075Session Title: THE LOPEZ FOUNDATION AND INTERNATIONAL CROSS SPECIALTY PEDIATRIC TELEHEALTH:IMPROVING ACCESS TO HEALTHCARE FOR CHILDREN IN LATIN AMERICA (IN CONJUNCTION WITH THEINTERNATIONAL TELEMEDICINE FORUM)Track: Pediatrics Telehealth Colloquium Meeting Room: 12 A/BPRESENTERS AND CONTRIBUTING AUTHORS:Silvio Vega, MD, MSc, Medical Director 1 , Evan Loevner, MBA, MHP 2 , Ivette Marciscno, RN, MPH 1 , Stuart Siegel, MD 2 .1 PNTT, Panama, 2 Children Hospital of Los Angeles, Los Angeles, CA, USA.Boldface indicates presenting author(s).A-2 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXMONDAY, MAY 6, 201311:00 am–12:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 001Session Title: IMPACT OF TELEHEALTH ON COST REDUCTIONTrack: Outcomes and Evidence Meeting Room 19 A/BMODERATOR: Rashid Bashshur, PhD, Director, UMH Telemedicine Core.University of Michigan Health System, Ann Arbor, MI, USA.575 REDUCING URGENT CARE VISITS THROUGH SECOND-LEVEL TRIAGEPRESENTERS AND CONTRIBUTING AUTHORS:Donna Williams, RN, Nurse Project Program Manager for ANGELS and CDH Call Center.University of Arkansas for Medical Sciences, Little Rock, AR, USA.169 SAVINGS IN TRAVEL COSTS FOR ALASKA MEDICAID: A CASE FOR STORE-AND-FORWARD TELEHEALTH SPECIALTY CAREPRESENTERS AND CONTRIBUTING AUTHORS:Stewart Ferguson, PhD, CIO 1 , John Kokesh, MD 2 , Chris Patricoski, MD 1 .1 Alaska Native Tribal Health Consortium, Anchorage, AK, USA, 2 Alaska Native Medical Center, Anchorage, AK, USA.696 THE LONG-TERM EFFECT OF TELECARE ON MEDICAL EXPENDITURES: NINE-YEAR EXPERIENCE OF A JAPANESE TOWNMasatsugu Tsuji, PhD, Professor 1,2 , Yuji Akematsu, PhD 3 .1 University of Hyogo, Kobe, Hyogo, Japan, 2 National Cheng Kung University, Tainan, Taiwan, 3 Osaka University, Toyonaka, Osaka, Japan.MONDAY, MAY 6, 201311:00 am–12:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 002Session Title: SUCCESSFUL TELEMEDICINE BUSINESS ENTERPRISESTrack: Finance and Operations I Ballroom EMODERATOR: Thomas S. Nesbitt, MD, MPH, Associate Vice Chancellor.UC Davis Health System, Sacramento, CA, USA.316 THE VIRTUAL VISIT PROVIDER: A NOVEL PRIMARY CARE CAREER PATHPRESENTERS AND CONTRIBUTING AUTHORS:Benjamin Green, MD, Medical Director.Carena, Inc, Seattle, WA, USA.600 TELEMEDICINE - HEALTHCARE REFORM WITHOUT ALL OF THE POLITICSPRESENTERS AND CONTRIBUTING AUTHORS:Joe Peterson, MD, CEO & Director.Specialists on Call, Leesburg, VA, USA.527 PRICE-CHECK, AISLE 1: SELLING PROVIDER-DEVELOPED TELEMEDICINE PRODUCTS TO THE MASSESPRESENTERS AND CONTRIBUTING AUTHORS:Curtis Lowery, MD, Chairperson for the Department of Obstetrics and Gynecology.University of Arkansas for Medical Sciences, Little Rock, AR, USAª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-3

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXMONDAY, MAY 6, 201311:00 am–12:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 003Session Title: DESIGNING FOR SCALETrack: Finance and Operations II Ballroom FMODERATOR: Adam Darkins, MD, FRCS, Chief Consultant, Telehealth Services.Department of Veterans Affairs, Washington DC, USA.467 THE INFLUENCE OF USER-CENTRED DESIGN AND THE DEVELOPMENT OF A LARGE-SCALE TELEHEALTH PROGRAMPRESENTERS AND CONTRIBUTING AUTHORS:Brendan Purdy, BN, MN(c), Program Coordinator, Telehealth, Dana Chmenitsky, BMR(PT), MBA, Carol Toenjes, BScN, RN,Joseph A. Cafazzo, PhD, PEng, Peter G. Rossos, MD, MBA, FRCP(C), FACP.University Health Network, Toronto, ON, Canada.79 SPECIALTY CONSULTATION VIA ELECTRONIC COMMUNICATION: THE MAYO CLINIC EXPERIENCEPRESENTERS AND CONTRIBUTING AUTHORS:Lorraine Uthke, MS, MBA, FACHE, Operations Administrator.Mayo Clinic, Rochester, MN, USA.217 THIS TIME ITS PERSONAL: DELIVERING SCALABLE TELEMEDICINE SERVICES THROUGH PCS AND MOBILE DEVICESPRESENTERS AND CONTRIBUTING AUTHORS:Ron Riesenbach, MSc, MBA, Vice President, Emerging Business, Anish Shah, BE, MMS.Ontario Telemedicine Network, Toronto, ON, Canada.MONDAY, MAY 6, 201311:00 am–12:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 004Session Title: DELIVERY OF SPECIALIZED HEALTHCARE SERVICES VIA MOBILE APPS & TECHNOLOGIESTrack: Best Practices and Service Delivery Models I Ballroom GMODERATOR: Ben Chodor, CEO.Happtique, New York, NY.104 ONLINE SPEECH REHAB FOR APHASIA: APPS TO TELE-SPEECHPRESENTERS AND CONTRIBUTING AUTHORS:Andrew Gomory, BA in English; MS in Computer Scince, CEO.Lingraphica, Princeton, NJ, USA.345 MOBILE HEALTH TECHNOLOGY TO ASSIST WITH MUSCULOSKELETAL INJURY PREDICTION AND PREVENTIONPRESENTERS AND CONTRIBUTING AUTHORS:Deydre S. Teyhen, PT, PhD, OCS, Deputy Director.TATRC, Ft Detrick, MD, USA.188 IMPLEMENTING SMART PHONE TELE-PHOTOGRAPHY IN TRAUMA: OVERCOMING THE HURDLESPRESENTERS AND CONTRIBUTING AUTHORS:Bellal Joseph, MD, Assistant Professor, Viraj Pandit, MD, Julie Wynne, MD, Arvie Webster, RN, Randall S. Friese, MD, Andrew Tang, MD,Terence O’Keeffe, MB,ChB, Narong Kulvatunyou, MD, Ronald S. Weinstein, MD, Rhee Peter, MD.The University of Arizona, Tucson, AZ, USA.A-4 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEX185 PHARMACISTS IN TELEMONITORING PRACTICE: A UNIQUE WAY TO PROVIDE CARE TO PATIENTS WITH DIABETESPRESENTERS AND CONTRIBUTING AUTHORS:Laura Shane-McWhorter, PharmD, BCPS, BC-ADM, CDE, FASCP, FAADE, Professor (Clinical) of Pharmacotherapy.University of Utah, Salt Lake City, UT, USAMONDAY, MAY 6, 201311:00 am–12:00 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 005Session Title: 619 REMOTE NEUROCOGNITIVE ASSESSMENT: MILITARY AND CIVILIAN PROJECTSTrack: Best Practices and Service Delivery Models II Meeting Room 17 A/BMODERATOR: Jay Shore, MD, MPH, Associate Professor Department of Psychiatry.University of Denver, Denver, CO, USA.PRESENTERS AND CONTRIBUTING AUTHORS:C. Munro Cullum, PhD, Professor, Psychiatry & Neurology 1 , Michael D. Lynch, PhD, Chief, Department of Tele-Health 2 , Robert L. Kane, PhD, SeniorSME/Program Manger TATRC 3 .1 University of Texas SW Med, Dallas, TX, USA, 2 US Army, Arlington, VA, USA, 3 Telemedicine & Advanced Technology Research Center, Ft. Detrick, MD, USA.MONDAY, MAY 6, 201311:00 am–12:00 pm Monday, May 6, 2013HOW-TO PANELSession Number: 006Session Title: 367 ATA TELEDERMATOLOGY PRACTICE GUIDELINES AND PEARLS: UPDATES ON STORE-AND-FORWARD AND REAL-TIME TELEDERMATOLOGYTrack: Best Practices and Service Delivery Models III Meeting Room 16 A/BPRESENTERS AND CONTRIBUTING AUTHORS:April W. Armstrong, MD MPH, Director of Teledermatology, UC Davis 1 , Karen McKoy, MD MPH, Senior Staff 21 University of California Davis, Sacramento, CA, USA, 2 Lahey Clinic, Dover, MA, USA.MONDAY, MAY 6, 201311:00 am–12:00 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 007Session Title: 963 SURGICAL TELE-MONITORING: THE NEXT MILESTONE AND POWERFUL QUALITYAND FINANCIAL USE-CASE FOR TELEMEDICINEMeeting Room 18 C/DMODERATOR: Yulan Wang, PhD, Chairman & CEO.InTouch Health, Santa Barbara, CAPRESENTERS AND CONTRIBUTING AUTHORS:Charles Wilhelm, President, Karl Storz, Endocscopy of America, Segundo, CA, Steven S Rothenberg, MD, Chief of Pediatric Surgery, The Rocky MountainHospital For Children, Denver, CO, Andrew R Watson, MD, MLitt, FACS, Vice President, International and Commercial Services Division, Executive Director,Telemedicine, UPMC, Pittsburgh, PAMONDAY, MAY 6, 201311:00 am–12:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 008Session Title: POLICY ISSUES FOR MULTI-STATE TELEHEALTHTrack: Policy Meeting Room 18 A/BMODERATOR: Gary Capistrant, Senior Director, Public Policy.American Telemedicine Association, Washington, DC, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-5

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEX147 LEGAL ISSUES IN TELEMEDICINE: OVERCOMING REGULATORY OBSTACLES TO A MULTI-STATE TELEHEALTH BUSINESSPRESENTERS AND CONTRIBUTING AUTHORS:Michael H. Cohen, JD, MBA, MFA, President.Michael H. Cohen Law Group, Beverly Hills, CA, USA.549 REGULATORY AND LEGAL DEVELOPMENTS IN TELEHEALTHPRESENTERS AND CONTRIBUTING AUTHORS:John D. Blum, JD, MHS, School of Law.Loyola University Chicago, Chicago, IL, USA.MONDAY, MAY 6, 201311:00 am–12:00 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 009Session Title: 812 EVALUATION METHODS IN PEDIATRIC TELEHEALTHTrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BMODERATOR: Madan Dharmar, MBBS, PhD, Assistant Research ProfessorPRESENTERS AND CONTRIBUTING AUTHORS:James Marcin, MD, MPH, Professor 1 , Kathleen Webster, MD, MBA, Director, Division of Pediatric Critical Care 2 ,Neil Herendeen, MD, Associate Professor 31 University of California Davis Health System, Sacramento, CA, USA, 2 Loyola University Medical Center, Maywood, IL, USA, 3 University of Rochester MedicalCenter, Rochester, CA, USA.MONDAY, MAY 6, 201311:00 am–12:00 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 010Session Title: 742 UNIVERSITY-BASED TELEHEALTH: THE NEXT WAVE–COMPETING SUCCESSFULLYOR RESTRUCTURING AROUND VALUE?Track: Outcomes and Evidence Meeting Room 19 A/BMODERATOR: Deborah E. Seale, MA, PhD, Assistant Professor.Saint Louis University, St Louis, MO, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Dale C. Alverson, MD, Medical Director, Center for Telehealth and Cyberm. 1 , Thomas S. Nesbitt, MD, MPH, Associate Vice Chancellor 2 ,Debbie Voyles, MBA, Director of Telemedicine. 31 University of New Mexico Health Sciences Center, Albuquerque, NM, USA, 2 UC Davis, School of Medicine, Sacramento, CA, USA, 3 Texas Tech University HealthSciences Center, Lubbock, TX, USA.MONDAY, MAY 6, 20131:15 pm–2:15 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 011Session Title: THE TELEMEDICINE VALUE PROPOSITION: ROI & SUSTAINABILITYTrack: Finance and Operations I Ballroom EMODERATOR: Molly Coye, MD, MPH, Chief Innovation Officer.UCLA Health System, Los Angeles, CA, USA.349 A THREE YEAR EXPERIENCE REVEALS A POSITIVE ROI FOR ALL FOUR STAKEHOLDERS IN A RURAL TELEMEDICINE CLINICPRESENTERS AND CONTRIBUTING AUTHORS:Andrew R. Watson, MD, MLitt, Vice-President.UPMC, Pittsburgh, PA, USA.A-6 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEX828 A STUDY OF THE FACTORS CONTRIBUTING TO THE LONG TERM SUSTAINABILITY OF A TELESTROKE NETWORKPRESENTERS AND CONTRIBUTING AUTHORS:Aaron Bridges, MPH, Data Analyst, Elizabeth Cothren, APRN, Rachelle Longo, BSN.Ochsner Medical Center, Jefferson, LA, USA.127 SUSTAINABLE BUSINESS MODELS- OPPORTUNITIES TO MANAGE THE CONTINUUM OF CAREPRESENTERS AND CONTRIBUTING AUTHORS:Alan Pitt, MD, University of Arizona, Professor of Neuroradiology.Barrow Neurological Institute, Phoenix, AZ, USA.MONDAY, MAY 6, 20131:15 pm–2:15 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 012Session Title: 485 NIMBILITY: EXPANDING YOUR TELEMEDICINE SERVICES VIA INTEGRATIONTrack: Finance and Operations II Ballroom FMODERATOR: Edward Loo, MSECE, Telemedicine Engineer.Inova Health System, Falls Church, VA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Theresa Davis, RN, MSN, NE-BC, Clinical Operations Director, Steven Dean, BS, Administrative Director of Telemedicine Operations,John Cochran, MD, FACP, FAHA, Medical Director, Cerebrovascular Services.Inova Health System, Falls Church, VA, USA.MONDAY, MAY 6, 20131:15 pm–2:15 pm Monday, May 6, 2013HOW-TO PANELSession Number: 013Session Title: 492 CREATING BETTER DISEASE MANAGEMENT FOR DIVERSE POPULATIONSTrack: Best Practices and Service Delivery Models I Ballroom GPRESENTERS AND CONTRIBUTING AUTHORS:Geeta Nayyar, MD, MBA, Chief Medical Information Officer 1 , Arthur G. Paniagua, BSN, MBA, Director of Clinical Policy and Support 21 AT&T, Dallas, TX, USA, 2 Centene Corporation, St. Louis, MO, USA.MONDAY, MAY 6, 20131:15 pm–2:15 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 014Session Title: 430 NEUROLOGY TELEMEDICINETrack: Best Practices and Service Delivery Models II Meeting Room 17 A/BMODERATOR: Jack W. Tsao, MD, DPhil, Chairman, Neurology Telemedicine Work Group.American Academy of Neurology, Minneapolis, MN, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Jack W. Tsao, MD, DPhil, Chairman, Neurology Telemedicine Work Group 1 , Lawrence Wechsler, MD, Neurologist and Department Chairman 2 .1 American Academy of Neurology, Minneapolis, MN, USA, 2 University of Pittsburgh, Pittsburgh, PA, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-7

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXMONDAY, MAY 6, 20131:15 pm–2:15 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 015Session Title: UNIQUE APPROACHES TO DELIVERING SPECIALTY SERVICESTrack: Best Practices and Service Delivery Models III Meeting Room 16 A/BMODERATOR: Peter Yellowlees, MD, MBBS, Director, Health Informatics Program.UC Davis Health System, Sacramento, CA, USA.422 TELEDERMATOLOGY AT SEAPRESENTERS AND CONTRIBUTING AUTHORS:Anne E. Burdick, MD, MPH, Associate Dean for TeleHealth, Scott C. Simmons, MS, Jennifer Herrera-Perdigon, MSN, NP-BC.University of Miami Miller School of Medicine, Miami, FL, USA.353 TELEPAIN: A PLATFORM FOR CONCURRENT EDUCATION, CLINICAL CARE, AND RESEARCHPRESENTERS AND CONTRIBUTING AUTHORS:David J. Tauben, MD, University of Washington, Cara Towle, RN.University of Washington, Seattle, WA, USA.961 PARTNERSHIPS IN MIDDLE TENNESSEE COLLABORATE TO DELIVER TELEPSYCHIATRY ACROSS MULTIPLE PROVIDERSAND EMERGENCY ROOMSPRESENTERS AND CONTRIBUTING AUTHORS:Michelle Robertson, Senior Advisor, Cisco Healthcare Business Transformation Team.Cisco, Austin, TX, USA.MONDAY, MAY 6, 20131:15 pm–2:15 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 016Session Title: 542 BRINGING HOME THE GOLD: TELEMEDICINE IN THE 2012 LONDON OLYMPICSTrack: Innovations Meeting Room 18 C/DMODERATOR: Antonio Marttos, MD, Assistant Professor of Surgery.University of Miami Miller School of Medicine, Miami, FL, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Antonio Marttos, MD, Assistant Professor of Surgery 1 , Orlando Vallone Junior, BS, President 2 , Fernanda Kuchkarian, MPH, Manager, Research Support 11 University of Miami Miller School of Medicine, Miami, FL, USA, 2 Specialty Telehealth Services, Miami, FL, USA.MONDAY, MAY 6, 20131:15 pm–2:15 pm Monday, May 6, 2013DISCUSSION PANELSession Number: 017Session Title: 137 TELEREHABILITATION ACROSS STATE LINES: WHERE’S OUR ROADMAP?Track: Policy Meeting Room 18 A/BMODERATOR: Ellen R. Cohn, PhD, Associate Dean for Instructional Development.RERC on Telerehabilitation at University of Pittsburgh, Pittsburgh, PA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Jana Cason, DHS, OTR/L, Associate Professor 1 , Janice A. Brannon, MA, Director, State Special Initiatives 2 , Mark Lane, PT, Vice President 3 ,Gary Capistrant, MS, Senior Director, Public Policy 41 Auerbach School of Occupational Therapy, Louisville, KY, USA, 2 American Speech-Language-Hearing Association, Rockville, MD, USA, 3 Federation of StateBoards of Physical Therapy, Alexandria, VA, USA, 4 American Telemedicine Association, Washington, DC, USA.A-8 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXMONDAY, MAY 6, 20131:15 pm–2:15 pm Monday, May 6, 2013DISCUSSION PANELSession Number: 018Session Title: 480 SYSTEMS ISSUES IN MEETING COMMUNICATION AND HEARING NEEDS OF INFANTSAND YOUNG CHILDREN VIA TELEHEALTHTrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BMODERATOR: Nina Antoniotti, RN, MBA, PhD, Telehealth Director.Marshfield Clinic, Marshfield, WI, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Diane Behl, MEd, Senior Research Scientist 1 , Anne Simon, AuD, Senior Audiologist 2 , Katheryn L. Boada, MA, CCC-SLP, Director of Audiology,Speech Pathology and Learning 31 National Center for Hearing Assessment and Management, Logan, UT, USA, 2 University of California, Davis Audiology Department, Sacramento, CA, USA,3 Children’s Hospital Colorado, Aurora, CO, USA.MONDAY, MAY 6, 20133:00 pm–4:00 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 019Session Title: 382 TELEMEDICINE AND HUMANITARIAN AIDTrack: Outcomes and Evidence Meeting Room 19 A/BMODERATOR: Peter Killcommons, MD, CEO.Medweb, San Francisco, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:John P. Howe, MD, President & CEO 1 , Roger Swinfen, Founder and Trustee 2 .1 Project Hope, Millwood, VA, USA, 2 The Swinfen Charitable Trust, Canterbury, United Kingdom.MONDAY, MAY 6, 20133:00 pm–4:00 pm Monday, May 6, 2013HOW-TO PANELSession Number: 020Session Title: 774 CHASING THE ELUSIVE REIMBURSEMENT FOR TELEHEALTH: UNDERSTANDING CURRENTAND FUTURE PAYMENT FOR TELEHEALTHTrack: Finance and Operations I Ballroom EPRESENTERS AND CONTRIBUTING AUTHORS:Nina Marie Antoniotti, RN, MBA, PhD, Director of TeleHealth Business.1 Marshfield Clinic, Marshfield, WI, USA.MONDAY, MAY 6, 20133:00 pm–4:00 pm Monday, May 6, 2013HOW-TO PANELSession Number: 021Session Title: 641 IMPLEMENTING TELEMEDICINE: ON TARGET, ON TIME, & ON BUDGETTrack: Finance and Operations II Ballroom FPRESENTERS AND CONTRIBUTING AUTHORS:Robert N. Cuyler, PhD, President 1 , Dutch Holland, PhD, President 21 Clinical Psychology Consultants LLP, Houston, TX, USA, 2 Holland Management Consulting, Houston, TX, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-9

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXMONDAY, MAY 6, 20133:00 pm–4:00 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 022Session Title: 412 INTEGRATION OF INNOVATIVE TELEHEALTH AND MOBILE APPLICATIONS FOR SUBSTANCEUSE DISORDERSTrack: Best Practices and Service Delivery Models I Ballroom GMODERATOR: Elizabeth Brooks, PhD, Instructor.University of Colorado Denver; Veterans Rural Health Resource Center, Denver, CO, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Janelle Jones Wesloh, MBA, LADC, Executive Director of Recovery Management 1 , Jan A. Lindsay, PhD, Health Services Researcher, Assistant Professor 2, ,Jin Ho Yoon, PhD, Assistant Professor 31 Hazelden, Center City, MN, USA, 2 MIRECC & Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA,3 Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.MONDAY, MAY 6, 20133:00 pm–4:00 pm Monday, May 6, 2013DISCUSSION PANELSession Number: 023Session Title: 624 NOW AVAILABLE 24/7: EXTENDING PRIMARY CARE BEYOND FOUR WALLS AND BUSINESSHOURS VIA ONLINE SERVICESTrack: Best Practices and Service Delivery Models II Meeting Room 17 A/BMODERATOR: Matt Levi, MHA, MPH, Virtual Health Services.Franciscan Health System, Tacoma, WA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Cliff Robertson, MD, MBA, COO 1 , Louis Lim, MD, MPH, Medical Director of Quality & Care Management 1 , Stacey Zierath, BS, Regional Director of Operations 1 ,Frances Gough, MD, CMO 21 Franciscan Health System, Tacoma, WA, USA, 2 Carena Inc., Seattle, WA, USA.MONDAY, MAY 6, 20133:00 pm–4:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 024Session Title: SUCCESSFUL OPHTHALMIC TELEMEDICINE APPLICATIONSTrack: Best Practices and Service Delivery Models III Meeting Room 16 A/BMODERATOR: Mark Horton, OD, MD, Director, IHS Teleophthalmology Program.Phoenix Indian Medical Center, Phoenix, AZ, USA.248 USE OF DIGITAL RETINAL IMAGING SERVICE IN A MEDICARE QUALITY IMPROVEMENT ORGANIZATIONPRESENTERS AND CONTRIBUTING AUTHORS:Ingrid E. Zimmer-Galler, MD, Associate Professor Ophthalmology.Johns Hopkins University Medical Institutions, Baltimore, MD, USA.836 TELE-GLAUCOMA: ISSUES RELATED TO SCREENING, DIAGNOSIS AND MANAGEMENT OF DISEASE REMOTELYPRESENTERS AND CONTRIBUTING AUTHORS:Yogesan Kanagasingam, PhD, MSc, BSc (Hons), National Research Director 1 , Leonard Goldschmidt, MD 2 , Louis Pasquale, MD 3 , Karim Damji, MD 4 .1 CSIRO, Floreat (Perth), Australia, 2 Dept. VA, Livermore, CA, USA, 3 MEEI, Harvard University, Boston, MA, USA, 4 University of Alberta, Edmonton,AB, Canada.A-10 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEX123 CLINICAL OUTSOURCING WITH A CLOUD-BASED OPHTHALMIC TELEMEDICINE SYSTEMPRESENTERS AND CONTRIBUTING AUTHORS:Neil F. Notaroberto, MD, Director 1,2 , Michael K. Smolek, PhD 2 .1 EyeCare 20/20, Mandeville, LA, USA, 2 CLEVER Eye Institute, Mandeville, LA, USA.MONDAY, MAY 6, 20133:00 pm–4:00 pm Monday, May 6, 2013DISCUSSION PANELSession Number: 025Session Title: 264 DIRECT-TO-CONSUMER TELEDERMATOLOGY: INNOVATIONS AND CHALLENGESTrack: Innovations Meeting Room 18 C/DMODERATOR: April W. Armstrong, MD MPH, Director of Teledermatology, UC Davis.University of California Davis, Sacramento, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Mark Seraly, MD, Founder of DermatologistOnCall 1 , Ryan Hambley, BA in Economics, Co-Founder, Co-CEO, and Head of Product Development 2 ,David J. Wong, MD, PhD, CEO 3 , Jeffrey Benabio, MD, Physician Director Innovation Kaiser Permanente SD.1 DermatologistOnCall, Pittsburg, PA, USA, 2 YoDerm, Carmel, CA, USA, 3 Direct Dermatology, Palo Alto, CA, USA. Kaiser Permanente, San Diego, CA, USA,4 Kaiser Permanente, San Diego, CA, USA.MONDAY, MAY 6, 20133:00 pm–4:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 026Session Title: LEGAL AND REGULATORY ISSUES: PART 1Track: Policy Meeting Room 18 A/BMODERATOR: Donald Jones, JD, Vice President, Global Strategy & Market Development.Qualcomm Life, San Diego, CA, USA.690 ‘‘YOU MEAN I CAN’T DO THAT?’’: LESSONS IN KEEPING TELEHEALTH PROVIDERS OUT OF HARM’S WAY (Abstract Withdrawn)PRESENTERS AND CONTRIBUTING AUTHORS:Harry Nelson, JD, Managing Partner 1 , Jorge Carreon, MD 2,3 .1 Fenton Nelson, LLP, Los Angeles, CA, USA, 2 International Health Consultants, Southgate, CA, USA, 3 Medical Board of California, Sacramento, CA, USA.626 TELEMEDICINE AND THE LAW: AN INTERACTIVE DISCUSSIONPRESENTERS AND CONTRIBUTING AUTHORS:Terrence Lewis, Juris Doctor, Associate Counsel.University of Pittsburgh Medical Center, Pittsburgh, PA, USA.613 HOW STATE MEDICAL BOARD RULES AFFECT YOUR TELEMEDICINE BUSINESSPRESENTERS AND CONTRIBUTING AUTHORS:Ellen Janos, JD, Member.Mintz Levin, Boston, MA, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-11

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXMONDAY, MAY 6, 20133:00 pm–4:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 027Session Title: THE USE OF TELEMEDICINE IN INPATIENT SETTINGSTrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BMODERATOR: Ron Nicholis, MD, FAAP, FHM, MD Medical Informatics/Department of Pediatrics.Children’s Mercy Hospital, Kansas City, KS, USA.101 COST-EFFECTIVENESS OF A TELEMEDICINE PROGRAM IN 5 COMMON PEDIATRIC DIAGNOSES IN RURAL EMERGENCY DEPARTMENTSPRESENTERS AND CONTRIBUTING AUTHORS:Nikki H. Yang, DVM, MPVM, PhD Candidate 1 , James P. Marcin, MD, MPH 1,2 , Byung-Kwang Yoo, MD, MSc, PhD 3 , J. Paul Leigh, PhD 3 ,Madan Dharmar, MBBS, PhD 1,2 .1 Department of Pediatrics, University of California, Davis, Davis, CA, USA, 2 Center for Health and Technology, University of California, Davis, Davis, CA,USA, 3 Center for Healthcare Policy and Research, University of California, Davis, Davis, CA, USA.210 THE IMPACT OF A PEDIATRIC HOSPITALIST PROGRAM AND TELEMEDICINE INTENSIVIST SUPPORT ON A COMMUNITY HOSPITALPRESENTERS AND CONTRIBUTING AUTHORS:Jaclin LaBarbera, MD, MPH, UCSF 1 , Miles Ellenby, MD 2 , Paul Bouressa, MD 3 , Jill Burrell, RN 3 , Heidi Flori, MD, FAAP 4 , James Marcin, MD, MPH 5 .1 Montefiore Medical Center, New York, NY, USA, 2 Doernbecher Children’s Hospital, Portland, OR, USA, 3 Sacred Heart Medical Center, Eugene-Springfield,OR, USA, 4 Children’s Hospital and Research Center of Oakland, Oakland, CA, USA, 5 Children’s Hospital at University of California, Davis, Sacramento, CA,USA.393 COMPARISON OF FACE-TO-FACE VERSUS TELEMEDICINE PATIENT ASSESSMENT IN A PEDIATRIC INTENSIVE CARE UNITPRESENTERS AND CONTRIBUTING AUTHORS:Phoebe Yager, MD, Director, PICU Telemedicine Program 1 , Maureen Clark, MS 1 , Heda Dapul, MD 2 , Sarah Murphy, MD 1 , Hui Zheng, PhD 1 ,Natan Noviski, MD 1 .1 Massachusetts General Hospital, Boston, MA, USA, 2 Maimonides Medical Center, Brooklyn, NY, USA.MONDAY, MAY 6, 20134:15 pm–5:15 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 028Session Title: EVIDENCE-BASED BEST PRACTICES IN TELEMEDICINE AND QUALITY IMPROVEMENTTrack: Outcomes and Evidence Meeting Room 19 A/BMODERATOR: Michael Ackerman, PhD, Assistant Director for High Performance Computing & Communications.National Library of Medicine at NIH, Bethesda, MD, USA.520 TELEHOMECARE IN ONTARIO: INSPIRING ADOPTION THROUGH EVIDENCE BASED GUIDELINES AND BEST PRACTICESPRESENTERS AND CONTRIBUTING AUTHORS:Laurie Poole, RN, BScN, MHSA, Vice President, Telemedicine Solutions.Ontario Telemedicine Network, Toronto, ON, Canada.628 VETERANS TELEMEDICINE OUTREACH FOR POST TRAUMATIC STRESS DISORDER SERVICESPRESENTERS AND CONTRIBUTING AUTHORS:Zia Agha, MD, MS, Interim Director VA HSR&D, Steven Thorp, PhD, Lin Liu, PhD, Lucy Moreno, MPH, Janel Fidler, MA, Ryan Barsotti, MA,Elizabeth Floto, MA, Bridgett Ross, PsyD, Andrea Repp, MA, Nilesh Shah, MD, Carla Hitchcock, MA, Annie Reader, MA, Tania Zamora, BS,Angela Robertson, Kyle Lowery.VA San Diego, San Diego, CA, USA.A-12 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEX625 EEMERGENCY CHEST PAIN MANAGEMENTPRESENTERS AND CONTRIBUTING AUTHORS:Donald J. Kosiak, MD, MBA, FACEP, eCARE Executive Medical Director, Sarah E. Kappel, RN, BSN.Avera Health, Sioux Falls, SD, USA.MONDAY, MAY 6, 20134:15 pm–5:15 pm Monday, May 6, 2013DISCUSSION PANELSession Number: 029Session Title: 951 MARKET WATCH: NOT ALL TELEHEALTH MARKETS ARE EQUALTrack: Finance and Operations I Ballroom EMODERATOR: Daniel Ruppar, Global Program Manager, Connected Health.Frost & Sullivan.PRESENTERS AND CONTRIBUTING AUTHORS:James Pursley, Vice President, Sales & Marketing 1 , John Bojanowski, President 2 , Amnon Gavish, Senior Vice President - Vertical Solutions 3 ,Anthony Shimkin, Senior Director, Marketing 41 Intel-GE Care Innovations, Roseville, CA, USA, 2 Honeywell HomMed, Brookfield, WI, USA, 3 Vidyo, Hackensack, NJ, USA, 4 Qualcomm Life, San Diego, CA, USA.MONDAY, MAY 6, 20134:15 pm–5:15 pm Monday, May 6, 2013HOW-TO PANELSession Number: 030Session Title: 552 CLINICAL, LEGAL AND ADMINISTRATIVE HURDLES IN DEVELOPING A TELEHEALTH NETWORKTrack: Finance and Operations II Ballroom FPRESENTERS AND CONTRIBUTING AUTHORS:Alan Shatzel, DO, Medical Director, Mercy Telehealth Network, Kelley Evans, JD, Dignity Health Senior Council1 Dignity Health, Sacramento, CA, USA.MONDAY, MAY 6, 20134:15 pm–5:15 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 031Session Title: INTEGRATION OF MOBILE HEALTH SOLUTIONS IN DEVELOPING AND UNDERSERVED NATIONSTrack: Best Practices and Service Delivery Models I Ballroom GMODERATOR: John P. Howe, MD, President & CEO.Project Hope, Millwood, VA, USA.281 INTEGRATION OF MOBILE HEALTH INTO DEVELOPING NATION’S HEALTH SYSTEMS AND ITS MARKETPLACESPRESENTERS AND CONTRIBUTING AUTHORS:Sikder M. Zakir, MBBS, Managing Director.Telemedicine Reference Center, Dhaka, Bangladesh.391 THE DESIGN AND INITIAL IMPLEMENTATION OF A NATIONAL MHEALTH PLATFORM IN ETHIOPIAPRESENTERS AND CONTRIBUTING AUTHORS:Mengistu Kifle, PhD, Consultant.Federal Ministry of Health, Addis Ababa, Ethiopia.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-13

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEX535 ‘ENHANCING PRIMARY CARE IN FIRST NATIONS COMMUNITIES USING INTEGRATED MHEALTH SOLUTIONS’PRESENTERS AND CONTRIBUTING AUTHORS:Karen Waite, BScN, MBA, Director 1 , Megan Hunt, MSW 2 , John Pawlovich, MD 3 .1 Healthtech Consultants, Toronto, ON, Canada, 2 Carrier Sekani Family Services, Prince George, BC, Canada, 3 University of British Columbia, Vancouver,BC, Canada.MONDAY, MAY 6, 20134:15 pm–5:15 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 032Session Title: 957 ATA PRACTICE GUIDELINES SHAPING SERVICE DELIVERYTrack: Best Practices and Service Delivery Models II Meeting Room 17 A/BMODERATOR: Elizabeth A. Krupinski, PhD, Professor, Department Medical Imaging.Radiology, University of Arizona, Tucson, AZ, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Carolyn Turvey, PhD, Associate Professor of Psychiatry 1 , Sunil Budhrani, MD, MPH, MBA, Chief Medical Officer 2 , Theresa M. Davis, RN, MSN, Patient CareDirector 31 University of Iowa, Iowa City, IA, USA, 2 Evergreen Health Insurance Company, Towson, MD, USA, 3 enVision eICU, Inova Health System, Falls Church, VA, USA.MONDAY, MAY 6, 20134:15 pm–5:15 pm Monday, May 6, 2013DISCUSSION PANELSession Number: 033Session Title: 133 INNOVATIVE RETINAL IMAGINGTrack: Best Practices and Service Delivery Models III Meeting Room 16 A/BMODERATOR: Paolo Sandico Silva, MD, Assistant Chief of Telemedicine, Beetham Eye Inst.Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Dana Keane, BS, CCRA, CCRP, Senior Manager of Clinical 1 , Mathew Muller, MBA, MS, Chief Operating Officer 2 , Alexander Walsh, MD, CEO 31 Optos, Marlborough, MA, USA, 2 Aeon Imaging, LLC, Bloomington, IN, USA, 3 Envision Diagnostics, Inc., Los Angeles, CA, USA.MONDAY, MAY 6, 20134:15 pm–5:15 pm Monday, May 6, 2013HOW-TO PANELSession Number: 034Session Title: 714 SUCCESSFULLY UTILIZING A REMOTE WORKFORCE IN TELEMEDICINETrack: Innovations Meeting Room 18 C/DPRESENTERS AND CONTRIBUTING AUTHORS:Kenneth W. Bleakley, MA, CEO of FONEMED, Charlene Slaney, RN, VP Client & Clinical Services at FONEMEDFONEMED, Ventura, CA, USA.MONDAY, MAY 6, 20134:15 pm–5:15 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 035Session Title: 344 LEGAL AND REGULATORY ISSUES IN TELEDERMATOLOGYTrack: Policy Meeting Room 18 A/BMODERATOR: Dennis H. Oh, MD, PhD, Associate Professor.University of California/Dept. of Veterans Affairs, San Francisco, CA, USA.A-14 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXPRESENTERS AND CONTRIBUTING AUTHORS:Marc E. Goldyne, MD, PhD, Clinical Professor 1 , Anna Orlowski, J.D., Chief Health System Counsel 2 , Dennis H. Oh, MD, PhD, Co-Lead, Teledermatology 31 University of California/Dept. of Veterans Affairs, San Francisco, CA, USA, 2 UC Davis, Sacramento, CA, USA, 3 Department of Veterans Affairs, San Francisco,CA, USA.MONDAY, MAY 6, 20134:15 pm–5:15 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 036Session Title: THE USE OF TELEMEDICINE IN OUTPATIENT SETTINGSTrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BMODERATOR: James McElligott, MD, MSCR, Assistant Professor.Medical University of South Carolina, Summerville, SC.109 DELIVERY OUTCOMES AND FACTORS INFLUENCING THE USE OF VIDEO TELEHEALTH IN A PEDIATRIC MEDICAL HOMEPRESENTERS AND CONTRIBUTING AUTHORS:Rhonda G. Cady, RN, PhD, Post-Doctoral Research Fellow 1 , Stanley M. Finkelstein, PhD 1 , Mary M. Erickson, RN, DNP 2 , Cathy Erickson, RN 1 ,Scott Lunos, MS 1 , Hongfei Guo, PhD 1 , Wendy Looman, RN, PhD 1 , Ann Garwick, RN, PhD 1 .1 University of Minnesota, Minneapolis, MN, USA, 2 Children’s Hospitals and Clinics of Minnesota, St. Paul, MN, USA.540 TELEHEALTH IN AN URBAN PUBLIC SCHOOL SYSTEMPRESENTERS AND CONTRIBUTING AUTHORS:Jennifer Herrera-Perdigon, MSN, NP-BC, Clinical TeleHealth Coordinator.UM Miller School of Medicine, Miami, FL, USA.813 RAPID RESPONSE FOR AT-RISK CHILDRENPRESENTERS AND CONTRIBUTING AUTHORS:Valerie Lauerman, Bachelor of Science in Nursing, RN, Director, Call Center Operations.Nurse Response, Saint Louis, MO, USA.TUESDAY, MAY 7, 201311:00 am–12:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 037Session Title: 627 MODEL POTENTIAL TELESTROKE SAVINGS: CAN TELESTROKE SAVE MEDI-CALAND MEDICARE MONEY?Track: Outcomes and Evidence Meeting Room 19 A/BMODERATOR: Mario Gutierrez, MPH, Executive Director.Center for Connected Health Policy, Sacramento, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Brett C. Meyer, MD, Co-Director, UCSD Stroke Center 1 , Thomas S. Nesbitt, MD, MPH, Associate Vice Chancellor 21 University of California, San Diego, Stroke Center & UCSD Telemedicine, San Diego, CA, USA, 2 UC Davis Health System, Sacramento, CA, USA.TUESDAY, MAY 7, 201311:00 am–12:00 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 038Session Title: ENHANCING MARKETABILITY AND THE BOTTOM LINETrack: Finance and Operations I Ballroom EMODERATOR: Joseph Ternullo, JD, MPH, Associate Director, Center for Connected Health.Partners Healthcare System, Boston, MA, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-15

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEX132 PRIVILEGING YOUR PROVIDERS PRACTICING TELEMEDICINE? WHY YOU SHOULD!PRESENTERS AND CONTRIBUTING AUTHORS:G. Ronald Nicholis, MD, FAAP, FHM, Director of Telemedicine.Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA.523 IMPROVING FACILITY REPUTATION WITH TELEMEDICINEPRESENTERS AND CONTRIBUTING AUTHORS:Joel E. Barthelemy, Founder and Managing Director.GlobalMed, Scottsdale, AZ, USA.583 MOVING FROM TELEHEALTH PROVIDER TO TELEHEALTH CERTIFYING AGENCYPRESENTERS AND CONTRIBUTING AUTHORS:Michael Manley, RNP, MNSc, Outreach Director for ANGELS and Center for Distance Health, Tina Butler, MNSc, WHNP-BC, APN, Dustin Vance, TCAP.University of Arkansas for Medical Sciences, Little Rock, AR, USA.TUESDAY, MAY 7, 201311:00 am–12:00 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 039Session Title: PROGRAM DESIGN FOR SUCCESSFUL SPECIALTY CARETrack: Finance and Operations II Ballroom FMODERATOR: Ed Brown, MD, Chief Executive Officer.Ontario Telemedicine Network, Toronto, ON, USA.297 TRANSITION FROM GRANT-FUNDED TO A SELF-SUPPORTING BURN TELEMEDICINE PROGRAM IN THE WESTERN USPRESENTERS AND CONTRIBUTING AUTHORS:Katie Russell, MD, Surgical Resident, Jeffrey R. Saffle, MD, Louanna Theurer, BS, Stephen E. Morris, MD, Amalia L. Cochran, MD.University of Utah, Salt Lake City, UT, USA.312 TELEHEALTH ADOPTION IN MULTIDISCIPLINARY CANCER CARE SERVICESPRESENTERS AND CONTRIBUTING AUTHORS:Caterina Masino, MA, Analyst, Dana Chmelnitsky, MBA, PMP, Peter G. Rossos, MD, MBA, FRCP(C).University Health Network, Toronto, ON, Canada.130 OUTCOMES ASSOCIATED WITH A HYBRID TRADITIONAL AND TELE-INTENSTIVIST MODELPRESENTERS AND CONTRIBUTING AUTHORS:Jeffrey Sadowsky, MD, Director of Telemedicine for Critical Care Medicine at Orlando Health, Carlos Carrasco, OT, MBA, Megan McLendon, MS-HSA.Orlando Health, Orlando, FL, USA.TUESDAY, MAY 7, 201311:00 am–12:00 pm Tuesday, May 7, 2013DISCUSSION PANELSession Number: 040Session Title: 791 WHAT WE KNOW ABOUT PRIVATE PAYERS AND TELEHEALTH: A SURVEY EXPERIENCEOF THE TELEMENTAL HEALTH AND BUSINESS AND FINANCE SIGSTrack: Finance and Operations II Ballroom GMODERATOR: Nina M. Antoniotti, RN, MBA, PhD, Director of TeleHealth.Marshfield Clinic, Marshfield, WI, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Nina Marie Antoniotti, RN, MBA, PhD, Director of TeleHealth Business 1 , Kenneth Drude, PhD, Clinical Psychologist 21 Marshfield Clinic, Marshfield, WI, USA, 2 Positive Perspectives, Fairborn, OH, USA.A-16 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXTUESDAY, MAY 7, 201311:00 am–12:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 041Session Title: 141 THE TELE-ICU: HOW TO COMMUNICATE, COMPARE, AND EVALUATE MODELS OF CARE,TECHNOLOGY, AND VALUE?Track: Best Practices and Service Delivery Models I Meeting Room 17 A/BMODERATOR: Herb Rogove, DO, FCCM, FACP, CEO.C3O Telemedicine, Ojai, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Herb Rogove, DO, FCCM, FACP, CEO 1 , Theresa Davis, RN, MSN, PhDc, Clinical Operations Director enVision eICU 2 , Neal Reynolds, MD, Director, ICU 6th FloorR.Adams Cowley Trauma Ctr 31 C3O Telemedicine, Ojai, CA, USA, 2 Inova Health, Falls Church, VA, USA, 3 University of Maryland School of Medicine, Baltimore, MD, USA.TUESDAY, MAY 7, 201311:00 am–12:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 042Session Title: 762 TELERADIOLOGY, TELEPATHOLOGY, TELECARDIOLOGY – SEPARATE NETWORKSOR INTEGRATED APPROACHESTrack: Best Practices and Service Delivery Models II Meeting Room 16 A/BMODERATOR: Sarah Sossong, MPH, Director of Telehealth, Mass General TeleHealth.Massachusetts General Hospital, Boston, MA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Garry Choy, MD, Radiology, Division of Teleradiology, David Wilbur, MD, Director of Pathology Imaging, Jason H. Wasfy, MD, MPhil, Chief Fellowin Cardiology, Roman DeSanctis, Clinical Scholar.Massachusetts General Hospital, Boston, MA, USA.TUESDAY, MAY 7, 201311:00 am–12:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 043Session Title: 173 TELEHEALTH IMPACT ON A WORKPLACE HEALTH PROGRAM – REDUCING COSTS/INCREASING CARETrack: Innovations Meeting Room 18 C/DMODERATOR: Rob Sprang, MBA, Director, Kentucky TeleCare.University of Kentucky, Lexington, KY, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Rob Sprang, MBA, Director, Kentucky TeleCare 1 , Raymond Wells, MD, Owner 2 , Kimberly Roe, Clinical Coordinator 21 University of Kentucky, Lexington, KY, USA, 2 Raymond Wells PSC, Lexington, KY, USA.TUESDAY, MAY 7, 201311:00 am–12:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 044Session Title: 242 NOTEWORTHY INITIATIVES INFLUENCING NATIONAL LICENSURE IN TELEHEALTH PRACTICETrack: Policy Meeting Room 18 A/BMODERATOR: Tania S. Malik, JD, CEO.COPE Today, Raleigh, NC, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-17

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXPRESENTERS AND CONTRIBUTING AUTHORS:Dan Winslow, JD, State Representative (R-Norfolk) 1 , Rene Y. Quashie, JD, BS, Semior Counsel 2 , Marlene M. Maheu, PhD, Executive Director 31 Massachusetts House of Representatives, Boston, MA, USA, 2 Epstein Becker & Green, Washington, DC, USA, 3 TeleMental Health Institute, Cheyenne, WY, USA.TUESDAY, MAY 7, 201311:00 am–12:00 pm Tuesday, May 7, 2013HOW-TO PANELSession Number: 045Session Title: 218 FROM CONCEPTUALIZATION TO IMPLEMENTATION: HOW TO CREATE A SCHOOL-BASEDTELEHEALTH CLINIC IN YOUR SCHOOL SYSTEMTrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BPRESENTERS AND CONTRIBUTING AUTHORS:Sherrie Williams, LCSW, School Based Health Liaison, Matthew Jansen, MPA, Executive DirectorGeorgia Partnership For Telehealth, Waycross, GA, USA.TUESDAY, MAY 7, 20131:15 pm–2:15 pm Tuesday, May 7, 2013DISCUSSION PANELSession Number: 046Session Title: 823 A NEW CONSENSUS-BASED APPROACH TO DEVELOP GUIDELINES AND OUTCOMESFOR TELEMENTAL HEALTHTrack: Outcomes and Evidence Meeting Room 19 A/BMODERATOR: Matt Mishkind, PhD, Program Lead, Research PsychologistNational Center for Telehealth and Technology (T2), Tacoma, WA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Jay Shore, MD, Associate Professor 1 , Trish Jordan, PhD, Research Psychologist 2 , Francis McVeigh, OD, Senior Clinical Consultant-Vision and Telehealth 3 ,Mike Lynch, PhD, ABPP, Chief, Department of Tele-Health 4 , Alexander Vo, PhD, Vice President 5 , Thomas Kim, MD, MPH 61 University of Colorado Health Sciences Center, Denver, CO, USA, 2 Pacific Telehealth & Technology Hui, Honolulu, HI, USA, 3 TATRC, Ft Detrick, MD, USA,4 Northern Region Medical Command, Arlington, VA, USA, 5 Electronically Mediated Services, Denver, CO, USA, 6 AGMP, Austin, TX, USA.TUESDAY, MAY 7, 20131:15 pm–2:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 047Session Title: MARKETING & PATIENT ENGAGEMENT STRATEGIESTrack: Finance and Operations I Ballroom EMODERATOR: Neil Versel, Freelance Healthcare Journalist.Chicago, IL.703 NEXT GENERATION PATIENT ENGAGEMENT: WHAT HEALTHCARE CAN LEARN FROM ADVERTISING (Abstract Withdrawn)PRESENTERS AND CONTRIBUTING AUTHORS:Bing Doh, MBA, CEO.HealthCrowd, Cupertino, CA, USA.448 SMARTER SOCIAL MEDIA - 10 WAYS TO MAKE IT WORK FOR TELEHEALTHPRESENTERS AND CONTRIBUTING AUTHORS:Nirav Desai, BS, MS, MBA, CEO.Hands On Telehealth, Marietta, GA, USA.A-18 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEX114 USING STRUCTURED WORKFLOW ANALYSIS TO INTEGRATE TELEMEDICINE INTO SMALL CLINICAL SETTINGSPRESENTERS AND CONTRIBUTING AUTHORS:Rex E. Gantenbein, MS, PhD, Director, Center for Rural Health Research and Education.University of Wyoming, Laramie, WY, USA.TUESDAY, MAY 7, 20131:15 pm–2:15 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 048Session Title: 711 BUILDING AN ENTERPRISE TELEHEALTH PROGRAM:PERSPECTIVES FROM THREE ACADEMIC MEDICAL CENTERSTrack: Finance and Operations II Ballroom FMODERATOR: Jan Ground, PT, MBA, Senior Project Manager.Permanente Medical Group, Denver, CO, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Sarah Sossong, MPH, Director of Telehealth, Mass General TeleHealth 1 , Peter Kung, MSIST, Director, Strategic Technologies 2 , Sarah Pletcher, MD, MedicalDirector, Center for Telehealth 31 Massachusetts General Hospital, Boston, MA, USA, 2 University of California Los Angeles, Los Angeles, CA, USA, 3 Dartmouth-Hitchcock Medical Center,Lebanon, NH, USA.TUESDAY, MAY 7, 20131:15 pm–2:15 pm Tuesday, May 7, 2013HOW-TO PANELSession Number: 049Session Title: 136 TELEHEALTH REIMBURSEMENT WORKSHOP: TOOLS, STRATEGIES AND RESOURCESFOR EMBRACING BILLING AND CODING AND ENHANCING ROITrack: Finance and Operations II Ballroom GPRESENTERS AND CONTRIBUTING AUTHORS:Kory Stetina, BS, CPC, President and Founder.Torch Health Solutions, San Diego, CA, USA.TUESDAY, MAY 7, 20131:15 pm–2:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 050Session Title: EFFICACY STUDY RESULTS: PROVING VALUE AND CLINICAL BENEFITS FOR THREESPECIALTY SERVICESTrack: Best Practices and Service Delivery Models I Meeting Room 17 A/BMODERATOR: Ronald C. Merrell, MD, FACS, Professor of Surgery.Virginia Commonwealth University, Richmond, VA, USA.487 BRIDGING GAPS IN CARE: USING COLPOSCOPIC TELEMEDICINE TO BENEFIT RURAL WOMENPRESENTERS AND CONTRIBUTING AUTHORS:Gordon Low, MSN, APN, Program Coordinator START Program, Wilbur C. Hitt, MD, FACOG.University of Arkansas for Medical Sciences, Little Rock, AR, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-19

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEX107 RANDOMIZED, CONTROLLED TRIAL OF VIRTUAL HOUSECALLS FOR PARKINSON DISEASEPRESENTERS AND CONTRIBUTING AUTHORS:E. Ray Dorsey, MD, MBA, Associate Professor of Neurology 1 , Vinayak Venkataraman, B.S.E. 1 , Matthew Grana, BA 2 , Michael T. Bull, BS 2 ,Ben P. George, MPH 3 , Balaraman Rajan, MBA, MS 4 , Christopher A. Beck, PhD, MA 5 , Abraham Seidmann, PhD 4 , Kevin M. Biglan, MD, MPH 2 .1 Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA, 2 Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA,3 School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA, 4 William E. Simon Graduate School of Business Administration, University ofRochester, Rochester, NY, USA, 5 Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA.196 EVIDENCE OF THE NON-INFERIORITY OF IN-HOME TELEREHABILITATION AFTER TOTAL KNEE ARTHROPLASTYPRESENTERS AND CONTRIBUTING AUTHORS:Helene Moffet, PhD, Full Professor 1,2 , Michel Tousignant, PhD 3 , Sylvie Nadeau, PhD 4 , Chantal Mérette, PhD 1,5 , Patrick Boissy, PhD 3 ,Hélène Corriveau, PhD 3 ,François Marquis, MD 1,6 , François Cabana, MD 3,7 , Pierre Ranger, MD 4,8 ,Étienne Belzile, MD 1,6 , Pascale Larochelle, MD 3,9 ,Ronald Dimentberg, MD 10 .1 Université Laval, Quebec, QC, Canada, 2 Centre for Interdisciplinary Research and Social Integration, Quebec, QC, Canada, 3 Université de Sherbrooke andResearch Center on Aging, Sherbrooke, QC, Canada, 4 Université de Montréal and Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal,Montreal, QC, Canada, 5 Centre de recherche de l’Institut universitaire en santé mentale, Quebec, QC, Canada, 6 CHUQ, Quebec, QC, Canada, 7 CHUS,Sherbrooke, QC, Canada, 8 Hôpital Jean-Talon, Montreal, QC, Canada, 9 CSSS-Arthabaska-Les-Érables, Arthabaska, QC, Canada, 10 McGill Universityand St. Mary’s Hospital, Montreal, QC, Canada.TUESDAY, MAY 7, 20131:15 pm–2:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 051Session Title: UNIQUE APPROACHES TO SERVING LOW INCOME URBAN POPULATIONSTrack: Best Practices and Service Delivery Models II Meeting Room 16 A/BMODERATOR: Neal Sikka, MD, Assistant Professor, Emergency Medicine, Chief, Innovative Practice.The George Washington University - Medical Faculty Associates, Washington, DC.110 A BORDERLESS DOCTOR-PATIENT RELATIONSHIP: PILOT OF MEXICAN PHYSICIANS CARING FOR HISPANIC AMERICANSPRESENTERS AND CONTRIBUTING AUTHORS:Eric Leroux, MD/MBA Candidate, Medical Student 1 , Dora Silva, BS 2 , Ovet Esparza, PA 3 , Becky Wai, BS 4 , Iana Simeonov, BA 5 , Homero Rivas, MD, MBA 1 .1 Stanford University School of Medicine, Palo Alto, CA, USA, 2 San Francisco State University, San Francisco, CA, USA, 3 Stanford University, Palo Alto,CA, USA, 4 UC Berkeley, Berkeley, CA, USA, 5 UC San Francisco, San Francisco, CA, USA.620 EXPANDING TELEMEDICINE TO INCLUDE CARE FOR THE ADULT PATIENT IN THE INNER CITYPRESENTERS AND CONTRIBUTING AUTHORS:Laura Markwick, DNP, Health-e-Access.University of Rochester, Rochester, NY, USA.TUESDAY, MAY 7, 20131:15 pm–2:15 pm Tuesday, May 7, 2013DISCUSSION PANELSession Number: 052Session Title: 299 NEW HOSPITAL-BASED TELEMEDICINE SERVICES: IMPLICATIONS OF A TELEHOSPITALISTPHYSICIAN SERVICETrack: Innovations Meeting Room 18 C/DMODERATOR: Richard B. Sanders, MPH, FACHE, Vice President Telemedicine Services.Eagle Hospital Physicians, Atlanta, GA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Doug Romer, RN, Executive Director, Patient Care Services 1 , Dana P. Giarrizzi, DO, FHM, National Medical Director, TeleHospitalist Service 2 ,Herb Rogove, DO, FCCM, FACP, President/CEO 31 Grande Ronde Hospital, La Grande, OR, USA, 2 Eagle Hospital Physicians, Atlanta, GA, USA, 3 C3O Telemedicine, Ojai, CA, USA.A-20 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXTUESDAY, MAY 7, 20131:15 pm–2:15 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 053Session Title: 718 T FOR TEXAS - (TELEHEALTH, THAT IS)Track: Policy Meeting Room 18 A/BMODERATOR: Hank Fanberg, PhD Candidate, Executive Director.Texas Health Information Network Collaborative (TxHINC), Dallas, TX, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Hank Fanberg, MBA, Executive Director 1 , Stephen Palmer, MA, Director, Office of e-Health Coordination, TX DSHS 2 , Nora Belcher, BA, Executive Director 31 Texas Health Information Network Collaborative, Dallas, TX, USA, 2 State of Texas Dept of State Health Services, Austin, TX, USA, 3 Texas eHealth Alliance,Austin, TX, USA.TUESDAY, MAY 7, 20131:15 pm–2:15 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 054Session Title: 844 MHEALTH APPLICATION IN PEDIATRICS – DEVELOPMENT, PRACTICE AND IMPACTTrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BMODERATOR: Madan Dharmar, MBBS, PhD, Assistant Research Professor.University of California Davis Health System, Sacramento, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Edmund Seto, PhD, Associate Adjunct Professor, School of Public HealthUniversity of California, Berkeley, Berkeley, CA, USA.TUESDAY, MAY 7, 20133:00 pm–4:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 055Session Title: 801 THE UK’S WHOLE SYSTEM DEMONSTRATORS PROGRAM: LESSONS FROM THE WORLD’SLARGEST TRIAL OF REMOTE CARETrack: Outcomes and Evidence Meeting Room 19 A/BMODERATOR: James Barlow, BA (Hons), PhD, Chair in Technology and Innovation Management.Imperial College Business School, London, United Kingdom.PRESENTERS AND CONTRIBUTING AUTHORS:Stanton Newman, BSoc Sci, PhD, Professor of Health Psychology and Dean 1 , Caroline Sanders, BSc, PhD, Lecturer in Medical Sociology 2 ,Martin Cartwright, BSc, PhD, Health Services Research 31 City University, London, United Kingdom, 2 University of Manchester, Manchester, United Kingdom, 3 City University, London, United Kingdom.TUESDAY, MAY 7, 20133:00 pm–4:00 pm Tuesday, May 7, 2013DISCUSSION PANELSession Number: 056Session Title: 992 A UNIQUE JOURNEY INTO TELEMEDICINE: PERSPECTIVES FROM A FEDERAL ENTITY,ACADEMIC MEDICAL CENTER, AND A PRIVATE INSTITUTIONMeeting Room Ballroom EMODERATOR: Joseph Tracy, MS, Vice President - Telehealth Services.Telehealth Services, Lehigh Valley Health Network, Allentown, PA, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-21

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXPRESENTERS AND CONTRIBUTING AUTHORS:Kristi Henderson, MD, Chief Advanced Practice Officer & Director of Telehealth, University Mississippi Medical Center, Jackson, MS, Jamie Adler, PhD,Director, Telehealth Program, Department of Defense - National Center for Telehealth and Technology, Tacoma, WA, Tom Hale, MD, PhD, Medical Directorfor the Center for Innovative Care, Mercy Health System, Chesterfield, MO, USA.TUESDAY, MAY 7, 20133:00 pm–4:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 057Session Title: 632 COUNTDOWN 2014: TELEMEDICINE PREPARATION IN MEETING THE GROWING MEDICAIDPOPULATIONTrack: Finance and Operations IIBallroom FMODERATOR: Tina Benton, RN, BSN, Program Director and Clinical Division Director.University of Arkansas for Medical Sciences, Little Rock, AR, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Curtis Lowery, MD, Chairperson of Department of Obstetrics/Gynecology 1 , Brian Evans, MBA, Chief Executive Officer 21 University of Arkansas for Medical Sciences, Little Rock, AR, USA, 2 Clarke County Hospital, Osceola, IA, USA.TUESDAY, MAY 7, 20133:00 pm–4:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 058Session Title: 491 USING OUTCOMES FROM NATIONAL TELEMENTAL HEALTH PROGRAMS TO DEVELOPBEST PRACTICESTrack: Best Practices and Service Delivery Models I Ballroom GMODERATOR: Linda Godleski, MD, Director, VA National Telemental Health Center.Yale School of Medicine, New Haven, CT, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Erica Abel, PhD, Yale Telemental Health Informatics Fellow 1 , Mark Bauer, MD, Lead, Nat’l Telemental Health Ctr Bipolar Program 2 , Phillip Gehrman, PhD,Lead National Telemental Health Center Insomnia Program 31 Yale School of Medicine, New Haven, CT, USA, 2 Harvard Medical School, Boston, MA, USA, 3 University of Pennsylvania, Philadelphia, PA, USA.TUESDAY, MAY 7, 20133:00 pm–4:00 pm Tuesday, May 7, 2013DISCUSSION PANELSession Number: 059Session Title: 565 HOT TOPICS IN TELEBEHAVIORAL HEALTH INTEGRATION AND OUTCOMES MANAGEMENTTrack: Best Practices and Service Delivery Models II Meeting Room 17 A/BMODERATOR: Phil Hirsch, PhD, Chief Clinical Officer.HealthLinkNow, Sacramento, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Barb Johnston, MSN, Chief Executive Officer 1 , Peter Yellowlees, MD, Director, Health Informatics Program 2 , Jonathan Hoistad, PhD, Director 31 HealthLinkNow, Sacramento, CA, USA, 2 UC Davis, Sacramento, CA, USA, 3 Natalis Counseling and Psychology Solutions, St. Paul, MN, USA.A-22 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXTUESDAY, MAY 7, 20133:00 pm–4:00 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 060Session Title: MODEL PROGRAMS DELIVERING HOME-BASED PATIENT SERVICESTrack: Best Practices and Service Delivery Models III Meeting Room 16 A/BMODERATOR: Kathy Duckett, RN, BSN, PHN, Director for Training and Development.Sutter Center for Integrated Care, Fairfield, CA, USA.735 ONTARIO’S TELEHOMECARE PROGRAM: AN ENGAGEMENT MODEL THAT FOSTERS CONTINUUM OF CARE AND COLLABORATIONPRESENTERS AND CONTRIBUTING AUTHORS:Susan Harnarine, MBA, Product Manager, Telehomecare.OTN, Toronto, ON, Canada.118 EMERGENCY MANAGEMENT GUIDELINES FOR HOME BASED TELEMENTAL HEALTH AND OTHER NON-CLINICAL SETTINGSPRESENTERS AND CONTRIBUTING AUTHORS:Peter Shore, PsyD, Assistant Professor of Psychiatry.Oregon Health & Science University, Portland, OR, USA.947 A HOME TELEHEALTH SERVICE DELIVERY MODEL FOR ACUTE AND CHRONIC CAREPRESENTERS AND CONTRIBUTING AUTHORS:Krisan Palmer, RN.Telehealth, Horizon Health Network, Saint John, NB, Canada.TUESDAY, MAY 7, 20133:00 pm–4:00 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 061Session Title: LEVERAGING HEALTH INFORMATION EXCHANGE & TELEMEDICINETrack: Innovations Meeting Room 18 C/DMODERATOR: Stewart Ferguson, PhD, Chief Information Officer.AFHCAN/Telehealth, Alaska Native Tribal Health Consortium, Anchorage, AK, USA.775 THE POWER OF INTEGRATING TELEMEDICINE WITH HEALTH INFORMATION EXCHANGE IN A CHANGING HEALTHCARE ENVIRONMENTPRESENTERS AND CONTRIBUTING AUTHORS:Dale Alverson, MD, Professor Emeritus.University of New Mexico, Albuquerque, NM, USA.472 TELEHEALTH SOLUTIONS: EVOLVING STORY FROM AN EHR PERSPECTIVEPRESENTERS AND CONTRIBUTING AUTHORS:Srini Kodali, MPH, MBA, BS (Electrical Eng.), Director, Global Telehealth Solutions.Allscripts, Raleigh, NC, USA.301 CLOSING THE LOOP: INTEGRATING A REMOTE MONITORING IN OUR EMRPRESENTERS AND CONTRIBUTING AUTHORS:Robert Havasy, BS, Technical Architect, Alyssa Woulfe, BA.Partners Healthcare Center for Connected Health, Boston, MA, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-23

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXTUESDAY, MAY 7, 20133:00 pm–4:00 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 062Session Title: NEXT STEPS FOR TELEHEALTH POLICY: IMPLEMENTING NATIONAL HEALTH REFORMSTrack: Policy Meeting Room 18 A/BMODERATOR: Julia Johnson, President.NetCommunications, LLC, Windermere, FL.476 INTEROPERABILITY CAN SUPPORT MEANINGFUL USE 2 & 3PRESENTERS AND CONTRIBUTING AUTHORS:Chuck Parker, BA, MS, Executive Director.Continua Health Alliance, Beaverton, OR, USA.567 TELEHEALTH AND MEANINGFUL USE: CAN IT BE DONE?PRESENTERS AND CONTRIBUTING AUTHORS:Ryan Spaulding, PhD, Director, Center for Telemedicine & Telehealth, Helen Connors, RN, PhD.University of Kansas Medical Center, Kansas City, KS, USA.394 ACOS AND INTEGRATION: WHAT IS ON HORIZON FOR TELEMEDICINEPRESENTERS AND CONTRIBUTING AUTHORS:Sarah E. Swank, Esq, Principal.Ober j Kaler, Washington, DC, USA.TUESDAY, MAY 7, 20133:00 pm–4:00 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 063Session Title: THE USE OF TELEMEDICINE FOR INTERNATIONAL SETTINGSTrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BMODERATOR: Silvio Vega, MD, Medical Director.PNTT, Panama.250 TELECARDIOLOGY PARTNERSHIP WITH MARRAKECH, MOROCCO: SUPPORTING PEDIATRIC CARDIOLOGY IN THE DEVELOPING WORLDPRESENTERS AND CONTRIBUTING AUTHORS:Craig Sable, MD, Medical Director, Telemedicine 1 , Yassine Boukadi, MD 2 , Mary Fuska, MHS 1 , Svetlana Sinykin, MD 1 , Molly Reyna, BA 1 ,Ron Dixon, BA 1 , Soloua Elkarimi, MD 2 , Drissi Boumzebra, MD 2 .1 Children’s National Medical Center, Washington, DC, USA, 2 Hospital Ibn Tofail /Centre Hospitalier Universitaire Mohammed VI,Marrakech, Morocco.124 INTERNATIONAL TELEMEDICINE CONSULTATIONS FOR NEURODEVELOPMENTAL DISABILITIESPRESENTERS AND CONTRIBUTING AUTHORS:Phillip L. Pearl, MD, Neurology Division Chief 1 , Mark A. Batshaw, MD 1 , Sarah Evans, MD 1 , Oussama El Baba, MHA 2 , Issam Ramadan, N/A 2 ,Nader Tabbara, N/A 2 , Molly Reyna, N/A 3 , Craig Sable, MD 3 , Philip Hopkins, N/A 3 , Joseph Knight, N/A 1 , Andrea Gropman, MD 1 , Sheela Stuart, PhD 1 ,Penny Glass, PhD 1 , Anne Conway, N/A 1 , Rachel Roberts, N/A 1 , Robert J. Packer, MD 1 .1 Center for Neuroscience and Behavioral Health, George Washington University School of Medicine, Washington, DC, USA, 2 International MedicineProgram, George Washington University School of Medicine, Washington, DC, USA, 3 Telemedicine Department, George Washington University Schoolof Medicine, Washington, DC, USA.A-24 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEX622 QUALITY IMPROVEMENT IN TELEGENETICS: THE DEVELOPMENT OF COMMON EVALUATION MEASURESPRESENTERS AND CONTRIBUTING AUTHORS:Liza M. Creel, MPH, Project Manager 1 , Sylvia Au, MS, CGC 2 , NCC Telegenetics Workgroup, N/A 3 .1 Mountain States Genetics Regional Collaborative, Austin, TX, USA, 2 Western States Genetic Services Collaborative, Honolulu, HI, USA, 3 NationalCoordinating Center for the Genetic and Newborn Screening Service Collaboratives, Bethesda, MD, USA.TUESDAY, MAY 7, 20134:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 064Session Title: BUSINESS AND OPERATIONAL DECISIONS IN TELEMEDICINETrack: Finance and Operations I Meeting Room 19 A/BMODERATOR: Molly Reyna, Senior Vice President, Strategy.Specialists on Call, Leesburg, VA.167 NIGHTHAWK V DAYHAWK - TWO MODELS FOR TELERADIOLOGYPRESENTERS AND CONTRIBUTING AUTHORS:Howard Reis, MBA, VP of Business Development.Teleradiology Specialists, West Nyack, NY, USA.120 TELEMEDICINE ANESTHESIA PRE-OPERATIVE CLINICS SUPPORTING THE EUROPEAN COMMANDPRESENTERS AND CONTRIBUTING AUTHORS:Jeffrey A. Faulkner, MD, CMR 402.Landstuhl Regional Medical Center, APO, AE, USA.707 THE POWER AND ECONOMIC IMPACT OF NETWORK BASED MEDICAL DEVICE AGGREGATORSPRESENTERS AND CONTRIBUTING AUTHORS:Dan McCafferty, BA, Vice President, Global Sales and Corporate Development.AMD Global Telemedicine, Chelmsford, MA, USA.TUESDAY, MAY 7, 20134:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 065Session Title: FUNDING TRENDS, STRATEGIES & OPPORTUNITIESTrack: Finance and Operations I Ballroom EMODERATOR: Nancy Rowe, Director of Telemedicine.NARBHA, Flagstaff, AZ, USA.277 RETROSPECTIVE REVIEW OF MEDICARE REIMBURSEMENT FOR TELEHEALTH IN AUSTRALIAPRESENTERS AND CONTRIBUTING AUTHORS:Anthony C. Smith, PhD, M ED, BN, Deputy Director, Nigel R. Armfield, PhD, MSc, Leonard C. Gray, PhD, MBBS, FRACP.The University of Queensland, Centre for Online Health, Brisbane, Australia.194 FUNDING TRENDS FOR TECHNOLOGY IN HEALTHCARE ORGANIZATIONSPRESENTERS AND CONTRIBUTING AUTHORS:Jeffrey M. Barlow, MPA, Grant Development Manager.Polycom Grant Assistance Program, Jefferson City, MO, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-25

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXTUESDAY, MAY 7, 20134:15 pm–5:15 pm Tuesday, May 7, 2013DISCUSSION PANELSession Number: 066Session Title: 590 CHANGING HEARTS AND MINDS: WHAT IT TAKES TO FACILITATE CULTURE CHANGEIN A LARGE, MULTI-SITE ORGANIZATIONTrack: Finance and Operations II Ballroom FMODERATOR: Sherene Schlegel, RN, BSN, Director of Telehealth, Swedish Health Services.Swedish Health Services, Seattle, WA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Jamile Mack, BA, Business Admin, Technology Liaison, Telehealth, Sherene Schlegel, RN, BSN, Director, Telehealth Depart, Todd Czartoski, Doctor ofMedicine, Director, Neurology, Pita Nims, Master of Nursing, Telehealth Clinical Program Coordinator, Juliette Lachner, MHAC, Business Analyst, TelehealthSwedish Health Services, Seattle, WA, USA.TUESDAY, MAY 7, 20134:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 067Session Title: TRAUMA & DISASTER RESPONSETrack: Best Practices and Service Delivery Models I Ballroom GMODERATOR: Carl Keldie, MD, FACEP, Chief Medical Officer.Corizon, Brentwood, TN, USA.413 MILITARY TELEMEDICINE IN DEPLOYED SETTINGS, ENROUTE CARE, TELE-COACHING AN UPDATE FROM THE FIELD LABORATORYPRESENTERS AND CONTRIBUTING AUTHORS:Dave L. Williams, FACHE, Masters in Health Care Administration, Project Manager Theater Telemedicine.TATRC, Fort Detrick, MA, USA.53 EVALUATION OF USING TELEMEDICINE IN UNEXPECTED DISASTERS IN CITY OF TEHRAN, IRANPRESENTERS AND CONTRIBUTING AUTHORS:Dina Ziadlou, MS, Engineer.SBMU, Tehran, Islamic Republic of Iran.660 INTEROPERABLE TECHNOLOGIES IN DISASTER RECOVERY: A CASE STUDY FROM THE GREAT JAPAN EARTHQUAKE OF 2011PRESENTERS AND CONTRIBUTING AUTHORS:Chuck Parker, BA, MS, Executive Director.Continua Health Alliance, Beaverton, OR, USA.TUESDAY, MAY 7, 20134:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 068Session Title: LESSONS LEARNED FROM TELEMEDICINE INITIATIVES IN OTHER COUNTRIESTrack: Best Practices and Service Delivery Models II Meeting Room 17 A/BMODERATOR: Roger Swinfen, Founder and Trustree.The Swinfen Charitable Trust, Canterbury, United Kingdom.A-26 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEX376 ‘‘REVIEW OF NATIONAL TELEMEDICINE RURAL SUPPORT PROGRAM NORTHERN PUNJAB-PAKISTAN’’PRESENTERS AND CONTRIBUTING AUTHORS:Asif Zafar, MBBS, MCPS, FRCS, FCPS, Surgical Unit II, Qasim Ali, FCPS, MRCS, Faisal Murad, MBBS, FCPS.Rawalpindi Medical College, Rawalpindi, Pakistan.615 TELEMEDICINE IN VIETNAM: APPLICATIONS FOR INFECTIOUS DISEASE CONTROLPRESENTERS AND CONTRIBUTING AUTHORS:Paul E. Kilgore, M.P.H., MD, Associate Professor 1 , Vu D. Thiem, MD, PhD 2 , Tran N. Duong, MD, PhD 2 .1 Wayne State University College of Pharmacy & Health Sciences, Detroit, MI, USA, 2 National Institute of Hygiene and Epidemiology,Hanoi, Viet Nam.603 LESSONS LEARNED IN LATIN AMERICA: AMI AND STEMI OUT OF 5,5MM EKGS INFORMED SINCE 2008.PRESENTERS AND CONTRIBUTING AUTHORS:Thais Waisman, PhD, MBA, Regional Innovation Director 1,2 , Francisco Fernandez, BSc 1 .1 ITMS do Brasil, Sao Paulo, Brazil, 2 USP - University of Sao Paulo-Engineering School, Sao Paulo - Brazil, Brazil.TUESDAY, MAY 7, 20134:15 pm–5:15 pm Tuesday, May 7, 2013HOW-TO PANELSession Number: 069Session Title: 701 STRATEGICALLY ESTABLISHING TELEHEALTH SERVICES FOR THE MANAGEMENTOF CHRONIC DISEASES: A BEACON PROGRAMTrack: Best Practices and Service Delivery Models III Meeting Room 16 A/BPRESENTERS AND CONTRIBUTING AUTHORS:Kathryn Lombardo, MD, Department Chair, Psychiatry and Psychology 1 , Christian Milaster, Dipl.-Ing., President, Telehealth Consultant 21 Olmsted Medical Center, Rochester, MN, USA, 2 Ingenium Consulting Group, Inc., Lanesboro, MN, USA.TUESDAY, MAY 7, 20134:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 070Session Title: VIRTUAL WORLDS & REMOTE PRESENCE IN DELIVERING PATIENT CARETrack: Innovations Meeting Room 18 C/DMODERATOR: Jerry Kolosky, Senior Healthcare Advisor, Office of the CTO.Panasonic Company of North America, Secaucus, NJ.193 REMOTE PRESENCE FOR SUPPORT AND MENTORING OF HIGH- CONSEQUENCE MEDICAL DEVICESPRESENTERS AND CONTRIBUTING AUTHORS:Perry S. Bechtle, DO, Anesthesiologist.Mayo Clinic in Florida, Jacksonville, FL, USA.667 TELEPRESENCE DESIGN REVOLUTION (Abstract Withdrawn)PRESENTERS AND CONTRIBUTING AUTHORS:Michael Meyer, BS, MBA, Partner.Essential, Boston, MA, USA.407 AVESS: VIRTUAL TECHNOLOGIES FOR VIRTUALLY EVERYONEPRESENTERS AND CONTRIBUTING AUTHORS:Troy A. Turner, Rehabilitation and Human Performance Scientific Domain Coordinator.TATRC, Fort Detrick, MD, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-27

CONCURRENT ORAL PRESENTATIONS ABSTRACT INDEXTUESDAY, MAY 7, 20134:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 071Session Title: CREDENTIALING AND RISK MANAGEMENTTrack: Policy Meeting Room 18 A/BMODERATOR: Alexis Gilroy, JD, Partner.Nelson Mullins Riley & Scarborough, Washington, DC, USA.712 THE HIGHWAYS AND BYWAYS OF CENTRALIZED CREDENTIALING FOR TELEHEALTHPRESENTERS AND CONTRIBUTING AUTHORS:Chris Veremakis, MD, Mercy Health 1 , Maureen Kolzowski, None 2 , Wendy Deibert, RN, BSN 1 .1 Mercy Health, Chesterfield, MO, USA, 2 Mercy - St. Louis, St. Louis, MO, USA.451 WELCOME TO THE PROXY CLUB! THE EVOLUTION OF PEER REVIEW THROUGH TELEMEDICINE CREDENTIALINGPRESENTERS AND CONTRIBUTING AUTHORS:John Mills, BA, JD, Attorney.Fenton Nelson, Los Angeles, CA, USA.666 MANAGING TELEMEDICINE LIABILITY RISKSPRESENTERS AND CONTRIBUTING AUTHORS:Kenneth E. Rhea, MD, FASHRM, Risk Management Specialist.Medical Interactive Community, Metairie, LA, USA.TUESDAY, MAY 7, 20134:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 072Session Title: SUBSPECIALIST USE OF TELEMEDICINETrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BMODERATOR: Kathleen Webster, MD, MBA, Director, Division of Pediatric Critical Care.Loyola University Medical Center, Maywood, IL, USA.674 EVALUATION OF TELEHEALTH TO SUPPORT PEDIATRIC SEXUAL ABUSE EXAMINATIONS IN RURAL COMMUNITIESPRESENTERS AND CONTRIBUTING AUTHORS:Sheridan Miyamoto, PhD Candidate, FNP, MSN, RN, Nurse Practitioner, Nurse Researcher 1 , Madan Dharmar, MBBS, PhD 2 ,Cathy Boyle, PNP, MSN, RN 3 , Nikki H. Yang, DVM, MPVM 3 , James P. Marcin, MD, MPH 2 .1 UC Davis Betty Irene Moore School of Nursing; UC Davis Department of Pediatrics, Sacramento, CA, USA, 2 UC Davis Department of Pediatrics; UC DavisCenter for Health and Technology, Sacramento, CA, USA, 3 UC Davis Department of Pediatrics, Sacramento, CA, USA.662 USING TELEMEDICINE TO SCREEN FOR RETINOPATHY OF PREMATURITY IN NEWBORNSPRESENTERS AND CONTRIBUTING AUTHORS:Shawn Farrell, MBA, Innovation Acceleration Program.Boston Children’s Hospital, Boston, MA, USA.163 ETHICAL DILEMMAS IN PEDIATRIC TELEPSYCHIATRYPRESENTERS AND CONTRIBUTING AUTHORS:Felissa P. Goldstein, MD, Child & Adolescent Psychiatrist.Marcus Autism Center, Atlanta, GA, USA.A-28 TELEMEDICINE and e-HEALTH 2013

Concurrent Oral Presentations AbstractsThe American Telemedicine Association EighteenthAnnual International Meeting and ExpositionMay 5–7, 2013 Austin, TXSUNDAY, MAY 5, 201312:00 pm–1:00 pm Sunday, May 5, 2013HOW-TO PANELSession Number: 073Session Title: 447 KEYNOTE AND TELEMEDICINETOOLKIT: THE FOUNDATION FOR STARTING ATELEMEDICINE PROGRAMTrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BPRESENTERS AND CONTRIBUTING AUTHORS:Stephen D. Minton, MD, Medical Director 1 , Bryan Burke, MD, AssociateProfessor and Director of Term Nursery 2 , Terri Imus, RN, LNC, ANGELSOutreach Nurse 21 Urban South Region Newborn Services, Intermountain Healthcare, Provo, UT,USA, 2 University of Arkansas for Medical Sciences, Little Rock, AR, USA.ATA Pediatric Telehealth Colloquium Keynote with Dr. Stephen Minton, MD,Intermountain Healthcare, followed by ‘‘The Telemedicine Toolkit’’. The TelemedicineToolkit aims to explain the four basic uses of telemedicine – tele-education,tele-consultation, tele-practice, and tele-research – to an audience interested inbeginning a telemedical program. The structure of the lecture begins with teleeducation,the least complex use, and builds through tele-research, the most complexuse. The applications and advantages of each step are explained, as well as thetools and expense needed for each additional step. The Toolkit has been presentednationally and internationally, with favorable reviews at each step of the way.Objectives:1. The learner will understand technical and program requirements forbeginning and growing a telemedicine program.2. The learner will be able to discuss the value of telemedicine in education,practice and research.3. The participant will be able to implement key strategies when beginningor expanding a telemedicine program.1:00 pm–2:00 pm Sunday, May 5, 2013DISCUSSION PANELSession Number: 074Session Title: 715 SPEED ROUNDS: MEET THEEXPERTS IN PEDIATRIC TELEMEDICINETrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BMODERATOR: Neil E. Herendeen, MD, MBA, Director, Health-e-Access.University of Rochester Medical Center, Rochester, NY, USA.PRESENTERS AND CONTRIBUTING AUTHORS:James P. Marcin, MD, MPH, Professor of Pediatric Critical Care 1 , MadanDharmar, PhD, Assistant Professor of Research 1 , Bryan Burke, MD,Associate Professor of Neonatology 2 , Julie Hall-Barrow, EdD, Director ofRural Health and Primary Care 21 UC Davis, Sacramento, NY, USA, 2 Arkansas Department of Health, LittleRock, AR, USA.The key to success in the pediatric telemedicine community has been thecollaboration, encouragement and teamwork of the entire Peds SIG membership.Reaching out to new members and engaging them with some of ourthought leaders and pioneers in pediatric telemedicine applications has beenat the forefront of each of the previous Pediatric Telemedicine Colloquiums. In2012, we developed our own version of speed dating with informal roundtablediscussions with eight pediatric experts and asked participants to rotate totheir top 3 areas of interest in 15 minute increments. This meet and greetapproach started many great conversations that continued as informal networkingthroughout the three day conference. This year’s speed rounds willallow participants to pick three topics for 20 minutes each from a panel ofeight experts representing inpatient telemedicine, outpatients telemedicine,network development/administrative support, school based telehealth, researchfunding, international applications, patient centered medical home andeducational opportunities. Case examples and data will be presented fromeach discipline as the presenter deems appropriate and all of our presentershave a wealth of telemedicine experience.Objectives:1. The learner will identify 3 pediatric applications to deliver outpatientcare2. The learner will identify potential barriers to pediatric health caredelivered by telemedicine.3. The learner will identify key individuals and resources to help themadvance their telemedicine interestPRESENTATION PANELSession Number: 075Session Title: THE LOPEZ FOUNDATION ANDINTERNATIONAL CROSS SPECIALTY PEDIATRICTELEHEALTH: IMPROVING ACCESS TOHEALTHCARE FOR CHILDREN IN LATIN AMERICA(IN CONJUNCTION WITH THE INTERNATIONALTELEMEDICINE FORUM)Track: Pediatrics Telehealth Colloquium Meeting Room: 12 A/BPRESENTERS AND CONTRIBUTING AUTHORS:Silvio Vega, MD, MSc, Medical Director 1 , Evan Loevner, MBA, MHP 2 ,Ivette Marciscno, RN, MPH 1 , Stuart Siegel, MD 2 .1 PNTT, Panama, 2 Children Hospital of Los Angeles, Los Angeles, CA, USA.Boldface indicates presenting author(s).ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-29

CONCURRENT ORAL PRESENTATIONS ABSTRACTSCare for sick children is not always done by a pediatrician or familypractitioner, especially if you live a distance away from big urban areas.Within many rural areas of Latin America, care is provided by a nursingassistant, and access to specialty care is difficult at best. The Lopez FamilyFoundation Panama Telehealth Program is focused on provision of specialtymedical care to places lacking connections to anything beyond basic medicalclinics. Telehealth is used to overcome the barriers of distance and the geographicaldifficulties of access. The program connects three pediatric specialtycare hospitals, a rural hospital, and three health clinics that serve the indigenouspopulation within the Republic of Panama. In additional to establishingthis local medical communications network infrastructure, a permanentconnection and partnership with Children’s Hospital Los Angeles, givesphysicians at all of these sites access to second-opinion services via casereview videoconferencing, and access to advanced medical education viaregular case review and interactive lectures.Materials and Methods: Telehealth systems based on the AMD architecturehave been installed in three pediatric hospitals, a regional rural hospital, andin three associated health clinics within the indigenous area of Panama. Allinstallations are connected via Internet. An internal network based onbroadband microwave radio technology provides connection to the threeremote health clinics located on the Indian reservation.Results: Virtual doctor visits among pediatric hospitals, presentation anddiscussion of cases, second opinion, continuing medical education activitiesare actions taken weekly from the start of activities in August 2012. Videoconferencesbetween surgeons at Children’s Hospital in Panama and Children’sHospital Los Angeles surgeons and critical care specialists have recently enabledthe successful separation of conjoined twins, who otherwise would havebeen sent out of the country for surgery at significant expense to the family.Conclusions: We consider this an excellent model of cooperation that leveragesthe power of telehealth for pediatric specialty service provision toneedy populations in Latin America. This model may be applicable to similarregions in Latin America and worldwide.Objectives:1. To facilitate the exchange of medical opinion between Panama pediatriciansand a major US pediatric academic medical center.2. To improve the health care of children in a rural indigenous populationin Panama by establishing a communications infrastructure for improvedtriaging and patient transfer.3. To raise the quality of continuing medical education for health personnelserving children and pregnant women in Panama11:00 am–12:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 001Session Title: IMPACT OF TELEHEALTH ON COSTREDUCTIONTrack: Outcomes and EvidenceMeeting Room 19 A/BMODERATOR: Rashid Bashshur, PhD, Director, UMH Telemedicine Core.University of Michigan Health System, Ann Arbor, MI, USA.575 REDUCING URGENT CARE VISITS THROUGH SECOND-LEVELTRIAGEPRESENTERS AND CONTRIBUTING AUTHORS:Donna Williams, RN, Nurse Project Program Manager for ANGELS andCDH Call Center.University of Arkansas for Medical Sciences, Little Rock, AR, USA.Since 2004, University of Arkansas for Medical Sciences’ ANGELS has beencoupling a robust statewide telemedicine infrastructure with a 24/7 call centerstaffed with high-risk obstetrical registered nurses to provide guidance torural, high-risk pregnant women seeking answers to questions, pregnancyadvice, and triage. To provide telephone triage to a patient, the call centernurse utilizes computer software that requires the nurse to ask a series ofalgorithmic questions to uncover the patient’s symptoms and medical history,which will offer recommendations toward the most appropriate level of care.Triage guidelines often lead nurses to send patients in for urgent care at theemergency department (ED) or labor and delivery (L&D) instead of suggestingalternate treatments or employing ‘‘wait-and-see’’ approaches that physiciansmight use in face-to-face consultation. In the fall of 2010, ANGELS beganoffering ‘‘second-level triage’’ to call center offerings in which a medicalspecialist or advanced practice nurse on-call would be incorporated into thetriage process when algorithms called for urgent or emergency care. Theaddition of ‘‘second-level’’ provider support often helps by empowering nursesto provide an appropriate over-book appointment, prescription, or advice inself-care, thus avoiding costly, unnecessary emergency room visits. Over twoyears, the number of avoided ED/L&D visits has increased impressively (seegraph below). To measure success, call center nurses polled callers on byasking whether the patient was planning on seeking urgent care prior tocalling for triage. Patients can choose from the following answers: called theclinic, gone to the ED/L&D, done nothing, scheduled an appointment, oradministered self-care. Those patients who state they would have visited theED/L&D but received a non-urgent triage solution were also calculated as‘‘urgent care avoided.’’ Each ED/L&D visit avoided equals a considerable costsavings to the patient, insurance, and possibly the facility, as shown in thefollowing second-level triage outcomes. In Fiscal Year 2011, the ANGELS CallCenter facilitated 2,747 avoided urgent care visits. The average ED triage visitcosts $1,161.27, and the average L&D triage visit costs $369. This means that,at a minimum, in one fiscal year, the second-level triage call center savedapproximately $1,013,643 in prevented unnecessary urgent care visits (2,747visits at $369 = $1,013,643).Objectives:1. The participants will be able to define the standard role of a triage callcenter.2. The participants will be able to recognize how second-level triage canprevent unnecessary urgent care visits.3. The participants will be able to identify potential cost savings related toprevented unnecessary urgent care visits.169 SAVINGS IN TRAVEL COSTS FOR ALASKA MEDICAID: A CASE FORSTORE-AND-FORWARD TELEHEALTH SPECIALTY CAREPRESENTERS AND CONTRIBUTING AUTHORS:Stewart Ferguson, PhD, CIO 1 , John Kokesh, MD 2 , Chris Patricoski, MD 1 .1 Alaska Native Tribal Health Consortium, Anchorage, AK, USA, 2 AlaskaNative Medical Center, Anchorage, AK, USA.Medicaid is the largest children’s health program in the country. It is alsothe primary source of health care for low-income families and for manyelderly and disabled people. One in six Americans under age 65 is insuredthrough Medicaid. In Alaska, Medicaid began to offer reimbursement fortelehealth for both ‘‘store-and-forward’’ as well as live video-conferencing in2002. The impact of telehealth on the Alaska Medicaid program has not,however, been the subject of any research despite that fact that AlaskaMedicaid expenditures per enrollee are the highest in the United States($10,417). This study accurately models the impact of telehealth specialtyconsultations on saving travel costs for Medicaid-eligible patients in Alaska.The study covers almost 10,000 store-and-forward telehealth specialty consultsconducted at the Alaska Native Medical Center (ANMC) from 2003 to2012 for more than 6,000 unique patients. The methodology combines directA-30 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSprovider assessments on a case-by-case basis on the impact of care on patienttravel with an accurate assessment of patient locations and ‘‘intended’’ traveldestinations for care. An earlier pilot study conducted in 2009 that reviewedapproximately 6,000 cases revealed savings of $11.50 to the Medicaid programfor every $1 spent on reimbursement, with the added benefit of preventing4,777 lost days at work and 1,444 lost days at school for children. Thecurrent study extends the analysis through 2012 and further supports therationale for state Medicaid programs to reimburse for store and forwardTelemedicine.Objectives:1. Understand the impact of telehealth on patient travel.2. Understand an accurate model for predicting travel savings of telehealth.3. Implement a methodology to measure travel savings from store-andforwardtelehealth11:00 am–12:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 002Session Title: SUCCESSFUL TELEMEDICINE BUSINESSENTERPRISESTrack: Finance and Operations IBallroom EMODERATOR: Thomas S. Nesbitt, MD, MPH, Associate Vice Chancellor.UC Davis Health System, Sacramento, CA, USA.696 THE LONG-TERM EFFECT OF TELECARE ON MEDICALEXPENDITURES: NINE-YEAR EXPERIENCE OF A JAPANESE TOWNMasatsugu Tsuji, PhD, Professor 1,2 , Yuji Akematsu, PhD 3 .1 University of Hyogo, Kobe, Hyogo, Japan, 2 National Cheng Kung University,Tainan, Taiwan, 3 Osaka University, Toyonaka, Osaka, Japan.Although the economic effect of telemedicine is mostly desired and expected,very few succeeded in demonstrating this. Accordingly, long-termeffects are not obtained so far. This paper aims to examine the long-termeffect of telecare (e-Health) on medical expenditures and treatment days in aproject of Nishi-aizu Town, Fukushima Prefecture, Japan from 2002–2010,which has been implementing the project to maintain the health of the elderlyor patients at home. In addition, this paper attempts to identify howtelecare reduces medical expenditures in the long-run and which chronicdiseases reduced medical expenditures or treatment days largely by telecareuse.Materials and Methods: The method of analysis is to compare the aboveoutcomes of two groups, namely users (treatment) and non-users (control) ofthe system based on the receipt data issued by National Health Insurance usingrigorous statistical analysis. Our previous papers used five-year data from2002 to 2006, and this paper expands the period of analysis to four more years.The samples in this analysis are the same as those in the previous analysis, butthe number of samples used here is reduced sharply, namely 90 of users and118 of non-users.Results: The results obtained so far are as follows: outpatients medical expendituresof all diseases and treatment days are almost the same in bothgroups, while if diseases are restricted to chronic diseases such as heart diseases,stroke, diabetes, and hypertension, then above two variables of thetreatment group are smaller than those of the control groups. In this nine yearsdata, the almost same results are obtained, and this paper analyzes how thislong-term effects are obtained. In particular, we focus on how four-year agingaffected their medical expenditures, and whether there was any change intheir telecare use such as frequency of use and their subjective beliefs of healthcondition.Conclusion: This paper demonstrates the role and effect of telecare or e-Health, which will provide the economic foundation or a basis of reimbursementfrom medical insurance. Some obstacles for telemedicine and howto promote it are also discussed.Objectives:1. Effect of telemedicine in medical expenditures2. How telecare reduces medical expenditures in the long-run3. Situations of telecare in Japan316 THE VIRTUAL VISIT PROVIDER: A NOVEL PRIMARY CARECAREER PATHPRESENTERS AND CONTRIBUTING AUTHORS:Benjamin Green, MD, Medical Director.Carena, Inc, Seattle, WA, USA.The future of Primary Care as a career is grim-medical students areflocking to specialty fields for the buzz, lifestyle, and compensation. Notenough new providers are choosing Primary Care as a career path, leavingtoo few providers struggling to carry the torch. This is bad for the providersleft in the field, and for the patients trying to get care. Primary Care viatelemedicine may be a solution to this problem. For the provider, providingcare via telemedicine has some real advantages in quality of life and workthat make its attractiveness begin to rival specialty care as a career option.‘‘Virtual’’ physicians, nurse practitioners and physician assistants can be avery real piece to the puzzle of solving the national Primary Care shortagecrisis by drawing more individuals back into the field. Real world case study:Primary Care providers at Carena Medical Providers of Seattle, WA haveembraced telemedicine as a full-time career, realizing a favorable lifestyle,professionally rewarding practice, and leadership within their field. Additionally,these providers have provided much needed support to their fellowcommunity PCPs, creating a symbiotic relationship that can helpdisprove the demise of Primary Care as a career. Most encouraging, ProviderSatisfaction metrics among this group are quite remarkable, offering tremendouspromise for the future. Who are these providers and how do wedevelop more? Why were they attracted to this care delivery model? How dolocal, office-based PCPs benefit?This individual oral presentation will:- Describe the challenges of sustaining primary care as an attractive careerpath- Present Telemedicine as a novel career option for the PCP- Discuss opportunities for supporting the existing office-based PCP- Present a real world Medical Group employing PCPs on a fulltime basis todeliver Telemedicine- Offer promising Provider metrics related to professional fulfillment,lifestyle satisfaction, and compensationObjectives:1. Present the promise of Telemedicine as a novel career option for thePrimary Care Provider2. Present a real world Medical Group employing Primary Care Providerson a Full Time Basis to deliver Telemedicine3. Offer promising Provider metrics related to professional fulfillment,lifestyle satisfaction, and compensationª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-31

CONCURRENT ORAL PRESENTATIONS ABSTRACTS600 TELEMEDICINE - HEALTHCARE REFORM WITHOUT ALL OF THEPOLITICSPRESENTERS AND CONTRIBUTING AUTHORS:Joe Peterson, MD, CEO & Director.Specialists On Call, Leesburg, VA, USA.Love it or loathe it, healthcare reform remains the law of the land. It is aseismic shift in healthcare that impacts every American on multiple levels.While it remains a complicated subject that continues to polarize our nation,another transformation in healthcare is revolutionizing medicine without anyof the political fallout. Telemedicine is a thriving industry that shares many ofthe same virtues and goals of healthcare reform - expanding access tohealthcare, improving the quality of care and reducing the costs of that samecare. Unlike healthcare reform, however, the early returns on telemedicine areoverwhelmingly positive. Most programs are delivering impressive clinicalresults along with incredibly high patient satisfaction scores. Private telemedicinecompanies are also combining equally positive clinical and patientsatisfaction data with a return on investment that is attractive to both hospitalsand their patients. While the efficacy of healthcare reform continues tobe debated, a real change in healthcare is occurring right before our eyes.Objectives:1. Healthcare reform has many shapes2. Telemedicine is truly transformative3. Healthcare shouldn’t fear change527 PRICE-CHECK, AISLE 1: SELLING PROVIDER-DEVELOPEDTELEMEDICINE PRODUCTS TO THE MASSESPRESENTERS AND CONTRIBUTING AUTHORS:Curtis Lowery, MD, Chairperson for the Department of Obstetrics andGynecology.University of Arkansas for Medical Sciences, Little Rock, AR, USAWhen a healthcare provider at a non-profit institution pioneers a brilliantconcept fueled by telemedicine, the idea of ‘‘profit’’ is often lost or neverconsidered. However, many times that innovative telemedical idea, if offeredon the public market, could benefit many others who could adapt the conceptand replicate it at their local level, not to mention the benefits offered to theinnovator who could sell his or her product. An academic medical center with along-standing telemedicine history has begun a ‘‘for-profit’’ venture in packagingand selling telemedicine ideas as a product line to meet the needs of othernetwork owners who have the infrastructure but desire more applications toutilize that infrastructure. With the establishment of a for-profit entity, thoseproducts will bring much-needed sustainability income to the pioneering telemedicineprogram. To date, this academic medical center spin-off business isactively selling a neonatal intensive care unit webcam system to hospitals thatcan offer remote family members the ability to view their hospitalized infantthrough a successful monitoring system and a proven product. Other ideas onthe horizon include mobile health applications and other concepts in remotemonitoring. While it is commendable to have a telemedicine network in yourownership, that network is only as good as the services and products deployedover it. Many networks, even those tried and true, are looking for ways toexpand their product line to reach more patients and providers in need. Forthose providers who have created niche products, this market could yieldbenefits to all with some accounting restructuring and legal considerations.These and other lessons learned will be discussed in this presentation.Objectives:1. Audience will learn how to produce a product line from their telemedicineideas and devices.2. Audience will learn how to navigate the creation of for-profit venturesfrom the basis of non-profit organizations.3. Audience will learn how market could yield benefits to all with someaccounting restructuring and legal considerations.11:00 am–12:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 003Session Title: DESIGNING FOR SCALETrack: Finance and Operations II Ballroom FMODERATOR: Adam Darkins, MD, FRCS, Chief Consultant, TelehealthServices.Department of Veterans Affairs, Washington DC, USA.467 THE INFLUENCE OF USER-CENTRED DESIGN AND THEDEVELOPMENT OF A LARGE-SCALE TELEHEALTH PROGRAMPRESENTERS AND CONTRIBUTING AUTHORS:Brendan Purdy, BN, MN(c), Program Coordinator, Telehealth,Dana Chmenitsky, BMR(PT), MBA, Carol Toenjes, BScN, RN,Joseph A. Cafazzo, PhD, PEng, Peter G. Rossos, MD, MBA, FRCP(C), FACP.University Health Network, Toronto, ON, Canada.The University Health Network (UHN) is an academic health sciences centrelocated in Toronto, Ontario, Canada. Over the last decade, the UHN TelehealthProgram has demonstrated steady growth in clinical consultations usingvideoconferencing technology. In fiscal 2011/12 the Program supported over3,000 clinical consultations across Canada in multiple specialty areas withinthree hospital sites. Since its inception in 2002, the program’s evolution andsuccess has been influenced by the principles of User-Centred Design (UCD),through the collaboration with Healthcare Human Factors at UHN. UCD focuseson task analysis and design iteration, which is ultimately associated witha high degree of user acceptability. In healthcare, clinician acceptance iscritical for any new initiative to be sustainable. Consequently, UHN Telehealthhas incorporated UCD principles to improve the level of user acceptance in theadoption of videoconferencing technology to enhance clinical service deliveryand sustain telehealth practice.Methods: This presentation will provide the following examples of how UCDprinciples have been incorporated into the establishment and evolution of alarge telehealth program.. Technology selection, deployment, and adoptionSelection of the most appropriate technology based on user needsleading to successful adoption across clinical sites.Evolution from a studio based telehealth model to the introduction anddeployment of mobile videoconferencing technology at the point ofcare within the clinic areas.. Space designDesign of the telehealth studio room to enhance the user experiencebased on best practices - including a brief description of a researchpaper that looked at optimizing the eye gaze angle.. Workflows and System IntegrationDescription of how UHN Telehealth engaged users in the various clinicalsettings to customize and adapt telehealth clinic workflows and processes.Focus on iterative changes to allow progression from pilot projects inselect clinical areas to the integration of telehealth into multiple clinicalpractices across UHN.. Clinician EmpowermentPhased model of UHN Telehealth Clinician Empowerment illustratedwith the integration of telehealth applications for Lung Transplantation.Results: Elements of UCD can contribute greatly to the design, successfulimplementation, and evolution of telehealth programs within a large academichealth care facility. Considerations also need to include leveraging andA-32 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSintroducing new technologies into the health care environment that are appropriateand user specific.Objectives:1. Understand how to apply principles of user centred design to telehealthimplementation and adoption.2. Describe an approach on how to deploy appropriate technology anddesign space based on the clinical user needs.3. Describe how to engage and empower users to incorporate telehealthinto their workflows and practices.79 SPECIALTY CONSULTATION VIA ELECTRONIC COMMUNICATION:THE MAYO CLINIC EXPERIENCEPRESENTERS AND CONTRIBUTING AUTHORS:Lorraine Uthke, MS, MBA, FACHE, Operations Administrator.Mayo Clinic, Rochester, MN, USA.Mayo Clinic has initiated practice redesign initiatives in the outpatientsetting with the objective of reducing cost per episode of care, and compressingthe length of time needed to complete an episode of care so that Mayocan provide access to those patients with complex medical conditions needingface-to-face consultation. Mayo Clinic developed an asynchronous electronichealthcare model to provide consultations between Mayo Clinic providers. AneConsult is a non-visit electronic consultation between a requesting providerand a Mayo Clinic specialist using the Mayo Clinic electronic medical record(EMR) and internal messaging. An eConsult request is initiated by placing anEMR order with a focused, clinical question. The concept was prototyped byMayo Clinic’s Center for Innovation. The focus was on offering asynchronous,electronic medical specialty (cardiology, gastroenterology, pulmonary) consultationto primary care providers as an option to scheduling a traditionalface-to-face visit. This pilot demonstrated an opportunity to reduce the cost tocare for Mayo Clinic’s established and primary care patient population andredirect specialty physician time to more complex patients. The concept wasadvanced to the Mayo Clinic eHealth team for implementation across theoutpatient practice at Mayo Clinic sites in Minnesota, Florida and Arizona. TheeConsult service is limited to asynchronous, electronic interactions and responsesare provided within one business day. Patients are billed for aneConsult and providers are given productivity credit for their effort. eConsultsrequests are now an option available to any Mayo Clinic provider who wouldlike to refer a patient for an electronic consultation, instead of scheduling aface-to-face visit. Common reasons to use eConsults are to save the patienttime and travel, and also more timely access to specialty care that has limitedaccess for traditional outpatient care. To this date, additional work flows arebeing developed as the breadth and depth of the eConsult model for externalaffiliates matures. Adaptation of existing clinical and financial systems andprocesses continue to pose barriers to streamline workflows. Thirty-twohundred eConsults have been provided by Mayo Clinic from January to July of2012. Compliance with the one business day turnaround time is seventy-eightpercent. Primary care providers order the majority of eConsults. Infectiousdiseases, hematology and neurology are the most requested specialties.eConsults are add-on work for specialists, when higher volumes are reachedthey will become scheduled appointments. Seventy-eight percent of physiciansrequesting eConsults strongly agree that eConsults work well withintheir department. Stakeholders strongly endorse eConsults for their efficiency.Physicians also comment that eConsults are not appropriate for all clinicalconditions. Demand for outpatient, specialty eConsults is increasing at asteady rate and requesting provider satisfaction is high. Adaptation of existingscheduling and clinical processes, and financial systems continue to posebarriers to streamline workflows. Dedicated eHealth systems and staffing areneeded to create scalable, sustainable solutions. The adaption of this new caremodel has enhanced the Mayo Clinic model of integrated care while creatingopportunities for cost savings and operational efficiency.Objectives:1. State the key criteria for an electronic specialty consultation requestthat results in requesting provide and patient satisfaction.2. Identify the actions needed to improve adoption of an electronic caremodel to provide specialty care.3. Explain how electronic consultations can reduce the cost to providepatient care and improve provider efficiency.217 THIS TIME ITS PERSONAL: DELIVERING SCALABLE TELEMEDICINESERVICES THROUGH PCS AND MOBILE DEVICESPRESENTERS AND CONTRIBUTING AUTHORS:Ron Riesenbach, MSc, MBA, Vice President, Emerging Business,Anish Shah, BE, MMS.Ontario Telemedicine Network, Toronto, ON, Canada.The revolution in consumer electronics has brought powerful mobile devicesand wireless high-speed connectivity to the general public. Levering thistrend is wave after wave of innovation in on-line personal and professionalcollaboration. Healthcare professionals are among the early adopters of thesetechnologies with many now using smart-phones and tablets as part of theirclinical practice. There is no doubt that this revolutions has brought aboutsignificant changes in the expectations of patient and clinicians as to howhealthcare services should be delivered. Telemedicine is not immune from thistrend. Room-based, shared, fixed hardware videoconference systems simplydo not meet the emerging needs of healthcare professionals. Changes need tobe made as to how we deliver telemedicine services to our healthcare professionalsand their patients. Over the last 12-months, OTN has been developingand deploying an integrated web and mobile portal called TelemedicineCentre. Our objective is to evolve telemedicine services in Ontario from fixed,room-based, shared videoconference systems to a personal telemedicine solution.More than merely PC-based videoconferencing, OTN’s solution bringsa set of comprehensive services directly to the PC or mobile device ofhealthcare professionals. On-line directories, telemedicine scheduling, professionaleducation calendar and other services are combined with videoconferencingto bring clinicians everything they need to conduct clinical andhealth-education from their personal PCs and tablets. There were numerouschallenges in adapting OTN’s traditional telemedicine delivery solutions toone that could be accessible through personal devices. These challenges includedimplementing a scalable identity and access management system,technical standards, security and privacy, technical support, just-in-timetraining, provisioning and interoperability with legacy systems. After extensiveplanning and a number of limited-scope deployments to test our solution,OTN has released its online Telemedicine Centre targeted at a wideswath of clinicians in Ontario. Over the last several months, thousands ofclinical consults have been conducted by hundreds of healthcare practitionersusing their PCs and tablets. Much of the work involved in introducing thispersonal telemedicine service was in overcoming scalability challenges -designing and supporting a self-serve model for hundreds of users. Interestingand significant usage patterns have emerged which is providing OTN withimportant insight into how personal telemedicine changes telemedicine activity.This presentation will outline the design and deployment decisionsmade, the challenges encountered, statistics on clinician acceptance and useof the personalized telemedicine service, and future plans for enhancement ofTelemedicine Centre.Objectives:1. Recognize the limitations of traditional fixed-room ‘shared’ telemedicinedelivery model.2. Understand the affordances of a new ‘personal’ telemedicine deliverymodel delivered through personal devices (PC, tablets, etc.).3. Realize the clinical productivity gains that have been achieved throughthe use of personal telemedicine model.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-33

CONCURRENT ORAL PRESENTATIONS ABSTRACTS11:00 am–12:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 004Session Title: DELIVERY OF SPECIALIZEDHEALTHCARE SERVICES VIA MOBILE APPS &TECHNOLOGIESTrack: Best Practices and Service Delivery Models IMODERATOR: Ben Chodor, CEO.Happtique, New York, NY.Ballroom G104 ONLINE SPEECH REHAB FOR APHASIA: APPS TO TELE-SPEECHPRESENTERS AND CONTRIBUTING AUTHORS:Andrew Gomory, BA in English; MS in Computer Scince, CEO.Lingraphica, Princeton, NJ, USA.We present a model for aphasia treatment that blends computer-basedtherapy with expert clinical input to maximize a person’s recovery. At the coreof the model are online therapeutic materials and exercises and our PatientCare Algorithm. The exercises cover all the areas of speech therapy at varyingdegrees of difficulty and are based on many years of use and refinement. Newexercises are continually added that leverage advances in technology, recentresearch and various treatment approaches with proven clinical effectiveness.The Patient Care Algorithm provides a treatment plan based a user’s assessment,goals and performance that use the online therapeutic materials. TheAlgorithm provides a structured path that is enhanced by a clinician’s expertiseand experience. Surrounding the therapeutic materials are assessmenttools, reporting and analysis. The initial assessment creates a user profile thatinforms goals and treatment options and establishes a baseline from whichprogress can be measured. Periodic re-assessment measures that progress andinforms changes to the treatment plan. The model is delivered in three ways:through an app, through a web-site subscription, and through a telemedicineplatform. The therapeutic materials are common to the three delivery methodswhile the assessment, reporting and analysis vary. The app runs on an iPhone,iPod touch and iPad and provides a broad range of therapy exercises at differentdegrees of difficulty within a single app. All the exercises have a similarapproach and interface so the user only has to learn one system to be able torun them all. Exercises are purchased separately so that costs are minimizedand a user only pays for what they will use. The web-site subscription offersusers unlimited access to exercises for a monthly fee. The application is deliveredthrough a browser so that it may be used by anyone with access to theInternet. The platform provides an assessment tool and detailed reporting on auser’s activity. These results are reviewed asynchronously by clinicians whoprovide guidance for working through the exercises. Live audio, video andtext-based help are provided on demand at the touch of a button. The finaldelivery method is tele-speech - regularly scheduled one-on-one speechtherapy with an SLP delivered over the Internet. The platform provides a twowayaudio and video connection, screen sharing and remote control so that anSLP can work with a patient as though they were sitting side by side. The SLPmakes use of the online exercises during their session and the user has unlimitedaccess for practice between sessions. Detailed reporting allows theSLP to see what a patient has done between sessions. The model provides aplatform for delivering multiple types of speech therapy in a consistentmanner to people who would normally receive no treatment. For SLPs, theplatform provides superior therapeutic materials and unmatched supportin reporting, assessment and analysis. Finally, the platform will gather dataon large numbers of patients providing evidence for the efficacy of therapydelivered.Objectives:1. Evaluate different types of support tools.2. Describe the basic techniques of distance-based.3. Describe how to make distance-based support and training work fordifferent types of patients.345 MOBILE HEALTH TECHNOLOGY TO ASSIST WITHMUSCULOSKELETAL INJURY PREDICTION AND PREVENTIONPRESENTERS AND CONTRIBUTING AUTHORS:Deydre S. Teyhen, PT, PhD, OCS, Deputy Director.TATRC, Ft Detrick, MD, USA.Musculoskeletal injuries are a primary source of disability in the U.S.Military. Musculoskeletal injuries resulted in approximately 2.4 millionmedical visits to military treatment facilities and accounted for $548 milliondollars in direct patient care costs. Screening tools to predict injury risk havebeen developed for collegiate and professional athletes. However, large scaleimplementation of these tests in a military setting would be difficult to implementbased on time requirements. Mobile health applications and technologycould provide a platform to screen, predict, and intervene to mitigateinjury risk. The purpose of this study is to demonstrate the ability to leveragetechnology to improve the efficiency of injury prediction screening, automatedrisk stratification that generates both individualized and group riskmitigation strategies, and electronic medical records entry to track injury risklongitudinally. A review of the literature led to the identification of bothobjective field expedient tests and survey questions that help predict injuryrisks. Data entry for these tests were automated using hand held computers(Motorola MC75) that used barcode scanning to identify the Soldier, smartlogic to minimize data entry errors, and the capability to download results to acommon server. Netbooks provided computer assisted testing of an 86 questionsurvey that addressed demographic data, fitness history, military fitness,load carriage requirements, injury history, and biopsychosocial questions. Analgorithm for injury risk stratification (modified version of Move2Performsoftware) was housed on a server computer than generated automated reportsfor the individual, the group, and the electronic medical record. Automationwas able to demonstrate a 37.4 minute average savings for each individual.Without mobile health, the screening and data entry required 84.5 – 9.1minutes per subject compared to 47.1 – 5.2 minutes when automation wasused. An additional 11.5 – 2.5 minutes were saved based on the automatedalgorithms to determine injury risk and an intervention strategy to minimizethat risk. In a sample of 247 healthy active duty service members (mean age28.6 + 6.3 years) without a current injury, poor performances on the screeningtests were able to identify Soldiers that had not recovered from a prior injury.Specifically, an asymmetry on the lower quarter Y-Balance Test compositereach greater than 5.2% or a > 6 cm asymmetry on the upper quarter Y-Balance test successfully identified those with < 80% self-reported recoveryfrom a prior injury. Mobile health applications were able to provide a platformfor field expedient injury prediction screening using hand held devices, netbookcomputers, and automated algorithms to stratify injury risk. The discriminatevalidity demonstrated provides a foundation for future prospectivestudies to determine if the mobile technology and the automated risk algorithmsare able to inform decisions regarding return to duty determinationsafter injury and predict future injury risk. Future applications could be appliedto help prevent the musculoskeletal conditions attributable to sports, recreationalactivities, and exercise participation that result in more than 10,000Americans seeking medical care on a daily basis.Objectives:1. To demonstrate the ability to leverage mobile health applicationsand technology to improve the efficiency of an injury risk screeningprotocol.A-34 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTS2. To demonstrate the ability of mobile health technology, automated riskstratification algorithms, and personalized report generation to minimizebarriers to large-scale implementation of injury preventionstrategies.3. To demonstrate the ability of the performance tests to identify functionalmovement deficits in those not fully recovered from a priorinjury.188 IMPLEMENTING SMART PHONE TELE-PHOTOGRAPHY IN TRAUMA:OVERCOMING THE HURDLESPRESENTERS AND CONTRIBUTING AUTHORS:Bellal Joseph, MD, Assistant Professor, Viraj Pandit, MD, Julie Wynne, MD,Arvie Webster, RN, Randall S. Friese, MD, Andrew Tang, MD,Terence O’Keeffe, MB,ChB, Narong Kulvatunyou, MD,Ronald S. Weinstein, MD, Rhee Peter, MD.The University of Arizona, Tucson, AZ, USA.Background: The use of smartphones is advancing and becoming an integralcomponent of patient care in tele-medicine. Now days, smart phones have thecapability to capture and transmit high resolution photographs and videos inreal time. Although recording photographs and videos of patients is notpermitted in most hospitals across the country, this practice is gaining acceptanceand revolutionizing patient care. The use of smart phones inhealthcare is under the peer review of Health Insurance Portability and AccountabilityAct (HIPAA) which allows the utilization of smart phones inhealthcare under certain strict security guidelines and rules. Our institution,over the last two years has safely implemented the use of smart phone telephotographyfor recording photos and videos of all injured trauma patients.The development and implementation of such a system had its intrinsic barrierswhich included:- Assuring hospital administrators and attorneys that smartphone photographycould be safely implemented under HIPAA guidelines.- Compliance of use across all patient care providers (residents, nurses,ancillary staff).- Patient tolerance.Results:- We collected a total of 7,200 photographs of which, 6,120 photographswere good quality.- 3,320 photographs were uploaded into patient electronic records. Thesuccess rate of tele-photography was 54% (3,320/6,120).- The error rate was 0.003% (10/3,320) as 10 photographs were incorrectlyuploaded.- We registered only 3 patient complaints due to HIPAA violations.Conclusion: Tele-photography can be safely and effectively implemented intrauma clinical practice. Fears of HIPAA violations are not valid, as the incidenceof patient complaints is minimal when tele-photography is implementedunder strict guidelines and rules.Objectives:1. The primary objective of this study is to spread awareness about themethods adopted at our institution to overcome practical, administrative,and security hurdles in implementing smart phone tele-photography.2. The secondary objective is to provide an experienced working modelfor other institutions to reference.3. Finally we aim to describe the expansive applications of smart phonetele-photography.185 PHARMACISTS IN TELEMONITORING PRACTICE: A UNIQUE WAYTO PROVIDE CARE TO PATIENTS WITH DIABETESPRESENTERS AND CONTRIBUTING AUTHORS:Laura Shane-McWhorter, PharmD, BCPS, BC-ADM, CDE, FASCP, FAADE,Professor (Clinical) of Pharmacotherapy.University of Utah, Salt Lake City, UT, USAThere are 26 million persons with diabetes, primarily Type 2 diabetes, in theUnited States. Because of lifestyle issues this number is expected to double by2025. Federally-qualified Community Health Centers (CHCs) provide diabetescare to many patients in both urban and rural sites. Traditionally patients seetheir primary care providers every three to six months to evaluate their diabetesstatus. Diabetes treatment involves medication therapy as well as therapeuticlifestyle changes including physical activity and healthy nutrition. Althoughpatients should receive education regarding appropriate healthy lifestyles thereis little time during a typical provider visit. Thus providers must rely on otherclinicians such as nurses, dietitians, and pharmacists to provide diabetes education.Although pharmacists have been traditionally involved in directdistribution of medications and counseling to patients in outpatient and inpatientsettings they are increasingly becoming involved in diabetes care. In anOffice of Assessment Technology grant, a pharmacist has served as the RemoteCare Coordinator for a telemonitoring project for patients with diabetes atCHCs. The pharmacist has a Collaborative Practice Agreement with medicalproviders and may thus directly impact patient care by providing educationand medication management therapy. Patients measure blood glucose, bloodpressure, and weight and transmit the information via a telemonitoring unit toa secure site; the pharmacist then evaluates the information. The pharmacistevaluates clinical outcomes and develops and provides education messages tohelp empower patients to better manage their diabetes. When an out of rangemonitoring parameter (glucose, blood pressure, or weight) is transmitted, thepharmacist works with the patient to determine the cause, provides specificpatient counseling, and delivers feedback to the medical provider. The pharmacistalso communicates with providers regarding the patients’ status andprovides graphical reports that are downloaded to the Electronic Medical Recordevery two weeks. The project has been ongoing for one year and thus farclinical endpoints such as Hemoglobin A1C and blood pressure have improvedfor the majority of patients and patients have increased their knowledge of howto manage their disease state. An important finding is that telemonitoringprovides a way to extend clinical patient care between traditional three or sixmonthmedical appointments. This model provides a unique venue for provisionof pharmacist care to patients.Objectives:1. Describe a unique model to provide diabetes care through telemonitoring.2. Provide specific examples of pharmacist-provided diabetes carethrough telemonitoring.3. Discuss the merits of pharmacist-formulated diabetes education messages.11:00 am–12:00 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 005Session Title: 619 REMOTE NEUROCOGNITIVEASSESSMENT: MILITARY AND CIVILIAN PROJECTSTrack: Best Practices and Service Delivery Models II Meeting Room 17 A/BMODERATOR: Jay Shore, MD, MPH, Associate Professor Department ofPsychiatry.University of Denver, Denver, CO, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-35

CONCURRENT ORAL PRESENTATIONS ABSTRACTSPRESENTERS AND CONTRIBUTING AUTHORS:C. Munro Cullum, PhD, Professor, Psychiatry & Neurology 1 ,Michael D. Lynch, PhD, Chief, Department of Tele-Health 2 ,Robert L. Kane, PhD, Senior SME/Program Manager TATRC 3 .1 University of Texas SW Med, Dallas, TX, USA, 2 US Army, Arlington, VA,USA, 3 Telemedicine & Advanced Technology Research Center, Ft. Detrick, MD,USA.Background & Objectives: This panel consists of presentations reportingdata, concepts, and lessons learned from projects demonstrating thefeasibility and validity of telemedicine-based neurocognitive assessment.Neurocognitive evaluation is an important aspect of patient carefor various neurological and psychiatric conditions. However, doctorallevel neuropsychologists are not available in all locations to performthese examinations; for individuals with certain neurological disorders,the demands of travel can also be an impediment for receiving thisservice. Program presenters will report experiences and data from projectsdesignedtoimplementandvalidateremoteapproachestoneurocognitiveassessment as methods to increase the availability of thisservice.Subject Matter: Findings will be reported from programs that havestudied or implemented telemedicine methods to provide both clinic andhome-based neurocognitive evaluations. Dr. C. Munro Cullum presentsdata from a project assessing over 200 subjects designed to measurewhether tests traditionally administered to a patient by an in-person examinercan be validly administered via a video connection. Dr. MichaelLynch will report on a DoD program to provide neurocognitive evaluationsto Service members at various remote locations not served by aneuropsychologist. The program uses a model of a video interview by aneuropsychologist, one-on-one test administration by a psychometristsitting with the patient, and transmission of test data to the remotelylocated neuropsychologist. Dr. Robert Kane, will detail a pilot project inthe Department of Veterans Affairs to integrate remote cognitive testing aspart of a larger home-based health-monitoring program for patients withMS. This project combines a store and forward implementation of acomputerized cognitive test battery, the use of video to verify that thepatient’s home environment is suitable for testing, a response monitoringprogram to track the patient as they take the computer-based tests, and anaudio link to stay in communication with the patient and to respond topertinent questions during the examination. In this pilot project, patientswere administered the computerized test battery once in person and onceremotely with the presentation order counterbalanced. The objective wasto refine the technology and demonstrate the validity of this testingapproach.Findings and Conclusions: Experience and data from these presentationsprovide initial support for telemedicine-based neurocognitive assessment.Data from these projects demonstrate: 1) the feasibility of administeringtraditional test measures through a video connection, 2) the use of localtechnicians for administering tests and coordinating with a remote examiner,and 3) the use of the Internet and computerized test with special monitoringmethods to implement home-based assessment for patients with MS. Theadvantages and challenges associated with remote neurocognitive assessmentwill be discussed.Objectives:1. To provide evidence supporting the feasibility and validity of remoteneurocognitive assessment2. To provide information on the practical issues of implementing a telemedicinebased neuropsychology program3. To present various methods and options by which a teleneuropsychologyprogram can be implemented11:00 am–12:00 pm Monday, May 6, 2013HOW-TO PANELSession Number: 006Session Title: 367 ATA TELEDERMATOLOGY PRACTICEGUIDELINES AND PEARLS: UPDATES ON STORE-AND-FORWARD AND REAL-TIME TELEDERMATOLOGYTrack: Best Practices and Service Delivery Models III Meeting Room 16 A/BPRESENTERS AND CONTRIBUTING AUTHORS:April W. Armstrong, MD MPH, Director of Teledermatology, UC Davis 1 ,Karen McKoy, MD MPH, Senior Staff 21 University of California Davis, Sacramento, CA, USA, 2 Lahey Clinic, Dover,MA, USA.This session will present the ATA Teledermatology Special Interest GroupGuidelines on store-and-forward and real-time teledermatology. Guidelinesand standards for operations will be presented. The audience will also gaininsights into optimal workflow for the various teledermatology deliverymodalities.Objectives:1. Present the ATA teledermatology quick guide to store-and-forwardteledermatology2. Present the ATA teledermatology quick guide to real-time teledermatology11:00 am–12:00 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 007Session Title: 963 SURGICAL TELE-MONITORING:THE NEXT MILESTONE AND POWERFUL QUALITYAND FINANCIAL USE-CASE FOR TELEMEDICINEMeeting Room 18 C/DMODERATOR: Yulan Wang, PhD, Chairman & CEO,InTouch Health, Santa Barbara, CAPRESENTERS AND CONTRIBUTING AUTHORS:Charles Wilhelm, President, Karl Storz, Endocscopy of America, Segundo,CA, Steven S Rothenberg, MD, Chief of Pediatric Surgery, The RockyMountain Hospital For Children, Denver, CO, Andrew R Watson, MD, MLitt,FACS, Vice President, International and Commercial Services Division,Executive Director, Telemedicine, UPMC, Pittsburgh, PAAs accountability rises in medicine, hospitals and doctors alike are lookingat their outcomes. Furthermore, payers and integrated systems are realizingthrough root cause analysis that procedural care and safety is vital to highqualitycare and excellent outcomes that drive institutional financial performance.Hospitals currently derive 40% of their revenue through proceduralcare. The procedural space, mainly the operating rooms, but also including thecardiac catheterization lab, the G.I. Lab, and pulmonary lab, are black boxes tomany. These are areas that need to go through a significant cultural changewith increased transparency, collaboration, and knowledge-transfers. Thesurgical suites house intensive, typically high risk interventions that involveA-36 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSmultiple team members, multiple technologies, and multiple levels of expertise.The ultimate responsibility falls onto the lead surgeon. A lead surgeoncan have 30 years of experience or 30 hours of experience after a residency.Currently, healthcare delivery does not distinguish between the two. Theculture of the operating room is currently focused on unique surgeon expertise,and not free-flowing collaboration that exists in many other industries.This free-flowing, supportive, and open ended collaboration will bemission-critical for all healthcare systems within the next 3 to 5 years.Avoidable surgical outcomes will drive this, such as unintended injuries tostructures, inability to remediate poor performing surgeons, and the inherentchallenges of distributing new knowledge about new technologies or newprocedures. Accountable care organizations and integrated delivery and financesystems will depend upon tele-mentoring in the procedural suites andmainly in the surgical suite to ensure high quality and cost effective care.Better surgical outcomes will potentially decrease readmissions, shorten lesslength of stay, increase patient satisfaction, and lessen the risk of transitionalcare. Specifically, examples of this would be one surgeon asking anothersurgeon to confirm a dissection plan, or one surgeon asking a colleague aboutthe extent of a cancer resection of surrounding organs, a junior surgeonasking the senior college for advice during a complicated case preventing anunnecessary conversion to an open procedure, or a senior surgeon asking ajunior surgeon about advice regarding a new procedure or technology that thejunior surgeon was specifically trained in. Accountability in healthcare reliesupon the multiple parties and stakeholders working together; with the risk andexpense being so high in the operating room in particular telementoring inthis domain will become mission critical and also a could potentially become acommercial resource for centers with domain expertise. This panel will discussall aspects of surgical tele-mentoring from a leader in surgical tele-mentoringtechnology, a leader and laparoscopic operating room integration, a leadingsurgeon with extensive surgical tele-mentoring experience, and a surgeonexecutive at one of the leading integrated and delivery finance systems wholeads their telemedicine and actively uses telemedicine in his practice.11:00 am–12:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 008Session Title: POLICY ISSUES FOR MULTI-STATETELEHEALTHTrack: Policy Meeting Room 18 A/BMODERATOR: Gary Capistrant, Senior Director, Public Policy.American Telemedicine Association, Washington, DC, USA.147 LEGAL ISSUES IN TELEMEDICINE: OVERCOMING REGULATORYOBSTACLES TO A MULTI-STATE TELEHEALTH BUSINESSPRESENTERS AND CONTRIBUTING AUTHORS:Michael H. Cohen, JD, MBA, MFA, President.Michael H. Cohen Law Group, Beverly Hills, CA, USA.To create successful models of care, telemedicine businesses must satisfactorilyaddress critical legal issues, such as: state telemedicine and healthcareprovider licensing laws; HIPAA/HITECH rules; anti-kickback concernsgoverning healthcare payments; legal rules prohibiting false and deceptiveadvertising; malpractice and vicarious liability rules; and other relevantregulation.Legal risks to the telemedicine enterprise can come from various sources:i.e., healthcare providers who contract with the enterprise to provide telemedicineservices; site users who become patients of these providers; andfederal and state agencies, ranging from the FDA and FTC to state medicalboards, who find regulatory fault with the enterprise’s activities. Attention tostructure will help the telemedicine enterprise refine its operational modelachieve greater compliance with applicable legal rules. For example, somestates consider it a standard of care violation to provide diagnostic andtherapeutic advice online without a prior in-person encounter. Others willallow the provider to forgo a face-to-face physical exam for more routinemedical issues, unless, for instance, e-prescribing is involved. On anotherfront, liabilities to the enterprise can widely diverge, depending on whetherthe telemedicine venture represents itself merely a pass-through directory oflicensed providers, or an entity that stands behind its vetting and as such maybe potentially liable for negligence in credentialing. HIPAA and HITECHcompliance, as suggested, present another regulatory landscape requiringcareful attention, as the telemedicine business will likely be considered a‘‘business associate’’ of its featured healthcare providers, and as such, responsiblefor ensuring the privacy and security of PHI (protected health information).With respect to site content, advertising restrictions may limit howpractitioners can position themselves in an online capacity. Legal tools thetelemedicine business should understand include privacy and security policiesand procedures; careful design of flow of payments from site users and patientsto physicians and other healthcare providers, and, to the telemedicinesite provider; and strong contractual provisions to appropriate reign in itslicensee subscribers, or at least set clear legal boundaries to contractually limitrogue behavior by practitioners. Understanding these kinds of key legal issuesin depth can help telemedicine ventures create a defensive legal bulwarkagainst unwarranted liabilities, while proactively extending their businessmodels in an emerging marketplace.Objectives:1. Understand telemedicine licensing issues and learn to navigate variationsamong states.2. Resolve legal issues relating to standard of care in delivery of differentkinds of telemedicine services (including e-prescription).3. Understand HIPAA/HITECH issues and operational strategies for implementingrequired privacy and security safeguards.549 REGULATORY AND LEGAL DEVELOPMENTS IN TELEHEALTHPRESENTERS AND CONTRIBUTING AUTHORS:John D. Blum, JD MHS, School of Law.Loyola University Chicago, Chicago, IL, USA.The focus of this presentation will be on current, evolving areas of law andpolicy that are impacting telehealth. In particular, three aspects of legal andpublic policy development will be considered. The first area to be covered inthe roundtable concerns a review of state laws/regulations. The presenter willoffer an update and review of legislative and regulatory developments in all50 states, highlighting activities and trends since 2010. In addition, the presenterwill discuss pending state legislation in telehealth, based on informationgathered from state legislative council services from 2012/2013 filings.The second portion of the roundtable will focus on public policy developmentsin state health insurance exchanges regarding telehealth. The particular areato be explored will deal with how states that are actively developing exchangesare treating telehealth for purposes of complying with the AffordableCare Act, and related minimum essential health benefit requirements. It wouldappear in states that have enacted telehealth coverage mandates for privateinsurers (i.e. Virginia, Michigan, and California) that such mandates would beapplied to health plans listed on the exchanges. There is, however, consider-ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-37

CONCURRENT ORAL PRESENTATIONS ABSTRACTSable ambiguity about how state mandates will be integrated into exchangeplan offerings, thus raising questions about whether state departments ofinsurance will be compelled to incorporate telehealth services into these newlylisted products. Arguably telehealth will serve to reduce costs, and that mayincentivize coverage in states generally, with or without specific telehealthcoverage laws, but the issue needs to be explored within individual statepolicies. In addition, it will be important to review how federally run healthexchanges are approaching the telehealth coverage issue as well. The thirdissue that will be presented at the roundtable will shift from state to federalpolicy, and focus on the evolving regulatory landscape impacting mobilehealth. With the increasing utilization of mobile apps for a range of healthuses, it is critical that regulatory developments in the field be considered. Theroundtable will explore the current status of FDA regulations and specificallyconsider the legal implications of classifying mobile devices as ‘‘medicaldevices’’. In addition, the evolving policy of the Office of the NationalCoordinator in DHHS will be discussed as it relates to best practices in them-health area.11:00 am–12:00 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 009Session Title: 812 EVALUATION METHODS INPEDIATRIC TELEHEALTHTrack: Pediatrics Telehealth ColloquiumMeeting Room 12 A/BMODERATOR: Madan Dharmar, MBBS, PhD, Assistant Research ProfessorUniversity of California Davis Health System, Sacramento, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:James Marcin, MD, MPH, Professor 1 , Kathleen Webster, MD, MBA, Director,Division of Pediatric Critical Care 2 , Neil Herendeen, MD, Associate Professor 31 University of California Davis Health System, Sacramento, CA, USA, 2 LoyolaUniversity Medical Center, Maywood, IL, USA, 3 University of RochesterMedical Center, Rochester, CA, USA.Introduction: In assessing the impact of telemedicine programs, it is importantto keep in mind how to determine if established goals have been met.The goals of telemedicine programs are often cited as the need to improve thequality of, access to, and efficiency of care. In designing a program, it isimportant to consider how these goals will be evaluated.Methods: This panel will discuss various types of outcome measures that canbe evaluated in a telehealth program based on the programmatic and institutionalneeds. The panel will explore explicit outcome measures such asmortality, morbidity, transfer rates and criterion-based outcomes; implicitmeasures such as quality and satisfaction of care; utilization measures such ascost-effectiveness, emergency department utilization and health dollars spentper patient. To achieve our objectives, the panel will illustrate the why, who,how and what defines possible outcome measures by discussing the experiencesof researchers in developing an evaluation plan for their program. Thispanel will discuss the following successful telemedicine programs: 1. Telemedicinerapid response program which was created to meet a Joint Commissionquality mandate and has been shown to decrease mortality in a highrisk patient population within a hospital; 2. Telemedicine pediatric criticalcare program, which has shown improved quality outcomes, satisfaction, andfinancial benefits due to outreach and telemedicine consultations to rural/underserved hospitals; and 3. Health-e-Access program which has shown adecrease in emergency department utilization and health care dollars spent byproviding access to daytime pediatric telemedicine services to school andchildcare centers.Conclusion: The use of telemedicine has increased exponentially and willcontinue to change the way healthcare is provided. Through this panel, we willhelp enable providers to establish evaluative outcome measures which willassess the success of their Telehealth programObjectives:1. This panel will discuss the importance of measurable outcomes inevaluating and improving telehealth programs which deliver telemedicineservices to care for children.2. This panel will discuss the why, who, how and what defines possibleoutcome measures for telehealth program evaluation.11:00 am–12:00 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 010Session Title: 742 UNIVERSITY-BASED TELEHEALTH:THE NEXT WAVE–COMPETING SUCCESSFULLYOR RESTRUCTURING AROUND VALUE?Track: Outcomes and Evidence Meeting Room 19 A/BMODERATOR: Deborah E. Seale, MA, PhD, Assistant Professor.Saint Louis University, St Louis, MO, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Dale C. Alverson, MD, Medical Director, Center for Telehealth andCyberm 1 , Thomas S. Nesbitt, MD, MPH, Associate Vice Chancellor 2 ,Debbie Voyles, MBA, Director of Telemedicine. 31 University of New Mexico Health Sciences Center, Albuquerque, NM, USA,2 UC Davis, School of Medicine, Sacramento, CA, USA, 3 Texas Tech UniversityHealth Sciences Center, Lubbock, TX, USA.Despite the proliferation of telehealth units in universities over the last twodecades to support the development of telehealth, few organizational studieshave been conducted to understand the work of these units (Whitten, Holtz, &Nguyen, 2010). A qualitative study using in-depth telephone interviews withexperienced leaders from 17 mature university-based telehealth units foundthat some community healthcare providers were increasingly using the university’stelemedicine services as a safety net for their nonpaying and lowerpaying patients. Meanwhile, paying patients were being referred to the universities’healthcare competitors – either commercial telemedicine providersor health systems that offer employer health insurance plans. Furthermore, theleader of one unit said that telemedicine providers at his university were beinghired in their off-hours to work for commercial telemedicine competitors.Interviewees described how their university-based telehealth units had earnedcommunity providers’ trust and established the telehealth unit’s credibility.They had complied with regulations that ensured community providers’ rightto make referral decisions. They had advocated for policies that requiredinsurers to pay for telemedicine services. They had provided assistance to theuniversity’s competitors in how to develop telehealth. They had taken the leadon infrastructure development projects that promised to make telecommunicationsservices more available and affordable to all healthcare providers.These efforts were in line with the ideals of public service at its best. Furthermore,they have succeeded in furthering the adoption of telehealth.Nevertheless, unintended consequences were clearly testing the allegiance ofuniversity-based units to the community on the one hand and their loyalty tothe institution on the other. Universities’ are heavily reliant on the incomegenerated from clinical services to fund the academic mission (Clark, 1998/2008, Ludmerer, 1999; Starr, 1982). Initially, community healthcare providersfeared that the university would use telemedicine to ‘‘steal’’ or ‘‘scrape off’’paying patients from the community while leaving the nonpaying and lowpay patients unserved. As a result, the local healthcare system would beA-38 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSweakened rather than strengthened with the use of telemedicine. By the sametoken, this research suggests that if telemedicine is used to divert a disproportionateshare of nonpaying or low paying telemedicine patents to theuniversity, the ability of the university to use clinical revenue to replace adiminishing share of public support to sustain the academic mission may bethreatened. This presentation panel will be used to lay out relevant findingsfrom this study, to hear the perspectives of university-based telehealth leadersfrom three states (California, New Mexico, and Texas), and to engage theaudience in discussion.Objectives:1. Attendees will be able to anticipate how telemedicine may be used tothe detriment of universities as adoption of telemedicine becomes morepervasive.2. Attendees will be able to describe unintended consequences for theuniversity from widespread adoption3. Attendees will be able to formulate options for minimizing negativeconsequences.1:15 pm–2:15 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 011Session Title: THE TELEMEDICINE VALUEPROPOSITION: ROI & SUSTAINABILITYTrack: Finance and Operations I Ballroom EMODERATOR: Molly Coye, MD, MPH, Chief Innovation Officer.UCLA Health System, Los Angeles, CA, USA.349 A THREE YEAR EXPERIENCE REVEALS A POSITIVE ROI FOR ALLFOUR STAKEHOLDERS IN A RURAL TELEMEDICINE CLINICPRESENTERS AND CONTRIBUTING AUTHORS:Andrew R. Watson, MD, MLitt, Vice-President.UPMC, Pittsburgh, PA, USA.With 20% of the US population living in rural America and 11% of specialistsgoing to rural America there is an immediate access problem. Telemedicineand the virtualization of specialist physicians address this, but theROI for rural tele-clinics remains unclear. A single colorectal surgeon practicedtelemedicine at a rural tele-clinic for 3.5 years using a collaborativemodel. The rural hospital referred patients to the telemedicine on-site clinic asneeded. The surgeon shifted appropriate urban ‘‘traditional’’ face to face encountersto the rural telemedicine clinic when possible. Patient selectioncriteria for ‘‘shifting’’ included proximity to the rural hospital, patient willingnessto participate in telemedicine, and other patient convenience factors(such as time of day, traffic and weather). The value proposition for the patient,rural hospital, urban hospital, and specialist in the past was undefined,but through prospective tracking is demonstrated as financially beneficial toall parties. Over 3.5 years 153 patient encounters were seen in the rural hospitaltele-clinic 90 miles from Pittsburgh. The average driving time betweenthe rural hospital and Pittsburgh was 2 hours; the cost of travel (includingparking, tolls, meals, gas) was estimated to be $95. Crohn’s, ulcerative colitis,diverticular disease and cancer represent 90% of the diagnoses. 67 were newpatient visits and 86 were follow-up. The ROI for the patient included anestimated $14,535 of avoided costs and 306 hours of driving time; this excludesthe intangible benefits of less time off work and more family membersattending the clinic due to convenience. A total of 36 cases were ‘‘captured’’,seen remotely and surgery performed at the urban hospital with an estimated$7000 marginal benefit per case for the urban hospital. The urban hospitalcaptured an estimated $252,000 with a $4,500 investment in the telemedicinedesktop unit, with a net profit of $247,500. Each case produced on average 20RVUs for the surgeon, 36 cases represent 750 RVUs. An average at a value of$45 the tele-clinics generated $32,000 and the surgeon was also able to focusface-to-face clinics on complex and re-operative encounters. The rural hospitalleveraged a floor nurse to staff the telemedicine clinics at no additionalcost and used a room in the outpatient setting that was available. Existingwired network infrastructure was used at no additional cost. There was aninvestment in a telemedicine cart that is now valued at $15,000. The telemedicineclinics generate ancillary tests and procedures at the rural hospitalincluding 24 radiology tests, 4 colonoscopies, 1 infusa-port insertion, 40blood draws, 8 EKGs and 1 stress test. The rural hospital derived and estimated$21,000 of ancillary revenue which was in addition to enhanced branding,patient engagement with their facility, and downstream future procedures.This is a projected benefit of $6,000. This experience of one surgeon and oneservice line demonstrates a successful model to start rural telemedicine clinicswith direct financial benefits to all parties involved if the clinic is establishedappropriately.Objectives:1. Participants will understand the convergent financial relationshipsbetween the 4 primary stakeholders in a rural telemedicine clinic.2. Participants will understand how to construct a rural telemedicinesubspecialty clinic in such a fashion to derive measurable financialvalue for each individual stakeholder.3. Participants will be able to estimate their financial success based onthis model when they invest in or consider starting a rural telemedicineclinic.828 A STUDY OF THE FACTORS CONTRIBUTING TO THE LONG TERMSUSTAINABILITY OF A TELESTROKE NETWORKPRESENTERS AND CONTRIBUTING AUTHORS:Aaron Bridges, MPH, Data Analyst, Elizabeth Cothren, APRN,Rachelle Longo, BSN.Ochsner Medical Center, Jefferson, LA, USA.Background: Telemedicine is increasingly considered as an effective tool foraddressing the disparities of areas with limited or no access to on-site strokecare specialists. Limited information is available about the long term financialbenefits of creating a telestroke network or partnering with an existing networkusing the hub-and-spoke model. The development of a telestroke networkrequires a significant investment for equipment, technical support,personnel, training, travel, and on-call allowances. Despite the substantialfinancial investment that organizations must make, there is a little informationon return on investment from existing program, and little or no reimbursementfor telemedicine consultations due to limitations of physical exam.Unfortunately, it is often concluded that these opportunities generate little tono return on their investment, preventing further program development.Purpose: The purpose of this study is to illustrate the financial benefits forboth the hub and the spoke within a telestroke network including: directreimbursements, higher reimbursements, increased admissions of patientswith a clinical diagnosis of a stroke, appropriate transfers of patients, andincreased medical procedures (advanced interventions).Methods: Patient transfer analysis was completed, which included comparingtransfer rates for participating hospitals pre- and post telestroke implementation.In addition, an evaluation of transfer rates for other medicalspecialties was analyzed with participating community hospitals. UsingMS-DRG classifications for ischemic stroke, hemorrhagic stroke, transientischemic attack, and other non-stroke final diagnoses, we compared patientvolume, financial data, and clinical data from participating hospitals. Longtermsustainability was evaluated by factoring external funding obtained atstart-up and patient transfer rates.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-39

CONCURRENT ORAL PRESENTATIONS ABSTRACTSResults:- Increased amount of stroke diagnoses made at partnering facilities- Increased utilization of appropriate higher MS-DRGs- Positive impact of transfer changes on hospital finances- Decreased transfer costs across the system associated with transferreduction.Conclusion: Because reimbursement is limited, it is important for hospitalsand physician leaders to understand the revenue and cost structure and toidentify an appropriate value proposition for a telestroke network. Withproper strategic planning telestroke networks can generate enough revenue tobecome self-sufficient.Objectives:1. Discuss the impact of MS-DRG education related to stroke.2. Discuss 2 ways to offset the capital costs associated with developing atelestroke program.3. Discuss the impact of a telestroke program on non-stroke diagnoses.127 SUSTAINABLE BUSINESS MODELS- OPPORTUNITIES TO MANAGETHE CONTINUUM OF CAREPRESENTERS AND CONTRIBUTING AUTHORS:Alan Pitt, MD, University of Arizona, Professor of Neuroradiology.Barrow Neurological Institute, phoenix, AZ, USA.Historically, telemedicine has focused on efforts relating to access, connectingrural to urban providers. Stroke care would be a typical example Thebusiness model typically relates to increased referral for an urban center andbranding for the rural spoke. However, CXO’s view this as a nice to have ratherthan a have to have in many cases. With the advent of cloud based technologyfor tele health, there are other business opportunities for telehealth related tomanaging the continuum of care with an enterprise rather than requiring anurban/rural partnership. These include hospital triage, length of stay and caretransitions. Each of these areas have large cost centers and teams of peoplelooking for innovation and opportunities for improvement. This presentationwill review the evolution of telehealth, from fixed end point hardware to acloud based opportunity leveraging BYOD (bring your own device). Examplesof successful deployments will be discussed along with relevant businessconsiderations in each case.Objectives:1. understand business analysis for telehealth decision making2. understand the role of cloud computing in telehealth3. be able to position a telehealth solution relevant to CXO considerationsfor funding1:15 pm–2:15 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 012Session Title: 485 NIMBILITY: EXPANDING YOURTELEMEDICINE SERVICES VIA INTEGRATIONTrack: Finance and Operations II Ballroom FMODERATOR: Edward Loo, MSECE, Telemedicine Engineer.Inova Health System, Falls Church, VA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Theresa Davis, RN, MSN, NE-BC, Clinical Operations Director,Steven Dean, BS, Administrative Director of Telemedicine Operations,John Cochran, MD, FACP, FAHA, Medical Director, CerebrovascularServices.Inova Health System, Falls Church, VA, USA.The time has come to move pilot projects from silos to integrated solutionsaffecting care. Cost efficient services are pivotal in creating new processes forcare delivery to meet the needs of patients in this era of healthcare reform. Thispresentation will address the challenges and opportunities when creating newprograms from existing pilots. Technology options available to facilitate caredelivery will be described. Workflow impact and simplified education planswill demonstrate ease of use and successful technology adoption. Planningcosts and return on investment to create a business plan prior to implementationwill be examined. The following programs will be presented:. TeleICU: Evidence based practice can be enhanced using the TeleICUleading to the prevention of complications. Critical thinking may beenhanced in the new graduate nurse entering the ICU using technologyand creative educational techniques.. Teledisaster: Creating a regional coalition to enhance communicationduring a mass casualty incident. Establishing three way voice and videocommunication between the trauma physician, the emergency roomteam and the regional triage officer during a disaster to resuscitate theseverely injured patient.. Telepsychiatry: Decreasing emergency room wait times by connecting apsychiatric liaison to the patient using wireless mobile technology.Impacting patient satisfaction, team satisfaction and facilitating hospitalthroughput.. Telestroke: Stroke is no joke. Enhancing physician response andavailability when a stroke patient is identified. Creating a multidisciplinaryteam approach to facilitate care. Tracking outcomes to explorethe progress of the program. Describing successful processes to expandthe program across a large metropolitan health system.Objectives:1. Creating outcomes for success when implementing multiple programs.2. Understanding the importance of business plan development prior toproject imitation.3. Identifying multiple technology models available to enhance patientcare delivery.1:15 pm–2:15 pm Monday, May 6, 2013HOW-TO PANELSession Number: 013Session Title: 492 CREATING BETTER DISEASEMANAGEMENT FOR DIVERSE POPULATIONSTrack: Best Practices and Service Delivery Models I Ballroom GPRESENTERS AND CONTRIBUTING AUTHORS:Geeta Nayyar, MD, MBA, Chief Medical Information Officer 1 ,Arthur G. Paniagua, BSN, MBA, Director of Clinical Policy and Support 21 AT&T, Dallas, TX, USA, 2 Centene Corporation, St. Louis, MO, USA.As the nation looks to improve chronic disease management, mHealth is apromising solution for enhancing care and improving outcomes. However,despite enthusiasm from patients, providers and other caregivers, adoptionand continual engagement for these solutions is still a key barrier to fulfillingthat promise. Additionally, offering a mHealth solution to diverse populationscan be challenging. Two organizations – the largest Medicaid provider in Ohioand one of the largest self-insured employers in the US were able to tailor theiroffer of the same mHealth solution and engage high-risk individuals with typeA-40 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTS2 diabetes. The FDA-cleared application is a self-management tool that enablespatients to manage their diabetes. Users can track food consumption andblood sugar levels by logging their activity via a highly-secure mobile application.Upon conclusion of the 6 month pilot, the Medicaid provider hasshown promising results, including long term and high engagement, reducedA1C levels, reduction in hospital admissions and ER visits. Of the 200 candidates,145 completed the pilot program. Members maintained an averagelevel of five to six blood glucose entries per week throughout the initiative.Additionally, comparisons were made between the program participants and asimilar population (high risk, type II diabetics, etc.) for hospital and emergencyroom utilization 90 days prior to program registration compared to 90days after registration. The results reflect a 55% decrease in hospital utilizationand decrease of 16% in emergency room utilization for program participantscompared to members who did not participate. Analysis of the largeself-insured employer’s initiative, including over 30,000 health data entries,represents one of the first large-scale data captures and implementations ofmHealth technology in a real-world setting. Initial findings also show highadoption and engagement of the solution, with 81% of program participantsshowing consistent use of the system, 35% of participants using the system atleast 75% of the time, and 18% of the participants making health data entriesevery week they participated in the program. Attend this session to learn howan interactive, mHealth solution with personalized coaching can drive thesustained engagement that has eluded other mHealth solutions for chronicdisease management.Objectives:1. Discover the steps to creating a successful mHealth implementation todiverse populations.2. Learn how to make an impact on the care of individuals struggling withdiabetes by extending care beyond the physician’s office.3. Explore the opportunities for using mobile technology for bettermanagement of diabetes and other disease states.1:15 pm–2:15 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 014Session Title: 430 NEUROLOGY TELEMEDICINETrack: Best Practices and Service Delivery Models II Meeting Room 17 A/BMODERATOR: Jack W. Tsao, MD, DPhil, Chairman, NeurologyTelemedicine Work Group.American Academy of Neurology, Minneapolis, MN, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Jack W. Tsao, MD, DPhil, Chairman, Neurology Telemedicine WorkGroup 1 , Lawrence Wechsler, MD, Neurologist and Department Chairman 2 .1 American Academy of Neurology, Minneapolis, MN, USA, 2 University ofPittsburgh, Pittsburgh, PA, USA.Background: Neurology telemedicine is becoming a more accepted methodfor delivering neurological care to remote areas of the world.Objectives: The American Academy of Neurology (AAN) has recently publisheda white paper describing the use of telemedicine to enable neurologicalcare to be provided to patients in need who may not have ready access to aneurologist. This panel will review AAN guidelines, discuss practical aspectsfor establishing a neurology telemedicine network for general neurologicalconditions and stroke, and discuss practice issues, including credentialing,billing and coding, and technology.Intent: Participants will leave this session with knowledge of how to enhancetheir clinical practice to improve and expand neurological care delivery.Objectives:1. Know the American Academy of Neurology practice recommendations,practice issues, and how to set up a practice incorporating telemedicine2. Know which general neurological conditions can be treated usingtelemedicine3. Know how to establish a stroke system of care including the delivery ofthrombolytic therapy via telemedicine consultation1:15 pm–2:15 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 015Session Title: UNIQUE APPROACHES TO DELIVERINGSPECIALTY SERVICESTrack: Best Practices and Service Delivery Models III Meeting Room 16 A/BMODERATOR: Peter Yellowlees, MD, MBBS, Director, Health InformaticsProgram.UC Davis Health System, Sacramento, CA, USA.422 TELEDERMATOLOGY AT SEAPRESENTERS AND CONTRIBUTING AUTHORS:Anne E. Burdick, MD, MPH, Associate Dean for TeleHealth,Scott C. Simmons, MS, Jennfier Herrera-Perdigon, MSN, NP-BC.University of Miami Miller School of Medicine, Miami, FL, USA.During the last three years, the University of Miami has provided a storeand-forwardteledermatology service for cruise ships around the world. Theservice is designed to be primarily for crewmembers, but passengers are seenwhen necessary. This presentation will address the operational and clinicalaspects of this service, including systems architecture and workflow, descriptionand classification of volume, and presentation of interesting cases.Our experience demonstrates that a store-and-forward approach can be usedto effectively provide teledermatology services for an employee populationthat is geographically dispersed. The service allows crew medical staff toeffectively manage skin conditions for their employees, reduce the need for onshore dermatology visits, and more effectively make medical evacuation decisions.Objectives:1. Describe the 3 year University of Miami store-and-forward teledermatologyfor cruise ships around the world.2. Understand the operational and clinical aspects of this service.3. Identify the benefits to crew medical staff in managing shipboarddermatology conditions, reducing on shore dermatology visits, and formore effectively making medical evacuations decisions.353 TELEPAIN: A PLATFORM FOR CONCURRENT EDUCATION, CLINICALCARE, AND RESEARCHPRESENTERS AND CONTRIBUTING AUTHORS:David J. Tauben, MD, University of Washington, Cara Towle, RN.University of Washington, Seattle, WA, USA.Telemedicine at the University of Washington is a multi-state regionalclinical and educational services network established in 2001. Recently, UWTelePain, has established a robust educational, clinical, and research platformª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-41

CONCURRENT ORAL PRESENTATIONS ABSTRACTSsupporting a health care provider educational network, a delivery service forclinical care, and an extended research population. As has much of America,the northwest US region has been overcome by poor pain treatment andinefficient delivery outcomes following the current uncoordinated, inconsistent,and financially unsustainable model that now characterizes pain carein the US. UWTelePain is an active solution to poor access, poor outcomes, andhigh patient and provider pain practice dissatisfaction. Implementation wasdriven by a confluence of events: inadequate pain medicine education acrossnearly all health sciences schools; inadequate access to pain specialists to meetthe need for expert consultation across a geographically, ethnically, andeconomically diverse population; and an urgent need to investigate innovativemodels of medical education and clinical treatment outcomes by a toprank university. UW TelePain was launched in anticipation of 2011 WashingtonState opioid prescribing law mandating both education in evidencebasedpain treatment practice and ready access to pain specialty consultationfor statewide community providers managing patients who were doing poorlydespite high opioid doses. Initially funded only with philanthropy, it quicklyearned several National Institute of Health and Centers for Medicare andMedicaid Innovations research and educational grant support. UWTelePain ispromoting research in many areas of pain care, already demonstrating improvedhealth system outcomes and accumulating the much needed evidenceto support re-valuation for a sustainable model for this efficient and effectivedelivery of provider-to-provider consultation. All students in UW’s 6 healthscience schools (medicine, nursing, dentistry, pharmacy, social work andpublic health) have access to twice weekly case-based inter-specialty expertpain consultation. In acknowledgment of TelePain, the UW was the top-rankawardee by NIH Pain Consortium Center of Excellence in Pain Education. TheUWTelePain program begins with a formal 20 minute didactic presentation bya university expert in designated topics relevant to primary care managementof pain. Each week 6–10 community providers present challenging cases to anassembled faculty of University of Washington pain experts. UWTelePain is aWashington State Department of Health approved platform to receive mandatedpain consultation for patients doing poorly on opioids. To date 2100medical providers from over 100 unique locations have received over 3000hours of chronic pain education and consultation. Valuable continuing educationcredit is awarded at no cost, and trainees of all levels and many schoolslearn crucial clinical skills. Health science students at UW and its partneruniversities now can readily access and participate in biweekly TelePainsessions. Patients, providers, society, corporate America, and government atall levels are seeking healthcare solutions that are both cost-effective andpatient focused, keeping patients close to home, family, and their work. TelePainoffers an important solution for this problem and offers a unique meansto demonstrate its high value regionally and nationally as an evidence-basedplatform for delivering high quality healthcare.Objectives:1. Recognize value of TelePain services for interprofessional pain education.2. Easily connect primary care providers managing challenging painpatients to multi-specialty experts in pain medicine.3. Promote innovative model for patient and community outcomes research.961 PARTNERSHIPS IN MIDDLE TENNESSEE COLLABORATE TO DELIVERTELEPSYCHIATRY ACROSS MULTIPLE PROVIDERS ANDEMERGENCY ROOMSPRESENTERS AND CONTRIBUTING AUTHORS:Michelle Robertson, Senior Advisor, Cisco Healthcare BusinessTransformation Team.Cisco, Austin, TX, USA.1:15 pm–2:15 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 016Session Title: 542 BRINGING HOME THE GOLD:TELEMEDICINE IN THE 2012 LONDON OLYMPICSTrack: Innovations Meeting Room 18 C/DMODERATOR: Antonio Marttos, MD, Assistant Professor of Surgery.University of Miami Miller School of Medicine, Miami, FL, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Antonio Marttos, MD, Assistant Professor of Surgery 1 , Orlando ValloneJunior, BS, President 2 , Fernanda Kuchkarian, MPH, Manager, ResearchSupport 11 University of Miami Miller School of Medicine, Miami, FL, US, 2 SpecialtyTelehealth Services, Miami, FL, USA.Telemedicine has the potential to revolutionize medicine and is quicklybecoming the gold standard in healthcare services delivery. High-speednetworks provide access to the best specialists anywhere in the world, aswell as transfer medical information in real-time. In collaboration with theBrazilian Olympic Committee, our interdisciplinary team established a telemedicinehub-and-spoke network to virtually connect specialists in London,Brazil and the United States. Spoke sites included three medical centersin Rio de Janeiro, Brazil; the Olympic Village in London; and the RyderTrauma Center in Miami, Florida. Through this initiative, a fully integratedsolution was deployed to offer state-of-the art medical care for the Brazilianteam. Leveraging the power of mobile devices, videoconferencing, andremote presence robots, the network provided access to specialists aroundthe-clockin case of injuries, emergencies or potential mass casualty scenarios.Athletes were each given wristbands with unique identifiers thatonce activated through SMS, provided medical personnel with emergencymedical information such as allergies, existing medical conditions andmedications. Remote presence robots were housed in the medical departmentof the sports training facility in London and team doctors wereequipped with mobile devices (i.e. smartphones and tablets) powered withvideoconferencing capabilities. When specialist consultation was needed,team doctors could immediately connect through the network’s main telehealthcommand center where calls were triaged to the appropriate medicalfacility. Specialist consultations were provided for the followingspecialties: trauma, orthopedics, cardiology, intensive care, gynecology,neurology and ophthalmology. During the games, network capabilities weretested with real cases requiring consultations for a variety of medicalconditions. This panel will give an in-depth account of our experience,highlighting the technological and human resources required during implementation.Lessons learned from this project will serve to strengthenfuture collaborations during large-scale sporting events, such as the 2014World Cup and 2016 Olympic Games in Rio de Janeiro. Ultimately, the goalof this initiative is to extend telemedicine capabilities to all participatingcountries.Objectives:1. Participants will identify the successes and challenges of a telemedicineproject implementation during the London Olympics.2. Participants will describe how a telemedicine network can be used tomaintain a high quality of care regardless of distance.3. Participants will demonstrate the importance of integrated solutionscombining mobile devices, electronic medical records, and remotepresence.A-42 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTS1:15 pm–2:15 pm Monday, May 6, 20131:15 pm–2:15 pm Monday, May 6, 2013DISCUSSION PANELSession Number: 017Session Title: 137 TELEREHABILITATION ACROSSSTATE LINES: WHERE’S OUR ROADMAP?Track: Policy Meeting Room 18 A/BMODERATOR: Ellen R. Cohn, PhD, Associate Dean for InstructionalDevelopment.RERC on Telerehabilitation at University of Pittsburgh, Pittsburgh, PA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Jana Cason, DHS, OTR/L, Associate Professor 1 , Janice A. Brannon, MA,Director, State Special Initiatives 2 , Mark Lane, PT, Vice President 3 ,Gary Capistrant, MS, Senior Director, Public Policy 41 Auerbach School of Occupational Therapy, Louisville, KY, USA, 2 AmericanSpeech-Language-Hearing Association, Rockville, MD, USA, 3 Federation ofState Boards of Physical Therapy, Alexandria, VA, USA, 4 AmericanTelemedicine Association, Washington, DC, USA.A panel of four experts will share their unique perspectives on the topic ofstate license portability. Beginning with a consumer approach, OccupationalTherapist Jana Cason will speak as the parent of a child who experienced barriersaccessing early intervention therapy services. She believes telehealth is a viablemodel that would have benefitted her family while receiving early interventionservices. Janice Brannon, an association executive (American-Speech-Language-HearingAssociation) who strives to promote telepractice friendly statelegislation, will present a professional association’s perspective. Mark Lane, aphysical therapist who is an executive with the Federation of State Boards ofPhysical Therapy, will convey the mindsets of diverse state licensure boards andthat of their federation. And, Gary Capistrant who leads the American TelemedicineAssociation’s federal legislative efforts will provide ATA’s perspectiveson federal solutions, and how these might relate to state based regulation. Thepanelist group has been debating these issues for the past three years as part ofthe ATA Telerehabilitation SIG’s Subcommittee on License Portability, whileseeking areas of uniformity that might guide productive change. Moderator EllenCohn will challenge the panelists: to explain why progress toward state licenseportability has been slower than desired; to project both the potential benefitsand liabilities of various approaches to consumers; to describe each of their ‘‘bestpractice scenarios;’’ and, to envision how the licensure landscape will actuallyappear in 10 years. Do state licensure boards and professional organizationsreally want state license portability? (Would a national or federalized approachaffect their sustainability?) Is state licensure a viable model for the future? Whatare the economic concerns all around? Could future events and alliances serve astipping points? For the final segment of the panel (15 minutes or more), the focuswill shift to the audience as the Moderator invites audience members to askquestions of the distinguished panelists, and share what’s on their minds. Appropriatequestions will be developed and mobile phone, text-based pollingtechnology will be used to survey the audience’s positions throughout. We expectspirited interaction, and look forward to audience-based inspiration!Objectives:1. The audience will understand the challenges and complexities of regulationin the effort to protect the consumer while not inhibiting effectivepractice.2. The audience will learn of current and planned ATA efforts to facilitaterehabilitation practice across state borders.3. Audience members will express their wants and expectations to panelistsconcerning practice across state borders.DISCUSSION PANELSession Number: 018Session Title: 480 SYSTEMS ISSUES IN MEETINGCOMMUNICATION AND HEARING NEEDS OF INFANTSAND YOUNG CHILDREN VIA TELEHEALTHTrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BMODERATOR: Nina Antoniotti, RN, MBA, PhD, Telehealth Director.Marshfield Clinic, Marshfield, WI, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Diane Behl, MEd, Senior Research Scientist 1 ,Anne Simon, AuD, Senior Audiologist 2 , Katheryn L. Boada, MA, CCC-SLP,Director of Audiology, Speech Pathology and Learning 31 National Center for Hearing Assessment and Management, Logan, UT,USA, 2 University of California, Davis Audiology Department, Sacramento, CA,USA, 3 Children’s Hospital Colorado, Aurora, CO, USA.Infants and young children with hearing loss and communication needsliving in remote areas often go without needed specialized diagnostic andintervention services. Telehealth is being used throughout the country toconnect these children to pediatric specialists. Although these services arecovered by public health systems - specifically Early Hearing Detection andIntervention programs and Part C Early Intervention programs - privateproviders are essential in the delivery of the services themselves. Implementingthese types of telehealth programs requires buy-in, shared values,and carefully articulated agreements. Private providers also must adhere topublic health policies and procedures when delivering these services. Thepurpose of the panel is to discuss salient issues surrounding the use of telehealthto serve infants and young children with hearing loss and communicationneeds. In addition to describing the various approaches to deliveringthese telehealth services, the panel will discuss the critical systems issuespertaining to implementing these specialized services. Panel members: 1. TheNational Center for Hearing Assessment and Management, which is facilitatinglearning community comprised of providers across the country engagedin ‘‘tele-audiology’’ to provide diagnostic evaluations and anotherlearning community focused on the use of ‘‘tele-intervention’’ to meet theneeds of infants and toddlers with hearing loss. This member will provideinsights into how these efforts are coordinated with state programs and how alearning community can move the field of telehealth in a positive direction.2. The University of California Davis Medical Center provides remote diagnostichearing evaluations for infants who do not pass their newborn hearingscreen. Partnering with the California Department of Education and CaliforniaDepartment of Health Care Services, this effort was developed to reduce theloss to follow-up rate observed with infants residing in rural California whohave limited access to pediatric audiology services. The panelist will describethe process that ensures parents are prepared to advocate for their child withhearing loss. 3. Children’s Hospital Colorado provides therapy and peer-topeerprofessional consultation to enhance the delivery of Part C early interventionservices via telehealth. Additionally, they have a tele-audiologyproject they are conducting with the EHDI program in Guam to provide remotetesting of newborns. Their lessons learned regarding successful collaborationacross families and providers of different cultures will be discussed. The telehealthdirector of the Marshfield Clinic, Wisconsin will moderate. Applying awealth of expertise in implementing telehealth across a variety of disciplines,she will ensure that the discussion focuses on relevant aspects to creating andsustaining successful telehealth efforts to serve children with special needs,ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-43

CONCURRENT ORAL PRESENTATIONS ABSTRACTSemphasizing important issues relevant to ensuring a strong business modelthat addresses both public and private interests.Objectives:1. Understand the role of telehealth in serving infants and young childrenwith hearing loss and other communication needs.2. Learn strategies to strengthen public-private partnerships in providingtelehealth services to meet these needs.3. Understand the complexities of developing a sustainable telehealthplan that involves public health services.3:00 pm–4:00 pm Monday, May 6, 2013understanding the requirements and procedures associated in federal researchgrant programs and may examine if existing federal needs are aligned withtheir current and ongoing research efforts.Objectives:1. Have a clear understanding of the federal government’s role in advancingtelehealth and telemedicine to service the medical needs of atriskand underserved populations.2. How AHRQ, HRSA, and ONC research agendas complement each otherand contribute to the Department of Health and Human Servicesmission to advance telemedicine.3. Attendees in academia and the private sector will examine federalgovernment grant opportunities in telemedicine and telehealth to determineif their research priorities are aligned with Agency prioritiesPRESENTATION PANELSession Number: 019Session Title: 382 TELEMEDICINE ANDHUMANITARIAN AIDTrack: Outcomes and EvidenceMeeting Room 19 A/BMODERATOR: Peter Killcommons, MD, CEO.Medweb, San Francisco, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:John P. Howe, MD, President & CEO 1 , Roger Swinfen, Founder and Trustee 21 Project Hope, Millwood, VA, USA, 2 The Swinfen Charitable Trust,Canterbury, United Kingdom.Since their inception, both telemedicine and telehealth have been embracedby the Department of Health and Human Services as essential resources toensure that cost-effective medical and health care is safe and of high quality,accessible to all Americans. With that, the Agency for Healthcare Researchand Quality (AHRQ), Health Resources and Services Administration (HRSA),and the Office of the National Coordinator for Health Information Technology(ONC) have worked in tandem to address the major challenge in meeting theprimary and specialty care needs of our underserved and at-risk populations.Exacerbating that challenge in the lack of providers in both rural and urbanareas where clinical care is most needed. To be a transformative agent, healthinformation technology must first help meet the needs of primary care physicians.To do so, smaller practices, particularly those in rural areas, must benetworked in order to help coordinate care for patients with chronic illnesses.Health IT can be the change element to enable primary care physicians, patients,laboratories, and pharmacies to operate more as partners with eachother. This panel presentation will provide an overview of how respectivefederal agencies are conducting and sponsoring research to develop andpromote the use of new technologies for health care delivery, education, andhealth information services. Senior leadership officials from AHRQ, HRSA,and ONC will offer their past, current, and future priorities, as well as a discussionof how health IT is an essential component to the creation of newpatient care delivery models described in recent health reform legislation.Each panel member will describe how their respective agency’s researchportfolio is aligned with its stated mission and how desired outcomes willcontribute to the national effort to use telemedicine and related technologiesto provide care to selected population groups. Examples of how past federalgovernment-funded research has led to improvements in patient care for theunderserved will be provided; where federal governments view telemedicineas an essential component to future health reform efforts will be discussed. Atthe conclusion of this presentation, attendees will have a clear understandingof federal agency research priorities in the effort to advance health IT andtelemedicine and how public-private sector engagement has resulted in newprograms benefitting patient care. Attendees will also achieve and enhanced3:00 pm–4:00 pm Monday, May 6, 2013HOW-TO PANELSession Number: 020Session Title: 774 CHASING THE ELUSIVEREIMBURSEMENT FOR TELEHEALTH:UNDERSTANDING CURRENT AND FUTURE PAYMENTFOR TELEHEALTHTrack: Finance and Operations I Ballroom EPRESENTERS AND CONTRIBUTING AUTHORS:Nina Marie Antoniotti, RN, MBA, PhD, Director of TeleHealth Business,1 Marshfield Clinic, Marshfield, WI, USA.Getting paid for TeleHealth encounters has long been listed as the numberone barrier to wide-spread deployment of TeleHealth. Even experts in thedelivery of care via TeleHealth still do not understand how to get paid forservices and many organizations simply do not bill for services delivered viaTeleHealth. With more and more emphasis on fiscal responsibility, and theever-declining revenue streams in health care, it is vital that TeleHealth administratorsunderstand how TeleHealth drives revenue streams and how toincrease and stabilize revenues associated with TeleHealth. This presentationreviews current Medicare payment policy and strategies to address deficits infederal payment policies; state Medicaid objectives of cost reduction andstrategies for gaining payment for services delivered via TeleHealth from statefunding agencies; and new models of payment that go beyond the currentMedicare/Medicaid policies. In addition, understanding private payer policiesfor payment for TeleHealth may be as important as federal policies. Thispresentation outlines a strategy and template for evaluating payment potentialfor each type of payer, and provides the participant with a practical toolto begin reimbursement discussions with payers. Understanding the differencesin Medicare, Medicaid, and private payer reimbursement policies iscritical to developing a comprehensive payment plan to achieve the highestlevel of retained earnings. Participants will learn how to gain organizationalfiscal information associated with each payer type and how to analyze thatdata to begin developing payment strategies. In addition, participants willlearn how to review a state budget to identify high cost areas where TeleHealthmay be supportive to a state’s initiatives to reduce cost while maintainingquality and equity in access. Developing a payment strategy is dependent onunderstanding an organization’s costs as well and this program will explainactivity-based costing and the difference between costs and charges. Uponcompletion of the presentation, attendees will understand the difference betweenfederal, state, and private payers and how to maximize reimbursementfrom each source. In addition, attendees will be able to customize the materialA-44 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSpresented to outline an organizational strategy to increase retained earningsthrough a comprehensive reimbursement and revenue strategy from Tele-Health initiatives.Objectives:1. Understand the different payer models including Medicare, Medicaid,and private pay.2. Identify key steps in implementing a comprehensive payment strategy.3. Knowledge of implementation steps in a reimbursement strategy.Objectives:1. Participants will learn the critical success factors for telemedicineimplementation in organizations.2. Participants will learn the steps of change management applied totelemedicine.3. Participants will judge their organizational readiness for change.3:00 pm–4:00 pm Monday, May 6, 2013HOW-TO PANELSession Number: 021Session Title: 641 IMPLEMENTING TELEMEDICINE:ON TARGET, ON TIME, & ON BUDGETTrack: Finance and Operations II Ballroom FPRESENTERS AND CONTRIBUTING AUTHORS:Robert N. Cuyler, PhD, President 1 , Dutch Holland, PhD, President 21 Clinical Psychology Consultants LLP, Houston, TX, USA, 2 HollandManagement Consulting, Houston, TX, USA.The complexity of telemedicine implementation in organizations is frequentlyunder-estimated, with the result that new programs miss deadlinesand budgets and under-perform in utilization and revenue. The history oftelemedicine includes many examples of excellent concepts that turn out to beunsustainable for a variety of reasons unanticipated at project start. Thisworkshop will apply the principles of organizational change management totelemedicine and address the critical steps involved in taking projects fromidea to functioning clinical service. The methodology presented here has beenproven in decades of experience in a variety of industries, including healthcare.The principles of change management can be applied to small projectswithin a department all the way to major strategic changes in large organizations.Using the theatre as a universal metaphor, the presenters will addressthe critical success factors of organizational change, including the roles ofleadership, communication of vision, and alteration of work processes. Thepresenters will address the negative impact on project implementation whenthe organization’s leaders are not clearly and demonstrably ‘on board’. Whiletelemedicine is often seen as technology-driven, successful implementation isreally predicated on a disciplined approach to project management that placestelemedicine technology in it proper context as only one component (andoften a secondary component) of a functioning program. Examples of successfuland faulty approaches will illustrate the critical decisions that projectmanagers face when leading organizational change and the resulting consequencesto telemedicine projects. The critical role of training will be addressedwith a broad ranging review of preparation of protocols, familiarity with newtechnology, and rehearsal of new roles prior to initiating patient care. Asorganizational transitions inevitably include revised roles for employees,management of personnel (including the key role of performance managementsystems) is a critical factor in telemedicine implementation. The principlesof change management will be tailored to telemedicine projects thatinvolve the linkage of multiple locations which may be within a single multisiteorganization or between unrelated organizations collaborating via contract.The roles of physicians (and other clinical providers) increase thecomplexity of telemedicine projects. Factors that are specific to physicianparticipation in telemedicine will be examined and related to project success.The presenters will challenge participants to review their organizationalreadiness for change and identify provide interactive discussion of strategiesto maximize success.3:00 pm–4:00 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 022Session Title: 412 INTEGRATION OF INNOVATIVETELEHEALTH AND MOBILE APPLICATIONS FORSUBSTANCE USE DISORDERSTrack: Best Practices and Service Delivery Models I Ballroom GMODERATOR: Elizabeth Brooks, PhD, Instructor.University of Colorado Denver; Veterans Rural Health Resource Center,Denver, CO, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Janelle Jones Wesloh, MBA, LADC, Executive Director of RecoveryManagement 1 , Jan A. Lindsay, PhD, Health Services Researcher, AssistantProfessor 2, , Jin Ho Yoon, PhD, Assistant Professor 31 Hazelden, Center City, MN, USA, 2 MIRECC & Menninger Department ofPsychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,USA, 3 Menninger Department of Psychiatry and Behavioral Sciences, BaylorCollege of Medicine, Houston, TX, USA.23–25 million adults in the United States meet diagnostic criteria for substanceuse and dependence. Only 2.3 to 2.5 million (1/10th of those that meetdiagnostic criteria) receive ANY kind of treatment. This creates an incrediblegap between those in need of help and those that receive it. An additional 65 to70 million people in the United States go back and forth across the line of nonproblematicuse of substance into harmful use (where the using impacts theperson’s health, productivity or relationships). This group, in need of brief andconvenient screening and interventions (to reduce use and prevent problemsfrom becoming worse) also represents a significant service gap. The use ofvarious forms of telehealth in the treatment of substance use disorders isgrowing and represents a key role in helping to close these gaps. Join ourpanelists as they review advances being used and developed in the screening,treatment and ongoing continuing care for substance use disorders to extendaccess and the range of services available to those with these disorders. Ourpanelists represent both private and public sectors in the substance treatmentfield and have expertise in how integrating these innovative tools can impactand improve the treatment experience and outcomes. The panelists are allactively working with telehealth applications in the substance use disorderfield, in a variety of modalities, across a wide spectrum of the care continuum.Examples will include: a Screening and Brief Intervention web-based tool;mobile apps for use during treatment to augment other evidence-basedpractices such as MET/CBT; mobile apps for use after treatment to teach essentialskills connected to core recovery principles; a tailored, web-basedrecovery support tool that includes integration of recovery coaching and EHR;the use of virtual reality for smoking cessation; the use of social-networkingand online mutual support meetings to increase and expand fellowship opportunities.The panel will discuss the utilization of evidence-based practicesin the development and delivery of these substance use disorder telehealthtools. Promising data analysis on the usage, efficacy and outcomes of thetools, including published research, will be referenced and presented.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-45

CONCURRENT ORAL PRESENTATIONS ABSTRACTSObjectives:1. Introduce cutting edge telehealth applications specific to substance usedisorders, representing both the private sector and public sector.2. Discuss specific concerns and opportunities seen in integrating innovativetelehealth applications in the substance use disorder field.3. Review existing data and research related to telehealth applications inthe substance use disorder field3:00 pm–4:00 pm Monday, May 6, 2013What has been the feedback from patients? - What has been the feedback fromthe primary care physicians? - What were the routine urgent conditions thatwere most often successfully managed by telemedicine? 5. As FHS considersextending the telemedicine service to support chronic care, what are some ofthe issues to consider?Objectives:1. Discuss how a telemedicine-based urgent care service can be integratedinto a primary care practice2. Highlight the patient, physician, and regional health system benefitsassociated with a providing telemedicine-based urgent care services3. Understand organizational and cultural challenges to adopting telemedicinewithin a regional primary care networkDISCUSSION PANELSession Number: 023Session Title: 624 NOW AVAILABLE 24/7: EXTENDINGPRIMARY CARE BEYOND FOUR WALLS AND BUSINESSHOURS VIA ONLINE SERVICESTrack: Best Practices and Service Delivery Models II Meeting Room 17 A/BMODERATOR: Matt Levi, MHA, MPH, Virtual Health Services.Franciscan Health System, Tacoma, WA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Cliff Robertson, MD, MBA, COO 1 , Louis Lim, MD, MPH, Medical Director ofQuality & Care Management 1 , Stacey Zierath, BS, Regional Director ofOperations 1 , Frances Gough, MD, CMO 21 Franciscan Health System, Tacoma, WA, USA, 2 Carena Inc., Seattle, WA,USA.The Franciscan Health System (FHS) is a leader in innovative care deliverymodels and is testing several telemedicine initiatives, including virtual urgentcare after regular clinic hours. As a rapidly growing, regional health systemwith 5 full-service hospitals and over 100 primary care and specialty clinics,FHS recognizes the need to extend the capabilities of its primary care servicesand provide comprehensive support for its patients 24 hours per day. However,the organizational and cultural acceptance and adoption of telemedicinehas demanded an evolving value proposition and easing many barriers. In2010 FHS partnered with Carena, Inc., a full-service 24/7 telemedicine urgentcare provider group, to introduce staff and physicians to telemedicine byoffering employees 24/7 urgent care services via telemedicine. The success ofthe employee program allowed FHS to further partner with Carena to offerthose services to patients as a seamless extension of urgent primary careservices after regular clinic hours. Initial results of these programs have beenvery encouraging. Patients benefit from 24/7 access to healthcare andavoidance of unnecessary ER visits. Physicians benefit from improved qualityof life, shifting some of the burden of evening/weekend ‘‘call duty’’ to adedicated after hours team while maintaining provider-patient relationshipsand the overall responsibility for their patient’s care. As the integration oftelemedicine services into physician practice continues to evolve, new opportunitiescontinue to arise. FHS is now considering the use of telemedicineto support chronic care patients effectively and efficiently. Given our earlyresults, it is clear that telemedicine will become an integral part of the primarycare continuum in the future. Panel Q and A will address the following: 1.What were some of the key challenges in implementing an ‘‘after-hours’’telemedicine service for patients? How did FHS overcome those challenges tosuccessfully launch the program? 2. How can a health system measure thesuccess of an acute care telemedicine program? What are some of the opportunitiesand challenges in developing appropriate metrics? 3. What are theunique technological challenges and solutions involved in creating and integratingtelemedicine into existing healthcare systems? 4. What has been theimpact of the after-hours call service for the Franciscan Medical Group? -3:00 pm–4:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 024Session Title: SUCCESSFUL OPHTHALMICTELEMEDICINE APPLICATIONSTrack: Best Practices and Service Delivery Models IIIMeeting Room 16 A/BMODERATOR: Mark Horton, OD, MD, Director, IHS TeleophthalmologyProgram.Phoenix Indian Medical Center, Phoenix, AZ, USA.248 USE OF DIGITAL RETINAL IMAGING SERVICE IN A MEDICAREQUALITY IMPROVEMENT ORGANIZATIONPRESENTERS AND CONTRIBUTING AUTHORS:Ingrid E. Zimmer-Galler, MD, Associate Professor Ophthalmology.Johns Hopkins University Medical Institutions, Baltimore, MD, USA.Background: The quality performance measure for annual diabetic retinopathyassessment stands as one of the lowest performance measures. Inspite of the long standing clinical recommendation for all patients with diabetesto receive an annual eye examination for the assessment for diabeticretinopathy (DR), nearly one in two patients does not receive this importantclinical requirement. Retinal imaging technology for fundus examination hasbeen in use for more than a decade. Despite data supporting the clinicalequivalency of these systems in assessing the retina and their recognizedstatus within government mandated quality measures, their use has beenlimited. The barriers have typically been associated with practice flow issuesand limited financial incentive.Objective: To improve the utilization rates of eye examinations in the underservedpopulation with diabetes, Delmarva Foundation for Medical Care(DFMC), a Medicare Quality Improvement Organization, sought and gainedapproval from Centers for Medicare and Medicaid Services (CMS) for the useof a telemedicine diabetic retinopathy assessment program. The telemedicineproject included remote retinal imaging of patients with diabetes with anautomated digital fundus camera in the primary care physician’s office, Internettransfer of data to an expert reading center, return of image assessmentand recommendations for follow-up to the primary care physician.Findings: The project was initiated in 2010. Of 38 physician practices invitedto participate, 10 practices initially entered the program and another 9 subsequentlyengaged in the service. The retinal imaging service was deployedduring a period spanning approximately 6 months in the clinical setting. 691patients with diabetes were imaged across 10 physician offices, with an av-A-46 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSerage of 11.3 patients tested per practice per month. Importantly, 69% of thepatients involved had not received the recommended annual eye examinationfor diabetic retinopathy in the year preceding their retinal image assessmentperformed within the project. The retinal assessment rates for these patientsdropped to as low as 4% of patients receiving the annual eye examination inthe 4 year period prior to project initiation. Of all patients tested, 19% requiredreferral to a specialist (with 4% of all patients requiring an urgent referral). Thephysician adoption rate of the telemedicine program was 26% initially with afinal adoption rate of 50% of all invited practices. Physician’s reported thegreatest clinical value of the system in improving diabetic retinopathy assessmentrates. Patients that utilizing the system reported that returning to theprimary care physician office was more convenient than going to a specialistand less expensive.Conclusions: Telemedicine remote retinal imaging in the primary care settingmay improve rates of evaluation for diabetic retinopathy in underservedpopulations. Diabetic retinopathy assessment in the primary care setting isalso projected to decrease utilization of CMS costs for specialist visits forpatients with diabetes that are not currently at high risk for retinal disease.Furthermore, this approach may be able to support the assessment of largenumbers of patients and increase the overall quality of care for the U.S.population.Objectives:1. To describe a telemedicine diabetic retinopathy assessment program aspart of a Medicare Quality Improvement Organization.2. To discuss improvement in rates of diabetic retinopathy assessment inan underserved population.3. To understand barriers to implementation of telemedicine diabeticretinopathy programs.836 TELE-GLAUCOMA: ISSUES RELATED TO SCREENING, DIAGNOSISAND MANAGEMENT OF DISEASE REMOTELYPRESENTERS AND CONTRIBUTING AUTHORS:Yogesan Kanagasingam, PhD, MSc, BSc (Hons), National ResearchDirector 1 , Leonard Goldschmidt, MD 2 , Louis Pasquale, MD 3 ,Karim Damji, MD 4 .1 CSIRO, Floreat (Perth), Australia, 2 Dept. VA, Livermore, CA, USA, 3 MEEI,Harvard University, Boston, MA, USA, 4 University of Alberta, Edmonton, AB,Canada.Glaucoma, a group of diseases that lead to optic neuropathy, is one of themost common causes of blindness worldwide. However, the remote screeningand diagnosis of glaucoma is not well established due to lack of appropriateprotocols and the need for multiple diagnostic technologies for accurate detection.Developing such a model could allow glaucoma patients living inremote and rural locations to be managed remotely with the help of localmedical staff. However, there are limited studies indicating the efficacy ofremote management of glaucoma patients. In an attempt to initiate discussionsaround protocols for tele-glaucoma and related issues, the presenterswill discuss their experience in providing remote screening, diagnosis andmanagement of glaucoma in USA (e.g. Department of Veterans Affairs) andaround the world. The ratio between optic disk and cup (cup:disk), intraocularpressure, visual field, disk asymmetry, and nerve fiber layer loss are some ofthe important clinical indicators for glaucoma. The discussions will focus onthe screening technologies needed to obtain above mentioned clinical indicators,sensitivity and specificity of diagnostic technologies for use in teleglaucoma,and the issues related to remote management of glaucoma. Thepresenters will also explore other studies published around the world in thefield such as the benefit of using stereo imaging for the diagnosis of glaucomaand examine the viability of using OCT imaging for tele- glaucoma. The panelmembers will review various challenges related to tele-glaucoma and suggestpossible protocol based on the lessons learned in USA and around the world.Objectives:1. Understand Tele-glaucoma implementation2. Understand lessons learned globally3. learn technologies used123 CLINICAL OUTSOURCING WITH A CLOUD-BASED OPHTHALMICTELEMEDICINE SYSTEMPRESENTERS AND CONTRIBUTING AUTHORS:Neil F. Notaroberto, MD, Director 1,2 , Michael K. Smolek, PhD 2 .1 EyeCare 20/20, Mandeville, LA, USA, 2 CLEVER Eye Institute, Mandeville,LA, USA.Ophthalmic telemedicine has quietly evolved into an entirely new phase ofdelivering clinical services. Specifically, the ophthalmic and optometriccommunities have recently adopted the use of encrypted, cloud-based Internetportals where eye care providers can freely discuss clinical information in asecure environment. In order to make these cloud portals into a true telemedicineservice, automated retinal camera systems can now be purchasedthat link directly to a cloud service. This means that anyone with one or moreretinal cameras can establish their own private and secure telemedicine servicesimply by registering cameras and placing them in remote locations,provided there is a link to the Internet. Furthermore, these new retinal telemedicinecameras use robotics and on-board artificial intelligence to acquirefundus photographs with virtually no assistance from the on-site operator.The only remaining step to full automation appears to be the implementationof retinal biometric detection to associate the photographs to a specific patient’selectronic health record. These new integrated systems have the potentialto greatly expand ophthalmic telemedicine services. For example, byproviding automated cameras to many primary care physicians in a community,a single eye care provider can screen hundreds if not thousands ofpatients annually for diabetic retinopathy or other retinal diseases withouthaving to schedule these patients at his or her clinic. Likewise, vision researcherscould automatically collect and transfer large amounts of multi-siteclinical trial data to a central location with better security and privacy assurancethan current methods.Objectives:1. Develop their own ophthalmic telemedicine service.2. Understand the clinical standards for ophthalmic telemedicine.3. Describe the latest cloud-based telemedicine technology for ophthalmology.3:00 pm–4:00 pm Monday, May 6, 2013DISCUSSION PANELSession Number: 025Session Title: 264 DIRECT-TO-CONSUMERTELEDERMATOLOGY: INNOVATIONS ANDCHALLENGESTrack: InnovationsMeeting Room 18 C/DMODERATOR: April W. Armstrong, MD MPH, Director of Teledermatology,UC Davis.University of California Davis, Sacramento, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Mark Seraly, MD, Founder of DermatologistOnCall 1 , Ryan Hambley, BA inEconomics, Co-Founder, Co-CEO, and Head of Product Development 2 ,David J. Wong, MD, PhD, CEO 3 , Jeffrey Benabio, MD, Physician DirectorInnovation Kaiser Permanente SD.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-47

CONCURRENT ORAL PRESENTATIONS ABSTRACTS1 DermatologistOnCall, Pittsburg, PA, USA, 2 YoDerm, Carmel, CA, USA,3 Direct Dermatology, Palo Alto, CA, USA. Kaiser Permanente, San Diego, CA,USA, 4 Kaiser Permanente, San Diego, CA, USA.Direct-to-consumer (DTC) teledermatology is one of the cutting-edge innovativehealthcare delivery models in dermatology. DTC teledermatologyallows patients to connect directly with dermatologists and bypass the potentiallylengthy referral process to seek specialist care. In this engaging paneldiscussion, the audience will hear from leaders in DTC teledermatology abouttheir practice models. Importantly, the audience will learn how these leadersare able to make their operations financially sustainable. The panelists willalso discuss real-world challenges in DTC teledermatology and ways toovercome these challenges.Objectives:1. Identify innovations in direct-to-consumer teledermatology2. Identify sustainable business models in direct-to-consumer teledermatology3. Determine ways to overcome challenges in direct-to-consumer teledermatology3:00 pm–4:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 026Session Title: LEGAL AND REGULATORY ISSUES:PART 1Track: Policy Meeting Room 18 A/BMODERATOR: Donald Jones, JD, Vice President, Global Strategy & MarketDevelopment.Qualcomm Life, San Diego, CA, USA.690 ‘‘YOU MEAN I CAN’T DO THAT?’’: LESSONS IN KEEPINGTELEHEALTH PROVIDERS OUT OF HARM’S WAYPRESENTERS AND CONTRIBUTING AUTHORS:Harry Nelson, JD, Managing Partner 1 , Jorge Carreon, MD 2,3 .1 Fenton Nelson, LLP, Los Angeles, CA, USA, 2 International HealthConsultants, Southgate, CA, USA, 3 Medical Board of California, Sacramento,CA, USA.ABSTRACT WITHDRAWN626 TELEMEDICINE AND THE LAW: AN INTERACTIVE DISCUSSIONPRESENTERS AND CONTRIBUTING AUTHORS:Terrence Lewis, JD, Associate Counsel.University of Pittsburgh Medical Center, Pittsburgh, PA, USA.Telemedicine is one of the fastest growing areas of medicine and continuesto be one of the most challenging from a legal and regulatory perspective. Thehealth care attorney’s perspective regarding telemedicine is one of research,challenge and diligence. The attorney must research and understand how thetechnology works in conjunction with the clinical provider. The attorney mustbe prepared to overcome challenging legal issues that have no precedent in thelaws or the courts. The attorney must be diligent to ensure that all elements ofthe telemedicine project have been vetted. The fundamental issues of definingwhat activities constitute telemedicine, provider licensure issues, hospital andfacility credentialing of telemedicine providers, patient privacy issues andreimbursement for telemedicine activities are in constant flux. The technologyand medical expertise behind telemedicine is out in front of the legal andregulatory guidelines established for the practice of medicine both domesticallyand internationally. In this session we will review and discuss the fundamentallegal issues surrounding the practice of telemedicine on a domesticand international level. We will also examine a hypothetical telemedicineproject and explore each of the unique legal issues related to that project andhow legal counsel tackles these difficult and complex clinical activities.613 HOW STATE MEDICAL BOARD RULES AFFECT YOUR TELEMEDICINEBUSINESSPRESENTERS AND CONTRIBUTING AUTHORS:Ellen Janos, JD, Member.Mintz Levin, Boston, MA, USA.Although the provider and patient communities have embraced telehealth,the state laws and rules that govern the delivery of medical care pose majorA-48 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSchallenges to the deployment of telehealth services. The sources of these legalimpediments may be statutes, medical board or pharmacy board regulations,individual disciplinary administrative cases or informal guidance, and will bedifferent in each state. The area of law that poses one of the greatest operationalchallenges for telehealth providers is the physical exam requirementthat exists in one form or another in many states. One state may require an‘‘adequate physical exam sufficient to make a diagnosis’’, another state willrequire a ‘‘personal examination’’ and still another will require an ‘‘in-personexamination’’. Telehealth providers must be prepared to address these varyingstandards. Another challenge for telehealth providers is the varying requirementsfor issuing a prescription as part of a telehealth service. There is widevariation among the states as to what type of history and physical is necessaryprior to the issuance of a prescription and similar variation as to the definitionsof ‘‘prescription’’, ‘‘dangerous substances’’ or ‘‘controlled substances’’.This session will explore how these state law issues impact business and operationaldecisions and how to formulate an effective strategy for educatingand working with state medical and pharmacy boards in order to deploy acompliant multi-state telehealth service.Objectives:1. Understand that the laws and rules that govern the provision of telemedicineservice vary widely from state to state thereby posing operationalchallenges to the delivery of telehealth on a nationwide basis.2. Understand that the state by state ‘‘physical exam’’ requirements thathave developed in response to Internet pharmacy abuses have thepotential to limit the deployment of telehealth services.3. Understand the sources of any legal barriers in order to effect thenecessary changes in the law.3:00 pm–4:00 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 027Session Title: THE USE OF TELEMEDICINE ININPATIENT SETTINGSTrack: Pediatrics Telehealth ColloquiumMeeting Room 12 A/BMODERATOR: Ron Nicholis, MD, FAAP, FHM, MD Medical Informatics/Department of Pediatrics.Children’s Mercy Hospital, Kansas City, KS, USA.101 COST-EFFECTIVENESS OF A TELEMEDICINE PROGRAM IN5 COMMON PEDIATRIC DIAGNOSES IN RURAL EMERGENCYDEPARTMENTSPRESENTERS AND CONTRIBUTING AUTHORS:Nikki H. Yang, DVM, MPVM, PhD Candidate 1 ,James P. Marcin, MD, MPH 1,2 , Byung-Kwang Yoo, MD, MSc, PhD 3 ,J. Paul Leigh, PhD 3 , Madan Dharmar, MBBS, PhD 1,2 .1 Department of Pediatrics, University of California, Davis, Davis, CA, USA,2 Center for Health and Technology, University of California, Davis, Davis, CA,USA, 3 Center for Healthcare Policy and Research, University of California,Davis, Davis, CA, USA.Context: Telemedicine is increasingly used to provide specialty consultationsto children presenting to rural and underserved emergency departments.However, there is little research on the impact of these consultations on thecosts and effectiveness.Objective: To evaluate the cost-effectiveness of critical care telemedicineconsultations to children presenting with asthma, bronchiolitis, dehydration,fever, and pneumonia to rural emergency departments, compared to thecurrent standard of telephone consultations.Design, Setting, and Participants: The model probabilities and the costs oftelemedicine deployment were derived from the Pediatric Critical Care TelemedicineProgram at University of California Davis Children’s Hospital. BetweenJanuary 2003 and December 2009, the program deployed telemedicineto eight rural emergency departments. We developed a decision-analyticmodel to estimate the incremental cost-effectiveness ratio (ICER) from thesocietal perspective and to compare the costs and effects of the use of telemedicineand telephone consultation among a cohort of children aged from 1day to 18 years old. We conducted a probabilistic cost-effectiveness analysis(PCEA) for each diagnosis using Monte Carlo Simulation (1,000 iterations).The cost for hospitalization for each diagnosis was derived from the 2009 Kid’sInpatient Database. All the costs were converted to 2009 US dollar value usingthe Consumer Price Index.Main Outcome Measures: Our effectiveness measure was the transfer ofchildren from the emergency department to a higher critical care center. Theunit of ICER was the incremental ‘‘cost per transfer avoided’’ in 2009 US dollarvalue.Results: Our PCEA showed that the telemedicine dominates telephone, thecurrent standard of care demonstrating that the telemedicine program ismore effective and less costly than usual care. Under the base-case analysis,the proportion of children with ‘‘avoided’’ transfer to a higher centerof care was 39.4% among the telemedicine group compared to 12.5%among the telephone group, resulting in an effectiveness of telemedicine of30.7%. The PCEA demonstrated that the cost of each child transferred waslower for the telemedicine consultation group than the telephone consultationgroup by $6,130 - $10,385. Given a willingness-to-pay to avoid onetransfer of $10,000, telemedicine is preferred (i.e., more cost-effective or dominating)among 74% to 87% of the cohort based on the PCEA. One-way sensitivityanalyses showed that the ICER estimates were sensitive to the probabilityof transferring one child with telephone consultation and the effectiveness oftelemedicine.Conclusion: Our economic evaluation shows that pediatric critical care telemedicineconsultations to rural emergency departments helps to reduce the rateof transfers, and is more cost-effective than telephone consultations amongchildren with asthma, bronchiolitis, dehydration, fever, and pneumonia.Objectives:1. To evaluate the impact of pediatric critical care telemedicine consultationon the costs compared to current standard of telephone consultation.2. To evaluate the impact of pediatric critical care telemedicine consultationon the effectiveness compared to current standard of telephoneconsultation.3. To determine if the pediatric critical care telemedicine consultation onis cost-saving and cost-effective than the current standard of telephoneconsultation.210 THE IMPACT OF A PEDIATRIC HOSPITALIST PROGRAM ANDTELEMEDICINE INTENSIVIST SUPPORT ON A COMMUNITYHOSPITALPRESENTERS AND CONTRIBUTING AUTHORS:Jaclin LaBarbera, MD, MPH, UCSF 1 , Miles Ellenby, MD 2 ,Paul Bouressa, MD 3 , Jill Burrell, RN 3 , Heidi Flori, MD, FAAP 4 ,James Marcin, MD, MPH 5 .1 Montefiore Medical Center, New York, NY, USA, 2 Doernbecher Children’sHospital, Portland, OR, USA, 3 Sacred Heart Medical Center, Eugene-Springfield, OR, USA, 4 Children’s Hospital and Research Center of Oakland,Oakland, CA, USA, 5 Children’s Hospital at University of California, Davis,Sacramento, CA, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-49

CONCURRENT ORAL PRESENTATIONS ABSTRACTSIntroduction: For over 10 years, telemedicine has been used as a means ofproviding subspecialty care patients residing in areas without these services.While there have been previous reports of high satisfaction and perceived highquality of care, the effectiveness and efficiency of telemedicine systems forpediatric critical care evaluation has not been thoroughly assessed. In thisstudy, we examined the impact of pediatric critical care telemedicine, hypothesizingthat a telemedicine program providing pediatric intensivist consultationsto community hospital inpatient ward would improve thedisposition decisions of patients possibly requiring transfer to an intensivecare unit. We also hypothesized that this program would decrease the rate oftransfers to higher levels of care.Methods and Results: This was a retrospective chart review of pediatricpatients at Sacred Heart Medical Center (Eugene-Springfield, Oregon) receivingcritical care consultations from Doernbecher Children’s Hospital(Portland, Oregon) from January 2006 to October 2009. We compared the rateof transfer to the tertiary hospital and proportion of transferred patients thatwere diverted to the tertiary hospital ward among three patient cohorts. Patientcohorts differed in the modality of critical care consultation (telephoneversus telemedicine) and the delivery of pediatric inpatient care at the communityhospital (primary care physician versus hospitalist). 153 charts wereanalyzed; 41 from prior to hospitalist and telemedicine implementation(Cohort 1), 56 from post-implementation of telemedicine but pre-hospitalistprogram (Cohort 2), and 56 after implementation of both the telemedicine andhospitalist programs (Cohort 3). Demographic data, length of stays and severityof illness did not differ between cohorts. Transfer rates after intensivistconsultation were lower in Cohorts 2 and 3 compared to Cohort 1 (100%,85.7% and 87.5 in Cohorts 1, 2, and 3, respectively; p = 0.04). Proportion oftransferred patients that were diverted to the tertiary ward decreased over time(19.5%, 14.5%, and 6.1% in Cohorts 1, 2, and 3, respectively; p = 0.003),suggesting greater accuracy in identifying severity of illness and triagingdisposition during the consultation.Conclusions: A telemedicine program between pediatric intensivists andcommunity hospital physicians with the addition of a pediatric hospitalistprogram at the community hospital has the potential to improve triage ofpediatric patients and reduce the need to transfer patients to higher levels ofcare. The potential cost-effectiveness of telemedicine consultation and pediatricinpatient hospitalist care systems should be the focus of future research.Objectives:1. Discuss the impact of telemedicine on retaining patients at a referringhospital.2. Recognize ways that telemedicine can enhance communication regardingtransfer of patient care.3. Discuss the differential impact of a hospitalist system in addition to atelemedicine consult system on non-tertiary hospitals.393 COMPARISON OF FACE-TO-FACE VERSUS TELEMEDICINE PATIENTASSESSMENT IN A PEDIATRIC INTENSIVE CARE UNITPRESENTERS AND CONTRIBUTING AUTHORS:Phoebe Yager, MD, Director, PICU Telemedicine Program 1 ,Maureen Clark, MS 1 , Heda Dapul, MD 2 , Sarah Murphy, MD 1 ,Hui Zheng, PhD 1 , Natan Noviski, MD 1 .1 Massachusetts General Hospital, Boston, MA, USA, 2 Maimonides MedicalCenter, Brooklyn, NY, USA.Introduction: Telemedicine has become popular as a means to supportclinical care at a distance, yet few limited studies have measured the reliabilityof the physical assessment obtained via telemedicine.Hypothesis: We hypothesized that many aspects of the circulatory, neurologicand respiratory examinations of patients admitted to a pediatric intensivecare unit can be reliably obtained via telemedicine.Methods: We designed a prospective, randomized study comparing telemedicineversus face-to-face assessments of 55 pediatric intensive care unitpatients. Study providers included six pediatric intensivists and seven criticalcare fellows. For each study patient, two providers were randomly assigned toperform an examination in-person or via telemedicine. Findings were recordedon a standardized data collection form and compared.Results: One hundred and ten comparisons were completed. There was goodagreement between the in-person and telemedicine care provider for mostelements of the circulatory and neurologic examinations (kappa = 0.61–1.00).Regarding the pulmonary assessment, there was good agreement on determinationof airway patency though less on other aspects of the respiratoryassessment. Providers identified equipment-related difficulties and environmentalinfluences that limited their ability to obtain a reliable pulmonaryassessment via telemedicine. Some of the equipment-related issues included:providers’ self-reported need for increased familiarity with use of the remotecontrol (to position camera, manually focus camera, zoom in/out) and theocular wand; lack of sharpness and picture clarity and inability to focus thecamera in patient rooms with inadequate lighting which made subtle differencesin respiratory symptoms (i.e., mild chest retractions) difficult to identify;inability of providers to discern between artifact and actual breath soundsmost likely due to the stethoscope quality.Conclusions: Telemedicine is a powerful tool to aid in assessment of criticallyill patients. It can be used to reliably identify normal and abnormalfindings on the circulatory, neurologic and pulmonary examinations. Oneneeds to be aware of certain limitations of telemedicine and how to overcomethem for its optimal use.Objectives:1. To measure the ability of telemedicine to accurately assess the neurological,circulatory and respiratory systems in critically ill children.2. To explain the capabilities of telemedicine in identifying both normaland abnormal findings in the assessment of critically ill children.3. To identify the limitations of telemedicine and discuss strategies todiminish these limitations.4:15 pm–5:15 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 028Session Title: EVIDENCE-BASED BEST PRACTICES INTELEMEDICINE AND QUALITY IMPROVEMENTTrack: Outcomes and Evidence Meeting Room 19 A/BMODERATOR: Michael Ackerman, PhD, Assistant Director for HighPerformance Computing & Communications.National Library of Medicine at NIH, Bethesda, MD, USA.520 TELEHOMECARE IN ONTARIO: INSPIRING ADOPTION THROUGHEVIDENCE BASED GUIDELINES AND BEST PRACTICESPRESENTERS AND CONTRIBUTING AUTHORS:Laurie Poole, RN, BScN, MHSA, Vice President, Telemedicine Solutions.Ontario Telemedicine Network, Toronto, ON, Canada.The poor management of chronic disease is well documented in Ontario andmany stakeholders are beginning to accept the fact that the root cause of thecrisis is directly attributable to a health care system that has focused its resourceson acute care management. In terms of a solution, most agree that theredesign of healthcare is long overdue and a revitalized system must aggressivelysupport chronic care management outside and beyond health careA-50 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSfacilities in order to be sustainable. The successful management of chronicdisease must occur on a daily basis in the home, community and primary caresetting of the individual with a chronic illness and with the engagement of theindividual in their own care. In 2007, OTN launched a phase one telehomecarepilot program and worked with primary care providers to enroll over 800individuals with heart failure and chronic obstructive pulmonary disease. Theevaluation demonstrated high levels of patient and provider satisfaction alongwith a significant reduction in hospitalization and emergency room visits.Leveraging the successful outcomes of the pilot, OTN is currently implementinga province-wide expansion beginning with three health regions.By year three, upwards of 30,000 patients will be enrolled. In building ascalable telehomecare program, it is widely recognized that telehomecarenurses will need to foster relationships across the care continuum to effectivelysupport patients. Further, there is the need to both maximize the scopeof practice for nurses while also finding ways to foster relationships betweennurses and primary care and other providers to best clinically support thepatient. The phase one pilot findings validated that patients with complexchronic diseases have a number of co-morbidities that could be robustlysupported during the telehomecare intervention. For the benefits of the telehomecareto be sustained, patients will also require support after discharge,which contemplates the need to consider the way in which these requirementscan come together as part of an integrated care pathway (ICP).ICPs arestructured multidisciplinary plans of care designed to support the implementationof evidence based guidelines and best practices for a specificclinical condition or problem. The challenge for chronic disease managementis that care plans and pathways across the care continuum are not well understoodor widely used; therefore an initiative aimed at developing an ICPwill have value for telehomecare in its current state and in the future as thescope of diseases grow. OTN is currently working with KPMG and clinicaladvisors to develop an ICP for heart failure and chronic obstructive pulmonarydisease within the boundaries of telehomecare expansion project. Followingthis, a framework for ICPs to support chronic disease management across thecontinuum of care, of which telehomecare is an integral component will bedeveloped. Leveraging OTN’s technology and provincial network, the goal isto inspire the adoption of evidence based guidelines and best practices so thatpatients with chronic diseases can live more productive and healthier livesregardless of where they live in the province.Objectives:1. Understand how an integrated telehomecare-enabled patient selfmanagementprogram will serve as a catalyst to transform chronicdisease management in the province of Ontario.2. Understand why evidence based care pathways must be part of a telehomecareprogram3. Outline the framework to integrate care pathways into telehomecareprograms628 VETERANS TELEMEDICINE OUTREACH FOR POST TRAUMATICSTRESS DISORDER SERVICESPRESENTERS AND CONTRIBUTING AUTHORS:Zia Agha, MD, MS, Interim Director VA HSR&D, Steven Thorp, PhD,Lin Liu, PhD, Lucy Moreno, MPH, Janel Fidler, MA, Ryan Barsotti, MA,Elizabeth Floto, MA, Bridgett Ross, PsyD, Andrea Repp, MA,Nilesh Shah, MD, Carla Hitchcock, MA, Annie Reader, MA,Tania Zamora, BS, Angela Robertson, Kyle Lowery.Va San Diego, San Diego, CA, USA.Introduction: Post-Traumatic Stress Disorder (PTSD) is considered a majorpublic health problem in the US due to high prevalence and rates of disabilityassociated with the disorder. Barriers to PTSD care include poor access, mistrust,and lack of benefit from traditional treatments. Recently developedevidenced-based treatments such as cognitive processing therapy (CPT) areeffective. Unfortunately, these treatments are not widely available to patientsin rural communities who have poor access to specialized mental health care.The project assessed the quality of CPT provided via telemedicine (TM) and itsimpact on outcomes.Hypotheses: PTSD symptom improvement for veterans receiving CPT viaTM will be noninferior to in-person (IP) care. Quality of life for veteransreceiving CPT via TM will be noninferior to IP care. Provider-patient satisfactionduring TM consultations is noninferior to IP consultations.Synopsis: A noninferior randomized clinical trial was performed. Patients(n = 207) received CPT via TM or IP care. Clinical services (12 60-minuteweekly sessions) were provided by 18 providers with specialized training inCPT. PTSD symptom severity (Clinician- Administered PTSD Scale, CAPS) andhealth related quality of life (SF-36) were measured at baseline, therapycompletion, and 6-months follow-up. Provider-patient communication andalliance were measured at session 6, and therapy completion. Patient andprovider satisfaction were measured post therapy. Linear mixed effects modelwas used to assess difference in change scores between TM and IP care.Noninferiority was assessed using two-sided 95% confidence intervals and amodified t-test. The p < 0.025 indicates noninferiority. We performed analysisfor all randomized patients (ITT) and completers (subjects completed baselineand post assessment).Results: Both TM (pre = 71.3, post = 62.3) and IP (pre = 72.7, post 53.3)groups showed significant improvements in PTSD symptoms on CAPS measure.At post treatment, TM was not shown to be noninferior to IP [p = 0.19,95% CI = (0.14, 0.87), NI margin = 0.67] per CAPS score. However, at 6-monthfollow-up, IP and TM groups had similar symptom improvements (CAPSscores TM = 56.1 and IP = 57.2), [p = 0.004, 95% CI = ( - 0.10, 0.29), NI margin= 0.35]. Quality of life change, measured by SF-36 (baseline to posttreatment), was similar for TM and IP for 7 out of 8 SF36 subscales. Patient andtherapist satisfaction was similar for TM and IP [p < 0.05]. All analyses wereperformed for both intention to treat and completers, and found to be similar.Discussion: Care delivery via telemedicine saves time for patients whonormally would travel long distances for care. Providing state-of-the-artpsychotherapies to rural patients will allow staff to offer more appointmentsand allow more time to treat greater numbers of serious mental health cases.Both TM and IP treatment groups showed significant improvements in PTSDsymptoms, as measured by the CAPS measure. While IP group had largerinitial improvement in symptoms at 6-month follow-up, both IP and TMgroups had similar symptom improvements. TM was found to be acceptable byclinicians and patients. This study advanced our understanding of TM’s role indelivering evidence-based psychotherapy and related outcomes.Objectives:1. Compare PTSD outcomes (symptom improvement and quality of life)for veterans receiving CPT via telemedicine versus in-person care.2. Compare provider-patient satisfaction during consultations.3. Compare provider-patient communication during consultations.625 EEMERGENCY CHEST PAIN MANAGEMENTPRESENTERS AND CONTRIBUTING AUTHORS:Donald J. Kosiak, MD, MBA, FACEP, eCARE Executive Medical Director,Sarah E. Kappel, RN, BSN.Avera Health, Sioux Falls, SD, USA.When a patient presents to a local emergency department with chest pain,time is muscle. Mortality for patients with emergent cardiac conditions, suchas myocardial infarction (MI) or acute coronary syndrome (ACS) is directlyrelated to the duration of symptoms and timeliness of treatment. In order toreduce mortality and complications, the American Heart Association and theAmerican College of Chest Physicians recommend a maximum ‘‘door toneedle’’ time of 30 minutes for the administration of fibrinolytic (clot-busting)ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-51

CONCURRENT ORAL PRESENTATIONS ABSTRACTSmedication, and a maximum ‘‘door to balloon’’ time of 90 minutes for theperformance of percutaneous coronary intervention (PCI) to open an occludedcoronary artery and restore blood flow to the heart[1]. Despite these recommendations,recent literature has demonstrated that patients presenting withchest pain to Critical Access Hospitals (CAHs) across the nation are not receivingthese life-saving treatments within the recommended timeframes dueto a lack of specialist resources in rural communities as well as delays in theactivation and arrival of transport teams[2]. In response to the needs identifiedby eEmergency and rural clinicians, a Chest Pain Project was designed andimplemented to increase coordination and collaboration between the eEmergencyand rural teams caring for emergency cardiac patients. The goals ofthe Chest Pain Project include facilitating the consistent delivery of evidencebasedcare across the eEmergency network, and measuring the impact ofeEmergency on the delivery of care for patients with chest pain. In order tomeasure effectiveness of care coordination and delivery using eEmergency,the team focused data collection on several CMS Outpatient measures for AMIand Chest Pain, including: Outpatient Measure 1 (OP-1): Median Time toFibrinolysis; OP-2: Fibrinolytic Therapy Received Within 30 Minutes of EDArrival; OP-3: Median Time to Transfer to Another Facility for Acute CoronaryIntervention; OP-4 1 : Aspirin at Arrival; and OP-5: Median Time to ECG.The Project population includes patients with ICD-9 coded diagnoses of chestpain, ACS or MI. In addition to the above listed quality data, the eEmergencyteam also monitors eEmergency utilization data, including Percent ofMonthly ED Visits Utilizing eEmergency, and Number of Avoided Transfers.Significant outcomes have been identified as a result of the project, including:- Improvement in compliance with aspirin administration by as much as44%.- A decrease in Median Time to ECG by 50%.- 100% of Eligible Patients Undergoing Fibrinolysis.- Median Time to Transfer decreased by more than 2 hours.- 29 Avoided Transfers with a savings of $175,091.The eEmergency Chest Pain Project has resulted in improved compliancewith evidence-based practices, improved clinical quality, and a reduction incost of care. In addition, the Project has enhanced collaboration between ruraland urban clinicians, resulting in a more efficient, streamlined system of carefor this critical population.[1] Masoudi, F., et al. (2008). ACC/AHA 2008 statement on performancemeasurement and reperfusion therapy: A report of the ACC/AHA Task Force onperformance measures. Circulation (118): 2694–2661.[2] Joynt, K. (2011). Quality of care and patient outcomes in critical access ruralhospitals. JAMA 306(1): 45–52.Objectives:1. Describe the collaborative, peer-to-peer telemedicine approach used inthe eEmergency Chest Pain Project.2. Examine the impact of eEmergency on management and coordinationof care for cardiac patients.3. Disseminate project clinical and quality outcomes, and cost savings.4:15 pm–5:15 pm Monday, May 6, 2013DISCUSSION PANELSession Number: 029Session Title: 951 MARKET WATCH: NOT ALLTELEHEALTH MARKETS ARE EQUALTrack: Finance and Operations I Ballroom EMODERATOR: Daniel Ruppar, Global Program Manager, Connected Health.Frost & Sullivan.PRESENTERS AND CONTRIBUTING AUTHORS:James Pursley, Vice President, Sales & Marketing 1 , John Bojanowski,President 2 , Amnon Gavish, Senior Vice President - Vertical Solutions 3 ,Anthony Shimkin, Senior Director, Marketing 41 Intel-GE Care Innovations, Roseville, CA, USA, 2 Honeywell HomMed,Brookfield, WI, USA, 3 Vidyo, Hackensack, NJ, USA, 4 Qualcomm Life,San Diego, CA, USA.While all telehealth opportunities have a place in the future of healthcare,increasingly distinct markets are forming within this emergent industry withsome growing faster than others. These markets possess a unique mixture ofcollaboration and distinctive market needs. Please join us for a forum consistingof representatives from each of the major telehealth verticals to assessthe current state of telehealth and what is in store for its future. Frost andSullivan will be presenting its findings on the current state of the industryalong with representatives from remote monitoring, video telemedicine,mHealth, and aging in place, and will be discussing key differences andsimilarities between these top market verticals concerning challenges, businessmodels, and future growth.Objectives1. Assess current state of telehealth business opportunities.2. Discuss and evaluate key areas including remote monitoring, mHealth,video telemedicine, aging in place.4:15 pm–5:15 pm Monday, May 6, 2013HOW-TO PANELSession Number: 030Session Title: 552 CLINICAL, LEGAL ANDADMINISTRATIVE HURDLES IN DEVELOPINGA TELEHEALTH NETWORKTrack: Finance and Operations II Ballroom FPRESENTERS AND CONTRIBUTING AUTHORS:Alan Shatzel, DO, Medical Director, Mercy Telehealth Network,Kelley Evans, JD, Dignity Health Senior Council1 Dignity Health, Sacramento, CA, USA.The Mercy Telehealth Network began through a philanthropic donationand has grown to over 13 acute partner sites. We are currently providing 3different clinical services and evaluating the timing of bringing on 4 more.Through the development of our network we have learned many approachesand tracked data that improve the clinical services through betterprovider response times, more efficient care delivery, and ongoing communicationwith our partner sites. We set a goal of having a specialist onthe robot in 7 minutes or less and through many iterations and processimprovements have been able to sustain that over the last 5 months. Inaddition to this we have dedicated Legal Council that sits on our ExecutiveSteering Committee who understands the nuances of Telemedicine andhow to keep us moving forward instead of halting the process. The clinicalvision and implementation of the network is an important story to tell andwe can share how the raging success of telestroke has attracted many otherspecialties to want to join the panel as well as hospitals that see the need ofadding clinical services to fill critical gaps in their medical staff. Ourpartnership with the Mercy Transfer Center demonstrated a 32% growth involume of services in year over year data - this is in a time where hospitalsarestrugglingtoholdontoexistingvolume.Objectives:1. Implement service criteria and measure outcomes to strengthen partnersite relations.A-52 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTS2. Understand how to streamline proxy credentialing across a large telehealthnetwork3. Develop a clinical service model that is scalable and specific to variouspartner sites.4:15 pm–5:15 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 031Session Title: INTEGRATION OF MOBILE HEALTHSOLUTIONS IN DEVELOPING AND UNDERSERVEDNATIONSTrack: Best Practices and Service Delivery Models IMODERATOR: John P. Howe, MD, President & CEO.Project Hope, Millwood, VA, USA.Ballroom G281 INTEGRATION OF MOBILE HEALTH INTO DEVELOPING NATION’SHEALTH SYSTEMS AND IT’S MARKETPLACES.PRESENTERS AND CONTRIBUTING AUTHORS:Sikder M. Zakir, MBBS, Managing Director.Telemedicine Reference Center, Dhaka, Bangladesh.Since 1999, Bangladesh, one of the developing countries of the world hasexperienced gradual integration of Telemedicine, eHealth and MobileHealth technologies at health systems level. From 2006, the country hasshowcased mobile health technology based services and business modelsthrough innovative and cost-effective use of emerging health informationtechnologies in health systems for nationwide service delivery, which wereresults of combined efforts of Telemedicine Reference Center Ltd. (TRCL),Diabetic Association of Bangladesh (BADAS) - largest comprehensiveprivate healthcare service provider and Center for Diarrheal Diseases andResearch, Bangladesh (ICDDRB) - a renowned public health research andprovider organization. Three most significant health systems and marketsfocused innovations serving the nation include (1) Medical Hotline, aconsumer mHealth program: a medical call center and electronic prescriptionplatform, manned by licensed physicians that is providing generalpopulations with 24/7 medical information and services, (2) AMCARE,a clinical mHealth program: a chronic disease management system toimprove patient-provider communication and relationship to positivelymodify behavior, compliance and adherence. AMCARE uses more than 100urban and rural medical facilities of Bangladesh Diabetic Association tofacilitate lifestyles of patients with chronic diseases like diabetes or hypertensionor both, and to manage and ensure necessary and timelymedical interventions to prevent worsening of disease conditions andcomplications, (3) eClinic24, a mHealth program for rural health: a programto link informal service providers in rural Bangladesh with licensedproviders of urban medical facilities, to improve capacity and quality ofinformal providers, who delivers 65% healthcare services in Bangladesh.These programs are delivered using sustainable business models andcombines man, machine and mechanisms using mobile health tools toensure cost-effective utilization of medical, information and communicationtechnologies. The presentation will show program overview formobile health ecosystem, business modeling for health markets in developingcountry context, challenges involved in deployment, adaptation,user-acceptance, utilization and benefits. Significant impacts involveimproved consumer access to health information and services, efficientclinical and cost-cutting measures for stakeholders in chronic diseasesmanagement, and ways to bring informal health markets in developingcountries under the umbrella of formal health systems thus improvingcapacity and quality of informal healthcare providers, who serves ruralpopulation markets.Objectives:1. Understand mobile health markets in developing countries2. Learn about mobile health ecosystem and its implementation3. Business modeling of consumer-centric and provider driven patientportal391 THE DESIGN AND INITIAL IMPLEMENTATION OF A NATIONALMHEALTH PLATFORM IN ETHIOPIAPRESENTERS AND CONTRIBUTING AUTHORS:Mengistu Kifle, PhD, Consultant.Federal Ministry of Health, Addis Ababa, Ethiopia.This presentation will highlight key considerations for those interested inlarge-scale implementations of mHealth programs, and will be relevant tothose interested in designing/implementing their own program. In 2003, theEthiopia Federal Ministry of Health (FMOH) launched the Health ExtensionProgram (HEP) as part of the Health Sector Development Program II (HSDP II).The HEP focused on the health-related Millennium Development Goals(MDGs) - namely, MDGs 4, 5 and 6. It identified challenge areas including:Unmet need for family planning, low rate of skilled birth attendance, shortageof skilled human resources, inadequate coverage of emergency obstetric careservices, a poor referral service and poor supply and logistics management.The FMOH decided to use mHealth as a tool to address those challenges.Realizing that the mHealth component, like any intervention, would requirethe development of a long-term vision, support of key stakeholders, carefulplanning and resources, the FMOH convened the mHealth Roadmap Project tohelp guide the design and implementation processes. In 2010, a needs assessmentof the existing mHealth ecosystem in Ethiopia was carried out as partof this plan. The findings of the assessment included: 1) initial mHealth implementationshould focus on the link between the Health Extension Workers(HEWs) at the community level and ‘formal’ health facilities and 2) work flowsaround Maternal, Neonatal and Child Health (MNCH) should be prioritized.The FMOH then partnered with several organizations to work through thedesign and initial implementation of what is to become the national mHealthplatform. The purpose of this initial phase of the roadmap project consists ofparallel processes of strategic requirements generation, technology assessmentand initial piloting. Key deliverables include the following: a stakeholder-basedsoftware requirements document/design document for anHEW-based MNCH information system; initial technical assessment and localizationplan; and a pilot of an interoperable, scalable technology platformcapable of delivering the requirements identified. By having a stakeholderbasedsoftware requirements/design document, the FMOH has been able togenerate objective criteria for any software under consideration for use in themHealth system, and the larger health information system. Stakeholder inputhas been obtained through the iterative Collaborative Requirements DevelopmentMethodology. The initial piloting further refined the requirements andgenerated the identification of pre-requisites and recommendations to theplatform prior to the system rolling out to a wider geographic area (andultimately, nationally). The pilot mHealth information system has been deployedin four districts with each district located in a different region inEthiopia. The pilot sites were selected to maximize the likelihood of success ina short period of time, but still reflect and represent some of the challenges thatwould need to be considered in Ethiopia, including multiple languages andregional variation of the implementation of the HSDP II and HEP. Several keylessons, including the need for inter-ministerial co-operation and having aplatform that can work within environments with limited network connectivityand power, have been gleaned from the pilot and work is being done forthe next phase of scale-up to 100 districts.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-53

CONCURRENT ORAL PRESENTATIONS ABSTRACTS535 ‘ENHANCING PRIMARY CARE IN FIRST NATIONS COMMUNITIESUSING INTEGRATED MHEALTH SOLUTIONS’PRESENTERS AND CONTRIBUTING AUTHORS:Karen Waite, BScN, MBA, Director 1 , Megan Hunt, MSW 2 ,John Pawlovich, MD 3 .1 Healthtech Consultants, Toronto, ON, Canada, 2 Carrier Sekani FamilyServices, Prince George, BC, Canada, 3 University of British Columbia,Vancouver, BC, Canada.Carrier Sekani Family Services (CSFS), an innovative health and familywelfare service delivery organization serving First Nations in NorthernBritish Columbia (BC), has partnered with the Northern Health Authority(NHA) to provide primary care services in an integrated provider model tomultiple First Nations communities using enabling technology. CSFS hasintroduced an electronic medical record (EMR) and two-way real-timevideoconferencing using a blended platform of both fixed and mobile devicesto support the primary care requirements of disparate, remote communitiesand a highly mobile interdisciplinary health care provider team.Through partnerships and contributions from federal, regional and privateorganizations, CSFS has positioned itself amongst the first organizations inCanada to blaze the path forward in providing primary care services inremote First Nations using emerging mHealth technology. This presentationwill highlight the challenges, complexities and strategies for success inproviding primary care services using rapidly deployed EMR and roombasedand desktop Polycom solutions along with Samsung and iPad tabletdevices to deliver integrated primary care services to First Nations. It willdemonstrate the power of integrating EMR and telehealth using multiplemodalities which are employed depending on the care context and providercircumstance towards delivering quality patient care while optimizingprovider productivity.Objectives:1. Gain insight into a telehealth enabled model for addressing challengesof providing primary care services to First Nations across disparate,remote settings.2. Gain insight into the complexities of introducing electronic medicalrecords and videoconferencing to a hyper mobile primary care workforceusing a blend of fixed and mobile devices.3. Gain an understanding of the key success factors to enhancing primarycare delivery productivity using enabling technology4:15 pm–5:15 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 032Session Title: 957 ATA PRACTICE GUIDELINESSHAPING SERVICE DELIVERYTrack: Best Practices and Service Delivery Models IIMeeting Room 17 A/BMODERATOR: Elizabeth A. Krupinski, PhD, Professor, Department MedicalImaging.Radiology, University of Arizona, Tucson, AZ, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Carolyn Turvey, PhD, Associate Professor of Psychiatry 1 ,Sunil Budhrani, MD, MPH, MBA, Chief Medical Officer 2 ,Theresa M. Davis, RN, MSN, Patient Care Director 31 University of Iowa, Iowa City, IA, USA, 2 Evergreen Health InsuranceCompany, Towson, MD, USA, 3 enVision eICU, Inova Health System, FallsChurch, VA, USA.ATA’s practice guidelines for telemedicine are the critical foundation for thedeployment of telemedicine services. Standards form the basis for uniform,quality patient care and safety, grounded in empirical research and clinicalexperience. The establishment of such standards also accelerates the adoptionof telemedicine by payers, administrators and providers who are full partnerswith ATA in their development along with industry, government agencies,medical societies and other stakeholders. Dr. Krupinski, Chair of the ATAStandards and Guidelines Committee will lead the discussion about howATA’s practice guidelines are helping to shape service delivery in today’shealthcare environment. Leaders of three guidelines development workgroups will share insights and discuss the importance and impact of theirprojects: Dr. Turvey, Chair, Internet-based practice guidelines for telementalhealth utilizing desktop and mobile technologies work group, D. Budhrani,Co-Chair, primary/urgent care guidelines work group, and Ms. Theresa M.Davis, RN, MSN, Chair, TeleICU guidelines work group.4:15 pm–5:15 pm Monday, May 6, 2013DISCUSSION PANELSession Number: 033Session Title: 133 INNOVATIVE RETINAL IMAGINGTrack: Best Practices and Service Delivery Models III Meeting Room 16 A/BMODERATOR: Paolo Sandico Silva, MD, Assistant Chief of Telemedicine,Beetham Eye Inst.Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Dana Keane, BS, CCRA, CCRP, Senior Manager of Clinical 1 ,Mathew Muller, MBA, MS, Chief Operating Officer 2 ,Alexander Walsh, MD, CEO 31 Optos, Marlborough, MA, USA, 2 Aeon Imaging, LLC, Bloomington, IN, USA,3 Envision Diagnostics, Inc., Los Angeles, CA, USA.Ocular telehealth programs for diabetic retinopathy have been shown tobe effective in preventing vision loss and preserving vision in varioussettings. However, the ability to scale current diabetic retinopathy programsto meet the growing global diabetic populations has not been established.One of the key hurdles to the scalability of diabetic retinopathyprograms is the lack of suitable imaging devices that meet the major requirementsof community based diabetic retinal surveillance; i.e., cost effectiveness,portability, ease of use, and applicability to the large anddiverse diabetes population. The novel approaches that are presented in thisdiscussion panel include confocal retinal imaging with a digital lightprojector (DLP), ultrawide field scanning laser ophthalmoscope (SLO), andhigh resolution optical coherence tomography (OCT). Mydriatic 7-field 30degree Early Treatment Diabetic Retinopathy Study (ETDRS) fundus photographyremains the current standard for the evaluation for diabetic retinopathy.These innovative approaches need to be rigorously measuredagainst this standard to ensure agreement and maintain scientific validity.Scanning laser ophthalmoscopy is a technique of confocal imaging thattraditionally illuminates a target with a point or line that is rapidly scannedacross the field of view. The light returning from the target is descannedand directed through an aperture to a photosensitive detector and a digitalimage of retina is created. An ultrawide field SLO utilizes the same principlesof confocal imaging but is combined with the use of a large ellipsoidalmirror that allows imaging of a 2000 retinal field representing over80% of the retinal surface. Substantial agreement with ETDRS photographyhas been established with this device when images are acquired andevaluated in a standardized manner. An alternative approach substitutesthe laser source and scanning element for a digital light projector (DLP). ToA-54 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSsimulate laser scanning, a sequence of illumination lines is rapidly projectedonto the retina. The light returning from the target is not descanned,but imaged directly onto a 2-dimensional rolling shutter CMOS sensor,which acts as a linear confocal aperture. The use of a DLP and CMOSdetector enables a low cost, flexible, and robust retinal camera design witha small footprint. Self-operated, binocular, ‘smart’ optical coherence tomography(OCT) has the potential to enable comprehensive, digital eyeexams to be completed by patients anywhere in the world and transmittedto eye doctors nearby for evaluation. OCT of the whole eye, so-called OCTbiomicroscopy, has the potential to provide as much information aboutnumerous tissues in the eye as slit lamp biomicroscopy. Finally, incorporationof software ‘apps’ capable of performing tests like visual acuity,visual fields, pupillometry, and intraocular pressure could make remotecomprehensive eye exams as informative as eye exams performed in thebest equipped clinics in the world.Objectives:1. To describe innovative retinal imaging approaches for diabetic retinopathyin telehealth programs2. To compare the agreement of retinal images obtained with these imagingsystems to the gold standard 30 degree ETDRS fundus photographyin determining diabetic retinopathy severity3. To assess applicability of these imaging systems in the context of costeffectiveness, portability, ease of use, and applicability to the need forglobal diabetes eye care.4:15 pm–5:15 pm Monday, May 6, 2013Remote Training Programs: Training using the web, telephone and videoworks. 3. Supervision and Quality Assurance Programs: Recruit from experiencedpersonnel, bring supervisors on-site and have unique, intensive QA inplace. 4. Equipment, Communications and Information Infrastructure: Haveredundant telecommunications and a robust infrastructure. 5. Security &HIPPA Compliance: Using encryption and solid policies and procedures toprotect PHI. 6. Employee Satisfaction: The importance of communication andfeedback, and employer support for remote workers. Acknowledging and addressingthe challenges associated with remote employees is necessary toachieve organizational success in the deployment of a remote workforce. Teleworkingis not without its challenges. Not everyone has the necessary competenciesto work successfully in a work-at-home program. Clinicians must beself-motivated and confident in their abilities to make critical healthcare decisionswithout the added benefit of physically turning to one’s co-worker for asecond opinion. There are few industries where call quality and criticalthinking decisions are more important than in telehealth. This panel presentationwill discuss the metrics and benefits associated with employing a remoteworkforce including critical factors such as attrition rates, response times andproductivity as measured against URAC, USG and related benchmarks.Objectives:1. To provide the novice in telehealth with key strategies for deploying aremote workforce of registered nurses and clinicians successfully byutilizing valuable strategies and lessons learned.2. To first acknowledge and then address the challenges associated withremote registered nurses and clinicians.3. To present the metrics and benefits associated with employing a remoteworkforce of registered nurses and clinicians.HOW-TO PANELSession Number: 034Session Title: 714 SUCCESSFULLY UTILIZING AREMOTE WORKFORCE IN TELEMEDICINETrack: Innovations Meeting Room 18 C/DPRESENTERS AND CONTRIBUTING AUTHORS:Kenneth W. Bleakley, MA, CEO of FONEMED, Charlene Slaney, RN,VP Client & Clinical Services at FONEMEDFONEMED, Ventura, CA, USA.The widespread adoption of telemedicine increasingly depends on theavailability of skilled workers at remote locations. This coincides with a generaltrend towards the use of remote resources and is particularly applicable tomedicine where clinical and technical personnel with the required skill sets arein short supply. There are copious benefits to such a program. A virtual workenvironment for nurses and other clinicians allows companies to address theparticularly daunting task of securing licensure in multiple states wherecommunication with patients may cross state lines. Employees enjoy theflexibility of tele-working; schedule flexibility, the elimination of a longcommute to work and of course the associated cost savings have resulted in anoverwhelming interest for nurses to work in this industry. The objectives of thispresentation are to provide key strategies for deploying a remote workforcesuccessfully by utilizing valuable lessons learned, acknowledge and address thechallenges associated with remote employees, and present the metrics andbenefits associated with employing remote workers. With over a decade ofexperience successfully deploying a continent –wide remote workforce operatingoff the cloud and handling over a million transactions, the panel willreview the most valuable lessons and strategies learned to successfully employ,deploy and measure the success of a remote workforce. Key Lessons andStrategies Topics 1. Recruitment and Selection Strategies: using the web andsocial media to attract a wide range of candidates for specialized positions. 2.4:15 pm–5:15 pm Monday, May 6, 2013PRESENTATION PANELSession Number: 035Session Title: 344 LEGAL AND REGULATORY ISSUESIN TELEDERMATOLOGYTrack: Policy Meeting Room 18 A/BMODERATOR: Dennis H. Oh, MD, PhD, Associate Professor.University of California/Dept. of Veterans Affairs, San Francisco, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Marc E. Goldyne, MD, PhD, Clinical Professor 1 , Anna Orlowski, JD, ChiefHealth System Counsel 2 , Dennis H. Oh, MD, PhD, Co-Lead, Teledermatology 31 University of California/Dept. of Veterans Affairs, San Francisco, CA, USA,2 UC Davis, Sacramento, CA, USA, 3 Department of Veterans Affairs,San Francisco, CA, USA.Background: Teledermatology practice requires more than patients, clinicalstaff and equipment. Practitioners need to be aware of institutional andgovernmental regulations and laws, and they need their services to be reimbursed.The evolving nature of technology also encourages extensions ofpractice into areas where the application of conventional rules is unclear. Thissession will address legal issues from the viewpoint of an institutional counsel.In addition, reimbursement will be discussed from the view points of a dermatologistwho has been a leader in guiding reimbursement policy in California.The session will include time for presenters to respond to questions andcase experiences from the audience.Objectives: 1) Gain familiarity with key legal and regulatory issues for teledermatology;2) Understand the challenges for reimbursement of teledermatology3) Identify strategies and steps for teledermatology reimbursement.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-55

CONCURRENT ORAL PRESENTATIONS ABSTRACTSTakeaways: 1) Understand key regulatory and legal issues for teledermatologypractice; 2) Identify strategies for pursuing teledermatology reimbursement inyour state. Conclusions: At the conclusion of this session, the participant willhave a better understanding of important reimbursement policy and legal issuesin teledermatology.Objectives:1. Gain familiarity with key legal and regulatory issues for teledermatology2. Understand the challenges for reimbursement of teledermatology3. Identify strategies and steps for teledermatology reimbursement4:15 pm–5:15 pm Monday, May 6, 2013INDIVIDUAL ORALSession Number: 036Session Title: THE USE OF TELEMEDICINE INOUTPATIENT SETTINGSTrack: Pediatrics Telehealth ColloquiumMeeting Room 12 A/BMODERATOR: James McElligott, MD, MSCR, Assistant Professor.Medical University of South Carolina, Summerville, SC.109 DELIVERY OUTCOMES AND FACTORS INFLUENCING THE USE OFVIDEO TELEHEALTH IN A PEDIATRIC MEDICAL HOMEPRESENTERS AND CONTRIBUTING AUTHORS:Rhonda G. Cady, RN, PhD, Post-Doctoral Research Fellow 1 ,Stanley M. Finkelstein, PhD 1 , Mary M. Erickson, RN, DNP 2 ,Cathy Erickson, RN 1 , Scott Lunos, MS 1 , Hongfei Guo, PhD 1 ,Wendy Looman, RN, PhD 1 , Ann Garwick, RN, PhD 1 .1 University of Minnesota, Minneapolis, MN, USA, 2 Children’s Hospitals andClinics of Minnesota, St. Paul, MN, USA.Integrating advanced practice nurse (APN) delivered clinic-to-hometelehealth into a pediatric medical home for children with complex healthneeds has the potential to change how and where health care service isdelivered. TeleFamilies is an on-going three-armed randomized controlledtrial (NIH R01NR010883) that compares the effects of increasinglevels of telehealth technology and nurse scope of practice on healthcareservice utilization, quality of life, and satisfaction for children withcomplex health needs. Study arms include a medical home model ofphysician-delivered care coordination (control group; n = 55) and twointervention groups using an APN model of care coordination: deliveredvia telephone (T group; n = 54) and delivered via telephone and supplementedwith video telehealth (T + Vgroup;n= 54). Delivery outcomes oftelephone encounters (n = 499) with the T group were compared to deliveryoutcomes of video encounters (n = 88) with the T + Vgroupfora20month period using a generalized estimating equations (GEE) model.Telephone encounters (n = 427) with the T + V group were excluded toreduce potential multiple-X interference threats to external validity. GEEwas used to account for correlations among multiple encounters withinsubject.Delivery outcome categories included relationship building, resolvedhealth/social issue typically not requiring clinic visit, and resolvedacute health issue which prevented clinic/emergency room (ED) visit. Thefrequency of the outcome ‘relationship building’ was significantly greater(p < 0.0001) for video encounters. Video interactions with parent andchild while healthy and in the home setting could influence future encountersand potentially prevent clinic visits. Frequency of the outcome‘resolved health/social issue typically not requiring clinic visit’ wassignificantly greater (p < 0.0001) for telephone encounters and suggestsvideo is not needed for these types of interactions. While video facilitateddiagnosis and treatment of acute conditions, there was no significantdifference between telephone and video encounters for the outcome‘resolved acute health issue/prevented clinic or ED visit.’ APN experiencecould explain this result and a novice clinician could yield differentfindings. The majority of encounters with the T + V group were conductedsolely by telephone. Factors influencing video telehealth use fell intothree categories: APN/parent/child availability, technology limitations,and appropriateness of video telehealth. Availability of APN/parent/childwas the most frequent factor influencing use. Video telehealth was limitedto the APNs workday and availability of child when parents called.Working parents could communicate easily with the APN by telephone,but not so by video. Technology limitations included an unreliable videoplatform that caused hesitancy in using video telehealth. The unreliableplatform was replaced eight months into the intervention and dependabilityof the new platform increased APN and parent confidence in videotelehealth use. Lastly, not all conditions were appropriate for video telehealth.Assessment of some conditions required data unobtainable byvideo (e.g. stethoscope, otoscope) or the location was inappropriate forvideo transmission (e.g. peritoneal area rash). In a few instances, videotelehealth was bypassed with an ED visit due to severity of a sudden onsetcondition. Understanding the outcomes and factors influencing the use ofvideo telehealth is necessary for developing evidence-based guidelinesand future translational research.Objectives:1. Understand how clinic-home telehealth facilitates care coordination ina pediatric medical home.2. Recognize factors that influence the use of telehealth in a pediatricmedical home.3. Describe outcomes of telehealth encounters conducted by an advancedpractice nurse.540 TELEHEALTH IN AN URBAN PUBLIC SCHOOL SYSTEMPRESENTERS AND CONTRIBUTING AUTHORS:Jennifer Herrera-Perdigon, MSN, NP-BC, Clinical TeleHealth Coordinator.UM Miller School of Medicine, Miami, FL, USA.In 2009 the UM Departments of Family Medicine and Telehealth establisheda school telehealth program that built upon an existing physician-centeredpublic school health program in an impoverished part of Miami-Dade county.The Telehealth program consists of pediatric primary care physicians andnurse practitioner overseeing the care for schools’ students, as well as pediatricspecialty consultation with UM specialty physicians providing care indermatology, mental health, nutrition and endocrinology. Recent developmentsinclude the addition of two more public schools to the original sixschool network, expansion of mental health services and the addition of teledentistryas part of a broader Centers for Medicare and Medicaid Services(CMS) innovations grant. A private foundation grant was initially used utilizedto support specialty consultation, but now CMS grant partners includeMedicaid managed care organizations, which will cover the specialty consultationsby fee-for-service reimbursement. This presentation will addressclinical and operational aspects of the school telehealth program; technicaland organizational issues; and challenges & lessons learned that can be appliedin establishing and growing telehealth services in public school systems.Objectives:1. Presentation will address clinical and operational aspects of the schooltelehealth program2. Understand technical and organizational issues3. Learn the challenges & lessons learned that can be applied in establishingand growing telehealth services in public school systems.A-56 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTS813 RAPID RESPONSE FOR AT-RISK CHILDRENPRESENTERS AND CONTRIBUTING AUTHORS:Valerie Lauerman, Bachelor of Science in Nursing, RN, Director, CallCenter Operations.Nurse Response, Saint Louis, MO, USA.NurseWise Ò of Arizona’s (NW AZ) Rapid Response program contributespositively to the promotion of behavioral health wellness by ensuring timelyand adequate access to services for children in the custody of Child ProtectiveServices (CPS). Review of claims data demonstrates high utilization of costlyemergency room and psychiatric hospital services and low utilization ofoutpatient services for this population. Rapid Response clinicians coordinatecompletion of comprehensive intake assessments in the first twenty four hoursfollowing a child’s removal from family of origin and placement into a CPSfoster care home. Success of this program can be attributed to NW AZavailability twenty four hours a day, seven days a week and NurseWise capabilityfor linkage to key community stakeholders such as CPS, fosterparents, intake clinicians and providers. Rapid Response clinicians are responsibleto document and communicate the child’s transition across thecontinuum of care until successfully linked to an outpatient provider. Transitioninformation is used by providers to develop care plans that address theunique needs of each child and family. Focus is given to individual needs,barriers to care and recommendations for services that promote the family’swellness. Rapid Response clinicians are clinically trained registered nurseswith experience in the behavioral health, case management and nursing acutecare arenas. Outcome data supports the value of this program in promotingsuccessful linkage to behavioral health services for an at risk population. Priorto development of this program in 2007, outcome data for average complianceto this timeline was 61%. Average compliance to this timeline through Octoberof 2010 remains steady at 91%. Rapid Response clinicians are alsoresponsible to ensure that children are transitioned to an outpatient providerfor ongoing case management, psychiatric and psychosocial rehabilitativeservices within 21 days of removal from family of origin. This represents 47percentage points improvement for the average compliance to completion ofintakes. Total completion percentage increase from 2007 to 2012 is 110%.Customer satisfaction results yield that Rapid Response clinicians have beenintegral in successfully transitioning families to needed services. Communitystakeholders such as CPS and providers have complimented the ability of ourRapid Response clinicians’ efforts to their success of creating successfultreatment and case management plans for families.Objectives:1. Obtain insight as to how to promote responsiveness in support of atriskchildren through care coordination.2. Learn illustrated outcomes as to how to ensure timely and adequateaccess to services for children in the custody of Child Protective Services(CPS).3. Takeaway ideas for improvement to compliance and proper pediatricutilization of the emergency room, psychiatric hospital services, andoutpatient services.11:00 am–12:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 037Session Title: 627 MODEL POTENTIAL TELESTROKESAVINGS: CAN TELESTROKE SAVE MEDI-CAL ANDMEDICARE MONEY?Track: Outcomes and Evidence Meeting Room 19 A/BMODERATOR: Mario Gutierrez, MPH, Executive Director.Center for Connected Health Policy, Sacramento, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Brett C. Meyer, MD, Co-Director, UCSD Stroke Center 1 , Thomas S. Nesbitt,MD, MPH, Associate Vice Chancellor 2 .1 University of California, San Diego, Stroke Center & UCSD Telemedicine, SanDiego, CA, USA, 2 UC Davis Health System, Sacramento, CA, USA.Telestroke refers to the use of information technology to assist strokecare. In spite of potential benefits of increased rt-PA and improved decision-making,questions about cost remain. Telemedicine research hasalso shown reduced disability and death following stroke, and somestrong signal of cost effectiveness. A main component of the Triple Aimof health care reform is to achieve improvements in the quality of careand health, while reducing per capita costs. Prior work has modeled costsand benefits from a societal rather than a payer perspective. We examinedwhether telestroke would reduce costs for Medi-Cal (Medicaid inCalifornia) and Medicare by decreasing lifetime stroke care costs andwhether the programs would experience savings from current and futureenrollees. We developed and assessed a robust model of stroke care forboth usual care and telestroke, tracing stages from hospitalizationthrough long-term care. Costs were identified at each stage as were eachtreatment and outcome probability. Costs that a public payer would incurat each stage were estimated. To test the dependence of our results onindividual input parameters, we conducted a sensitivity analysisinwhichwe varied key input parameters across a likely range. Our analyses suggestthat Medicare could experience cost savings of $1,100/enrollee,while Medi-Cal could experience cost savings of $2,400/Medi-Cal onlypatient and $600/dual eligible patient. Both systems could experiencesavings in the 90-day and lifetime timeframes. Increasing access to telestrokealso reduces costs associated with current and future beneficiaries.For every 100 patients that gain access to telestroke, the Medi-Calprogram would save $44,000 and the Medicare program $85,000.Medicare and Medi-Cal experience additional savings ($29,000 and$9,000/100 patients, respectively) from the reduction in disability levelsfor patients that become eligible for these programs after the initialstroke. When telemedicine and facility fees are taken into account thesesavings decrease, but do not disappear. Though the results are sensitive tovarious input assumptions, sensitivity analysis does suggest that telestrokeis likely to produce cost savings to public payers under a majorityof the potential outcomes. This is a relatively robust modeled analysis oftelestroke vs. usual care costs from the public payer perspective. Thoughlimitedbyitsnatureofonlybeingascaledmodelofestimatedcostswithvarious assumptions, this modeling does show that these payers couldindeed experience cost savings. Both programs could also experienceadditional savings from privately insured or uninsured stroke victims.The more widespread adoption of telestroke is dependent on a very realprovider and hospital upfront and continuedinvestmenttodevelopandutilize these systems. Technology costs were not included as this analysisis from a payer’s perspective. Widespread adoption of telestroke would beaccelerated if payer savings were then shared with providers and hospitalfacilities providing these services.Objectives:1. To learn in addition to demonstrated societal benefits of informationtechnology (telestroke) to improve decision-making in stroke care, costsavings can also be achieved in Medi-Cal and Medicare.2. To gain a deeper understanding of how the widespread adoption oftelestroke can be a significant contributor to the achievement of theTriple Aim of health care reform.3. To achieve the promise of cost savings from widespread use oftelehealth, payers will need to adopt policies that share the financialbenefits with hospitals and providers who bear the upfrontcosts.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-57

CONCURRENT ORAL PRESENTATIONS ABSTRACTS11:00 am–12:00 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 038Session Title: ENHANCING MARKETABILITY AND THEBOTTOM LINETrack: Finance and Operations I Ballroom EMODERATOR: Joseph Ternullo, JD, MPH, Associate Director, Center forConnected Health.Partners Healthcare System, Boston, MA, USA.132 PRIVILEGING YOUR PROVIDERS PRACTICING TELEMEDICINE?WHY YOU SHOULD!PRESENTERS AND CONTRIBUTING AUTHORS:G. Ronald Nicholis, MD, FAAP, FHM, Director of Telemedicine.Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA.Telemedicine is a relatively new and growing practice for most providers ofhealthcare. Many organizations do not have established methods for privilegingtheir providers because it is so new. For any organization it is important providersusing this technology conform to some simple standards unique to telemedicinein order to provide the patient a personable and effective encounter.In addition, to their audio-visual presentation to the patient the provider must beable to manage the technology professionally to maintain the patient’s confidencein their care. I will discuss the role ‘‘privileging’’ can play to enhanceprovider confidence in their telemedicine practice and at the same time enhancethe credibility of your telemedicine program. The privileging process used in ourregional pediatric referral center will be shared to include:- Telemedicine principles, agnostic to the equipment they will use, taughtour providers- Provider and Patient evaluation questionnaires- Focused Professional Practice Evaluation (FPPE) and Ongoing ProfessionalPractice Evaluation (OPPE) training and proctoring523 IMPROVING FACILITY REPUTATION WITH TELEMEDICINEPRESENTERS AND CONTRIBUTING AUTHORS:Joel E. Barthelemy, Founder and Managing Director.GlobalMed, Scottsdale, AZ, USA.Many small hospitals and those in rural areas do not have favorablereputations in their communities due to the perception, warranted or not,that they lack sufficient resources and treatment experience to provide adequatehealthcare. As a result, patients drive to larger, urban medical centers.A recent study by BlueCross BlueShield of Tennessee Health Institutehighlights this problem. It found that nearly half of Tennesseans living inrural areas who seek healthcare bypass the hospitals closest to their homes,even if their local hospitals offer the same services as the more urban settings,for big city facilities. Unless steps are taken to improve the perceptionsof smaller hospitals in their communities, Steven L. Coulter, MD, president ofthe Health Institute believes the hospitals will have to decide to close or sellout a company that knows how to stop the patient migration. Unfortunately,smaller hospitals rarely have specialty care, so when patients present withsymptoms of stroke or cardiac problems, patients must be transferred tohospitals in larger cities, usually via expensive ground ambulance or helicopter.In this presentation, Joel E. Barthelemy - Founder and ManagingDirector of GlobalMed will explain how several hospitals turned the negativeperceptions into very positive relationships within their communities. Theresults indicate that those hospitals that have embarked on telemedicineprograms to import specialty care to their communities retain more patients,increase bed rates and improve their bottom line. The Copper Queen CommunityHospital (CQCH) in Bisbee, Arizona, is within three miles of theMexican border. Until December 2009, patients presenting at the hospitalwith potential heart problems had to be transferred to a Tucson medicalcenter, 85 miles away. The hospital utilized emergency helicopter flights thatcost $10,000 per patient. While in Tucson, it was common for a two or threeday hospital stay for evaluation and tests to run another $10,000. In December2009, the CQCH started a telecardiology program. During the first sixmonths of the program, 36 patients with cardiology issues presented atCQCH. After a telemedicine evaluation, only nine had to be transferred toTucson. The other 27 were given medication, a heart monitor, and/or werekept for observation in Bisbee. CQCH CEO James Dickson believes the telecardiologyprogram saved the healthcare system more than $500,000 in justsix months. By increasing the bed rate at CQCH with patients who otherwisewould have gone to Tucson, the hospital is one of the few acute care, criticalaccess hospitals to boost their bottom lines and be in the black. Telemedicineprograms provide specialty care to rural areas where it otherwise did notexist. Thanks to telemedicine, specialists help decide whether the patient canstay in the local hospital or should be transferred. Since in the past a hospitalmay have erred on the side of caution, more patients are able to remain intheir communities. Bed rates at these hospitals rise, and word spreads in thecommunity about the hospitals’ ability to provide quality, specialtyhealthcare.Objectives:1. Understand the dilemma smaller hospitals face in their communities.2. Learn what hospitals facing a reputation problem are doing about it.3. See what a sustainable telemedicine program looks like.583 MOVING FROM TELEHEALTH PROVIDER TO TELEHEALTHCERTIFYING AGENCYPRESENTERS AND CONTRIBUTING AUTHORS:Michael Manley, RNP, MNSc, Outreach Director for ANGELS and Center forDistance Health, Tina Butler, MNSc, WHNP-BC, APN, Dustin Vance, TCAP.University of Arkansas for Medical Sciences, Little Rock, AR, USA.With the advent of telehealth growing across America, more and moreentities are expecting reimbursement for providing services over a distance;however, not all technologies are equal when it comes to quality and safety,which can greatly affect reimbursement, and more importantly patient care.Recently, it had been requested that Arkansas Medicaid pay for rehabilitativeservices for persons with mental illness (RSPMI) being provided via telehealth.This request came at an ideal time in the development of Arkansas’s healthcaresystem: Arkansas e-Link, a 456-partner, statewide broadband infrastructure,was being implemented. With such telehealth capabilities, it only made sincefor Medicaid to devise a solution to increase access for children in need ofRSPMI to the limited providers giving these services. Medicaid requested thatthe University of Arkansas for Medical Sciences’ (UAMS) Center for DistanceHealth provide guidance and form a committee to develop guidelines andtechnical specifications to allow an RSPMI provider to deliver his or herhealthcare services over the Telehealth Network. As such, the committee developedguidelines and technical parameters to ‘‘certify’’ a provider to bereimbursed for the delivery of RSPMI care over interactive video. Preceded bypaperwork and technical specification checks, the certification is completedwith a physical inspection of a facility’s telemental health equipment locationto ensure HIPAA requirements are met and the technology will integrate withUAMS’ network. Once a facility passes inspection, the contract is received, thefees are collected, and the site receives its certification. The Center for DistanceA-58 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSHealth is a long-standing leader in the state’s providers of telehealth, somoving into the arena of Certification Agency came naturally because of theCenter’s vast experience. It is a different mode of responsibility that ensuresthe Center continues to be up-to-date and innovative with its own telehealthdelivery infrastructure. Providing quality care safely (through HIPAA regulations)and effectively (through nationally recognized broadband recommendations)creates better outcomes for the patient and allows the scarceproviders to be more efficient in their expertise. This presentation will describeto attendees the transformation and process the Center for Distance Healthwent through in order to evolve into its new, expanded role in the everchanginghealthcare system.Objectives:1. The audience will understand the importance of a Telehealth certificationprocess for a clinical delivery system.2. The audience will be able to apply the certification processes in theirindividual telehealth systems.3. The audience will understand the process of moving from a Telehealthclinical provider to telehealth certification provider.11:00 am–12:00 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 039Session Title: PROGRAM DESIGN FOR SUCCESSFULSPECIALTY CARETrack: Finance and Operations II Ballroom FMODERATOR: Ed Brown, MD, Chief Executive Officer.Ontario Telemedicine Network, Toronto, ON, USA.297 TRANSITION FROM GRANT-FUNDED TO A SELF-SUPPORTINGBURN TELEMEDICINE PROGRAM IN THE WESTERN USPRESENTERS AND CONTRIBUTING AUTHORS:Katie Russell, MD, Surgical Resident, Jeffrey R. Saffle, MD,Louanna Theurer, BS, Stephen E. Morris, MD, Amalia L. Cochran, MD.University of Utah, Salt lake City, UT, USA.Background: Burn center care is one of the smallest surgical specialties inAmerica, with only US 56 centers verified by the American College of Surgeons.Many Americans have no convenient access to burn centers, and this isespecially true for the Mountain West. A number of telemedicine programshave been founded on grant support, then failed when this support expired.Our burn center has transitioned successfully from a small grant-fundedproject to one which is increasingly busy, financially viable, and of greatvalue in our region.Methods/Results: The University of Utah Burn Center is a 12-bed facilitywhich provides the only dedicated burn center serving all of Utah, Idaho,Montana, and parts of Wyoming, Colorado and Nevada, one-fifth the geographicalarea of the continental US, with a total population of 5.8 million.Patients are referred from as far as 800 miles away, which makes even smallerrors in over- and under-triage costly and dangerous, and often makes patientfollow-up at our facility impossible. To address these problems, we begana small telemedicine program with three hospitals in Idaho and Montana in2005 with a Technology Opportunities Grant from the US Dept of Commerce.During the three years of the grant, we evaluated approximately 62 patients/year, and documented reductions in transports and improvements in initialburn assessment. After the grant expired in 2009, activity declined. However,with continued support of telemedicine by burn center staff and our regionalpartners, referrals rebounded; we began scheduled televideo clinics for patientfollow-up from over 40 hospitals and rural clinics, and encouraged store andforward evaluation for emergency patient consults. From a low of 47 consultationsin 2009, the program has grown, with projections for well over 300visits in 2012. We connect to several regional, federal, and state-run telemedicinenetworks using a number of platforms. Licensure, credentialing, andliability have been addressed. Billing for telemedicine evaluations is successful,with reimbursement equal to that of our face-to-face hospital clinic.Keys to the success of our program include engaging the entire burn team intelemedicine use, providing studios both within the burn center and in attendingphysicians’ homes, and employing a full-time telemedicine coordinator.The program is tremendously popular with patients and providersbecause of its convenience, rapid access to expertise, and ability to obtainprolonged, multi-visit follow-up for wound assessment and rehabilitation.Conclusion: We have successfully transitioned from a grant-funded ‘‘pilot’’project to a financially-successful and increasingly popular telemedicineprogram which brings our expertise within reach of even the farthest cornersof our far-flung catchment area.Objectives:1. Describe the methods used to successfully transition to a self-supportingburn telemedicine system2. Understand the challenges of providing burn care to a vast, sparselypopulated area3. Understand the advantages of a rural burn telemedicine program312 TELEHEALTH ADOPTION IN MULTIDISCIPLINARY CANCER CARESERVICESPRESENTERS AND CONTRIBUTING AUTHORS:Caterina Masino, MA, Analyst, Dana Chmelnitsky, MBA, PMP,Peter G. Rossos, MD, MBA, FRCP(C).University Health Network, Toronto, ON, Canada.Introduction: At the University Health Network (UHN) in Toronto, a decentralizedmultidisciplinary Telehealth program model has been successfulat significantly increasing Telehealth clinical adoption and integrationwithin various clinical programs and patient care areas. In FY 2011-12,over 3200 teleconsultations were completed resulting in a 14% increasefrom the previous year. A main success factor for the its growth and sustainabilityis the reversal of the traditional referral patterns early on in theprogram’s infancy, where referrals for Telehealth services at UHN aregenerated from within the organization rather than externally as in traditionalprograms.Background: Although Telehealth services at UHN have been used in a varietyof clinical applications across three specialized consultant hospital sites,its adoption within the oncology service domain has been more complex. ThePrincess Margaret Cancer Program (PMH) offers comprehensive multidisciplinarycancer care with a clinical program organized by modality-based anddisease-specific interprofessional groups. In the early years, Telehealth atPMH was adopted by a few Telehealth clinician champions within the BoneMarrow Transplant department of medical oncology. Recently, the use ofTelehealth at PMH has undergone a positive shift and Telehealth adoption nowspans various modalities and multidisciplinary professionals within the departmentsof surgical oncology, radiation medicine, medical oncology, psychosocialoncology and cancer genetics. This presentation will highlight keystrategies of Telehealth adoption, successes, challenges and lessons learned.Methods: Over the years, the UHN Telehealth program has employed multiplestrategies to encourage adoption of Telehealth services for oncologypatients. Key elements include:1. Promotion and awareness about the Telehealth program services toboth clinicians and patients;ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-59

CONCURRENT ORAL PRESENTATIONS ABSTRACTS2. Proactively pursuing opportunities to secure telehealth-enabled clinicrooms/space for equipment, thereby promoting service visibility inclinical areas;3. Finding Telehealth champions including patient flow coordinators andadministrative staff; and4. Telehealth integration within patient scheduling systems.Results: In FY 2011-12, the PMH Cancer program completed 372 teleconsultationswith the majority in surgical oncology (64%), 20% in radiationmedicine, 7% in genetics, 6% in medical oncology, and 3% in psychosocialoncology visits. In particular, Telehealth use by surgical oncologists has steadilyincreased over the last 3 years with an average growth of 53%. Currently, tomaintain uptake and sustainability, the following initiatives were undertaken:1. Using a combination of mobile units, satellite studios in clinical areas,and desktop units in offices;2. Implementation of a scalable technical support model including trainingtools that allows expert users to facilitate their teleconsultations;3. Working collaboratively with clinicians to create Telehealth environmentsthat are adapted to their unique clinical requirements; and4. Using data to drive adoption.Conclusion: Although a number of unanticipated effects will be shared, bothsuccesses and obstacles have enriched our knowledge and maybe useful toother programs to take into consideration.Objectives:1. Gain awareness of the complex service delivery in cancer care and howit may or may not align with a traditional telehealth service delivery.2. Understand the changing interrelationship between technology use andprovider workflow.3. Learn best practices for creating a collaborative telehealth environmentfocused on delivering the best patient-centered experience.130 OUTCOMES ASSOCIATED WITH A HYBRID TRADITIONALAND TELE-INTENSIVIST MODELPRESENTERS AND CONTRIBUTING AUTHORS:Jeffrey Sadowsky, MD, Director of Telemedicine for Critical Care Medicineat Orlando Health, Carlos Carrasco, OT, MBA, Megan McLendon, MS-HSA.Orlando Health, Orlando, FL, USA.A hybrid traditional and tele-intensivist model is a model of care usingtraditional intensivist care during the day and remote presence technologyafter-hours (5pm-7am). The remote presence physician’s activities mimic thatof an in-house intensivist. They review patient treatment plans, interacts withnurses, respiratory therapists and other caregivers, as well as, discuss thepatient’s status with family members. These physicians also evaluate newadmissions to the ICU and can be available to participate in rapid responsealerts and inpatient deteriorations. Because the remote presence device isguided by many of the same physicians present in-house during a patient’sstay, continuity is improved and the patient/family and physician relationshipsare enhanced. Since inception in 2011, this hybrid model has enabledintensivists to manage an average of 25 patients per night, at 3 communityhospitals, within the Orlando Health system. Utilization of this technology hasallowed for a an estimated savings of $1.3 million, all while providing a modelof care that is comparable to the in-house physician care model. The clinicaloutcomes observed during the time of this hybrid model’s implementation,suggests improved efficacy with a 1.05 day decrease in length of stay forpatients in the ICU. A small increase in ventilator days was seen which isbelieved to reflect a higher patient acuity at the community hospitals. Prior tothe use of the hybrid model , these patients would have been transferred to atertiary center, due to limited intensivist resources at these community hospitals.Satisfaction levels from caregivers in the ICU are overwhelminglypositive, as a result of the accessibility of the intensivist. When situationsarise, there is little to no delay in response or treatment when compared withexperiences in more traditional environments without a telepresence. Thecommunication among staff and with patients’ family members also increased,secondary to the presence of the technology and subsequent accessibilityof the intensivist. While some technical limitations exist, this hybridmodel of care increased physician presence and accessibility, benefittingpatients, their families and caregivers. The improved physician presence allowedthe community hospitals to care for higher acuity patients, smoothershift transitions and enhanced communication between caregivers.Objectives:1. To describe a hybrid traditional and tele-intensivist model of care.2. To review clinical and financial outcomes perceived to be associatedwith the hybrid traditional and tele-intensivist model of care.3. To describe patient and staff perception and satisfaction with a hybridtraditional and tele-intensivist model of care11:00 am–12:00 pm Tuesday, May 7, 2013DISCUSSION PANELSession Number: 040Session Title: 791 WHAT WE KNOW ABOUT PRIVATEPAYERS AND TELEHEALTH: A SURVEY EXPERIENCEOF THE TELEMENTAL HEALTH AND BUSINESSAND FINANCE SIGSTrack: Finance and Operations II Ballroom GMODERATOR: Nina M. Antoniotti, RN, MBA, PhD, Director of TeleHealth.Marshfield Clinic, Marshfield, WI, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Nina Marie Antoniotti, RN, MBA, PhD, Director of TeleHealth Business 1 ,Kenneth Drude, PhD, Clinical Psychologist 21 Marshfield Clinic, Marshfield, WI, USA, 2 Positive Perspectives, Fairborn,OH, USA.Often, the focus of efforts to understand and obtain reimbursement forTeleHealth services is focused on payer mixes heavy with Medicare andMedicaid as well as dual eligible patients. Little seems to be known aboutprivate payer reimbursement across the United States despite multipleattempts to identify all private payers in each state. Payers often changepayment policies from year to year, paying for TeleHealth services on year,and not the next. Some payers pay the facility fee, for home TeleCare, andfor remote monitoring, as well as store-and-forward, while others do not.The TeleMental Health Policy Subcommittee and the Business and FinanceSIG, with the help of ATA staff, conducted a private payer reimbursementsurvey. The survey was sent out to over 13,000 eligible respondents, bothfrom within ATA and outside of ATA. An impressive response was experienced.The results of the survey were surprising. This discussion panelwill relay the results of the survey and what was learned about privatepayer reimbursement across the United States. In addition, many respondentswere from Canada and outside North America. Information wasgained about other countries’ reimbursement issues. The results of thesurvey will be discussed, with each question and its impact on private payreviewed and analyzed. The discussion panel allows participants to talk totwo experts in TeleHealth reimbursement from the TeleMental Health andBusiness and Finance SIG. This collaborative discussion panel between twoATA SIGs supports ATA’s goal of cross-SIG activities and the advancementof understanding of reimbursement for TeleHealth. Participants will gainknowledge of the current state of private pay for TeleHealth in the UnitedA-60 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSStates and will have an opportunity to discuss specific individual programreimbursement questions regarding private payers.Objectives:1. Understand the level of private payers who support Telehealth acrossthe country2. List five private payers who pay for Telehealth in the US3. Relate strategies for understanding how to determine if private payersin specific areas support Telehealth11:00 am–12:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 041Session Title: 141 THE TELE-ICU: HOW TOCOMMUNICATE, COMPARE, AND EVALUATE MODELSOF CARE, TECHNOLOGY, AND VALUE?Track: Best Practices and Service Delivery Models I Meeting Room 17 A/BMODERATOR: Herb Rogove, DO, FCCM, FACP, CEO.C3O Telemedicine, Ojai, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Herb Rogove, DO, FCCM, FACP, CEO 1 , Theresa Davis, RN, MSN, PhDc,Clinical Operations Director enVision eICU 2 , Neal Reynolds, MD, Director,ICU 6th Floor R. Adams Cowley Trauma Ctr 31 C3O Telemedicine, Ojai, CA, USA, 2 Inova Health, Falls Church, VA, USA,3 University of Maryland School of Medicine, Baltimore, MD, USA.The combination of the rising need for ICU beds, the high cost of caring forthese patients, along with the growing shortage of intensivists is an ongoingproblem that will only intensify to crisis levels over the next decade or sooner.A major solution lies in the implementation of Tele-ICUs that will allow accessto Leapfrog compliant hospitals that need not be isolated by geography alone.While the concept of the Tele-ICU has been around for over twenty-five years,hospitals are at a disadvantage of not understanding how to evaluate, compare,and see value in these programs. The panel will take a critical look at allcare delivery models and answer the question, what is the best-fit and mostaffordable solution for their hospital or healthcare system? Do they need 24/7Tele-ICU monitoring or will the Reactive model in which the Tele-Intensivistwho is on-call as needed for a critical care consultation suffice? Is there a needto invest in a costly closed architecture system with bricks and mortar or willan open architecture system of remote communication by laptops and tabletssolve the need? What are the key components of structure, process, andoutcomes that are needed to implement a Tele-ICU program? Does the datasupport the outcomes and value of the Tele-ICU? What is the value drivenformula for investing in the Tele-ICU solution especially for smaller or ruralhospitals? Finally, participants will learn how the ATA Tele-ICU SIG isworking to develop guidelines and serve as an excellent resource for hospitalspursuing remote ICU programs. These and other pertinent questions will beanswered by a qualified panel of physician and nursing leaders who utilizedifferent technologies and represent experienced and respected programs in alarge hospital system, an academic medical center and a physician serviceprovider medical group.Objectives:1. To demonstrate how the Tele-ICU will provide a solution to the growingvolume of ICU patients and the increasing shortage of intensivists.2. To provide healthcare leaders with the tools to evaluate, compare, andunderstand the value of different Tele-ICU models.3. To ask the right questions in designing and implementing a Tele-ICUprogram11:00 am–12:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 042Session Title: 762 TELERADIOLOGY, TELEPATHOLOGY,TELECARDIOLOGY – SEPARATE NETWORKSOR INTEGRATED APPROACHESTrack: Best Practices and Service Delivery Models II Meeting Room 16 A/BMODERATOR: Sarah Sossong, MPH, Director of Telehealth, Mass GeneralTeleHealth.Massachusetts General Hospital, Boston, MA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Garry Choy, MD, Radiology, Division of Teleradiology, David Wilbur, MD,Director of Pathology Imaging, Jason H. Wasfy, MD, MPhil, Chief Fellow inCardiology, Roman DeSanctis Clinical Scholar.Massachusetts General Hospital, Boston, MA, USA.In this session, the Medical Directors for Telecardiology, Telepathology, andTeleradiology will provide perspectives on the current state and future direction oftheir programs. Each medical director will address key components of their currentservice delivery model including the core business model, image transfer solutions,research, patient tracking, and the logistics of marketing and contracting.With the creation of Mass General TeleHealth, these three programs are comingtogether to identify common solutions where it makes sense for their servicedelivery network. Each medical director will provide their perspectives on thework currently underway to develop integrated approaches with a focus on imagetransfer, documentation, billing, contracting, and branding and marketing.Objectives:1. Identify the differences between telecardiology, telepathology, and teleradiologythat have resulted in the development of separate networks.2. Identify the commonalities across teleradiology, telepathology, andtelecardiology that lend themselves to an integrated approach.3. Share approaches for bringing together diverse stakeholders that haveworked well and lessons learned about strategies that have not been assuccessful.11:00 am–12:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 043Session Title: 173 TELEHEALTH IMPACT ON AWORKPLACE HEALTH PROGRAM – REDUCING COSTS/INCREASING CARETrack: Innovations Meeting Room 18 C/DMODERATOR: Rob Sprang, MBA, Director, Kentucky TeleCare.University of Kentucky, Lexington, KY, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Rob Sprang, MBA, Director, Kentucky TeleCare 1 , Raymond Wells, MD,Owner 2 , Kimberly Roe, Clinical Coordinator 21 University of Kentucky, Lexington, KY, USA, 2 Raymond Wells PSC,Lexington, KY, USA.The 2012 Towers Watson Onsite Health Center Survey of 74 employers representingover 1.7 million employees was targeted to companies that haveª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-61

CONCURRENT ORAL PRESENTATIONS ABSTRACTSestablished, or are planning to establish, onsite health centers. While only 8%have implemented telemedicine technology, 28% are considering such an implementation.While this is a small sample, it offers evidence of the tremendousopportunity for telehealth programs to work with employer-based health programsto utilize technology to facilitate their efforts to improve employee health,increase employee productivity and reduce the rapidly escalating cost ofhealthcare. The Appalachian Mountainsarerichwithcoal,andmuchoftheindustry in the region is fueled by coal generated power. As coal mining operationshave become more mechanized, fewer people are employed in the industry,but every employee is vital to the productivity of the operation of the mine. Theaverage coal miner is over 50 years old, and there is a significant shortage ofyoung people to backfill the positions of retiring miners. The survival of the coalindustry is dependent upon keeping existing employees healthy and productivefor as long as possible and attracting new workers with appropriate skills to theindustry. Easy access to worksite health services can offer a company a competitiveadvantage to retain existing workers and to recruit new employees.Telehealth programs across the country struggle with many legal and regulatoryissues, but the most significant is reimbursement for telehealth-delivered clinicalservices. Workplace health programs that choose to leverage telehealth technologyto improve access to healthcare for employees are able to negotiate suchreimbursement into their health plans, thus eliminating this barrier. This presentationwill focus on a specific example of how a large, multi-state coal miningcompany worked with a community-based FamilyMedicinephysicianandtheUniversity of Kentucky to develop a workplace health program that includedtelehealth technology at each mine site and corporate office to (1)bring highquality healthcare services to rural, isolated employees and their dependents, (2)launch a wellness program that has had a significant positive impact on the wellbeingof its employees, (3) increase employee productivity and (4) reduce the costof healthcare while providing expanded access to care. It will become evident tothe participants that without telehealth technology, this forward-thinking initiativewould not have been possible. The data presented, such as, (1) the 14%improvement in health status, measured by ‘‘heart health age’’ vs. real age, (2)productivity improvements, measured by a 20% reduction in employee absencesand (3) financial benefits, as measured by a 7% reduction in the per employee/permonth healthcare cost will help telehealth programs and employers recognize thevalue of a telehealth-enhanced worksite health program and will lead to newopportunities for telehealth initiatives in the workplace.Objectives:1. Understand the growing interest in workplace health programs fromthe perspective of a multi-state industrial company that has implementedsuch a program.2. Understand how telehealth services can be the foundation for aworkplace health program.3. Understand how the highlighted program reduced per employeehealthcare costs by 7% while the industry average increased 9% andreduced absences 18% during one year.11:00 am–12:00 pm Tuesday, May 7, 2013Rene Y. Quashie, J.D., B.S., Semior Counsel 2 ,Marlene M. Maheu, PhD, Executive Director 31 Massachusetts House of Representatives, Boston, MA, USA, 2 Epstein Becker &Green, Washington, DC, USA, 3 TeleMental Health Institute, Cheyenne, WY, USA.One of the most daunting barriers to telehealth is professional licensure, whichoften restricts practice across states, resulting in the need for multiple licensures,fees and the paperwork. For decades, regulators have been in disagreement aboutdiffering requirement standards and enforcement approaches, leaving manypractitioners caught in the crosshairs and burdenedbydifferentrequirements.The Commonwealth of Massachusetts recently approved a law that requires areport be submitted to the state examining how physicians licensed anywhere inthe United States can consult, diagnose and treat Massachusetts residents byInternet video examinations. The law includes this mandate: ‘‘the board of registrationin medicine shall conduct a report on the potential for out-of-statephysicians to practice telemedicine in the commonwealth.’’ Massachusetts appearsto be leading the way in examining how a telemedicine license will integratewith meaningful use for EHRs and HITs. Massachusetts’ consideration of atelemedicine license was preceded by other innovative policy change, that is,mandated health insurance coverage. Because of these developments, Massachusettsmay prove to be a bellwether for creative and comprehensive approachesto solving some very complex regulatory challenges. As such, Massachusetts isworthy of note by telehealth professionals, vendors and other stakeholders. Californiaalso recently passed a law that sets the bar for various issues of relevanceto telehealth, such as practicing from the home and the need for in-personassessment prior to delivering telehealth. However, not all states are as progressive.States like Georgia has a medical board that is considering rules to maketelemedicine more restrictive. This presentation will focus primarily on theconsiderationsweighedbyMassachusettsandotherkeystatesintryingtomanage the complex issues raised by consumers who are increasingly demandinghealthcare delivered via technology. It will review the arguments for and againstthe outdated, inconsistent and inadequate licensing rules currently in forcearound the country. Recommend paths will also be outlined and a discussion withthe audience will be invited. The panel will include: (a) Representative DanielWinslow from Massachusetts who wrote the telemedicine bill who can explainthe reasons behind the law and any objections to its passage; (b) Rene Y. Quashie,Senior Counsel at the Washington, DC law office of Epstein Becker Green, whowill focus on legislative and health policy and general compliance; and (c)Marlene M. Maheu, PhD, Executive Director of Telemental Health Institute, Inc.,who will focus on the practical implications of the laws and provide recommendationsabout how to proceed. This panel will be moderated by Tania S.Malik, J.D., with over 20 years of legal and regulatory experience.Objectives:1. Know about the innovative initiatives (and some restrictive actions)taking place in different states to address telemedicine licensure andrequirements, particularly in Massachusetts.2. Understand the practical meaning on those initiatives on providersregarding malpractice insurance, electronic medical records, meaningfuluse, and potential disciplinary actions.3. Understand the effect of mandated coverage on telemedicine.PRESENTATION PANELSession Number: 044Session Title: 242 NOTEWORTHY INITIATIVESINFLUENCING NATIONAL LICENSURE IN TELEHEALTHPRACTICETrack: PolicyMeeting Room 18 A/BMODERATOR: Tania S. Malik, JD, CEO.COPE Today, Raleigh, NC, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Dan Winslow, J.D., State Representative (R-Norfolk) 1 ,11:00 am–12:00 pm Tuesday, May 7, 2013HOW-TO PANELSession Number: 045Session Title: 218 FROM CONCEPTUALIZATION TOIMPLEMENTATION: HOW TO CREATE A SCHOOL-BASEDTELEHEALTH CLINIC IN YOUR SCHOOL SYSTEMTrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BA-62 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSPRESENTERS AND CONTRIBUTING AUTHORS:Sherrie Williams, LCSW, School Based Health Liaison,Matthew Jansen, MPA, Executive DirectorGeorgia Partnership For Telehealth, Waycross, GA, USA.Rural areas of the United States have historically gone unserved orunderserved in terms of healthcare. School based telehealth care is arelatively new modality for delivering care to the most vulnerablemembers of our communities: children. Rural areas have many barriersto overcome in terms of healthcare, with one of the barriersbeing lack of primary care providers and specialty care providers. InGeorgia, over the past 15 year, initializing school based health centershas been difficult. With the introduction of telemedicine as a part ofthe school based health clinic, Georgia has moved from two clinics to13. Ten of the clinics are utilizing telemedicine as a way to providecare. This panel will teach you the steps in conceptualizing and implementinga school based telehealth center in your school system.You will walk away with a road map that can be translated to yourcommunity.Objectives:1. Articulate the meaning of School Based Health Clinics2. Describe how telemedicine can be incorporated into a School BasedHealth Clinic3. Develop a plan for developing a School Based Telehealth Clinic1:15 pm–2:15 pm Tuesday, May 7, 2013DISCUSSION PANELSession Number: 046Session Title: 823 A NEW CONSENSUS-BASEDAPPROACH TO DEVELOP GUIDELINES ANDOUTCOMES FOR TELEMENTAL HEALTHTrack: Outcomes and Evidence Meeting Room 19 A/BMODERATOR: Matt Mishkind, PhD, Program Lead, Research PsychologistNational Center for Telehealth and Technology (T2), Tacoma, WA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Jay Shore, MD, Associate Professor 1 , Trish Jordan, PhD, ResearchPsychologist 2 , Francis McVeigh, OD, Senior Clinical Consultant-Vision andTelehealth 3 , Mike Lynch, PhD, ABPP, Chief, Department of Tele-Health 4 ,Alexander Vo, PhD, Vice President 5 , Thomas Kim, MD, MPH 61 University of Colorado Health Sciences Center, Denver, CO, USA, 2 PacificTelehealth & Technology Hui, Honolulu, HI, USA, 3 TATRC, Ft Detrick, MD,USA, 4 Northern Region Medical Command, Arlington, VA, USA,5 Electronically Mediated Services, Denver, CO, USA, 6 AGMP, Austin, TX,USA.Telemental health (TMH) has advanced on historic promises to improveaccess, cost, and quality of care. However, the extent to whichthese promises have been achieved is unclear as the impact based onconsistent evidence and consistent measurements is still developing.Many have identified the need for a more standard evaluation model toimprove perceptions of the field, promote advancement of a sounderempirical base, and promote collaborations and multidisciplinary research.The ATA’s TMH Special Interest Group (SIG) made a commitmentto address this issue. This panel presentation will discuss the results andprocess of a collaborative workgroup designed to form broad consensuson the selection of assessment and outcome measures that best reflectthe impacts of TMH. The TMH SIG convened a group of 25 TMH expertsrepresenting academia, private practice, private industry, and the federalgovernment during the 2012 ATA Fall Forum in New Orleans, LA toparticipate in a consensus building workshop run by the University ofNebraska’s Center for Collaboration Science. The workshop followed aproven process to efficiently build consensus through group work. Theoverall purpose of this workshop was to lay the foundation for a whitepaper to guide the telemental health field towards unity in the appropriateselection of assessment and outcome measures. Additionally, staffmembers from the ATA observed the process to assess whether a consensusworkshop format may be useful for Special Interest Groups (SIGs)working on group documents in the future such as standards, guidelinesand white papers. This panel presentation will be comprised of bothworkgroup participants and ATA staff who observed the process. Thepanel moderator will begin with a brief overview of the process and theoverall results. The workshop participants will then be asked to provideadditional details on specific categories of outcome measures that wereidentified during the workshop to include: 1) Acceptability, 2) SymptomOutcomes, 3) Access, and 4) Cost. Workshop participants also identifiedthe need to develop a framework of perspectives to better align outcomeswith programmatic needs. Each participant will be asked tocomment on how the above categories align with patient, provider,health system, and societal perspectives. This will include a discussion ofconcepts, such as readiness, that were identified during the process asnecessary precursors to initiating TMH programs. Participants will alsoelaborate on how the different stakeholder groups such as academics,private practitioners, and governmental agencies can utilize a morestandard approach to outcomes measurement. Finally, all participantswill discuss the consensus building process and whether they believe itis valuable for future efforts.Objectives:1. Audience members will leave this presentation with a better understandingof the types of outcomes that the TMH field believes are mostappropriate.2. Audience members will leave this presentation with a better understandingfor how to demonstrate potential telemental health programsuccesses.3. Audience members will leave this presentation with a better understandingfor how to consider and evaluate multiple outcomes.1:15 pm–2:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 047Session Title: MARKETING & PATIENT ENGAGEMENTSTRATEGIESTrack: Finance and Operations IBallroom EMODERATOR: Neil Versel, Freelance Healthcare Journalist.Chicago, IL.703 NEXT GENERATION PATIENT ENGAGEMENT: WHAT HEALTHCARECAN LEARN FROM ADVERTISINGPRESENTERS AND CONTRIBUTING AUTHORS:Bing Doh, MBA, CEO.HealthCrowd, Cupertino, CA, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-63

CONCURRENT ORAL PRESENTATIONS ABSTRACTS- getting exposure for a product or service,- increasing the chances of the product or service being adopted,- increasing the chances that the product or service could be used,- enhancing the way a product or service is used, and- improving the reputation of a telehealth solution.ABSTRACT WITHDRAWN448 SMARTER SOCIAL MEDIA - 10 WAYS TO MAKE IT WORK FORTELEHEALTHPRESENTERS AND CONTRIBUTING AUTHORS:Nirav Desai, BS, MS, MBA, CEO.Hands On Telehealth, Marietta, GA, USA.The buzz around social media in healthcare has been around for quite sometime. There is less clarity for how social media can specifically be applied totelehealth. It’s not about getting onto Facebook and talking to patients (althoughthere are ways to do that appropriately). It’s important to first understandthe benefits that social media can bring to the table for a telehealthsolution. These include:Once you understand these objectives, you can identify which social mediatools can support them. In this presentation, we will overview some of themost common social media: blogs, LinkedIn, Facebook, Twitter, and YouTube.Then we will overview how these media can be used in the context ofhealthcare and specifically telehealth. We will provide examples from both theprovider and industry side to show how these media are being used to effectivelygrow telehealth programs and products. We will even use an examplefrom the ATA. Ultimately, these examples will show how social media is a wayof building relationships with different constituents. Finally, because socialmedia management can be a full time job, we will share time-saving strategiesand freely available tools that can simplify the process of managing all thesesocial media outlets.Objectives:1. Identify the most popular social media tools in healthcare and theirpurpose.2. Learn how blogs, LinkedIn, Facebook, YouTube, and Twitter can beused in telehealth.3. Learn how to effectively manage multiple social media outlets so that itdoesn’t become a full time job.114 USING STRUCTURED WORKFLOW ANALYSIS TO INTEGRATETELEMEDICINE INTO SMALL CLINICAL SETTINGSPRESENTERS AND CONTRIBUTING AUTHORS:Rex E. Gantenbein, MS, PhD, Director, Center for Rural Health Researchand Education.University of Wyoming, Laramie, WY, USA.Two primary issues in integrating telemedicine technology into a smallclinical practice (the majority of practices in rural regions) are (1) identifyingthe features of telemedicine needed by the practice and (2) identifying howtelemedicine would affect (positively or negatively) the workflow in thepractice. Clearly, a way of addressing these issues prior to making the decisionto implement a telemedicine system is needed; introducing telemedicine intoworkflows unable to absorb the technology will not only exacerbate existingproblems, but also potentially create new ones. Structured workflow analysisis a well-known engineering technique for identifying a series of actions thatproduce (or are needed to produce) a desired outcome. The technique consiststypically of analyzing the inputs, processes, and outcomes/outputs of a givensystem (such as the flow of patients and care in a clinic) and determiningwhere redundancies, inefficiencies, or bottlenecks occur. The results of suchanalysis are then used to evaluate where improvements could be made and/ortechnology introduced to improve the workflow. Unfortunately, most‘‘toolkits’’ that exist to guide non-experts through the process of workflowanalysis focus on the workflow from the process (or ‘‘actor’’) point of view -that is, they look at ‘‘who does what’’ in order to accomplish the tasks in theclinic. The problem with this approach is that the outcomes are largely takenfor granted as those desired. Instead, the focus ought to be on the requirementsof the clinic - the desired outcomes - so that the workflow to achieve thoseoutcomes can be developed independently of that already in place. This isclassically used in developing software systems, but has application in theintegration of telemedicine technology. Furthermore, such analysis can bemade simple enough to be accomplished by non-experts, especially in a smallclinical setting where requirements are relatively easy to identify. One approachto structured analysis effective in this environment is scenario (or usecase) workflow modeling. In this approach, the requirements of a particularscenario are identified by its stakeholders, scope, and goals. From there, theA-64 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSobjects and activities needed to meet those requirements are listed; once thelikely scenarios have been described, generally as a series of processes andtheir inputs, outputs, and interactions, then interactions among these variousworkflows are examined for possible errors, interferences, and improvements.The scenarios can be described using either simple narratives or visual models- such as activity diagrams - that represent the workflow graphically. Visualmodels are typically more intuitive and more easily represent both the individualscenarios and the crossovers between different scenarios in the sameclinic. In either case, once the model is completed, it can be evaluated to seewhether it is capable of producing the desired outcomes in the system, andthen used as a guide to integrating the processes and associated technologyinto practice. This presentation will first describe how structured analysis canbe accomplished with simple visual tools, then present an example for a smallclinical practice.Objectives:1. Analyze clinical workflow processes.2. Create simple workflow diagrams.3. Develop a plan for integrating telemedicine into clinical practice.1:15 pm–2:15 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 048Session Title: 711 BUILDING AN ENTERPRISETELEHEALTH PROGRAM: PERSPECTIVES FROM THREEACADEMIC MEDICAL CENTERSTrack: Finance and Operations II Ballroom FMODERATOR: Jan Ground, PT, MBA, Senior Project Manager.Colorado Permanente Medical Group, Denver, CO, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Sarah Sossong, MPH, Director of Telehealth, Mass General TeleHealth 1 ,Peter Kung, MSIST, Director, Strategic Technologies 2 , Sarah Pletcher, MD,Medical Director, Center for Telehealth 31 Massachusetts General Hospital, Boston, MA, USA, 2 University of CaliforniaLos Angeles, Los Angeles, CA, USA, 3 Dartmouth-Hitchcock Medical Center,Lebanon, NH, USA.Envisioning, building, launching, and coordinating an enterprise Telehealthservice delivery is complex. C Suite leadership must address complexitiesof organizational structure, competing strategic priorities, and costand technology constraints in the development of an enterprise telehealthprogram. In this session, the Directors of three Academic Medical Centerprograms at Massachusetts General Hospital, UCLA, and Dartmouth HitchcockMedical Center will provide an overview of the approaches each has taken inbuilding their respective multispecialty telehealth programs with their C Suiteleadership team. The presenters will discuss some of their unforeseen challengesand the approaches that they have used to work through these barriersincluding insights on the development of their respective organizations’ telehealthstrategies, business case models, and governance structures. Each willdiscuss strategies of how to foster a culture of innovation and collaboration,what resources are needed to support a telehealth program, and key lessonslearned on designing and implementing an enterprise telehealth program.Objectives:1. Identify essential considerations and strategies for C Suite decisionmakers to consider in planning and building an integrated, enterprisetelehealth program.2. .Share strategies to bring groups together for collaboration and innovation.3. Delineate the pros and cons of an AMC environment to a coordinatedtelehealth service.1:15 pm–2:15 pm Tuesday, May 7, 2013HOW-TO PANELSession Number: 049Session Title: 136 TELEHEALTH REIMBURSEMENTWORKSHOP: TOOLS, STRATEGIES AND RESOURCESFOR EMBRACING BILLING AND CODING ANDENHANCING ROITrack: Finance and Operations II Ballroom GPRESENTERS AND CONTRIBUTING AUTHORS:Kory Stetina, BS, CPC, President and Founder.Torch Health Solutions, San Diego, CA, USA.As physician reimbursement for telemedicine services continues toevolve and expand, those evaluating the implementation of a telemedicineprogram are faced with some challenging questions: How do we get paidfor providing telemedicine? And how important is getting paid for establishinga sustainable telemedicine business model? Those alreadyproviding telemedicine face a similar dilemma: Is there value to startbilling? Due to complex coding and reimbursement requirements andpayer guidelines varying from the state to specialty level, telemedicineproviders often simply avoid it altogether. This however comes withhidden costs, including higher coverage fees, reimbursement left ‘‘on thetable,’’ and the deceleration of expanding reimbursement for the future.Although telemedicine does present some unique billing considerations,performing the right research and developing some straight-forward toolscan allow your program to tap into today’s available reimbursement withminimal disruption or customization to your existing billing practices. Tohelp explain these strategies and how to implement these tools withinyour program’s infrastructure, a certified professional coder, founder of aTelemedicine billing company, and strategic consultant who has managedthe implementation of over a dozen unique telemedicine programs willpresent a hands-on, detailed guide to capturing available telemedicinereimbursement and enhancing your program’s ROI as a result. Goingbeyond just a description of the current guidelines, this workshop willtake the coding and billing discussion to a deeper level and empower theaudience with experience-based guidance from an expert who has successfullybilled for telemedicine services in multiple states and specialtyenvironments. Find answers to the following questions: What will we getpaid for and how should we bill our clinical services? How should theclaim form be submitted for telemedicine compared to in-person services?How can I efficiently handle payers requiring different codes for the sametelemedicine service and how should our physicians code their servicesconsidering this? How do I implement telemedicine-specific operations orlogic into the charge capture process? What questions should I ask andwhat information should I request when determining if the payers I billmost often will pay for telemedicine? How much reimbursement per yearcan I expect my program to obtain and how can I build that into otherfinancial considerations of the program such as coverage fees, pricingmodels, and profitability analyses? By presenting both the current reimbursementlandscape across the country and real-world examples forsuccessfully billing common telemedicine services and cross walking CPTcodes across unique payer guidelines, physicians and hospitals will bebetter positioned than ever to embrace telemedicine billing and codingand to build a more cost-effective, profitable, and financially sustainableprogram as a result.Objectives:1. Develop a firm understanding of 2012 and 2013 coding and reimbursementguidelines across all major patient financial classes.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-65

CONCURRENT ORAL PRESENTATIONS ABSTRACTS2. Learn strategies and develop tools for managing complex payer-specificcoding requirements to maximize reimbursement and regulatorycompliance.3. Learn how to incorporate billing and reimbursement data/forecasts/results into a larger telehealth program ROI analysis and best-practicefinancial models.1:15 pm–2:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 050Session Title: EFFICACY STUDY RESULTS: PROVINGVALUE AND CLINICAL BENEFITS FOR THREESPECIALTY SERVICESTrack: Best Practices and Service Delivery Models IMeeting Room 17 A/BMODERATOR: Ronald C. Merrell, MD, FACS, Professor of Surgery.Virginia Commonwealth University, Richmond, VA, USA.487 BRIDGING GAPS IN CARE: USING COLPOSCOPIC TELEMEDICINE TOBENEFIT RURAL WOMENPRESENTERS AND CONTRIBUTING AUTHORS:Gordon Low, MSN, APN, Program Coordinator START Program,Wilbur C. Hitt, MD, FACOG.University of Arkansas for Medical Sciences, Little Rock, AR, USA.Between 1999 and 2003, Arkansas averaged 148 cases of invasive cervicalcancer and 52 deaths annually, ranking 4 th in the nation in cervical cancermortality. Arkansas’ poorest women suffer from a healthcare system unsupportiveof colposcopy, a diagnostic biopsy of the cervix that determines thepresence of pre-cancerous lesions and cervical cancer and/or what level ofcancer is present. In the sixth poorest state in the nation, Arkansas Medicaiddoes not cover colposcopic exams and only provides reimbursement andtreatment for women with colposcopic biopsies showing moderate dysplasiaor worse. However, the University of Arkansas for Medical Sciences’ (UAMS’)ANGELS pioneered a telecolposcopy clinic combining the expertise of localand remote specialists to identify women at risk for cervical cancer whileadministering telemedicine-based monitoring and follow-up for women withless severe conditions. Nurse Practitioners, trained in the mechanics of colposcopy,perform the exams at four rural spoke sites while broadcasting realtimeimages of the cervix to an ANGELS’ gynecologist who monitors andsupervises. Through interactive telemedicine, these experts visually assess thecervix to identify the presence of pre-cancerous cervical lesions requiringtreatment. Between January 2010 and August 2012, the ANGELS TelecolposcopyProgram performed 2,604 exams, taking referrals from 68 of Arkansas’s75 counties. These visits produced 2,380 sets of biopsies and identified 608(25%) women with high-grade lesions requiring treatment. Evaluation of thedata showed that this project was able to provide accurate, sensitive colposcopicevaluation comparable to traditional exams through simple interactiveimaging, and telecolposcopy serves as an essential intervention for Arkansas’srural women facing inadequate access to needed care. When combined withgynecological specialist expertise, telecolposcopy can help assess severity,guide biopsy, and provide follow-up for rural cervical cancer patients withoutaccess to specialty care.Objectives:1. Attendees will understand the steps and mechanisms involved in establishinga procedure-based telemedicine clinic, in particular for telecolposcopy.2. Attendees will understand the limitations and potentials for deliveringskilled care by interactive video.3. Attendees will understand how telecolposcopy compares to traditionalcolposcopy in regards to sensitivity and positive predictive value.107 RANDOMIZED, CONTROLLED TRIAL OF VIRTUAL HOUSECALLSFOR PARKINSON DISEASEPRESENTERS AND CONTRIBUTING AUTHORS:E. Ray Dorsey, MD, MBA, Associate Professor of Neurology 1 ,Vinayak Venkataraman, BSE 1 , Matthew Grana, BA 2 , Michael T. Bull, BS 2 ,Ben P. George, MPH 3 , Balaraman Rajan, MBA, MS 4 ,Christopher A. Beck, PhD, MA 5 , Abraham Seidmann, PhD 4 ,Kevin M. Biglan, MD, MPH 2 .1 Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA,2 Department of Neurology, University of Rochester Medical Center, Rochester,NY, USA, 3 School of Medicine and Dentistry, University of Rochester,Rochester, NY, USA, 4 William E. Simon Graduate School of BusinessAdministration, University of Rochester, Rochester, NY, USA, 5 Department ofBiostatistics and Computational Biology, University of Rochester MedicalCenter, Rochester, NY, USA.Background: Access to specialty care for individuals with Parkinson disease(PD) is frequently limited due to distance, disability, and doctor distribution.Many organizations are working to connect physicians to patients in theirhomes, but few, if any, randomized, controlled trials have been performed.Objective: To evaluate the feasibility, effectiveness, and economic benefitsof using web-based videoconferencing (telemedicine) to provide specialtycare to patients with Parkinson disease in their homes.Design: Six-month, two-center, randomized controlled clinical trial.Setting: Patients’ homes and outpatient clinics at two academic medical centers.Participants: 20 patients with mild to moderate Parkinson disease with Internetaccess at home.Intervention: Care from a Parkinson disease specialist delivered remotely inthe home or in-person in the clinic.Main Outcome Measures: The primary outcome variable was feasibility, asmeasured by the percentage of telemedicine visits completed as scheduled.Secondary outcome measures included clinical benefit as measured by theParkinson Disease Questionanaire-39 (PDQ-39) and economic outcomes asmeasured by time and travel.Results: Twenty participants enrolled in the study and were randomized totelemedicine (n = 9) or in-person care (n = 11). Ninety-six percent (n = 26) of 27scheduled telemedicine visits were completed compared to eighty-eight percent(n = 29) of 33 scheduled in-person visits. The change in the PDQ-39 for thoserandomized to telemedicine was similar to the change for those randomized to inpersoncare (5.6 point improvement v. 7.1 point improvement; p = 0.77). Patientswho met their specialist in clinic devoted 187 minutes for their appointment, 26minutes (14%) of which were spent with their specialist. By contrast, patients whomet their specialist via telemedicine devoted 37 minutes for their appointment, 29minutes (78%) of which were spent with their specialist.Conclusions: Using Web-based video conferencing to provide specialty careto patients with Parkinson disease in their homes is feasible and appears tooffer comparable clinical benefit and provide substantial value to patientscompared to traditional in-person care.Clinical Trial Registry: clinicaltrials.gov Identifier: NCT01476306Objectives:1. Confirm the feasibility of providing specialty care to patients withParkinson Disease via telemedicine.2. Understand the clinical and economic value of providing specialty careto patients with Parkinson disease via telemedicine.3. Use Web-based videoconferencing to care for other chronic conditions.A-66 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTS196 EVIDENCE OF THE NON-INFERIORITY OF IN-HOMETELEREHABILITATION AFTER TOTAL KNEE ARTHROPLASTYPRESENTERS AND CONTRIBUTING AUTHORS:Helene Moffet, PhD, Full Professor 1,2 , Michel Tousignant, PhD 3 ,Sylvie Nadeau, PhD 4 , Chantal Mérette, PhD 1,5 , Patrick Boissy, PhD 3 ,Hélène Corriveau, PhD 3 , François Marquis, MD 1,6 , François Cabana, MD 3,7 ,Pierre Ranger, MD 4,8 ,Étienne Belzile, MD 1,6 , Pascale Larochelle, MD 3,9 ,Ronald Dimentberg, MD 10 .1 Université Laval, Quebec, QC, Canada, 2 Centre for Interdisciplinary Researchand Social Integration, Quebec, QC, Canada, 3 Université de Sherbrooke andResearch Center on Aging, Sherbrooke, QC, Canada, 4 Université de Montréaland Centre for Interdisciplinary Research in Rehabilitation of GreaterMontreal, Montreal, QC, Canada, 5 Centre de recherche de l’Institutuniversitaire en santé mentale, Quebec, QC, Canada, 6 CHUQ, Quebec, QC,Canada, 7 CHUS, Sherbrooke, QC, Canada, 8 Hôpital Jean-Talon, Montreal, QC,Canada, 9 CSSS-Arthabaska-Les-Érables, Arthabaska, QC, Canada, 10 McGillUniversity and St. Mary’s Hospital, Montreal, QC, Canada.Relevance: Finding a cost-effective alternative to home physiotherapy visitsfor post-surgical rehabilitation following knee and other orthopedic surgeriesis a major issue considering the increasing need for home care services andshortage of health resources.Purpose: To determine if an in-home telerehabilitation (TR) approach is aseffective as a face-to-face home visit approach (Control; CTL) after hospitaldischarge in persons with total knee arthroplasty (TKA).Participants: 205 persons who underwent a primary TKA for a diagnosis ofosteoarthritis in 3 different geographical regions of the Province of Quebecfrom July 2009 to February 2012.Methods: Participants were randomly assigned just before hospital dischargeto the TR group or the Face-to-face home visit group (CTL). Bothgroups received the same rehabilitation intervention (16 supervised exercisesessions) over the 2 first months after hospital discharge. Participants wereevaluated 4 times by a blind evaluator: before TKA (E1), at discharge (E2), 2months (E3; immediately after intervention) and 4 months (E4; 2 monthspost-intervention) post-discharge. The primary outcome measure was theWOMAC questionnaire at E4 (Total and Pain, Stiffness and Function subscales).Analysis: A per-protocol analysis was performed to test the main researchhypothesis : mean gain in the WOMAC score at E4 in comparison to baseline(E1) won’t be inferior in the TR group as compared to the one in the CTL group(H 0 : l CTL -l TR ‡ 9%). Subjects who participated to all evaluations (E1 to E4)and attended at least 75% of the planned intervention sessions were consideredin this analysis.Results: 177 out of the 205 randomized subjects were considered in the perprotocolanalysis (TR, n = 82; CTL, n = 95). Subjects of both groups had similarcharacteristics (age, gender, side of operated knee) and functional status(WOMAC total score; TR 52.4 – 19.2%; CTL 54.1 – 17.0%) at baseline (E1).WOMAC gains at E4 (total and subscales) did not differ between groups. Meandifferences between groups (CTL-TR) adjusted for E1 [2-sided 95% confidenceintervals (CIs)] were close to zero and, on average, slightly favored the TRgroup: Total: - 1.48% [ - 5.51, 2.54]; Pain: - 1.67% [ - 6.02, 2.68]; Stiffness:0.03% [ - 6.25, 6.32]; Function: - 1.65% [ - 5.79, 2.49] and 95%CIs were allwithin 9%.Conclusion: Our results support the non-inferiority of the in-home TR approachand its consideration as an effective alternative to conventionalphysiotherapy service delivery. Future analyses will clarify the conditions inwhich TR is cost-effective and its impact on secondary outcomes such asquality of life, physical impairments and capacities and patient satisfaction.Implications: In-home telerehabilitation is an effective alternative approachto face-to-face in-home rehabilitation after a first TKA.Objectives:1. Consider using in-home telerehabilitation approaches to follow postoperativeconditions.2. Discuss the non-inferiority of an in-home telerehabilitation approachcompared to a conventional approach.3. Discuss the factors that should be taken into account in such anapproach.1:15 pm–2:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 051Session Title: UNIQUE APPROACHES TO SERVINGLOW INCOME URBAN POPULATIONSTrack: Best Practices and Service Delivery Models IIMeeting Room 16 A/BMODERATOR: Neal Sikka, MD, Assistant Professor, Emergency Medicine,Chief, Innovative Practice.The George Washington University - Medical Faculty Associates, Washington,DC.110 A BORDERLESS DOCTOR-PATIENT RELATIONSHIP: PILOT OFMEXICAN PHYSICIANS CARING FOR HISPANIC AMERICANSPRESENTERS AND CONTRIBUTING AUTHORS:Eric Leroux, MD/MBA Candidate, Medical Student 1 , Dora Silva, BS 2 ,Ovet Esparza, PA 3 , Becky Wai, BS 4 , Iana Simeonov, BA 5 ,Homero Rivas, MD, MBA 1 .1 Stanford University School of Medicine, Palo Alto, CA, USA, 2 San FranciscoState University, San Francisco, CA, USA, 3 Stanford University, Palo Alto,CA, USA, 4 UC Berkeley, Berkeley, CA, USA, 5 UC San Francisco, SanFrancisco, CA, USA.In the United States there are approximately 50 million HispanicAmericans, of whom more than 75% require a Spanish-speaking doctor,and of whom over 40% are uninsured, meaning their access to medicalcare is severely limited or non-existent. We have piloted and are nowexpanding a global telehealth model where supply and demand of medicalconsult is not constrained by borders. Salud Sin Fronteras utilizesHIPAA-compliant video-conference software and a secure electroniccloud-based personal health record through which doctors from LatinAmerica connect with Spanish-speaking patients living throughout theUnited States. In addition to basic access to care, cultural and languagecompatibility are ensured in order to foster and nurture the doctor-patientrelationship. However, because of current prescription laws, our providerscannot directly offer treatment, so they serve three other vital functionsin increasing the accessibility and quality of health care. First, for theapproximately 25–50% of doctor visits in the United States that requireonly education and reassurance, cross-border telehealth is a highly efficientcost-saving alternative to in-person visits to a clinic or emergencydepartment. Secondly, in cases where further work-up or follow-up isrequired, patients can be referred to local practitioners with the appropriatelanguage and medical background, thereby formally entering themedical system. Thirdly, the personal health record improves care coordinationand medical system efficiency as people relocate. Finally, regardingthe providers, by prioritizing the doctor-patient relationshipregardless of State, Provincial, or National boundaries, we offer a platformfor global telehealth volunteerism, practice expansion, and careª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-67

CONCURRENT ORAL PRESENTATIONS ABSTRACTScontinuity when patients travel abroad. In partnership with Vsee, a proprietaryand secure file-sharing and video conference service, our pilotstudy of underinsured Mexican citizens in San Jose shows patient satisfactionrates above 95%, a willingness to pay $10–15 for a ten minutevideo consult, and the two most common reasons for utilization are nonacutesymptom checking and education about a diagnosis or medication.Providing healthcare access to an underserved population of SpanishspeakingHispanics living in the United States has confirmed the value ofcross-border telehealth and further demonstrated its promise as a valuableinstrument in the delivery and coordination of global health care.Objectives:1. Understand the business model of cross-border telehealth.2. Know the value proposition of cross-border telehealth, and also thelimitations.3. Apply lessons learned about reaching the underserved with telemedicinesolutions.620 EXPANDING TELEMEDICINE TO INCLUDE CARE FOR THE ADULTPATIENT IN THE INNER CITYPRESENTERS AND CONTRIBUTING AUTHORS:Laura Markwick, DNP, Health-e-Access.University of Rochester, Rochester, NY, USA.Current data shows that ethnic minorities and low socioeconomic statuspeople tend to have poorer health than other Americans. Contributing tothis disparity is lack of access to healthcare. While the uninsured are morelikely to make ED visits for non-emergency problems, they are not alone.According to the Centers for Disease Control, 40% of adults receivingMedicaid will utilize the ED more than once per year, with 15% having twoor more ED visits. Estimates for adult non-urgent ED visits are 20% and50%. Approximately 20% of ED visits are for minor illnesses that can betreated successfully via telemedicine. Access to care not only includesinsurance coverage and transportation, but also accessibility to provider.This would include whether they accept the individual’s insurance plan andhours of availability, as many do not accept Medicaid, or have evening andweekend hours. According to the National Healthcare Data Report, Hispanicsand people of lower socioeconomic status are increasingly likely toreport unmet healthcare needs. Lack of routine care may contribute tohigher rates of avoidable admissions by African Americans and those inlower socioeconomic positions. With this lack of routine care comes amissed opportunity to provide preventative care, such as blood pressurescreening and smoking cessation counseling. Telemedicine has been in usefor 10 years in an inner city community providing pediatric care with greatacceptance. A decrease in unnecessary ED visits with a resulting decreasein health care costs has been demonstrated. Parents of these children requestedaccess to this same mode of care for their own healthcare needs,alleviating their need for missed time from work or requiring them toobtain childcare to tend to their own health related needs. Telemedicinewas expanded to include care of patients of all ages. It allows for timelycare in their own neighborhood, avoiding costly ED visits and improvingaccess to care. Health promotion activities are able to be addressed witheach patient encounter.Objectives:1. Understand how telemedicine can be used to improve access to care inthe inner city.2. Understand how telemedicine can be integrated into current officepractice in order to be consumer responsive to care needs.3. Identify ways that telemedicine can be used in primary care of the adultpatient.1:15 pm–2:15 pm Tuesday, May 7, 2013DISCUSSION PANELSession Number: 052Session Title: 299 NEW HOSPITAL-BASEDTELEMEDICINE SERVICES: IMPLICATIONS OF ATELEHOSPITALIST PHYSICIAN SERVICETrack: Innovations Meeting Room 18 C/DMODERATOR: Richard B. Sanders, MPH, FACHE, Vice PresidentTelemedicine Services.Eagle Hospital Physicians, Atlanta, GA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Doug Romer, RN, Executive Director, Patient Care Services 1 ,Dana P. Giarrizzi, DO, FHM, National Medical Director, TeleHospitalistService 2 , Herb Rogove, DO, FCCM, FACP, President/CEO 31 Grande Ronde Hospital, La Grande, OR, USA, 2 Eagle Hospital Physicians,Atlanta, GA, USA, 3 C3O Telemedicine, Ojai, CA, USA.Telemedicine has and continues to benefit from increasingly favorablepolicies, improved technology, broader application and patient care successstories. However, certain telemedicine services have grown more rapidlythan others. As technology continues to improve, and allows for more robustservice selections, there remains a need to consider and expand upon thevision and implications of these new possibilities from a physician serviceprovider’s perspective. The impact of the shortage of physicians to manageincreasing inpatient volumes has many service providers; health systemsand administrators seeking innovative and sustainable solutions to bringand maintain high quality care to their respective communities. Accordingto a commentary in the February 2010 edition of Today’s Hospitalist, telemedicinehospitalists and access to hospital based subspecialists via telemedicine,‘‘will be in hospital medicine’s future’’. For hospitalist practicesoffering 24/7 care, nighttime coverage can be particularly problematic.Nighttime hospitalist coverage is typically more expensive than day coveragedue to lower volumes of billable services. Call models and rotatingshifts from days to nights may be unsustainable due to physician burnoutand expensive compensation requirements which make recruiting effortsdifficult, especially for smaller practices. Furthermore, at night, staff-topatientratios are inefficient and, in certain scenarios, the quality of care atnight has been documented to be lower than daytime services. These inconsistenciesare unacceptable. A Telemedicine Hospitalist (TeleHospitalist)service may offer an innovative solution to the dilemma of night coveragefor hospitals. As with any new inpatient service however, there are operationaland clinical implications for stakeholder adoption, care processes,satisfaction and service viability. A panel of industry experts and practitioners,with experience in new inpatient service development and hospitalisttelemedicine services, will discuss the following issues andimplications related to a new inpatient TeleHospitalist service: (a) Inpatientprovider shortages as the genesis for TeleHospitalist service, (b) Hospital andcommunity stakeholder buy-in, (c) Clinical service implications, (d) Comparisonswith in-person hospitalist service delivery and call-based care, (e)Cost and reimbursement implication, and (f) Future areas of investigation,standardization and implementationObjectives:1. Participants will learn of a novel application of inpatient telemedicinephysician services.2. Participants will understand the drivers for adoption of a new hospitalbased telemedicine physician service.A-68 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTS3. Participants will be prepared to assess their own environment for potentialinpatient telemedicine physician services.1:15 pm–2:15 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 053Session Title: 718 T FOR TEXAS - (TELEHEALTH,THAT IS)Track: Policy Meeting Room 18 A/BMODERATOR: Hank Fanberg, PhD Candidate, Executive Director.Texas Health Information Network Collaborative (TxHINC), Dallas, TX, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Hank Fanberg, MBA, Executive Director 1 , Stephen Palmer, MA, Director,Office of e-Health Coordination, TX DSHS 2 , Nora Belcher, BA, ExecutiveDirector 31 Texas Health Information Network Collaborative, Dallas, TX, USA, 2 State ofTexas Dept of State Health Services, Austin, TX, USA, 3 Texas eHealthAlliance, Austin, TX, USA.Texas’ 1,115 Medicaid waivers opens the door for using telehealth as bothinfrastructure and for innovative care delivery with the goal of improving quality,outcomes and efficiency. With more than 3.6 million Medicaid beneficiaries, and$25 billion in payments, Texas’ Medicaid budget is greater than the entire budgetof 32 states, and accounts for more than 20% of the Texas state budget. TheMedicaid waiver allows Texas to establish innovative ways to enhance primaryand specialty care coverage, behavioral health, chronic diseases and patientcentered care. Learn how Texas plans to leverage telehealth as a core enabler ofthese goals and how it will measure the impact of telehealth adoption.Objectives:1. Understand Texas’ 1,115 Medicaid Waiver as a driver for healthcaredelivery reform in Texas and the role of telehealth in innovatingMedicaid care delivery2. Leveraging HIEs and telehealth for Medicaid reform including thepublic schools3. strategies to pursue the same in other states1:15 pm–2:15 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 054Session Title: 844 MHEALTH APPLICATION INPEDIATRICS – DEVELOPMENT, PRACTICE AND IMPACTTrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BMODERATOR: Madan Dharmar, MBBS, PhD, Assistant Research Professor.University of California Davis Health System, Sacramento, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Edmund Seto, PhD, Associate Adjunct Professor, School of Public HealthUniversity of California, Berkeley, Berkeley, CA, USA.Introduction: The adoption of mobile technologies (mobile phones, tablets,laptops, etc.) in health care is on the fast track as these technologies havebecome ubiquitous in our day to day lives. mHealth application has the potentialto revolutionize the way we care for our patients, especially childrenwith chronic diseases such as diabetes, hypertension, asthma, etc. The goal ofthis panel is to demonstrate the development process, practice, and impact ofmHealth application.Presenter 1: Iterative design of the CalFit smartphone system pediatricobesity studies. (Authors: Edmund Seto, Gretchen Casazza, Alina Nicorici,Jenna Hua, and Jay Han). Development of mHealth technologies often involvehealth and non-health professionals to identify the need and use cases, createrequirements and prototypes, and demonstrate proof of concept, validity,clinical efficacy, and cost savings. While this process is challenging, we havefound increasing opportunities to repurpose technologies to fit differenthealth studies. As a form of iterative design, with each new health study thatour research group has confronted, we have reflected upon technologies thathave been successfully validated and deployed in a project that can be reusedas is, or easily modified to fit a new project. As an example of this approach,we describe our experience developing the CalFit smartphone system, anAndroid application that objectively measures physical activity using phonebasedaccelerometry. We have subsequently reused this core system in multiplestudies. For instance, it was utilized to quantify physical activity levels ofhealthy adults as well as in children with Duchenne muscular dystrophy.Additionally, we have added technology components to CalFit over time to fitthe needs of diet assessment for obesity studies, air pollution exposure forenvironmental health studies, and self-reported outcomes for studies ofemotion. We describe the challenges our group is currently facing designingmodifications to fit the needs of children’s obesity research.Objectives:1. To describe a form of iterative design, in which new mHealth apps aredeveloped and modified from existing apps to fit the needs of a newhealth study.3:00 pm–4:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 055Session Title: 801 THE UK’s WHOLE SYSTEMDEMONSTRATORS PROGRAM: LESSONS FROM THEWORLD’s LARGEST TRIAL OF REMOTE CARETrack: Outcomes and Evidence Meeting Room 19 A/BMODERATOR: James Barlow, BA (Hons), PhD, Chair in Technology andInnovation Management.Imperial College Business School, London, United Kingdom.PRESENTERS AND CONTRIBUTING AUTHORS:Stanton Newman, BSocSci, PhD, Professor of Health Psychology and Dean 1 ,Caroline Sanders, BSc, PhD, Lecturer in Medical Sociology 2 ,Martin Cartwright, BSc, PhD, Health Services Research 31 City University, London, United Kingdom, 2 University of Manchester,Manchester, United Kingdom, 3 City University, London, United Kingdom.The Whole Systems Demonstrator (WSD) program was set up by the UKDepartment of Health in 2007 to provide the most robust evidence possible onwhich to base policy and investment decisions about future implementation oftelecare and telehealth (remote care). In three sites in England, remote care wasdeployed in what was intended to be an integrated redesign of care services. Amajor quantitative and qualitative evaluation was funded by the Departmentof Health and conducted by University College London, City University, ImperialCollege Business School, the Nuffield Trust, the London School ofEconomics and Political Science, and Oxford and Manchester universities (seeBower et al. 2011). The evaluation included what is believed to be world’slargest randomized controlled trial of remote care technologies to date, focusingon telecare (n = 2,600) and telehealth (n = 3,230). This large sample sizeª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-69

CONCURRENT ORAL PRESENTATIONS ABSTRACTSwas made possible by exploiting linkage of records drawn from operationalinformation systems, which were also used for risk stratification. The evaluationexplored cost and cost effectiveness, quality of life and psychologicaloutcomes. Other evaluation strands addressed key stakeholder experiences,the impact on care services and organizational implications. Parallel researchwas also carried out on the supply chain and industry-readiness for scalingup.Findings from WSD are now becoming available as they go through peerreview. Early papers (Steventon et al. 2012, Sanders et al. 2012) are identifyingsome benefits, some surprises and important cautionary elements. Analysis iscontinuing and findings will be further refined by the time of ATA2013. Theaim of the proposed Presentation Panel is to provide an overview of the keyfindings from the WSD and draw internationally transferrable lessons. Presentationswill discuss the most significant results of the RCT focusing on (1)clinical outcomes and patient reported outcomes, (2) service users and carer’sexperiences, (3) changes in service use and economic impacts, and (4) theorganizational, supply chain and service delivery implications for scaling-up.A moderated discussion will address the generic lessons from WSD on the roleof large-scale trials and alternative methodologies, and the use of robustevidence in strategic and policy decision-making around remote care.REFERENCES:1. Bower P et al. A comprehensive evaluation of the impact of telemonitoring inpatients with long-term conditions and social care needs: protocol for theWhole Systems Demonstrator cluster randomized trial. BMC Health ServicesResearch (2011) 11, 184. Doi:10.1186/1472-6963-11-184.2. Sanders C et al. Exploring barriers to participation and adoption of telehealthand telecare within the Whole System Demonstrator trial: a qualitativestudy. BMC Health Services Research (2012) 12, 220 doi:10.1186/1472-6963-12-220 Steventon A. et al. Effect of telehealth on use of secondary care andmortality: findings from the Whole System Demonstrator cluster randomizedtrial. BMJ (2012) 344, e3874. doi: 10.1136/bmj.e3874.Objectives:1. To present the latest findings from the UK Dept of Health’s Whole SystemDemonstrators program, focusing on clinical and economic impact.2. To explore the implications for scaling up, focusing on organizationaland service delivery implications.3. To draw general lessons on the role of large scale trials and the use ofrobust evidence in strategic and policy decision making around remotecare.3:00 pm–4:00 pm Tuesday, May 7, 2013DISCUSSION PANELSession Number: 056Session Title: 992 A UNIQUE JOURNEY INTOTELEMEDICINE: PERSPECTIVES FROM A FEDERALENTITY, ACADEMIC MEDICAL CENTER, AND A PRIVATEINSTITUTIONMeeting Room Ballroom EMODERATOR: Joseph Tracy, MS, Vice President - Telehealth Services.Telehealth Services, Lehigh Valley Health Network, Allentown, PA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Kristi Henderson, MD, Chief Advanced Practice Officer & Director ofTelehealth, University Mississippi Medical Center, Jackson, MS, Jamie Adler,PhD, Director, Telehealth Program, Department of Defense - National Centerfor Telehealth and Technology, Tacoma, WA, Tom Hale, MD, PhD, MedicalDirector for the Center for Innovative Care, Mercy Health System,Chesterfield, MO, USA.The ATA 2013 Institutional Council will host a panel discussion highlightingthree unique viewpoints into the development and implementation ofa telemedicine program. Leaders will share their experiences from the academic,federal and private sector perspective. Join us for an opportunity tolearn and connect with other institutional professionals.3:00 pm–4:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 057Session Title: 632 COUNTDOWN 2014: TELEMEDICINEPREPARATION IN MEETING THE GROWING MEDICAIDPOPULATIONTrack: Finance and Operations IIBallroom FMODERATOR: Tina Benton, RN, BSN, Program Director and ClinicalDivision Director.University of Arkansas for Medical Sciences, Little Rock, AR, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Curtis Lowery, MD, Chairperson of Department of Obstetrics/Gynecology 1 ,Brian Evans, MBA, Chief Executive Officer 2 .1 University of Arkansas for Medical Sciences, Little Rock, AR, USA, 2 ClarkeCounty Hospital, Osceola, IA, USA.With the Affordable Care Act, expanded Medicaid eligibility in 2014 willsoon create an influx of new patients into hospitals and clinics everywhere,placing a burden on the healthcare system to meet the needs of these newlyinsured patients. To address these challenges, telemedicine networks will playa more significant role than ever in increasing clinical capacities by enablingproviders to see more patients in a more effective timeframe and individuallyaddressing patient needs through real-time technologies from peripheraldriveninteractive video systems to home-based devices. A successful designmay see telemedicine spoke sites handling more routine-type care, while hubsites coordinate more specialized care by providing evidence-based recommendationsthrough co-management with specialists, patient consultations,and incorporation of mobile health technologies to support patient needs. Ineffect, telemedicine networks across the nation should prepare for thehealthcare system changes through adrenaline-powered expansions: workingquickly to build, upgrade, and expand broadband, telemedicine, and mobilehealth resources on a statewide level. Three statewide telemedicine networkleaders will explore this need for expansion in their panel presentation byoffering strategies and lessons learned from their efforts in building comprehensivetelemedical networks. The presenters will provide insight on expandingtelemedicine infrastructures to accommodate the growing needs ofnewly insured patient populations. University of Arkansas for Medical Sciences(UAMS): By 2019, Arkansas is estimated to see a 27.9% increase inenrollment in Medicaid. The state’s 400 + telemedicine site network is deployingconnectivity and/or equipment upgrades to every county in Arkansasto meet this need. UAMS will provide a macro-level review of the challengesfaced, lessons learned, and successes to date of their infrastructure expansion,along with a review of telemedicine-based programs that could translate intoother networks, thereby easing the workload of overburdened hospitals andclinics, while also offering needed quality control and specialty oversight.Clarke County Hospital, Iowa (CCH): Iowa is expected to see a 25.3% increasein Medicaid enrollment by 2019. In its infancy stage, the CCH network iscurrently providing telemedicine services in outpatient and inpatient settingsand will soon bring services to emergency department settings. North CarolinaTelehealth Network (NCTN): By 2019, North Carolina is estimated to deliverservices to Medicaid beneficiaries that will grow by 38.2% following theMedicaid eligibility expansion. The NCTN will help the North Carolina PublicA-70 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSHealth offices, free clinics, and not-for-profit hospitals meet aggressive federalrequirements for electronic health records and health information exchanges,both of which will be enacted with the Affordable Care Act toaccommodate the increased patient population.Objectives:1. Attendees will learn lessons and tips to cultivate and grow telemedicinenetworks in all stages of development.2. Attendees will learn how to accommodate the expanding Medicaidpopulation.3. Attendees will learn about infrastructure and essential programmingdelivered through telemedicine.3:00 pm–4:00 pm Tuesday, May 7, 2013PRESENTATION PANELSession Number: 058Session Title: 491 USING OUTCOMES FROMNATIONAL TELEMENTAL HEALTH PROGRAMS TODEVELOP BEST PRACTICESTrack: Best Practices and Service Delivery Models I Ballroom GMODERATOR: Linda Godleski, MD, Director, VA National TelementalHealth Center.Yale School of Medicine, New Haven, CT, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Erica Abel, PhD, Yale Telemental Health Informatics Fellow 1 ,Mark Bauer, MD, Lead, National Telemental Health Center Bipolar Program 2 ,Phillip Gehrman, PhD, Lead National Telemental Health Center InsomniaProgram 31 Yale School of Medicine, New Haven, CT, USA, 2 Harvard Medical School,Boston, MA, USA, 3 University of Pennsylvania, Philadelphia, PA, USA.The US Department of Veterans Affairs established an extensive telementalhealth (TMH) network that has delivered over 600,000 TMH encountersthrough 2012. This panel will present national outcomes data derived from theextensive data base accompanying the 75,000 TMH patients treated annually.Results of national programs focusing on specific diagnoses will also bepresented by national expert clinician-researchers. Linda Godleski, MD, Directorof the VA National Telemental Health Center (NTMHC) from Yale, willbegin with a review of previous years’ national TMH outcomes demonstratingaverage 25% decreases in hospitalization rates of telemental health patients.She will present new data demarcating specific patient populations withdiffering outcome utilization rates leading to recommendations for bestpractices. Erica Abel, PhD, Yale Informatics and Telemental Health Fellow,will use primary Electronic Medical Records data and informatics techniquesto drill down national outcomes and best practices specific to depressivedisorders. She will focus on outcomes from VA’s recent initiative to expandremote delivery of evidence based psychotherapies and provide specializedtele-care for mental health patients with medical co-morbidities. Mark Bauer,MD, at Harvard is the Lead for the VA National Telemental Health Center’sBipolar Program (BDTH) with national clinical experts delivering tele-evaluationand care focusing on the Chronic Illness Care collaborative model. Inthe first year of this new national program, over 120 individuals have beenremotely and extensively evaluated and treated across the nation. Specificoutcomes data on acceptability and feasibility will be presented to address bestpractices for this population with serious mental illnesses. Finally, PhillipGehrman, PhD. at the University of Pennsylvania, is the Lead for the VANational Telemental Health Center’s Insomnia Program, and focuses on providingnational tele-consultation to both clinicians and patients with sleepdisorders. He will present outcomes of his work on the delivery of CognitiveBehavioral Therapy using remote technologies, to include utilization, acceptability,and clinical ratings using the Insomnia Severity Index.Objectives:1. Describe impact of large scale telemental health programs.2. Use different measures of telemental health outcomes as they relate tovaried diagnoses.3. Develop best practices based upon the outcome findings.3:00 pm–4:00 pm Tuesday, May 7, 2013DISCUSSION PANELSession Number: 059Session Title: 565 HOT TOPICS IN TELEBEHAVIORALHEALTH INTEGRATION AND OUTCOMEMANAGEMENTTrack: Best Practices and Service Delivery Models IIMeeting Room 17 A/BMODERATOR: Phil Hirsch, PhD, Chief Clinical Officer.HealthLinkNow, Sacramento, CA, USA.PRESENTERS AND CONTRIBUTING AUTHORS:Barb Johnston, MSN, Chief Executive Officer 1 , Peter Yellowlees, MD,Director, Health Informatics Program 2 , Jonathan Hoistad, PhD, Director 31 Health Link Now, Sacramento, CA, USA, 2 UC Davis, Sacramento, CA, USA,3 Natalis Counseling and Psychology Solutions, St. Paul, MN, USA.Most health care analysts have settled on the ‘‘Triple Aim’’ as a conceptualframework for meaningful reform of health care delivery (as opposed to simplyreform of health care insurance). The essence of the Triple Aim is a reformedhealthcare delivery system which: 1) Improves healthcare from patients’ perspective;2) Improves population health; and 3) Bends the cost curve. It is alsowidely accepted that ‘‘Efforts to provide everyone a medical home will requireinclusion of mental health care if they are to succeed in improving care andreducing costs.’’ Abundant data document the value proposition of bidirectionalintegration of behavioral health and primary care services and the ability of thatintegration to help focus on the Triple Aim successfully. However, the majorityof the more than 120,000 medical groups and delivery systems in the U.S.struggle to find the workforce and integrative technologies that will permitthem to implement the key elements of this integrated model. Those elementsinclude, without being limited to: (a) Colocation and integration of behavioralhealth specialists in primary care settings, and primary care practitioners inbehavioral health settings; (b) Presence of well trained and supervised behavioralhealth navigators to improve case finding, increase patient complianceand monitor treatment response; (c) Didactic and case-consultation mechanismsby which BH specialists can provide decision support to primary care in atimely manner; (d) Warm hand off capability, in which a primary care team canhave immediate access to a behavioral health specialist for a warm patient‘‘handoff; and (e) Open access appointment scheduling with BH specialists inorder to provide timely response to need and to decrease no-show rates for BHservices. This panel of experts will describe and provide preliminary data from aservice line that combines synchronous and asynchronous telebehavioralhealth service delivery with technology for timely and effective screening,outcomes measurement and management, and sharing of patient records andinformation to enhance effective tele-integration of behavioral health andprimary care services.Objectives:1. Provide a unified construct definition of the Telebehavioral HealthIntegration and Outcomes Management.2. Use TBHI initiatives as an illustration of how to avoid creating inadvertentlynew information silos among Telehealth content domains(e.g., Finances, Best Practices, Public Policy and others).ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-71

CONCURRENT ORAL PRESENTATIONS ABSTRACTS3. Provide actionable information and tools that decision makers can useto inform policy development, make implementation decisions, andintegrate telebehavioral health process and outcomes in general.3:00 pm–4:00 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 060Session Title: MODEL PROGRAMS DELIVERINGHOME-BASED PATIENT SERVICESTrack: Best Practices and Service Delivery Models IIIMeeting Room 16 A/BMODERATOR: Kathy Duckett, RN, BSN, PHN, Director for Training andDevelopment.Sutter Center for Integrated Care, Fairfield, CA, USA.735 ONTARIO’S TELEHOMECARE PROGRAM: AN ENGAGEMENT MODELTHAT FOSTERS CONTINUUM OF CARE AND COLLABORATIONPRESENTERS AND CONTRIBUTING AUTHORS:Susan Harnarine, MBA, Product Manager, Telehomecare.OTN, Toronto, ON, Canada.Chronic disease is expensive to treat, accounting for 55% of Ontario healthcare costs. An aging population coupled with an increased prevalence ofchronic disease results in a greater demand on health resources. Ontario’scurrent health system is designed to treat chronic disease but there is often alack of coordination and continuity of care across sectors which contribute togaps in care. Heart Failure (HF) and Chronic Obstructive Pulmonary Disorder(COPD) hospitalizations have improved only slightly, and readmission ratesfor these two conditions have not changed in the past four years. There is ademand for an innovative, coordinated model of care that enables and supportspatient centered care which will improve patient outcomes and helpreduce system costs. The Ontario Ministry of Health and Long-Term Care hasadopted a Chronic Disease Management (CDM) framework which includes afocus on patient self-management. In 2007, OTN began Canada’s largestTelehomecare (THC) Program to date, enrolling over 800 patients with HF and/or COPD from 8 Family Health Teams across the province. The program helpedpatients manage their conditions, using technology to deliver daily monitoringinformation to nurses trained in health coaching. An evaluation of thepilot by an external party found that it demonstrated significant benefits topatients’ health while dramatically reducing their utilization of health systemresources. Telehomecare was shown to improve patient self-management,clinical outcomes, patient and provider satisfaction, best practice and dataintegration. Leveraging the successful outcomes of the pilot, OTN is currentlyimplementing a province-wide expansion that will begin with 2,000 patientsin three health regions. By year three, upwards of 30,000 patients will beenrolled across all 14 health regions in Ontario. In order to design a scalableand sustainable Program, a comprehensive engagement model has been developedthat brings awareness of Telehomecare to influential decision makersat the provincial and regional levels. These decision makers include governmentpolicy makers, clinical leaders in Primary Care and CDM-related specialties,professional associations, relevant HF/COPD associations as well aspatient advocacy groups that can promote and support the goals of the THCProgram. By building partnerships with influential individuals and organizations,OTN can identify opportunities to leverage existing delivery structuresand align with key government strategies. These partnerships will alsofoster a continuum of care and collaboration among primary care health careproviders by influencing, aligning and integrating with existing CDM programs.The goal of the engagement model is to foster collaboration amonggovernment, health care providers and key associations to deliver a sustainablemodel of care that will improve the lives of patients with chronic conditionsand transform healthcare delivery.Objectives:1. Identify key components of a holistic engagement model that fosterscare coordination.2. Identify key stakeholders that should be involved to expand and sustaina Telehomecare Program.3. Learn strategies and techniques to effectively engage influential decisionmakers.118 EMERGENCY MANAGEMENT GUIDELINES FOR HOME BASEDTELEMENTAL HEALTH AND OTHER NON-CLINICAL SETTINGSPRESENTERS AND CONTRIBUTING AUTHORS:Peter Shore, PsyD, Assistant Professor of Psychiatry.Oregon Health & Science University, Portland, OR, USA.The information contained in this presentation represents the view of theauthor and does not represent any existing policy within the Veterans HealthAdministration and/or any other known agency. There are few known clinicalpractice guidelines in the field of telemental health that offer recommendedguidance on emergency management. Dr. Shore will provide an overview ofpublished materials and will illustrate similarities and differences between theguidelines. Dr. Shore will highlight where some of the guidance may be relevantto unsupervised clinical settings. Dr. Shore will provide an introduction to theDepartment of Veterans Affairs VISN 20 Home Based Telemental Health PilotProgram. Providers deliver various mental health services utilizing a web-cam,secure and encrypted software (MOVI) on the Veteran’s side aimed at serving themental health needs of those whose access to care is restricted by geography,resources or who are home bound due to psychiatric and/medical conditions. ThePatient Support Person (PSP) is unique clinical feature to the program and offers apotential risk management solution. Dr. Shore will describe specific emergencymanagement procedures to consider for imminent patient risk in unsupervisedclinical settings that utilize the PSP and access to the Veterans Crisis Line. Otherrelevant topics covered in the presentation will be: state laws: involuntary psychiatrichold and commitment evaluations, evaluating patients for dangerousness,firearms and weapons, interfacing with local emergency personnel, specialconsiderations when evaluating dangerousness and exclusion criteria, transferringof care to local resources and post crisis. The presentation will also highlightethical considerations and handling the ambiguity and lack of control in thehome and/or unsupervised clinical environment.Objectives:1. Be familiar with known clinical practice guidelines.2. Be familiar with basic emergency management protocols for homebased telemental health.3. Be better prepared to provide interventions during a crisis.3:00 pm–4:00 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 061Session Title: LEVERAGING HEALTH INFORMATIONEXCHANGE & TELEMEDICINETrack: Innovations Meeting Room 18 C/DMODERATOR: Stewart Ferguson, PhD, Chief Information Officer.AFHCAN/Telehealth, Alaska Native Tribal Health Consortium, Anchorage,AK, USA.A-72 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTS775 THE POWER OF INTEGRATING TELEMEDICINE WITH HEALTHINFORMATION EXCHANGE IN A CHANGING HEALTHCAREENVIRONMENTPRESENTERS AND CONTRIBUTING AUTHORS:Dale Alverson, MD, Professor Emeritus.University of New Mexico, Albuquerque, NM, USA.The evolving healthcare environment is demanding changes in the deliveryof healthcare services and sharing of health information that can enhanceaccess, improve health, and reduce costs. Telemedicine can provide an effectivedistribution of expertise to support distant providers and patients. Witha patient’s consent to opt in or opt out, a Health Information Exchange (HIE)provides a platform for the secure sharing of patient information from avariety of healthcare provider organizations in a format that consolidates thatinformation at the site of care from all the HIE network participants. The HIEuses a Continuity of Care Document (CCD) that lists the original source andtime of all diagnoses, medications, allergies, immunizations, procedures, laband radiology reports, and even progress notes and summaries, usually accessedthrough an interface with each organization’s electronic health record.The integration of Telemedicine and HIE are powerful tools to improve thecontinuity and coordination of appropriate comprehensive care for both diagnosticevaluation and management, decrease unnecessary variations incare, improve efficiencies in care, avoid unnecessary duplication of tests orprocedures, reduce the need for higher cost services, and hospitalization.There are several examples of both Telemedicine and HIE achieving thosegoals independently. When combined and effectively integrated they can beboth complimentary and synergistic and become important components of anevolving healthcare environment, providing the right care, at the right place,at the right time. Examples will be presented that demonstrate that value ofintegrating HIE into the effective delivery of healthcare and potential value ofcombination with telemedicine.Objectives:1. Understand the relationship between telemedicine and health informationexchange.2. Understand the value of the integration of telemedicine and healthinformation exchange.3. Understand how together telemedicine and health information exchangeimproves healthcare.The Center for Connected Health, part of Partners Healthcare in Boston,has a long history of collecting physiological data from patients as acomponent of our broader telemedicine initiatives. Our remote monitoringprograms generate large volumes of data: we have over 1.2 million discretevital signs in our remote monitoring database and are currently receivingan additional two-hundred thousand annually, with significant growthexpected in coming years. Our technology is rapidly becoming the standardplatform for all Partners Healthcare entities for information gatheredfrom the patient home. The demand for these programs is expected toincrease significantly in the coming years as Meaningful Use provisions(Stage 3 recommendations to capture home data) along with the care coordinationrequired for effective ACO implementation drives demandamong clinicians and administrators. While great strides have been madein the devices and connectivity necessary to collect such data, there is alarge gap in the market when it comes to tightly integrating this data intoclinical workflows to facilitate adoption and uptake by clinicians. No offthe-shelfsolutions exist for easily integrating this data with an electronicmedical record, and standards for this type of data do not yet exist. Ourresearch from our diabetes and hypertension programs indicate that patientsusing remote monitoring have better outcomes when their providersare also engaged in the program and actively monitoring a patient’s data.In order to drive that provider engagement, the Center for ConnectedHealth built an integration which allows for the viewing of remotelycollected data via a patient’s record page in our EMR. All of Partners’30,000 + clinicians can now see if their patients are collecting remotemonitored data and can view and interact with that data right from apatient’s summary page in our EMR. This data is also viewable for patientsthrough our patient portal, in order to facilitate collaboration betweenpatients and providers. Today clinicians and patients are viewing bloodglucose and blood pressure readings through this enterprise integration.We have the ability to add other parameters, such as weight and activity,and to display parameters in combinations, such as weight, activity, andblood pressure. The expansion to other parameters is expected within thecoming months. We have constructed this integration by utilizing a ‘‘babysteps’’approach to overcome the typical inertia associated with such alarge undertaking, and by leveraging a set of simple services to enable thedisplay and facilitate the transfer of data to our EMR. In this roundtable wewill deliver the lessons learned from this project and discuss the futuregoals for our integrated system.472 TELEHEALTH SOLUTIONS: EVOLVING STORY FROM AN EHRPERSPECTIVEPRESENTERS AND CONTRIBUTING AUTHORS:Srini Kodali, MPH, MBA, BS (Electrical Eng), Director, Global TelehealthSolutions.Allscripts, Raleigh, NC, USA.EHR/EMR companies have been relatively low key in the telehealth solutionsspace. The author believes this is about to change and the next wave oftelehealth solutions enablement will be spear-headed by the EHR/EMR players.Objectives:1. Impact of EHR and Telehealth applications integration.2. How EHRs are adapting to evolving Telehealth solutions.3. Convergence between EHR and Telehealth.301 CLOSING THE LOOP: INTEGRATING A REMOTE MONITORING INOUR EMRPRESENTERS AND CONTRIBUTING AUTHORS:Robert Havasy, BS, Technical Architect, Alyssa Woulfe, BA.Partners Healthcare Center for Connected Health, Boston, MA, USA.3:00 pm–4:00 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 062Session Title: NEXT STEPS FOR TELEHEALTH POLICY:IMPLEMENTING NATIONAL HEALTH REFORMSTrack: Policy Meeting Room 18 A/BMODERATOR: Julia Johnson, President.NetCommunications, LLC, Windermere, FL.476 INTEROPERABILITY CAN SUPPORT MEANINGFUL USE 2 & 3PRESENTERS AND CONTRIBUTING AUTHORS:Chuck Parker, BA, MS, Executive Director.Continua Health Alliance, Beaverton, OR, USA.At stages 2 and 3, Meaningful Use demands increasing reporting capability,adds a diverse range of measures, requires additional data sharingª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-73

CONCURRENT ORAL PRESENTATIONS ABSTRACTSbetween providers and patients, and reduces the options available formeeting objectives. Specifically, Stage 2 adds clinical quality measures thatalign with national quality programs in six different domains, and proposesa measure for data transmittal to other providers during patient discharge orreferral. At Stage 3, it appears that Meaningful Use will impose additionalrequirements for clinical decision support, computerized physician orderentry (CPOE), structured, machine-readable data, and medication reconciliation.Current recommendations for Stage 3 also strengthen requirementsfor patient engagement, accepting patient medical histories and home-baseddevice readings electronically; and for transmitting electronic care plans toother providers. Clearly, the technological requirements of Meaningful Usewill become more complex at Stages 2 and 3. For many providers andhospitals, implementation at these stages is likely to require data sharingbetween a greater number of devices, consolidation of a larger volume ofdata and/or promoting home monitoring programs or other forms of connectedhealth. Adopting technology standards for interoperability of EHRsand medical devices will ease the transition into Stages 2 and 3 and provideflexibility to accommodate changes in reporting requirements and patientdemographics over time. The Guidelines published by Continua Health Allianceare designed to support HIT systems, mobile, and home-based connectedhealth programs with end-to-end, plug-and-play connectivitybetween devices and EHRs. Implementing a Continua-certified program willhelp providers and hospitals to meet Meaningful Use requirements andachieve new clinical efficiencies for population and individual patientmanagement.Objectives:1. Identify requirements of MU2 & 32. Explain how adopting interoperability standards can help with MU23. Explain how adopting interoperability standards can help with MU3567 TELEHEALTH AND MEANINGFUL USE: CAN IT BE DONE?PRESENTERS AND CONTRIBUTING AUTHORS:Ryan Spaulding, PhD, Director, Center for Telemedicine & Telehealth,Helen Connors, RN, PhD.University of Kansas Medical Center, Kansas City, KS, USA.Parallels are often drawn between electronic health records (EHRs) andtelehealth. This is primarily because they are both health technologies designedfor remote patient care and management, but also because they haveboth experienced similar challenges with adoption, integration, cost andsustainability. However, EHRs received a major boost toward overcomingthese issues when they became a priority of the federal government throughmajor legislation such as the HITECH act and the Affordable Care Act, particularlythe meaningful use components that set timelines and incentives foreligible providers and institutions to implement successful EHR systems. Incontrast, no such policy or focused effort has been implemented by the U.S.government for telehealth, yet adding telehealth to meaningful use has beensuggested by telehealth proponents and practitioners. This presentation willoutline the major similarities and differences between EHR and telehealthimplementation, as well as issues that need to be addressed for telehealth to besuccessfully mainstreamed. Priorities such as definitions, standardization,scope, incentives and governance will be described. A model of telehealthmeaningful use will be presented, including identification and roles of importantstakeholders at the federal, state and local levels. While the EHRmeaningful use initiative provides many lessons for the telehealth model,several differences will be explored and discussed. Overall, this presentationwill provide some provocative thoughts toward a productive dialogue abouthow telehealth can enjoy the same meaningful momentum that EHRs are nowexperiencing.Objectives:1. Better understand telehealth/EHR similarities/differences2. Better understand telehealth and meaningful use3. Better understand structure for adding telehealth to meaningful userequirements.394 ACOS AND INTEGRATION: WHAT IS ON HORIZON FORTELEMEDICINE?PRESENTERS AND CONTRIBUTING AUTHORS:Sarah E. Swank, Esq., Principal.Ober j Kaler, Washington, DC, USA.In March of 2010, President Obama signed the Affordable Care Act establishingthe Medicare accountable care organization program (ACOs) and theCMS Innovation Center to achieve a three-part aim: lower costs, improvedcare and better health. The first ACOs were accepted into the program on July1, 2012, marking a change from fee for service productivity era to a new erawith incentives for efficient and high quality outcomes. Originally specific tothe Medicare program, the term ACO has come to mean accountable or integratedcare. The CMS Innovation Center and several payors now use the termACOs to describe an integrated, and often a risk sharing, approach to caredelivery or managed care reminiscent of capitation, but with more emphasison quality data and point of care decision making. To continue to meet thedemands of these quality programs, providers will undoubtedly be required toadopt, maintain and upgrade technology, such as telemedicine. These programsemphasize primary care services and the ability to coordinate care withspecialty and other providers. Telemedicine enables patients to receive care ina timely manner and provides more flexibility especially to small hospitalsand rural providers with a limited supply of primary care and specializedphysicians. Providers now turn to the integration of telemedicine technologywith EHRs to enable to track quality and claims data. This session will walkthrough the requirements of the ACO model and contrast them with the othermethods to provide accountable care through the CMS Innovation Center. Wewill also compare the HITECH requirements for ‘‘meaningful use’’ as the newstages are announced and these quality programs. Advances in technologyand chronic physician shortages are causing hospitals and health care organizationsto consider implementing telemedicine programs or expand existingtelemedicine programs, both nationally and internationally. This session willoffer a strategic planning analysis to establish a framework for creating orexpanding a telemedicine program that meet the goals of the Affordable CareAct. Real life examples of successful ACOs, CMS Innovation Center programparticipants and telemedicine programs across care settings, including at largeacademic medical centers will be discussed.Objectives:1. Discuss the requirements for ACOs and the role of telemedicine2. Evaluate current CMS Innovation Center programs3. Identify legal pitfalls with new integration programs under health carereform3:00 pm–4:00 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 063Session Title: THE USE OF TELEMEDICINE FORINTERNATIONAL SETTINGSTrack: Pediatrics Telehealth ColloquiumMODERATOR: Silvio Vega, MD, Medical Director.PNTT, Panama.Meeting Room 12 A/BA-74 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTS250 TELECARDIOLOGY PARTNERSHIP WITH MARRAKECH, MOROCCO:SUPPORTING PEDIATRIC CARDIOLOGY IN THE DEVELOPING WORLDPRESENTERS AND CONTRIBUTING AUTHORS:Craig Sable, MD, Medical Director, Telemedicine 1 , Yassine Boukadi, MD 2 ,Mary Fuska, MHS 1 , Svetlana Sinykin, MD 1 , Molly Reyna, BA 1 ,Ron Dixon, BA 1 , Soloua Elkarimi, MD 2 , Drissi Boumzebra, MD 2 .1 Children’s National Medical Center, Washington, DC, USA, 2 Hospital IbnTofail /Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco.Background: Only 7% of the world’s population has access to modern pediatriccardiac, resulting in nearly 6 million children with treatable conditionsthat are denied care. Telemedicine has the potential to help bridge this gap byproviding remote consultation and distance education.Methods: Through grants from the Mosaic Foundation (Arab Ambassadors’wives) and Intelsat, Children’s National Medical Center developed a telemedicinepartnership with hospitals in Marrakech, Morocco. Our goal was to augment theskill level of the pediatric cardiovascular team through telemedicine and onsitevisits. Videoconferencing units and satellite dishes were installed in 2009 withsubsequent training in 2010. Our cardiovascular surgery team visited Marrakechin March 2010 and March 2011, performing 8 operations in 2011. We report onutilization, outcomes, barriers and sustainability of this program.Results: Live monthly videoconferences were started in 2009, increasing toweekly (Tuesdays-10 AM Washington/3 PM Morocco) in 2011 between thecardiovascular teams in Washington (CS, SS) and Marrakech (DB, YB). Patientdata and echocardiograms were reviewed in real time.. The Children’s technicalteam managed conferences remotely through our multipoint conference unit.38 conferences occurred in the last 12 months. 14 were cancelled due toscheduling conflicts (none due to technical difficulties). 95 cases/73 patientswere presented; 22 patients were discussed two or more times. Most commondiagnoses were tetrology of Fallot (n = 14), transposition (n = 10), double outletright ventricle (n = 9), atrioventricular canal (n = 8), and ventricular septal defect(n = 6). Mean age was 4.8 years (3 days to 30 years). 44 patients were underage 2 years (average age 7 months). Mean oxygen saturation was 83%; 22patients had a saturation of £ 80%. Additional imaging was recommended in22 patients; considerable improvement in echocardiography skills was observed.Cardiac surgery was performed in 25% of patients discussed, more thanhalf had a difference in approach as a result of the teleconference. Three operations(tetralogy of Fallot, atrioventricular canal, D-Transposition) wereperformed successfully in infants for the first time. Meetings with US andMoroccan government officials (including Ambassadors from both countries)have contributed to ongoing support. Focus on barriers including technology,satellite availability, language (most of the Moroccan team speaks English),funding and time difference has contributed to the success of the project.Conclusions: Telemedicine is an innovative and practical means to augmentthe skills of pediatric cardiovascular surgery teams in the developing world. Weare optimistic that our program will be sustainable for the foreseeable future.Objectives:1. Understand role of telemedicine in pediatric cardiology.2. Know keys to sustainable international telehealth program.3. Observe best practice of telehealth.124 INTERNATIONAL TELEMEDICINE CONSULTATIONS FORNEURODEVELOPMENTAL DISABILITIESPRESENTERS AND CONTRIBUTING AUTHORS:Phillip L. Pearl, MD, Neurology Division Chief 1 , Mark A. Batshaw, MD 1 ,Sarah Evans, MD 1 , Oussama El Baba, MHA 2 , Issam Ramadan, N/A 2 ,Nader Tabbara, N/A 2 , Molly Reyna, N/A 3 , Craig Sable, MD 3 ,Philip Hopkins, N/A 3 , Joseph Knight, N/A 1 , Andrea Gropman, MD 1 ,Sheela Stuart, PhD 1 , Penny Glass, PhD 1 , Anne Conway, N/A 1 ,Rachel Roberts, N/A 1 , Robert J. Packer, MD 1 .1 Center for Neuroscience and Behavioral Health, George WashingtonUniversity School of Medicine, Washington, DC, USA, 2 International MedicineProgram, George Washington University School of Medicine, Washington, DC,USA, 3 Telemedicine Department, George Washington University School ofMedicine, Washington, DC, USA.Background: A combined project between Children’s National Medical Center(CNMC) Center for Neuroscience and Behavioral Health in Washington, DC andthe Khalifa bin Zayed Al Nahyan Foundation in the United Arab Emirates isdedicated to providing clinical services and professional training for the underservedEastern regions. This includes regular training conferences for professionals,establishment of an evaluation and treatment center, and telemedicine.Objectives: Weekly telemedicine consultations are provided by a neurodevelopmentalteam from CNMC for families and clinicians based in the easternregion of the UAE. The families and patients are presented by a group of clinicianslocated in the Fujairah Rehabilitation Center for the Disabled or the RehabilitationCenter for the Disabled, Dibba Al Fujairah, operated by the UAEMinistry of Social Affairs. There are bilingual members of the team in bothlocations for English and Arabic translation. These teams have been developedduring a series of educational symposia held at the Fujairah Center in the EasternUAE region. Following two screening trips to review clinical facilities, commondiagnoses, and a needs assessment in this region, a curriculum was devised toprovide on-site week-long training programs. Three symposia were held betweenDecember 2011 and May 2012 with emphasis on the clinical topics of cerebralpalsy, spina bifida, and autism. Concomitantly, regular real-time (Video over IP/average connection 768 kbps) were scheduled for clinical assessments of patientsand families selected by the UAE clinicians. Medical records are reviewed prior tothe telemedicine session and each session is followed by a full consultation reportincluding diagnostic formulation and specific treatment recommendations.Findings: Between 2/29/12 – 9/12/12, 17 weekly one-hour live interactivetelemedicine sessions have been conducted with consultations on 19 patients(9 M/10 F; age range 12 months to 22 years; mean age 8 years). The primarydiagnoses were cerebral palsy (N = 11), neurogenetic disorder (3, includingDown and Rett syndromes), autism (2), myelomeningocele (1), and neuromusculardisorder (1). Common comorbidities were cognitive impairment,communication disorders, and epilepsy. Specific recommendations includedparticular imaging and DNA studies for diagnosis, alteration of antiepilepticmedications, spasticity management including botulinum toxin protocols,and specific therapy modalities including wrapping techniques and customizedbody vests to assist with motor tone and stability. Referral for specificorthopedic surgical procedures was provided in three cases. Recommendationsfor speech generating equipment and specific apps for communicationwere also provided. Informational materials were commonly sent as well, suchas specifications for equipment modalities and specific language and behavioralrecommendations. The recommendations have been received withimproved outcomes including clinician satisfaction for training, reportedattainment of therapy goals for patients, and requests for ongoing sessions. Notelemedicine sessions were cancelled due to technical difficulties.Conclusions: International consultations in neurodevelopmental disabilitiesutilizing telemedicine services offer a reliable and productive method for jointprograms with clinically effective sessions and improved outcomes.Objectives:1. Establish multidisciplinary telemedicine consultations.2. Utilize telemedicine for diagnosis in neurology.3. Broaden use of telemedicine for children with neurodevelopmentaldisabilities.622 QUALITY IMPROVEMENT IN TELEGENETICS: THE DEVELOPMENTOF COMMON EVALUATION MEASURESPRESENTERS AND CONTRIBUTING AUTHORS:Liza M. Creel, MPH, Project Manager 1 , Sylvia Au, MS, CGC 2 , NCCTelegenetics Workgroup, N/A 3 .ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-75

CONCURRENT ORAL PRESENTATIONS ABSTRACTS1 Mountain States Genetics Regional Collaborative, Austin, TX, USA, 2 WesternStates Genetic Services Collaborative, Honolulu, HI, USA, 3 NationalCoordinating Center for the Genetic and Newborn Screening ServiceCollaboratives, Bethesda, MD, USA.Telemedicine is a well-recognized tool for expanding access to primarycare and subspecialty services in underserved communities. Withinthe genetic services delivery system, use of telemedicine is variableacross the US. A small number of genetics clinics have long-standingtelemedicine programs and new programs have been implemented inrecent years, thus providing an opportunity to begin identifying telegeneticsbest practices. Through the Health Resources and ServicesAdministration (HRSA), The Regional Genetic and Newborn ScreeningServices Collaboratives (RCs) support several of these telegenetics initiatives.The RCs serve to expand and improve newborn screening andgenetic services for individuals affected or at risk for heritable disordersand their families; translate genomic medicine into health care deliverysystems; and assist states in strengthening their capacity to providegenomic information and services to the public. The RCs serve regionsthat are culturally and geographically diverse and present uniquechallenges to families needing access genetic services. The NationalCoordinating Center for the Genetic and Newborn Screening ServiceCollaboratives (NCC), which focuses on coordinating and promoting RCactivities, developed a national Telegenetics Workgroup in 2007. Thisworkgroup concentrates on understanding the current status of telemedicinewithin genetics services delivery systems; identifying bestpractices and opportunities for cross-regional collaboration, adoption,and expansion; and evaluation and quality improvement of currentprograms. Recently, the NCC Telegenetics Workgroup started an initiativeto develop a minimum set of evaluation measures for telegeneticsprograms developed or supported through the RCs. The goal of thisactivity is to demonstrate collective improvements in access to andquality of genetic services within and across regions, and to informquality improvement of these activities. The workgroup conducted aliterature review, collected national evaluation measures from the HRSAOffice for the Advancement of Telehealth, and reviewed evaluation toolscurrently used in telegenetics programs from across the country. Fromthese reviews, the workgroup has identified common measures in theareas of program demographics, satisfaction, access, and costs. Currently,the workgroup is affirming its definition of telegenetics (seewhite paper available on www.nccrcg.org) and working through consensus-basedselection of a minimum set of measures. The workgroupwill then make recommendations to the entire NCC/RC system at itsNovember 2012 meeting for consensus-based adoption. Once the finalset of measures is selected, the workgroup will partner with the NCCEvaluation Workgroup to develop data collection mechanisms, reportingperiods, implement a quality improvement component to this activity,and link to the NCC/RC-selected HealthyPeople 2020 measures (MICH30, MICH 31) on access to care, which assure that that all RC activitiesare tracking their larger health impact. The workgroup expects thisactivity to be completed by May 2013, with data collection to beginJune 2013. Other telegenetics programs not funded through the HRSANCC/RC system will also be invited to participate. The NCC and each ofthe seven RCs are funded through the HRSA Maternal and Child HealthBureau (MCHB), Division of Services for Children with Special HealthNeeds (DSCSHN), Genetic Services Branch (GSB).Objectives:1. To understand the application of telemedicine in the delivery of geneticservices.2. To understand the process through which a minimum set of evaluationmeasures can be developed for quality improvement purposes.3. To understand how a minimum set of measures can inform bestpractices and quality improvement activities.4:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 064Session Title: BUSINESS AND OPERATIONALDECISIONS IN TELEMEDICINETrack: Finance and Operations I Meeting Room 19 A/BMODERATOR: Molly Reyna, Senior Vice President, Strategy.Specialists on Call, Leesburg, VA.167 NIGHTHAWK V DAYHAWK - TWO MODELS FOR TELERADIOLOGYPRESENTERS AND CONTRIBUTING AUTHORS:Howard Reis, MBA, VP of Business Development.Teleradiology Specialists, West Nyack, NY, USA.There are now well over 100 commercial Teleradiology providers deliveringservice to healthcare facilities throughout the United States. While the firstand best known provider, Nighthawk is no longer in existence since their 2010acquisition by vRad, Nighthawk has become the generic term for the practiceof having an outside service company read emergency room medical images,primarily at night and on weekends. Nighthawk provided the benefits ofpermitting the in-house radiology group to sleep at night, and offering multispecialtycapability which small staff radiology groups could not provide.Over the past few years, a second model has evolved. Dayhawk Teleradiologyfirms have begun to provide service primarily to imaging centers, urgent carecompanies, mobile medical companies and individual physician offices suchas orthopedists and ENT practices. The Dayhawk model primarily evolved asworkflow efficiencies enabled these firms to read large number of X-Raystudies at very low price points. A study of the firms involved in the delivery ofTeleradiology establishes the following similarities and differences:NIGHTHAWKMost Frequent Exam CT X-RayDAYHAWKTurnaround SLA 30 min/ 10 min stroke 24 hrs./ 30 min statType of Reads Prelims/ Finals All FinalsTypical Customer Radiology Groups /Hospitals Radiology Dept.RadiologistCompensationSalary plus incentivesUrgent Care, IDTF, mobilemedical, PhysicianpracticePay per clickOn-Site Coverage Growing trend Almost neverLocation of Doctors U.S. or overseas All U.S. BasedFavorite Conference RSNA UCAOA (Urgent Care)X-Ray Pricing Rather not Approaching $10 perexamBoth types of firms face similar challenges. Pricing has become extremelycompetitive with the need to provide lower prices while maintaining a qualitylevel of service. All firms need to maintain workflow models which optimizethe type of service delivered. Radiology reports will increasingly need to beintegrated with the electronic medical record of the system which sends thestudy. All firms are expected to deliver a high level of customer service to theirclients, and their clients’ patients.A-76 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSObjectives:1. Understand alternative teleradiology business models.2. Use teleradiology as a model for other telemedicine activities.3. Anticipate business challenges they will encounter as their businessmatures.120 TELEMEDICINE ANESTHESIA PRE-OPERATIVE CLINICSSUPPORTING THE EUROPEAN COMMANDPRESENTERS AND CONTRIBUTING AUTHORS:Jeffrey A. Faulkner, MD, CMR 402.Landstuhl Regional Medical Center, APO, AE, USA.The Landstuhl Regional Medical Center serves as a tertiary referral hospitalfor European Continent, Africa and the Middle East. Many primary care clinicsare remote from the hospital with travel times reaching fourteen hours. Thetravel times cause logistical difficulties in processing a patient from theirinitial surgical clinic visit through the Pre-operative and Operative process.This pilot project demonstrated decreased patient travel, decreased patienttime away from work and an increase in patient satisfaction. In addition, therewas a demonstrated reduction in unnecessary pre-operative laboratory andradiology requests as well as a decrease in the number of patients with incompletework-ups. The presentation demonstrates the organization and workflow needed for a network of clinics to cover a large geographic region. Thehardware and software requirements are explicitly explained as well as thecoding required for proper reimbursement.Objectives:1. Organize a Telemedicine Anesthesia Preop Clinic for a large population2. Predict cost savings resulting from implementation of TelemedicinePre-Op Clinics3. Understand the Hardware and Software requirements for implementingTelemedicine Pre-op Clinics707 THE POWER AND ECONOMIC IMPACT OF NETWORK BASEDMEDICAL DEVICE AGGREATORSPRESENTERS AND CONTRIBUTING AUTHORS:Dan McCafferty, BA, Vice President, Global Sales and CorporateDevelopment.AMD Global Telemedicine, Chelmsford, MA, USA.After almost twenty (20) years of deploying the same architecture formedical device information delivery the world is rapidly changing. Newmethodologies that use the best of older principles and the most promisingnew technologies are shaping the industry at a very rapid pace. This presentationwill explore the history of telemedicine and its associative technology.The pros and cons of different architectures will be reviewed delving into thepros and cons associated with them. Methodologies for addressing the disadvantageswhile driving physician adoption and lower costs will be exploredand organizations utilizing these newer methods will be profiled.4:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 065Session Title: FUNDING TRENDS, STRATEGIES &OPPORTUNITIESTrack: Finance and Operations IBallroom EMODERATOR: Nancy Rowe, Director of Telemedicine.NARBHA, Flagstaff, AZ, USA.277 RETROSPECTIVE REVIEW OF MEDICARE REIMBURSEMENT FORTELEHEALTH IN AUSTRALIAPRESENTERS AND CONTRIBUTING AUTHORS:Anthony C. Smith, PhD, MEd, BN, Deputy Director,Nigel R. Armfield, PhD, MSc, Leonard C. Gray, PhD, MBBS, FRACP.The University of Queensland, Centre for Online Health, Brisbane,Australia.Introduction: Worldwide, telehealth uptake has generally been slow andfragmented [1]. One reason might be that there is inadequate remuneration forreferrers and referees. In Australia, the Commonwealth Government is investingaround $620 million towards reimbursement and incentive paymentsfor video consultations, effective from July 2011. The initiative is intended tohelp improve access to specialist services through the increased use of telehealth[2]. Under this funding arrangement, teleconsultations are currentlylimited to medical consultations between patients and specialists via videoconference,with GPs potentially accompanying the patient. Specialist consultationswithin Residential Aged Care Facilities (RACFs) and to indigenousservices are also supported. The provision of generous payments and incentives,under the Medicare Benefits Schedule (MBS) is a clear sign of a policyshift and recognition of the need for new technology based health solutions.This aims of this study were to review telehealth activity performed under theMBS and to examine how this activity compares to overall spending throughthe MBS.Methods: We conducted a retrospective review of activity by analyzingstatistical data from Medicare Australia [3, 4]. Outcome measures included1.MBS telehealth activity (services recorded) and 2. MBS costs (benefits paid)during the 12 month period from July 2011 to June 2012. Comparisons weremade with overall costs and services administered through the MBS. Costs arereported in Australian Dollars (1AUD = 1.04USD).Results: During 2010-11, around 319 million MBS services were funded bythe Government at a cost of about $16.3 billion. During the following 12months, 26,062 telehealth services were funded through the MBS at a cost ofaround $3.38 million, excluding the additional one-off incentive paymentsavailable for a limited time to service providers. Based on the present activityreported through the MBS, telehealth represents about 0.008% of all servicesand 0.02% of all benefits overall.Conclusions: It is anticipated that the major funding strategy will encourageclinicians to explore the use of telehealth as a mechanism of supporting patientsin remote locations; improving access to specialist health services andreducing the costs and inconvenience of travel [1]. In the context of the overallfunding available under this new initiative, the uptake appears seemingly low,which is not dissimilar to what has been reported in terms of the uptake oftelepsychiatry in Australia [5]. However there are encouraging signs thattelehealth activity is increasing gradually. It is hoped that this activity will besustained in the long-term, as telehealth services are integrated appropriatelywithin mainstream practice.REFERENCES1. Smith AC and Gray LC. Telemedicine across the ages. The Medical Journal ofAustralia. 2009, 190 (1): 15–19.2. Australian Government. Connecting Health: Modernizing Medicare by providingrebates for online consultations. 2011.3. Medicare Australia. MBS Statistics. 2012.4. Australian Government, Medicare Australia Annual Report 2010-11. Availableat: http://www.humanservices.gov.au/spw/corporate/publications-and-ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-77

CONCURRENT ORAL PRESENTATIONS ABSTRACTSresources/annual-report/resources/1011/medicare-australia-annual-report-2010-11-full-report.pdf5. Smith AC, Armfield NR, Gray LC. A review of Medicare expenditure in Australiafor psychiatric consultations delivered by in person and via videoconference.Journal of Telemedicine and Telecare, 2012, 18(3):169–171.Objectives:1. Understand the context of health service delivery in Australia and thelogistical challenges in supporting patients in rural and remote areas.2. Understand the basic components of the new funding initiative designedto encourage telehealth uptake.3. Learn about the impact of the new funding scheme in the context oftelehealth uptake throughout Australia.194 FUNDING TRENDS FOR TECHNOLOGY IN HEALTHCAREORGANIZATIONSPRESENTERS AND CONTRIBUTING AUTHORS:Jeffrey M. Barlow, MPA, Grant Development Manager.Polycom Grant Assistance Program, Jefferson City, MO, USA.A consideration for any healthcare organization in the development anddeployment of telemedicine programs is how they will fund it. In today’stough economic climate, where budgets are strapped, a funding strategy is anecessary component of any plan for the creation and implementation oftelemedicine programs. Recently, federal funding trends have supported telemedicineprojects and focused on reducing the cost of healthcare, encouragingprevention and wellness, and increasing access of healthcare tounderserved or unserved areas. Additional federal funding mechanisms existthat support the acquisition of, deployment of, and maintenance of technologyfor telemedicine, including infrastructure, mobile solutions, cloud serviceofferings, video-conferencing endpoints, and training of healthcare personnel.Attendees will hear from a national grant and public policy expert withover 20 years experience in federal, state and local government grant funding,about these funding trends, existing grant resources for telemedicine projects,and important components that must be included in any successful grantproposal.Objectives:1. Understand federal funding trends for healthcare technology.2. Identify specific funding sources to support the purchase of technologyfor telemedicine projects.3. Integrate funding plans into their operations and technology planningprocesses.PRESENTERS AND CONTRIBUTING AUTHORS:Jamile Mack, BA, Business Admin, Technology Liaison, Telehealth,Sherene Schlegel, RN, BSN, Director, Telehealth Depart, Todd Czartoski,Doctor of Medicine, Director, Neurology, Pita Nims, Master of Nursing,Telehealth Clinical Program Coordinator, Juliette Lachner, MHAC, BusinessAnalyst, TelehealthSwedish Health Services, Seattle, WA, USA.Swedish Health Services has successfully implemented 6 telemedicineprograms both internally and externally since 2004. We now have 20telemedicine partners throughout Washington State. From the initialprogram (TeleICU 2004), we have added Telestroke (2005), TeleNeurology,Inpatient (2011), TeleSocial Work (2011), TeleHospitalist (2012) and TelePsych(2012). Currently, we are able to offer a menu of over 20 programsboth internally to one of our 5 campuses and externally to our partnersites. Through this growth, we have learned the importance of collaborationwith both physician and nursing leadership along with partneringwith our IT department in order to facilitate program sustainability. A keycomponent in expanding telehealth programs and services was the implementationof a new role within our organization of the Telepresenter.This new role required development of a training program based on theATA white paper. Included in the discussion will be lessons learned regardingdetermining appropriate staff, time to train, collaboration withNursing leadership and managing implementation of new programswithin our system. The programs that were launched internally specificallyto increase efficiencies across our 5 campus system include Tele-Neurology, inpatient, TeleHospitalist, TeleStroke, TeleSocial Work andTelePsych. Each program was specifically built to leverage current existingresources to maximize efficiencies and increase access to timelypatient care. Evaluation of the programs is ongoing looking specifically atquality, patient and provider satisfaction. Additionally, lessons learnedregarding assessment and implementation of new technology within ourorganization will be discussed regarding partnering with our internal IT/IS department. Also addressed will be lessons learned regarding determiningappropriate equipment implemented from both the technical andclinical perspective. Finally, data extraction and evaluation will be addressedas a means to help determine benefits of various programs from abusiness perspective addressing revenue streams, return on investments,and quality metrics.Objectives:1. Discuss increasing physician efficiencies and productivity by leveragingtelehealth technology.2. Identify key components necessary to launch programs targetingleveraging current resources.3. Demonstrate through metrics increased productivity and to includequality and safety measurements.4:15 pm–5:15 pm Tuesday, May 7, 2013DISCUSSION PANELSession Number: 066Session Title: 590 CHANGING HEARTS AND MINDS:WHAT IT TAKES TO FACILITATE CULTURE CHANGE INA LARGE, MULTI-SITE ORGANIZATIONTrack: Finance and Operations II Ballroom FMODERATOR: Sherene Schlegel, RN, BSN, Director of Telehealth, SwedishHealth Services.Swedish Health Services, Seattle, WA, USA.4:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 067Session Title: TRAUMA & DISASTER RESPONSETrack: Best Practices and Service Delivery Models I Ballroom GMODERATOR: Carl Keldie, MD, FACEP, Chief Medical Officer.Corizon, Brentword, TN, USA.A-78 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTS413 MILITARY TELEMEDICINE IN DEPLOYED SETTINGS, ENROUTECARE, TELE-COACHING AN UPDATE FROM THE FIELDLABORATORYPRESENTERS AND CONTRIBUTING AUTHORS:Dave L. Williams, FACHE, MHA, Project Manager Theater Telemedicine.TATRC, Fort Detrick, MD, USA.The delivery of best practices medical care in remote/ deployed setting is amajor challenge for military first responders. Current research in militarymedicine, is finding promising technologies, which offer hands-free commands,real-time electronic clinical data capture and transfer between thepoint of care, first responder and the emergency room PA /NP / doctor. Thetimely integration of bring your own device, with off-the shelf clinical sensors,connected by high speed digital LTE communications, reduces the‘‘golden hour to minutes’’. The strategy for overcoming these challenges isfocused on four research areas of emerging digital technologies. First, istargeted clinical intervention while en-route from the point of injury to thereceiving medical treatment facility. Second, is the ability to provide near-realtime, tele-vials and receive just-in-time tele-coaching between first respondersand doctor level providers. Third, is continuous connectivity andmonitoring of a warriors physiologic profile, with early reporting of heat,exhaustion, hydration, which could lead to becoming combat ineffective.Finally, the way ahead strategy: the military is exploring multiple avenues forsuccess, embracing emerging technology, leveraging data from the EMR, andtraining providers to assimilate/respond to the data/information rich environmentssoon to be available in remote and natural disaster settings (deployed).During NETMOD-12, military units performed clinical recordexchanges, ahead of patient arrivals, air/ground, provided live VTC, withclinical data streaming from on-patient near-field physiologic sensors. Thison-going collaboration between medics (TATRC, Fort Detrick, MD) and engineers,(US Army Communications & Electronics Research Development &Engineering Center) (CERDEC) has validated military capacity to supporttelemedicine & medical information exchange technologies in a field laboratoryenvironment. Next year’s events will focus on advanced sensors, providerinteractions, en-route care delivery, and Tele-coaching by PA / NPprofessionals, when (air/ground) evacuation is delayed or not available. 293-wordsObjectives:1. Explain how the current level of effort by military telemedicine researchersis enhancing remote care delivery using tele-coaching andjust-in-time clinical interventions to preserve life and limb leveragingLTE communications and clinical decisions.2. Review a series of emerging (promising) voice controlled telemedicinedevices that provide both clinical data to providers and electronicdocumentation for care continuity.3. Tell how advanced on-patient clinical sensors connect via near-fieldcommunications with the EHR to store and update medical treatmentstatus while enroute (air/ground) to the military medical facility.53 EVALUATION OF USING TELEMEDICINE IN UNEXPECTED DISASTERSIN CITY OF TEHRAN, IRANPRESENTERS AND CONTRIBUTING AUTHORS:Dina Ziadlou, MS, Engineer.SBMU, Tehran, Islamic Republic of Iran.Subject of decrease in effects of a disaster is a complex process because allmeasures leading to decrease in damages of a disaster should be consideredwhich itself requires considering many matters like engineering, managementand medicine. One of the most important needs of developing countries isoffering health and treatment services in disasters and emergency situations.Human disputes, droughts, natural disasters (floods, earthquakes and storms)can rapidly cause death or a big catastrophe. Meanwhile crisis managementwith an appropriate planning can set the society for prevention, preparation,aid and reconstruction. Considering that country of Iran geo-technologicallyis situated on earthquake belt, it is subject to devastating earthquakes andusing new technologies like Telemedicine can have a great effect in thestructure of crisis management of Iran. In this research proposed for the firsttime in Iran, structure of crisis management, Telemedicine devices and telecommunicationsystems have been verified and by assessing needs in time ofunexpected disasters- earthquake in Tehran metropolis; I have reached to aproposed plan for adding Telemedicine unit in structure of crisis managementplan in e-government. In a crisis maneuver, performed in a hospital forevaluation of using Telemedicine in crisis, using present telecommunicationconnections and Telemedicine systems in one group included that twentypersons and not using Telemedicine systems in other group with the samenumber, the status of both were verified and their weak and strong points wereevaluated. The results showed that using telemedicine technology and offeringspecialized of the doctors that are not at the scene of disaster leads to decreasein medical mistakes and decrease in transfer of the injured people to otherregions. Making condition of the injured people static by prescribing drugs orprescribing collar due to increase chance that injured stay alive. Increasingpreparedness of medical teams in main hospital by transferring information ofthe injured from disaster area to there, continues monitoring in the transferroute, leading to faster and more correct treatment of injured were otherresults of plan; Of course culture making, accepting technology, holding educationalclasses, performing crisis maneuvers, increasing technical knowledgeof work group are of important matters that should be paid attention to.Key words: Telemedicine, Crisis management, EarthquakeObjectives:1. Situation of telemedicine in Iran.2. SWOT of TM in Iran.3. Structure of crisis management in Iran.660 INTEROPERABLE TECHNOLOGIES IN DISASTER RECOVERY: A CASESTUDY FROM THE GREAT JAPAN EARTHQUAKE OF 2011PRESENTERS AND CONTRIBUTING AUTHORS:Chuck Parker, BA, MS, Executive Director.Continua Health Alliance, Beaverton, OR, USA.Following a disaster, medical support for survivors must shift from emergencymedical treatment to daily primary healthcare and disease managementto mitigate health risks associated with stress and environmental changes.Earthquake exposure and living in an evacuation camp are factors associatedwith elevated cardiac risk. After the Great East Japan Earthquake of 2011, JichiMedical University worked with A&D Medical to develop a remote monitoringprogram for 1,400 evacuees in an area that had suffered enormous losses. Thedisaster site lacked basic services such as electricity, water and sewer for the firstthree months, limiting the capability to monitor and treat patients and accessmedical records to assess pre-existing cardiovascular disease. A rapid solutionwas needed and no off-the-shelf solution could meet the requirements. TheDisaster Cardiovascular Prevention Network (D-CAP) was developed to remotelymonitor the blood pressure of evacuees, with a goal to prevent cardiacevents in survivors identified as ‘‘high risk.’’ Screening of 1,500 evacueesidentified 400 people with elevated cardiac risk. D-CAP has been credited withsaving lives. Every one of the 400 ‘‘high risk’’ D-CAP evacuees is still livingtoday and the program remains in operation. Participating companies hadpreviously certified their products for interoperability through Continua, facilitatingsignificant reductions in time to launch and implement the program. Itcan be inferred that the time saved may have resulted in fewer cardiac incidentsand/or saved lives. The D-CAP program demonstrates clearly the clinical, timeª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-79

CONCURRENT ORAL PRESENTATIONS ABSTRACTSand cost advantages of interoperability for program implementation followinga disaster, when time is of the essence. It has also shown how the availability ofcertified, interoperable devices supports innovation in connected healthcare.Objectives:1. Explain time value of preexisting interoperability in this application ofremote monitoring in disaster mgmt.2. Explain the cost value of preexisting interoperability for remotemonitoring in this disaster mgmt program.3. Explain the implications of preexisting interoperability for outcomes inthis remote monitoring program.4:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 068Session Title: LESSONS LEARNED FROMTELEMEDICINE INITIATIVES IN OTHER COUNTRIESTrack: Best Practices and Service Delivery Models II Meeting Room 17 A/BMODERATOR: Roger Swinfen, Founder and Trustree.The Swinfen Charitable Trust, Canterbury, United Kingdom.376 ‘‘REVIEW OF NATIONAL TELEMEDICINE RURAL SUPPORTPROGRAM NORTHERN PUNJAB-PAKISTAN’’PRESENTERS AND CONTRIBUTING AUTHORS:Asif Zafar, MBBS, MCPS, FRCS, FCPS, Surgical Unit II,Qasim Ali, FCPS, MRCS, Faisal Murad, MBBS, FCPS.Rawalpindi Medical College, Rawalpindi, Pakistan.Introduction: Government of Pakistan initiated National Telemedicine RuralSupport Program in November 2007. Hub and spoke model was followed withTertiary care centers linked to rural hospitals. Federal Ministry of Informationtechnology will be transferring management to Provincial governments ofPunjab and Sind.Materials and Methods: Northern Punjab hub in Holy Family hospital,Rawalpindi was linked to Tehsil and District hospitals in Attock, PindiGheb, Khushab and DG. Khan. All sites are equipped with Video conferencingequipment, and Peripheral devices. Connectivity was initially satellitebased; it has now been shifted to DSL Broad band. Designated ITSupport staff was provided at the HUB and remote sites. Customized webbased software was utilized in all Teleconsultations. Hybrid approachutilizing Store & Forward and Virtual Clinics provided basic telemedicineservices in ENT, Dermatology, and surgical specialties. Weekly Tele consultationschedule was followed.Results: Holy family provided 8,475 Teleconsultations from July 2008 -30 th June 2012. Highest numbers of consultations were in Dermatology(2,285), otolaryngology (2,195), and ultrasonology (1,547). Attock Districtutilized the facility most. Rajan Pur and DG Khan Districts of southern Punjabwere worst affected by floods in 2010. They were provided 3,593 consultations.The additional benefit was Education and CME programs for health careprofessionals working in remote areas. Challenges are in transfer of theseservices to Provincial governments, retaining trained support staff businessplan for proper remuneration for Medical staff providing these services.Conclusions: Rural telemedicine centers have enabled rural population toseek consultation, advice and treatment from specialist doctors in urbancenter hospitals. The results clearly demonstrate that Specialty services can berun from the hub hospitals provided standard procedures are followed. Thisexperience can be utilized in planning National Telemedicine Program providedthe challenges and difficulties are addressed.Objectives:1. Setting up Rural Telemedicine centers in developing countries2. Prioritize Specialties when starting rural telemedicine programs3. Additional benefits : Education and running CME programs615 TELEMEDICINE IN VIETNAM: APPLICATIONS FOR INFECTIOUSDISEASE CONTROLPRESENTERS AND CONTRIBUTING AUTHORS:Paul E. Kilgore, MPH, MD, Associate Professor 1 , Vu D. Thiem, MD, PhD 2 ,Tran N. Duong, MD, PhD 2 .1 Wayne State University College of Pharmacy & Health Sciences, Detroit, MI,USA, 2 National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam.Vietnam is a large country that is both geographically and culturallydiverse. Over the past 30 years, Vietnam has made great strides in improvinghealth care delivery and improving health indicators. These effortshave produced sustained high levels of immunization coverage particularlyfor infants and children. Despite significant achievements, resourcesfor healthcare services in Vietnam remain limited. As a result, the populationof Vietnam now remains at risk for major communicable and noncommunicable diseases. This dual challenge requires innovative solutionsthat leverage existing technologies and telecommunications capacitywithin Vietnam while taking advantage of existing healthcare facility infrastructure.A model for introduction of a telemedicine network fortracking and responding to reports adverse events following immunizationand reports of acute infectious disease case clusters was created. The modelwas evaluated for its ease of introduction, ability for integration within theexisting health care and public health system, anticipated training requirements,linkage with existing Internet and telecommunications facilities,and ability to generate actionable data. Measures for systemperformance were also devised in order to compare the telemedicine systemfor vaccine safety and infectious disease with existing paper-based reportingand monitoring systems now present in Vietnam. Development ofthe model telemedicine system for vaccine safety and infectious diseases inVietnam has resulted in a step-by-step plan that will enable system deploymentand analysis of disease-related outcomes in representativepopulations living in the northern region of Vietnam. An adjunct benefit ofthis project has been the development of a detailed plan for deployingInternet accessible resources that support standardized clinical evaluationof adverse events following immunization. Future work in this model willinvolve pilot evaluation of standardized electronic case reports for reportableinfectious diseases. In the short-term, this project is expected toimprove the quality of individual disease case reports as well as thetimeliness of reporting to central health authorities. In turn, such improvedtimeliness is expected to hasten provincial, regional and national healthauthorities’ response to serious adverse events following immunizationand infectious diseases. Due to the ongoing threat of H5N1 avian influenzathat was initially reported from Vietnam, innovations provided in thetelemedicine model described here are likely to reap longer term benefitsby improving the quality of immunization programs and infectious diseasecontrol. Proof-of-principle and demonstration of telemedicine’s benefits inthese high-priority areas is likely to spur application of telemedicine toother clinical disciplines throughout Vietnam.Objectives:1. Understand the context for telemedicine in VietNam2. Describe the proposed model for telemedicine applied to infectiousdiseases3. Understand future telemedicine applications for improving quality ofimmunization programsA-80 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTS603 LESSONS LEARNED IN LATIN AMERICA: AMI AND STEMI OUT OF5,5MM EKGS INFORMED SINCE 2008PRESENTERS AND CONTRIBUTING AUTHORS:Thais Waisman, PhD, MBA, Regional Innovation Director 1,2 ,Francisco Fernandez, BSc 1 .1 ITMS do Brasil, Sao Paulo, Brazil, 2 USP - University of Sao Paulo-Engineering School, Sao Paulo, Brazil.The beauty of Telemedicine (tele-EKG) is the incredible shortening timefrom the procedure to the results. After 8 years experience in Latin America,especially Brazil, Chile and Colombia in totally different environments, thequestions have changed from the exam stand point to the patient stand point:What should a patient do with a AMI diagnosis do if there is no reliableambulance network to transport them to a hospital? Tragically, this situationoccurs in the vast majority of countries in the world. In such situations, patientslean on transporting themselves to the hospital and taking massive risksthat they will reach urgent care at the hospital to treat their life-threateningAMI. The absence of an ambulance or existence of unreliable and inefficientambulance systems, hugely delay the treatment of an AMI. It must be understoodthat management of AMI, either by thrombolysis or Primary PCI, iscritically time-dependent. For thrombolytic therapy, a door to needle time ofless than 30 minutes, and for Primary PCI, a door to balloon time of less than90 minute, are the desired goals that are a part of advocated guidelines. With aqualitative and quantitative absence of ambulances, achieving these mandatedtreatment times is simply not possible, and results with both thrombolytictherapy and Primary PCI will therefore be sub-optimal. Unfortunately, thissituation, tragically, is a norm rather than the exception. Telemedicine effectivelyreduces these shortcomings. In ways, it can even improve upon theresults of thrombolytic therapy and Primary PCI by its ability to initiate veryearly management, both within and outside an ambulance. Telemedicine allowsthe diagnosis of AMI in the field capturing a diagnostic quality 12 leadelectrocardiogram. Some o f the lessons learned are described below:- It is also already well known that pre-hospital ECG reduces ischemic time.- Telemedicine is a tool of a great value for the early diagnosis of AMI andits treatment, particularly in remote areas.- Telemedicine decreases of patients transfer from Primary Care to Hospitals.- Significantly reducing the transport of patients with suspected heart attack.- Another item, perhaps most important, is the immediate care of patientsnewly infarted, allowing the medical help immediately and an expectationof recovery up to 50% higher than patients transported to a hospitalunit. Resources can also be used for periodic evaluation of patients withheart disease and other chronic and diabetic, hypertensive with COPDenrolled in Hypertensive and other programs available.The main benefits of a Telemedicine implementation are described below:1. Reduce transfers, time and cost of transporting patients;2. Increase the capacity to resolve points of attention;3. Extend the virtual presence of specialists at the point of care;4. Improve management of health resources through the assessment andscreening by experts, reducing the pressure on hospitals; and5. Enhance cooperation and integration of researchers with sharing ofclinical records, contributing to the decision making of local publicpolicies and national as well as clinical research itself.Objectives:1. Understand that Telemedicine (tele-EKG) is the current lead resource tooptimize ST elevation myocardial infarction (STEMI)2. Comprehend that telemedicine is a useful tool in decreasing delays inaccurate diagnosing of STEMI.3. Telecardiology has shown cost beneficial and globally applicable despiteeconomic, geographic and political differences.4:15 pm–5:15 pm Tuesday, May 7, 2013HOW-TO PANELSession Number: 069Session Title: 701 STRATEGICALLY ESTABLISHINGTELEHEALTH SERVICES FOR THE MANAGEMENT OFCHRONIC DISEASES: A BEACON PROGRAMTrack: Best Practices and Service Delivery Models III Meeting Room 16 A/BPRESENTERS AND CONTRIBUTING AUTHORS:Kathryn Lombardo, MD, Department Chair, Psychiatry and Psychology 1 ,Christian Milaster, Dipl.-Ing., President, Telehealth Consultant 21 Olmsted Medical Center, Rochester, MN, USA, 2 Ingenium Consulting Group,Inc., Lanesboro, MN, USA.Leveraging technology to improve the management of chronic diseases—including diabetes, congestive heart failure, and psychiatric disorders—is ahigh-priority initiative of many innovative healthcare organizations. Butgetting started with just the right technology, with the right services, and withthe right providers is crucial to the long-term, sustainable success of suchinitiatives. And while the menu of feasible telehealth and telemedicine solutionsis growing quickly, picking the right pilots and technologies can bedaunting and difficult. Olmsted Medical Center, located in southeasternMinnesota, operates a geographically distributed integrated health care networkincluding two multi-specialty outpatient clinics, physical and occupationaltherapy facilities, a weight loss & wellness center, two walk-in FastCareretail clinics, a 61-bed hospital with a 24-hour emergency department andBirthCenter in Rochester, MN as well as primary care clinics with 2 to 5clinicians in nine Southeastern Minnesota municipalities. In 2012, OlmstedMedical Center received funding from the Beacon grant, funded through theOffice of the National Coordinator (ONC), to launch demonstration projects inthe area of distant and remote chronic disease management. We started withmental health telecare in nursing homes and then expanded into specialtytele-education, tele-visits and tele-exams in the regional primary care clinicsas well as pilots in remote monitoring for the management of diabetic patientsand high-risk pregnancies. Several barriers and facilitators of this work rangedfrom Medicare reimbursement policies, technical limitation to high speedcommunication in several of the rural sites, patient privacy concerns, issueswith EHR documentation, training for onsite staff to facilitate telehealth visits,clinician reluctance, patient and family reluctance to impatience of earlyadopter clinicians. In this session the presenters will share the lessons learned(what worked well and what didn’t) from launching and running telehealthprojects across multiple modalities (including: live A/V telemedicine, remotemonitoring, and store & forward), multiple specialties (including psychiatry,diabetes education, cardiology, occupational health, OB/Gyn), and multiplelocations (including: nursing homes, rural primary-care clinics, employersites and patients’ homes). The presentation will be based on a discussion ofthe underlying principles of systems thinking, design thinking, metrics-drivenperformance improvement, and formal project management along withbuilding support across the organization’s leadership and proactively managingthe organizational change that laid the foundation for the success of thisinitiative. Presented solutions will be practical and transferrable to other organizationsor health care systems considering moving into similar types oftelehealth services to improve access and help bridge the distance betweenpatients and providers.Objectives:1. Participants will be able to describe how to overcome the reimbursement,technical, and cultural barriers to establishing telehealthservices.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-81

CONCURRENT ORAL PRESENTATIONS ABSTRACTS2. Participants will be able to describe a multi-modal, multi-location,multi-specialty approach to leveraging telehealth for the managementof chronic diseases.3. Participants will be able to describe the opportunities and benefits oftelemental health visits for nursing home residents.667 TELEPRESENCE DESIGN REVOLUTIONPRESENTERS AND CONTRIBUTING AUTHORS:Michael Meyer, BS, MBA, Partner.Essential, Boston, MA, USA.4:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 070Session Title: VIRTUAL WORLDS & REMOTEPRESENCE IN DELIVERING PATIENT CARETrack: Innovations Meeting Room 18 C/DMODERATOR: Jerry Kolosky, Senior Healthcare Advisor, Office of the CTO.Panasonic Company of North America, Secaucus, NJ.193 REMOTE PRESENCE FOR SUPPORT AND MENTORINGOF HIGH- CONSEQUENCE MEDICAL DEVICESPRESENTERS AND CONTRIBUTING AUTHORS:Perry S. Bechtle, DO, Anesthesiologist.Mayo Clinic in Florida, Jacksonville, FL, USA.The FDA approved medical devices that support the most advanced surgical,minimally invasive and interventional procedures including those inneurosurgery, neurointerventional, cardiac, cath lab, general, urologic, gynecologicsurgery are high-tech, high consequence, and costly both from thestandpoint of manufacturing and the extensive support network requiredto inform, contract, supply, and train both surgical teams and surgeon /interventionalist in clinical and technical training. This support, mostly doneby field technical specialists and physicians, currently involves extensivetravel and logistics that is both costly and can limit the availability of supportduring cases, even in the early experience of the surgeon with the device.Further, increasingly competitive medical device markets, sluggish economy,diminishing hospital budgets and new taxes on medical devices have causedsignificant industry-wide cuts in sales and support staff making in-personsupport even more challenging. The aggregation of these factors: high cost,high-tech, high consequence, flat learning curves that require experientiallearning, and fiscal constraints on technical support creates an ideal environmentfor developing new lines of medical device support using RemotePresence as the platform for education and training of hospital staff, supplementingopportunities for mentoring physicians, extending medical devicesupport far into the user experience, extending quality control and shorteningthe feedback-device improvement cycle. Using RP in device support has thelikely potential to improve procedural safety, provide more standardization ofdevice deployment, improve the experience of the user and their teams, improvethe productivity of the medical device support workforce–all at lowercost than business as usual. This presentation will be both fast paced andentertaining, providing a background into the patient safety, device safety andlogistical problems that are common to many high-consequence medicaldevices and how Remote Presence and Remote Video Conferencing technologycan address these problems.Objectives:1. Understand the regulatory issues surrounding mentoring of medicaldevices.2. Understand the economics of medical device support and mentoring.3. Understand the safety issues and opportunities for Remote Presence insupporting high consequence medical devicesABSTRACT WITHDRAWN407 AVESS: VIRTUAL TECHNOLOGIES FOR VIRTUALLY EVERYONEPRESENTERS AND CONTRIBUTING AUTHORS:Troy A. Turner, Rehabilitation and Human Performance Scientific DomainCoordinator.TATRC, Fort Detrick, MD, USA.The growing area of virtual world technology provides a unique opportunityto research this potential application for a remote patient careand support delivery model. The Telemedicine and Advanced TechnologyResearch Center (TATRC) is currently developing the ‘‘Amputee VirtualEnvironment Support Space’’ as a proof of concept virtual world environmentto determine the ability for and efficacy of delivering care througha virtual environment. AVESS was originally constructed to provide avirtual support environment to facilitate peer support regardless of one’sphysical or geographic constraints among military amputees. It consistedof four main virtual environment regions which include areas for meeting,avatar customization, building, group activities, and social activities. ASmall Business Innovative Research (SBIR) effort is currently underway toprovide additional capability to the environment through the integrationof physical therapy support utilizing the Microsoft Kinect system in con-A-82 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSjunction with the virtual world, and also allowing for gesture and facialmapping to provide a more immersive experience for the user. Thesetechnological enhancements could provide the means for clinicians toprovide remote care beyond traditional video-teleconferencing, especiallyfor patients in remote areas. The AVESS model serves as a proof-of-conceptdemonstration that has broader clinical and technological applications.This presentation will discuss the current development status of AVESS aswell as the lessons learned from this research, which comprise broaderissues of security and authentication requirements and also more focusedissues of determining specific modules, activities, and environmentalconcerns for different clinical needs.712 THE HIGHWAYS AND BYWAYS OF CENTRALIZED CREDENTIALINGFOR TELEHEALTHPRESENTERS AND CONTRIBUTING AUTHORS:Chris Veremakis, MD, Mercy Health 1 , Maureen Kolzowski, None 2 ,Wendy Deibert, RN, BSN 1 .1 Mercy Health, Chesterfield, MO, USA, 2 Mercy - St. Louis, St. Louis, MO, USA.Maneuvering the rules and regulations of telemedicine licensing and credentialingis a process full of speed bumps, pot holes and potential collisions.With a tele-ICU, 70 + telehealth initiatives crossing 4 states (Arkansas, Kansas,Missouri and Oklahoma), Mercy Health understands the true need for a centralizedcredentialing process. This session will travel the road of implementinga centralized credentialing process across, within and outside ahealth system, in both the inpatient and outpatient venues.451 WELCOME TO THE PROXY CLUB! THE EVOLUTION OF PEER REVIEWTHROUGH TELEMEDICINE CREDENTIALINGPRESENTERS AND CONTRIBUTING AUTHORS:John Mills, BA, JD, Attorney.Fenton Nelson, Los Angeles, CA, USA.Objectives:1. Understand what comprises a virtual world.2. Understand key concerns and requirements when developing virtualworld environments for patient care.3. Determine the potential role of virtual worlds in delivering patient care.4:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 071Session Title: CREDENTIALING AND RISKMANAGEMENTTrack: Policy Meeting Room 18 A/BMODERATOR: Alexis Gilroy, JD, Partner.Nelson Mullins Riley & Scarborough, Washington, DC, USA.A major obstacle to achieving cost-effective telemedicine services wasovercome when the Centers for Medicare and Medicaid (CMS) issued newregulations in 2011 that eased the requirements for hospitals to credential andgrant privileges to physicians and practitioners located remotely. Prior to the2011 regulations, the telemedicine credentialing process was widely viewed asa major deterrent for receiving telemedicine services, because of the administrativeburden it imposed on hospitals and medical staffs in having to performtheir own separate review and verification of licensure, training anddisciplinary background of the remote practitioner. Both CMS and the JointCommission now allow for credentialing by proxy, which means that thehospital receiving the telemedicine services, or the ‘‘patient-site’’ hospital, canrely on a ‘‘distant-site’’ hospital’s credentialing of the same practitioner. Ifhospitals choose to credential by proxy, they must enter into a writtenagreement with a Medicare-certified hospital or telemedicine entity, i.e., the‘‘distant-site,’’ where the physician or other licensed practitioner deliveringthe service is located at the time the service is provided via telecommunications.The written agreement must satisfy certain conditions. One of thoseconditions is that the ‘‘patient-site’’ hospital must ensure that an internalreview is conducted of the remote practitioner’s performance of his or herprivileges, and it must send the distant-site hospital or telemedicine entity theresults of its review for use in the distant-site’s periodic appraisal of thepractitioner. Although there should be little doubt that credentialing by proxygreatly expands patient access to health care and provides greater opportunityfor the advancement of telemedicine delivery, it also raises new challenges inhow peer review is conducted at hospitals. For example, under the law of moststates, hospitals can be liable for negligently credentialing the practitionerswho treat the hospital’s patients. Hospitals that choose to credential by proxywill consequently want to have a thorough understanding of the credentialingand privileging process utilized by the distant-site hospital or telemedicineentity, and may even seek indemnity as part of the written agreement. Anothernew challenge is in the patient-site hospital’s reporting of its peer review of theremote practitioner to the distant sites. Most states consider peer review informationto be confidential and privileged. Providing internal peer reviewreports to outside organizations potentially undermines the confidentiality ofthis information. This presentation, by an expert in the law of medical staffand peer review, will provide an overview of the standards for telemedicinecredentialing under CMS’ new regulations as well the Joint Commission;explore the resulting complex legal issues that arise for hospital boards,medical staff leadership and the practitioners providing the telemedicineservices; and suggest best practices for drafting medical staff bylaws and theª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-83

CONCURRENT ORAL PRESENTATIONS ABSTRACTSagreements between the patient-site hospitals and distant sites so as to minimizeliability and promote quality of care through peer review.Objectives:1. Assess when and under what circumstances credentialing by proxy canbe used, and how to appropriately implement it through carefullydrafted medical staff bylaws and contracts.2. Assess when traditional credentialing methods should be used, eventhough credentialing by proxy is an available option.3. Ensure the continuing privilege and confidentiality of peer reviewinformation.666 MANAGING TELEMEDICINE LIABILITY RISKSPRESENTERS AND CONTRIBUTING AUTHORS:Kenneth E. Rhea, MD, FASHRM, Risk Management Specialist.Medical Interactive Community, Metairie, LA, USA.It is clear that implementation of telehealth is rapidly affecting medical careand has become a broadly accepted, modern means of delivering medicalinformation and clinical healthcare. By changes in physician practice, governmentregulation, and economic conditions this trend will rapidly increaseover the next years. While there are without question many advantages totelehealth and telemedicine, any physician, medical group, or institutionparticipating in this type of healthcare must be aware of possible malpracticeand liability issues and possess the know-how to manage these risks. Thisshort presentation is an overview of these issues and strategies. It is wellknown that the risks in conventional medical practice cover a large spectrumincluding such things as violations, perceived or otherwise, of the legal duty topatients, violations of statutory regulations, improper practice management,failed confidentiality of protected health information, and poor patientcommunications all of which can lead to patient harm and medical adverseevents. Adverse medical events, with or without diagnostic and treatmenterror, are a fact of medical practice, but these events lead to litigation, andfinancial loss. Every year sees large numbers of malpractice allegations andincreasing levels of regulatory requirements. Unfortunately these risks are inmany instances increased by the use of telehealth and telemedicine and in factnew levels of current risks are being added. While every hospital and medicalorganization recognizes to some degree the need of risk planning the necessityhas now increased. Rapid advances in technology with resultant increasedtelemedicine and remote practice capability has moved potential liability issuesto a new level. Attention to important risk reduction and preventativefactors has always been necessary, but now become even more critical. Forexample areas such as patient communication and informed consent nowbecome even more important when the healthcare provider is remote. Jurisdictionalissues, usually of little concern to a physician seeing a patient inhis/her private office, now take on increased importance. Depending on thelocation of the physician or patient familiarity with other state regulationsmay be critical. The possible creation of the physician/patient relationshipbecomes a more important factor as well as the consideration of generalagency and vicarious liability. Important regulatory requirements of otheragencies and organizations also become more relevant to healthcare providersthan in the past, e.g. Food & Drug Administration (FDA), Federal CommunicationCommission (FCC), The Joint Commission, and others. Fortunate inmany respects and unfortunate in others, the increasing use of advancedtechnology to monitor, diagnose, and treat patients bring new emphasis to oldconcerns and layers of new risk concerns. This overview presentation willaddress these issues and provide some guidance to healthcare providers andtelemedicine programs on making necessary risk decisions. This informationwill increase the knowledge of risk factors that have always been present andwhich are now even more relevant. Beyond having a greater appreciation ofthe risks in telehealth and telemedicine practice, there will be a better understandingof how to prepare for the risks before liability problems occur.Objectives:1. Recognize the broad areas of potential liability in telemedicine encounters.2. Discuss methods of risk reduction in telemedicine activity.3. Develop risk management planning specific to particular types of telemedicineencounters.4:15 pm–5:15 pm Tuesday, May 7, 2013INDIVIDUAL ORALSession Number: 072Session Title: SUBSPECIALIST USE OF TELEMEDICINETrack: Pediatrics Telehealth Colloquium Meeting Room 12 A/BMODERATOR: Kathleen Webster, MD, MBA, Director, Division of PediatricCritical CareLoyola University Medical Center, Maywood, IL, USA.674 EVALUATION OF TELEHEALTH TO SUPPORT PEDIATRIC SEXUALABUSE EXAMINATIONS IN RURAL COMMUNITIESPRESENTERS AND CONTRIBUTING AUTHORS:Sheridan Miyamoto, PhD Candidate, FNP, MSN, RN, Nurse Practitioner,Nurse Researcher 1 , Madan Dharmar, MBBS, PhD 2 , Cathy Boyle, PNP, MSN,RN 3 , Nikki H. Yang, DVM, MPVM 3 , James P. Marcin, MD, MPH 2 .1 UC Davis Betty Irene Moore School of Nursing; UC Davis Department ofPediatrics, Sacramento, CA, USA, 2 UC Davis Department of Pediatrics; UCDavis Center for Health and Technology, Sacramento, CA, USA, 3 UC DavisDepartment of Pediatrics, Sacramento, CA, USA.Objectives: To evaluate the impact of telehealth consultation and qualityassurance on the ability of a rural examiner to conduct a complete andthorough examination.Methods: Telehealth consultation connections were established in six ruralsites in Northern California. Real-time and store-and-forward consultationswere provided by child sexual abuse experts from University of CaliforniaDavis Children’s Hospital (UCDCH) to examiners conducting forensic childsexual abuse examinations in the rural communities. Examinations wereevaluated by the UCDHS experts to identify 1) changes suggested in examtechnique; 2) changes suggested in evidence collection; 3) whether the remoteexaminer was able to accurately identify physical findings; and 4) whether theexam was comprehensive enough to arrive at a diagnosis. Additionally, anindependent, expert reviewer provided assessments of the exam quality whenconducting ‘usual care’ examinations (without telehealth intervention) comparedto examinations aided by telehealth consultations.Results: Between 2000 and 2008, 138 evidentiary telehealth examinationswere conducted. Of those, 8 were ‘live’ exams and 50 were ‘storeand forward’. Consultants recommended collection of additional forensicevidence in 35.5% of all live examinations. The live consultation resultedin the rural provider incorporating use of adjunct techniques 80.4% ofthe time. Rural examiners were able to accurately describe the examfindings 46% of the time during live exams; however, when rural examinersconducted exams without telehealth consultation, they were ableto accurately describe exam findings only 11.6% of the time (p < 0.01).Live telehealth examinations resulted in ‘‘complete examinations’’ in 47%of cases compared to 14.5% of the cases without live telehealth (p < 0.01).Independent review of telehealth exam consultations versus control examsdemonstrated significantly greater overall exam quality when atelehealth consultation was used (p < 0.01).A-84 TELEMEDICINE and e-HEALTH 2013

CONCURRENT ORAL PRESENTATIONS ABSTRACTSConclusions: Telehealth quality assurance consultations result in significantchanges to evidence collection, completeness of examination, and accuracy ofdiagnosis. Further, telehealth results in significantly improved overall examquality when compared to rural communities without this service. In ruralcommunities, expert involvement through telehealth can provide the goldstandard of peer review and supports examiners in an emotionally burdensomearea of pediatrics.Objectives:1. Learn how telehealth improves exam quality versus usual care2. Understand the elements of the forensic examination that can be improvedupon by use of store and forward versus live exam consultation3. Recognize the potential of telehealth as a mechanism to achieve thegold-standard of peer review662 USING TELEMEDICINE TO SCREEN FOR RETINOPATHY OFPREMATURITY IN NEWBORNSPRESENTERS AND CONTRIBUTING AUTHORS:Shawn Farrell, MBA, Innovation Acceleration Program.Boston Children’s Hospital, Boston, MA, USA.Background: Retinopathy of Prematurity (ROP) is the result of abnormalblood vessel development in the retina of the eye in a premature infant. Assmaller and younger babies are surviving, the incidence of ROP has increased.Early detection and treatment has been shown to improve a baby’s chances fornormal vision. However, due to liability concerns, local ophthalmologistscovering NICUs in suburban community hospitals are unwilling to provide inhouseconsultation coverage.Methods: Boston Children’s Hospital ophthalmic specialists established atelemedicine consultation program utilizing specialized, high-definitiondigital cameras and asynchronous ‘‘store-and-forward’’ technology. The NICUstaff capture images of the newborn’s eyes and transmit the images securely toa server. The specialist at CHB accesses and reviews the images, and generatesa consultation report which is securely transmitted back to the communityhospital’s NICU. For babies testing positive for ROP, a detailed treatment planis recommended. The BCH consulting ophthalmologist is available via phonefor follow-up discussion.Findings: Proper program design is essential to developing a successful teleROPprogram that screens newborns for ROP in the community hospital setting.Program can be a ‘‘win-win-win’’. Patients are screened by a highly skilledpediatric ophthalmologist in a timely manner without being transported to atertiary care center, allowing their treatments to begin more rapidly and preventsfurther complications associated with ROP. Specialists are able to providethe service more efficiently and effectively via telemedicine, eliminating theneed for travel between locations. Also, the solution embraces the core principleof delivering ‘‘the right care at the right place at the right time’’, eliminatingthe need for unnecessary and very costly transfers of extremelyvulnerable patients from one facility to another more costly facility.Objectives:1. Articulate the ideal design of a telemedicine-based ROP screeningprogram.2. Recognize implementation challenges and apply lessons learned.3. Implement and evaluate a similar program163 ETHICAL DILEMMAS IN PEDIATRIC TELEPSYCHIATRYPRESENTERS AND CONTRIBUTING AUTHORS:Felissa P. Goldstein, MD, Child & Adolescent Psychiatrist.Marcus Autism Center, Atlanta, GA, USA.Objective: Define and illustrate ethical principles that impact telepsychiatry,and their use in development of a telepsychiatry program. Discuss ethicaldilemmas that develop when providing specialized care in rural areas.Methods: Ethical principles are identified and defined using the AmericanAcademy of Child and Adolescent Psychiatry (AACAP) Code of Ethics andliterature on the ethics of telepsychiatry and healthcare access. Examples aretaken from the Marcus telepsychiatry program, which applies these principlesto provide compassionate and excellent healthcare for children with developmentaldisabilities throughout Georgia.Results: The principles of beneficence, justice, confidentiality, and inperson contact are critical to developing a successful telepsychiatry program.The telepsychiatry program at the Marcus Autism Center in Atlanta,GA is used as a model to illustrate how these principles help to define aclinical program and optimize clinical care. Due to healthcare shortages,many areas are lacking other essential therapies for children with developmentaldisabilities, but psychiatry can still serve a critical role in educatingandempoweringfamilies.Conclusion: Telepsychiatry is an ideal way to provide specialized patientcare for families that are unable to travel for in person appointments. Becauseof their social skills deficits, agitation, and anxiety, children with developmentaldisabilities are excellent candidates for healthcare by telemedicine.The Marcus Autism Center’s telepsychiatry program served as a model, forhow these principles can be applied in clinical practice.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-85

Poster Presentations Abstract IndexThe American Telemedicine Association EighteenthAnnual International Meeting and ExpositionMay 5–7, 2013 Austin, TX4 th Floor Foyer, Austin Convention Center87 CHANGE MANAGEMENT ENABLED BY TELEMEDICINE: FOCUS THE ICUPRESENTER & CONTRIBUTING AUTHORS: Mary Jo Gorman, MD, Chief Executive Officer.Advanced ICU Care, St. Louis, MO, USA.90 EBEHAVIORAL HEALTH SUPPORT FOR THE RURAL EMERGENCY ROOMPRESENTER & CONTRIBUTING AUTHORS: Donald Kosiak, MD, MBA, FACEP, eCARE Medical Director, Tammy Hatting, MPA.Avera Health, Sioux Falls, SD, USA.91 CARE BEYOND WALLS & WIRES: IMPORTANCE OF PUBLIC PRIVATE PARTNERSHIPSPRESENTER & CONTRIBUTING AUTHORS: Gisele (Gigi) Sorenson, RN, MSN, Director, Telemedicine.Flagstaff Medical Center, Flagstaff, AZ, USA.96 VIDEOCONFERENCING FOR PEDIATRIC DIABETES CARE IN WYOMINGPRESENTER & CONTRIBUTING AUTHORS: Scott A. Clements, MD, Physician 1 , Darla J. VanEssen, MS, RN, NEA-BC 2 , John F. Thomas, PhD, LCSW 2 ,James F. Bush, MD 3 , Jay H. Shore, MD, MPH 1 , Robert H. Slover, MD 4 , Raj P. Wadwa, MD 4 .1 University of Colorado Anschutz Medical Campus, Aurora, CO, USA, 2 Children’s Hospital Colorado, Aurora, CO, USA, 3 Wyoming Department of Health,Cheyenne, WY, USA, 4 Barbara Davis Center for Childhood Diabetes, Aurora, CO, USA.117 MY AVATAR IS PREGNANT! THE POTENTIAL OF VIRTUAL WORLDS FOR IMPROVING PRENATAL HEALTH CAREPRESENTER & CONTRIBUTING AUTHORS: Anna M. Lomanowska, PhD, Postdoctoral Fellow, Matthieu J. Guitton, PhD.Laval University, Quebec, QC, Canada.122 EXPANDING TELEMEDICINE IN A MULTI-NATIONAL COMBAT ZONEPRESENTER & CONTRIBUTING AUTHORS: Jeffrey A. Faulkner, MD, CMR 402.Landstuhl Regional Medical Center, APO, AE, USA.131 VIDEOCONFERENCING AND DEPRESSION: A SYSTEMATIC REVIEW OF THE EVIDENCE BASEPRESENTER & CONTRIBUTING AUTHORS: Erica A. Abel, PhD, Telemental Health and Medical Informatics Fellow 1,2 , Linda Godleski, MD 1,2 ,Cynthia Brandt, MD, MPH 1,2 .1 VA Connecticut Healthcare System, West Haven, CT, USA, 2 Yale School of Medicine, New Haven, CT, USA.139 TECHNOLOGY SUPPORTED EFFECTIVE AND UBIQUITOUS CLINICAL EDUCATION FOR OT AND ALLIED HEALTH SCIENCE PROGRAMSPRESENTER & CONTRIBUTING AUTHORS: Masako Miyazaki, PhD, Associate Professor, Lili Liu, PhD.University of Alberta, Edmonton, AB, Canada.Boldface indicates presenting author(s).A-86 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACT INDEX140 USING INTERACTIVE VOICE RESPONSE TO IMPROVE COMPLIANCE WITH BEST PRACTICE GUIDELINESPRESENTER & CONTRIBUTING AUTHORS: Christine Struthers, MScN, Advanced Practice Nurse Cardiac Telehealth, Sharon Ann Kearns, BScN,Heather Sherrard, MHA.University of Ottawa Heart Institute, Ottawa, ON, Canada.150 UNDER CONSTRUCTION: A PARALLEL VIRTUAL HOSPITALPRESENTER & CONTRIBUTING AUTHORS: Anne Cryderman, RN, Telemedicine Program Development, Trina Diner, IT (Mgt).Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada.153 OVERVIEW OF STATES’ USE OF TELEHEALTH FOR THE DELIVERY OF EARLY INTERVENTION (IDEA PART C) SERVICESPRESENTER & CONTRIBUTING AUTHORS: Jana Cason, DHS, OTR/L, Associate Professor 1 , Diane Behl, MEd 2 , Sharon Ringwalt, PhD 3 .1 Spalding University, Louisville, KY, USA, 2 National Center for Hearing Assessment and Management; Utah State University, Logan, UT, USA, 3 NationalEarly Childhood Technical Assistance Center (NECTAC), Chapel Hill, NC, USA.164 MOBILE TELEDERMATOLOGY AS A TEACHING TOOL FOR PRIMARY CARE PROVIDERS IN-TRAININGPRESENTER & CONTRIBUTING AUTHORS: Ivy Ann Lee, MD, Assistant Clinical Professor of Dermatology, Toby Maurer, MD, Kieron Leslie, MD.University of California San Francisco, San Francisco, CA, USA.165 OPTIMIZING NETWORK CONNECTIVITY FOR REAL-TIME MOBILE HEALTH TECHNOLOGIES IN SUB-SAHARAN AFRICA (Abstract Withdrawn)PRESENTER & CONTRIBUTING AUTHORS: Mark J. Siedner, MD, MPH, Clinical and Research Fellow 1 , Alexander Lankowski, MA 2 ,Derrick Musinga, BS 3 , Jonathon Jackson, BS MEng 4 , Conrad Muzoora, MD 3 , Peter W. Hunt, MD 5 , Jeffrey N. Martin, MD MPH 5 ,David R. Bangsberg, MD MPH 1 , Jessica E. Haberer, MD MS 1 .1 Massachusetts General Hospital, Boston, MA, USA, 2 Boston University, Boston, MA, USA, 3 Mbarara University of Science and Technology, Mbarara,Uganda, 4 Dimagi Inc, Boston, MA, USA, 5 University of California, San Francisco, San Francisco, CA, USA.172 REMOTE DELIVERY OF THE LEE SILVERMAN VOICE TREATMENT TO INDIVIUDALS WITH PARKINSON DISEASEPRESENTER & CONTRIBUTING AUTHORS: Michael Campbell, MS, MBA, CCC-SLP, Assistant Chief, Audiology and Speech Pathology Service.Gulf Coast Veterans Health Care System, Biloxi, MS, USA.186 GLOBAL TRENDS IN INTERNET SEARCH VOLUME FOR TELEMEDICINE-RELATED TERMINOLOGYPRESENTER & CONTRIBUTING AUTHORS: Venessa Pena-Robichaux, MD, Resident Physician, Melody Eide, MD, MPH.Henry Ford Health System, Detroit, MI, USA.197 TELEMEDICINE AND REMOTE PATIENT MONITORING TRAINING BEST PRACTICESPRESENTER & CONTRIBUTING AUTHORS: Hasan Sapci, MD, Assistant Professor of Health Informatics, Aylin Sapci, MD.Northern Kentucky University, Highland Heights, KY, USA.198 CLINICAL CONSIDERATIONS IN DEVELOPING A SYSTEM TO SUPPORT SELF-MANAGEMENTPRESENTER & CONTRIBUTING AUTHORS: Andrea D. Fairman, PhDc, OTR/L, CPRP, PhD Candidate & Adjunct Faculty Member 1,2 .1 University of Pittsburgh, Pittsburgh, PA, USA, 2 Philadelphia University, Philadelphia, PA, USA.216 EFFICACY OF TELEREHABILITATION FOR THE DELIVERY OF A REMOTE COGNITIVE REHABILITATION PROGRAMPRESENTER & CONTRIBUTING AUTHORS: Michelle L. Sporner, MS, Instructor, Michael McCue, PhD, Bambang Parmanto, PhD, David Brienza, PhD.University of Pittsburgh, Pittsburgh, PA, USA.235 A MANAGED HOME TELEHEALTH SERVICE FOR SEVERE COPD PATIENTS IN SPAINPRESENTER & CONTRIBUTING AUTHORS: Ofer Atzmon, BSc, VP Business Development and Marketing 1 , Cristina Gómez Suárez, PhD 2 .1 Aerotel Medical Systems, Holon, Israel, 2 Air Products Healthcare, Madrid, Spain.238 INTRODUCING THE TELE-INTERVENTION RESOURCE GUIDEPRESENTER & CONTRIBUTING AUTHORS: Diane Behl, MEd, Senior Research Scientist.Utah State University, Logan, UT, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-87

POSTER PRESENTATIONS ABSTRACT INDEX245 MEDICAL INFORMATION EXCHANGE AND TELEMENTORING WITH ROTARY WING MEDEVAC AIRCRAFT OVER TACTICAL RADIO NETWORKSPRESENTER & CONTRIBUTING AUTHORS: Gary R. Gilbert, MS, PhD, IPA, Army Telemedicine and Advanced Technology Research Center (TATRC).Georgetown University Department of Radiology, Frederick, MD, USA.249 FROM LOCAL TO GLOBAL: ECG TELECONSULTATION ON THE CLOUDPRESENTER & CONTRIBUTING AUTHORS: Jui-chien Hsieh, PhD, Assistant Professor 1 , Ai-Hsien Li, MD, PhD 2 , Yi-hsing Chiu, PhD 3 ,Hsiu Chiung Lo, MS 1 .1 Yuan Ze University, Chungli, Taoyuan, Taiwan, 2 Far East Memorial Hospital, Taipei, Taiwan, 3 Hsun Chuan University, Hsin-chu, Taiwan.251 CLINICAL AND POLICY GUIDELINES TO TELEHEALTH APPLICATIONS FOR OCCUPATIONAL THERAPY SERVICESPRESENTER & CONTRIBUTING AUTHORS: Tammy Richmond, MS, OTR/L, FAOTA, Chair of Telehealth Ad Hoc.Occupational Therapy Association of California, Los Angeles, CA, USA.263 COMMUNITY-ENGAGED DEVELOPMENT OF A TELEMEDICINE PILOTPRESENTER & CONTRIBUTING AUTHORS: Deborah Meyer, PhD, RN, Assistant Professor 1 , Albert Lai, PhD 2 .1 Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA, 2 The Ohio State University, Columbus, OH, USA.270 LEVERAGING MOBILE DEVICES TO SUPPORT COGNITIVE BEHAVIORAL THERAPY FOR STRESS AND ANGER MANAGEMENTPRESENTER & CONTRIBUTING AUTHORS: David L. Jones, MS, Director, Medical Innovations 1 , Sara Dechmerowski, MS 1 , Kelly Hale, PhD 1 ,Courtney L. Crooks, PhD 2 , Leanne West, MS 2 , Philip Gehrman, PhD 3 .1 Design Interactive, Inc., Oviedo, FL, USA, 2 Georgia Tech Research Institute, Atlanta, GA, USA, 3 University of Pennsylvania, Philadelphia, PA, USA.273 THE WORLD OF TELEMEDICINE PUBLICATIONS - POINTERS TO THE DEVELOPMENTS IN TELEMEDICINE AND TELEHEALTHPRESENTER & CONTRIBUTING AUTHORS: Murthy Remilla, BE, MBA, PhD, Executive Committee Member.Telemedicine Society of India, Hyderabad, India.276 TELEMEDICINE - ANOTHER POWERFUL TOOL IN EMERGENCY MANAGEMENT - PROSPECTS FOR INDIAPRESENTER & CONTRIBUTING AUTHORS: Murthy Remilla, BE, MBA, PhD, Department of Space, Bhanumurthy V, BE.Indian Space Research Organisation (ISRO), Hyderabad, India.282 ROLE OF TRANSCRANIAL DOPPLER ULTRASOUND IN EVALUATION OF PATIENTS AFTER WARTIME TRAUMATIC BRAIN INJURYPRESENTER & CONTRIBUTING AUTHORS: Alexander Razumovsky, PhD, Director 1 , Francis L. McVeigh, OD, FAAO, MS 2 .1 Sentient NeuroCare, Hunt Valley, MD, USA, 2 Senior Clinical Consultant-Telehealth and Vision Telemedicine and Advanced Technology Research CenterUSA Medical Research and Materiel Command, Frederick, MD, USA.296 THE DEVELOPMENT OF AN INEXPENSIVE MOBILE-BASED TELESTROKE NETWORKPRESENTER & CONTRIBUTING AUTHORS: Carolyn Lauckner, BA, Doctoral Student 1 , Syed Hussain, MD 1,2 , Anmar Razak, MD 1,2 .1 Michigan State University, East Lansing, MI, USA, 2 Sparrow Hospital, Lansing, MI, USA.298 BATTLEFIELD POINT OF INJURY PHYSIOLOGICAL MONITORING WITH TELEMEDICINE CAPABILITYPRESENTER & CONTRIBUTING AUTHORS: Carl H. Manemeit, Masters of Arts, Medical R&D Project Manager/COR.Telemedicine and Advance Technology Research Center, Ft Detrick, MD, USA.303 EVOLUTION OF A TELEMEDICINE APPLICATION IN THE NATION’S 3RD LARGEST EMS SYSTEM, HOUSTON, TEXASPRESENTER & CONTRIBUTING AUTHORS: David Persse, MD, Physician Director, EMS 1,2 .1 City of Houston, Houston, TX, USA, 2 Baylor College of Medicine, Houston, TX, USA.310 INSTITUTION SPECIFIC PATIENT READINESS TO CONNECT AT HOME WITH A PROVIDER IN A VIDEO APPOINTMENT: A SURVEYPRESENTER & CONTRIBUTING AUTHORS: Matthew Gardner, MDes, MBA, Service Designer/Design Researcher, Daniel O’Neil, MSIE/MBA,Sarah Jenkins, MS.Mayo Clinic, Rochester, MN, USA.A-88 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACT INDEX315 THE ESSENTIAL COMPONENT: INTEGRATING EDUCATION INTO TELEHEALTH NETWORKSPRESENTER & CONTRIBUTING AUTHORS: Ragan A. DuBose-Morris, MA, Director of Learning Services.South Carolina AHEC/Medical University of South Carolina, Charleston, SC, USA.318 DEVELOPMENT OF A PROVIDER INTERFACE FOR BEHAVIORAL TAGGING DURING AUTISM SPECTRUM DISORDER SERVICE DELIVERYPRESENTER & CONTRIBUTING AUTHORS: Keith Kline, PhD, Research Scientist II, Courtney Crooks, PhD.Georgia Tech Research Institute, Atlanta, GA, USA.325 NONMYDRIATIC ULTRAWIDE FIELD IMAGES IMPROVE GRADABLE RATE AND RETINOPATHY IDENTIFICATION IN TELEHEALTH PROGRAMSPRESENTER & CONTRIBUTING AUTHORS: Paolo S. Silva, MD, Assistant Chief of Telemedicine 1,2 , Jerry D. Cavallerano, OD, PhD 1,2 ,Dorothy Tolls, OD 1 , Komal Thakore, OD 1 , Bina Patel, MD 1 , Mina Sahizadeh, OD 1 , Jennifer K. Sun, MD 1,2 , Ann M. Tolson, BS 1 , Lloyd M. Aiello, MD 1,2 ,Lloyd P. Aiello, MD, PhD 1,2 .1 Joslin Diabetes Center, Boston, MA, USA, 2 Harvard Medical School, Boston, MA, USA.327 RURAL HOSPITALS PROVIDE ACCESS TO HIGH QUALITY ACUTE STROKE CARE THROUGH TELEMEDICINEPRESENTER & CONTRIBUTING AUTHORS: Martin Tremwel, BA, Student Volunteer 1 , Duane Birky, MD 2 , Bob Carter, RN 3 , Eric Carter, RN 4 ,Debbie Dill, RN 5 , Mellissa Gamer, RN 6 , Jon Gustafson, MD 2 , Susan McCartt, RN 2 , Stephanie Parsons, RN 2 , Margaret F. Tremwel, MD, PhD, FAHA 2 ,Carolyn Turrentine, RN 7 .1 Arkansas-Oklahoma Healthcare Consortium, Van Buren, AR, USA, 2 Sparks Health System, Fort Smith, AR, USA, 3 Eastern Oklahoma Medical Center,Poteau, OK, USA, 4 Sequoyah Memorial Hospital, Sallisaw, OK, USA, 5 Choctaw Nation Health Services Authority, Talihina, OK, USA, 6 MemorialHospital, Stilwell, OK, USA, 7 Haskell County Community Hospital, Stigler, OK, USA.332 TELERETINAL SURVEILLANCE AND TELEHEALTH IN PRIMARY CAREPRESENTER & CONTRIBUTING AUTHORS: Sven E. Bursell, PhD, Dir, Telehealth Programs 1 , Joseph Humphry, MD 1 , Alicia Jenkins, MD 2 ,Laima Brazionis, PhD 3 , Mark B. Horton, MD, OD 4 .1 University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA, 2 Melbourne University, Melbourne, Australia, 3 University of Melbourne,Melbourne, Australia, 4 Phoenix Indian Medical Center, Phoenix, AZ, USA.334 USING TELEMEDICINE TO PREVENT RE-HOSPITALIZATION IN VERY HIGH RISK PATIENTS WITH ESRDPRESENTER & CONTRIBUTING AUTHORS: Patricia J. Jordan, Ph.D., Principal Investigator 1,2,3 , Steven J. Berman, MD 4,3 , Dayna Minatodani, PhD,RN 4,3 , Timothy Halliday, PhD 3 .1 Pacific Health Research and Education Institute, Honolulu, HI, USA, 2 VA Pacific Islands Health Care System, Honolulu, HI, USA, 3 University of Hawaii,Honolulu, HI, USA, 4 St. Francis Healthcare Foundation, Honolulu, HI, USA.346 MAXIMIZING PROFITS BY INTEGRATING TELEMEDICINE CONSULTATIONS IN PRIVATE PRACTICESPRESENTER & CONTRIBUTING AUTHORS: Raj Devasigamani, MS, MBA, Doctoral Student, John McCracken, PhD, Lakshman S. Tamil, PhD.University of Texas at Dallas, Richardson, TX, USA.350 PARENT READINESS FOR TELEHOME CONSULTATIONS IN PERIOPERATIVE PEDIATRIC SURGICAL CAREPRESENTER & CONTRIBUTING AUTHORS: Stacey L. Cole, MBA, Medical Student, Heidi White, MSN, Jaymus Lee, Catherine deVries, MD.University of Utah, Salt Lake City, UT, USA.351 THE USE OF ANDROID APPS FOR IMPROVING PSYCHOLOGICAL FUNCTIONING IN CHILDREN WITH CANCERPRESENTER & CONTRIBUTING AUTHORS: Nina M. Antoniotti, RN, MBA, PhD, Director of TeleHealth Business.Marshfield Clinic, Marshfield, WI, USA.352 TELESURGERY: REMOTE VIRTUAL PRESENCE IN ORTHOPAEDIC EDUCATIONPRESENTER & CONTRIBUTING AUTHORS: Brent Ponce, BA, MD, Associate Professor 1 , Evan Sheppard, BS 2 , Jonathan K. Jennings, MD, BS 1 ,Matthew May, BA 3 , Terry B. Clay, BS 4 , Joseph Kundukulam, BS 1 .1 University of Alabama, Birmingham, Birmingham, AL, USA, 2 UMDNJ- Robert Wood Johnson Medical School, New Brunswick, NJ, USA, 3 VIPAAR,Birmingham, AL, USA, 4 University of Alabama, Birmingham School of Medicine, Birmingham, AL, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-89

POSTER PRESENTATIONS ABSTRACT INDEX378 MHEALTH, AFRICA AND THE DIGITAL DIVIDE: A SOLUTION OR A PROBLEM?PRESENTER & CONTRIBUTING AUTHORS: Maurice Mars, MBChB, MD, University of KwaZulu-Natal.Nelson R Mandela School of Medicine, Durban, South Africa.381 EVALUATION OF NORMAL HUMAN INFRA-RED (IR) IMAGES TO IMPROVE THE REMOTE CLINICAL EXAMINATIONPRESENTER & CONTRIBUTING AUTHORS: Howard N. Reynolds, MD, Associate Professor of Medicine, University of Maryland Schoolof Medicine 1 , Eliza M. Reynolds, BS 2 , Marco Pinter, BS 3 .1 University of Maryland Shock Trauma Center, Baltimore, MD, USA, 2 University of Maryland School of Medicine, Baltimore, MD, USA, 3 InTouch Health,Santa Barbara, CA, USA.398 COMMUNITY HOSPITAL BASED ICU TELEMEDICINE PROGRAM- CLINICAL CHARACTERISTICS AND PATIENT OUTCOMES 3 YEAR CASEPRESENTER & CONTRIBUTING AUTHORS: P. William Ludwig, MD, FCCP, President, Bryan Ludwig, MBA, Jonathan Marcus, MD, FCCP,Michael Marquez, FACHE.NuVIEW Health, Boca Raton, FL, USA.400 QUALITATIVE AND QUANTITATIVE OUTCOMES OF A WEB-BASED AND PILL ORGANIZER APPROACH TO IMPROVE MEDICATION ADHERENCEPRESENTER & CONTRIBUTING AUTHORS: Nathaniel M. Rickles, PharmD, PhD, Associate Professor of Pharmacy Practice & Administration,Jennifer Wilson, PharmD Candidate, Deena Magdy, PharmD Candidate.Northeastern University, Boston, MA, USA.409 ONTARIO TELESTROKE PROGRAM - ENSURING ONGOING AND FUTURE SUCCESS (Abstract Withdrawn)PRESENTER & CONTRIBUTING AUTHORS: Angela Nickoloff, RN, BNSc, MHS, Program Lead Emergency Services 1 ,Linda Kelloway, RN, MN, CNN(c) 2 , Darren Jermyn, BScPT, MBA 3 , Christina O’Callaghan, BAppSc (PT) 2 .1 Ontario Telemedicine Network, Toronto, ON, Canada, 2 Ontario Stroke Network, Toronto, ON, Canada, 3 Northeastern Ontario Stroke Network, Sudbury,ON, Canada.415 SATELLITE-SUPPLEMENTED TELE - MEDICAL OUTREACH CLINICS: OBSTACLES, SOLUTIONS AND NEEDSPRESENTER & CONTRIBUTING AUTHORS: Blake M. Fechtel, N/A, MD/PhD Student 1 , Bart Demaerschalk, MD, MSc 2 .1 The Mayo Clinic, Rochester, MN, USA, 2 The Mayo Clinic, Phoenix, AZ, USA.420 STRENGTHENING CLINICAL CARE THROUGH THE IHVN EHEALTH PLATFORM IN NASARAWA STATE.PRESENTER & CONTRIBUTING AUTHORS: Genevieve N. Eke, MD, MPH, Regional Program Coordinator.Institute of Human Virology Nigeria, Abuja, Nigeria.423 EFFECT OF PROVIDER INTERVENTION AND SCORECARD REPORTING ON BP AND GLUCOSE TELEMONITORING: RESEARCH INTO PRACTICEPRESENTER & CONTRIBUTING AUTHORS: Donato Borrillo, MD, JD, MS, Collaborating Physician 1,2 , Thomas Schwann, MD, MBA 2 ,Sonny Ariss, PhD 2 .1 Northeast Surgical Associates of OH, Independence, OH, USA, 2 University of Toledo Medical Center, Toledo, OH, USA.444 ENHANCING REMOTE EXAMINATION WITH INFRA RED (IR) IMAGING USE OF IR IN THE INTENSIVE CARE UNIT ENVIRONMENTPRESENTER & CONTRIBUTING AUTHORS: Howard N. Reynolds, MD, Associate Professor of Medicine, University of Maryland Schoolof Medicine 1 , Eliza M. Reynolds, BS 2 , Marco Pinter, BS 3 .1 University of Maryland Shock Trauma Center, Baltimore, MD, USA, 2 University of Maryland School of Medicine, Baltimore, MD, USA, 3 InTouch Health,Santa Barbara, CA, USA.470 FROM BIG TO GIGANTIC: LESSONS LEARNED FROM A STATEWIDE TELEMEDICINE EXPANSIONPRESENTER & CONTRIBUTING AUTHORS: Roy Kitchen, MBA, Business Administrator.University of Arkansas for Medical Sciences, Little Rock, AR, USA.477 THE WARM HANDOFF - USING TELEMEDICINE FOR TRANSITIONAL CARE FROM A UNIVERSITY HOSPITAL TO A SKILLED NURSING FACILITYPRESENTER & CONTRIBUTING AUTHORS: Jean McCormick, RN, MSN, Telehealth Services Clinical Nurse Educator, Miles Ellenby, MD.Oregon Health & Science University, Portland, OR, USA.A-90 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACT INDEX478 USABILITY AND FEASIBILITY OF SMARTPHONE TWO-WAY VIDEO TECHNOLOGY FOR TELEHEALTH APPLICATIONSPRESENTER & CONTRIBUTING AUTHORS: David D. Luxton, PhD, Research Psychologist & Program Manager.National Center for Telehealth & Technology, Tacoma, WA, USA.482 NURSE PRACTITIONERS: ADVANCING PRACTICE THROUGH TELEMEDICINEPRESENTER & CONTRIBUTING AUTHORS: Margaret Horie, RN, Clinical Coordinator, Telemedicine Program, Karen Fontana Chow, RN, BScN, MN,Cathy Daniels, RN(EC), MS, NP-Paediatrics.The Hospital for Sick Children, Toronto, ON, Canada.484 AN OVERVIEW OF TELEMEDICINE IN IRANPRESENTER & CONTRIBUTING AUTHORS: Milad S. Makkie, PhD Student, Student.University of Georgia, Athens, GA, USA.503 TELE REHABILITATION FOR RURAL VETERANS WITH MULTIPLE SCLEROSISPRESENTER & CONTRIBUTING AUTHORS: Sean C. McCoy, PhD, Veterans Rural Health Resource Center-Eastern Region 1 , Huanguang Jia, PhD 1 ,David L. Omura, DPT, MHA, MS 2 , David Charland, MS, PT 1 , Toni Chiara, MS, PT, PhD 3 , Paul M. Hoffman, MD 3 , Charles Levy, MD 1 .1 VAMC, Gainesville, FL, USA, 2 William Jennings Bryan Dorn VAMC, Columbia, SC, USA, 3 Veterans Rural Health Resource Center-Eastern Region,Gainesville, FL, USA.504 IMPLEMENTATION OF TELEHEALTH INNOVATIONS IN PRIMARY CARE TO IMPROVE THE PARADIGM FOR SPECIALTY CARE INTERACTIONPRESENTER & CONTRIBUTING AUTHORS: Khushbu Khatri, BS, Research Assistant 1 , Nicole Jepeal, BA 1 , Daren Anderson, MD 2 ,Jacqueline Olayiwola, MD, MPH, FAAFP 2 .1 Community Health Center, Inc., Weitzman Center for Research and Innovation, Middletown, CT, USA, 2 Community Health Center, Inc., Middletown, CT,USA.532 INFRASTRUCTURE MANAGEMENT OF E-HEALTH ENVIRONMENTSPRESENTER & CONTRIBUTING AUTHORS: Jeanette R. Little, MS, mCare Technical Director, Mike Bairas, BS.TATRC, Fort Detrick, MD, USA.574 OCEANS APART: A TELEMEDICINE CONNECTION AWAY. REMOVING THE DISTANCE FROM DISTANCE EDUCATIONPRESENTER & CONTRIBUTING AUTHORS: Agnes Cheng Tsallis, Education Coordinator - Telemedicine 1 , Shelly K. Weiss, MD, FRCPC 1 ,Manish Parakh, MD 2 .1 The Hospital for Sick Children, Toronto, ON, Canada, 2 Umaid Hospital for Women and Children, Jodhpur, India.595 USING SECURE MOBILE TECHNOLOGY TO SUPPORT SOLDIER REINTEGRATION AND REHABILITATIONPRESENTER & CONTRIBUTING AUTHORS: Holly Pavliscsak, BS, MHSA, mCare Program Manager, James Tong, BS.TATRC, Fort Detrick, MD, USA.601 KIDSAFE TELENET - OUR RETURN ON INVESTMENT AFTER 2 YRSPRESENTER & CONTRIBUTING AUTHORS: Candace Shaw, Bachelor of Science, Assistant Vice Provost 1 , Sherri Snyder, Bachelor of Science 2 ,Janet Wilson, PhD, RN 1 , Cynthia Scheideman-Miller, BS, MS 1 .1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA, 2 Children’s Advocacy Centers of Oklahoma, Ardmore, OK, USA.621 AN ECONOMIC EVALUATION OF HOME MONITORING IN COPD PATIENTSPRESENTER & CONTRIBUTING AUTHORS: Malcolm Clarke, PhD, Reader 1 , Joanna Fursse, BSc 2 , Russell W. Jones, MD 2 , Nancy Connolly-Brown,BSc 1 , Shirley Large, PhD 3 .1 Brunel University, Uxbridge, United Kingdom, 2 Chorleywood Health Centre, Chorleywood, United Kingdom, 3 NHS Direct, London, United Kingdom.635 JOSLIN VISION NETWORK PEDIATRIC DIABETES EYE CARE PROGRAM IN CARACAS, VENEZUELA: FIVE YEAR FOLLOW-UPPRESENTER & CONTRIBUTING AUTHORS: Kristen M. Hock, OD, Optometrist 1 , Paolo S. Silva, MD 1,2 , Andreina Millan, BS 1 ,Morella Mendoza Grossmann, BS 1,3 , Jerry D. Cavallerano, OD, PhD 1,2 , Jennifer K. Sun, MD, MPH 1,2 , Lloyd M. Aiello, MD 1,2 .1 Joslin Diabetes Center, Boston, MA, USA, 2 Harvard Medical School, Boston, MA, USA, 3 Fundación M.M.G., Caracas, Venezuela, Bolivarian Republic of.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-91

POSTER PRESENTATIONS ABSTRACT INDEX646 WHY TELEMEDICINE IS NOT JUST AN ACCESS TO CARE ISSUE IN RURAL COMMUNITIESPRESENTER & CONTRIBUTING AUTHORS: Debbie Voyles, BS, MBA, Director of Telemedicine, Laura Lappe, BS.TTUHSC, Lubbock, TX, USA.664 THE REACTION PROJECT - TOTAL MANAGEMENT OF A WHOLE POPULATION OF DIABETES PATIENTS IN PRIMARY CAREPRESENTER & CONTRIBUTING AUTHORS: Malcolm Clarke, PhD, Reader 1 , Joanna Fursse, BSc 1 , Russell W. Jones, MD 2 .1 Brunel University, Uxbridge, United Kingdom, 2 Chorleywood Health Centre, Chorleywood, United Kingdom.670 COMPUTERIZED, TAILORED INTERVENTIONS IMPROVE OUTCOMES AND REDUCE BARRIERS TO CAREPRESENTER & CONTRIBUTING AUTHORS: Patricia Jordan, Ph.D., Principal Investigator 1,2 , Kerry E. Evers, PhD 3 , James L. Spira, PhD 4,2 ,Laurel King, PhD 1,2 , Viil Lid, MA 1 .1 Pacific Health Research and Education Institute, Honolulu, HI, USA, 2 VA Pacific Islands Health Care System, Honolulu, HI, USA, 3 Pro-Change BehaviorSystems, Inc., Kingston, RI, USA, 4 National Center for PTSD, Pacific Islands Division, Honolulu, HI, USA.699 SLOVENIA’S NATIONAL TELEMEDICINE PROGRAM: TELEMEDICINE AS A BASIS FOR THE HEALTHCARE REFORMPRESENTER & CONTRIBUTING AUTHORS: Mateja de Leonni Stanonik, MA, MD, PhD, Fellow in Endovascular Neurology.MUSC Department of Neurosciences, Charleston, SC, USA.708 FROM PILOT TO PROGRAM: GROWTH OF A STATEWIDE TELEMEDICINE NETWORK - THE OREGON EXPERIENCEPRESENTER & CONTRIBUTING AUTHORS: Miles S. Ellenby, MD, MS, Associate Professor, Pediatric Critical Care Medicine, Medical Director,Telemedicine Program.Oregon Health & Science University, Portland, OR, USA.719 AN OUTCOME STUDY OF THE CLINICAL IMPACT OF A FULL STROKE MANAGEMENT PLAN WITHIN A HUB AND SPOKE NETWORKPRESENTER & CONTRIBUTING AUTHORS: Rachelle Longo, RN, Telestroke Program Coordinator, Elizabeth Cothren, APRN, Aaron Bridges, MPH.Ochsner Medical Center New Orleans, Jefferson, LA, USA.722 NEW PROGRESS ON A CLIENT-SERVER BASED TELEAUDIOLOGY SYSTEMPRESENTER & CONTRIBUTING AUTHORS: Daoyuan Yao, PhD, Gregg Givens, PhD, Professor and Chair, Jianchu Yao, PhD.East Carolina University, Greenville, NC, USA.727 REMOTE MONITORING AND SELF CARE MANAGEMENT OF TYPE 1 DIABETES PATIENTSPRESENTER & CONTRIBUTING AUTHORS: Mark A. Clements, MD PhD CPI FAAP, Assistant Professor, Pediatrics 1 , Abhi Ray, MBA, MS, MHA 2 .1 Children’s Mercy Hospitals & Clinics, Kansas City, MO, USA, 2 Heart To Heart Network Inc., Kansas City, MO, USA.731 VALIDATION OF A CANCER SCREENING MESSAGING SYSTEM DESIGNED TO INCORPORATE INDIVIDUALIZED GENOMIC DATAPRESENTER & CONTRIBUTING AUTHORS: Michael J. Yuan, PhD, CEO.Ringful Health, Austin, TX, USA.737 SCALE OF SERVICES AND PROPOSED SCOPE FOR TELEHEALTH IN PAKISTANPRESENTER & CONTRIBUTING AUTHORS: Asif Zafar, MBBS, MCPS, FCPS, FRCS, Surgical Unit II.Rawalpindi Medical College, Rawalpindi, Pakistan.741 TELERHEUMATOLOGY: THE ARIZONA TELEMEDICINE PROGRAM EXPERIENCEPRESENTER & CONTRIBUTING AUTHORS: Ana Maria Lopez, MD, MPH, FACP, Medical Director, Arizona Telemedicine Program 1 ,Nouralhoda Dehdashti, BA 1 , Jeffrey Lisse, MD 1 , Phyllis Webster, BS 2 , Angela Valencia, MPH 3 .1 University of Arizona College of Medicine, Tucson, AZ, USA, 2 Arizona Telemedicine Program, Tucson, AZ, USA, 3 University of Arizona Cancer Center,Tucson, AZ, USA.746 EVALUATION OF MOBILE TABLET DEVICES FOR ON-CALL COVERAGE IN A COMPREHENSIVE ADULT CARE FACILITYPRESENTER & CONTRIBUTING AUTHORS: Sarah E. Velasquez, MS, MAB, Senior Coordinator 1 , Eve-Lynn Nelson, PhD 1 , Joseph G. Schlageck, MD 2 ,Mariah Jones, CNA 3 .1 University of Kansas Medical Center, Kansas City, KS, USA, 2 Meadowlark Hills, Manhattan, KS, USA, 3 Kansas State University, Manhattan, KS, USA.A-92 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACT INDEX763 AN ELECTRONIC PROCESS MANAGEMENT CHECKLIST TO IMPROVE THE EFFICIENCY AND SAFETY OF SURGERYPRESENTER & CONTRIBUTING AUTHORS: Matthew J. Hadfield, BS, Clinical Research Coordinator, Homero Rivas, MD, MBA, Eric Leroux, MD, MBAcandidate, Drew Hart, MBA.Healthcheck Systems Inc., Brighton, MA, USA.765 UTILIZING TELENEUROLOGY TO ADDRESS GENERAL NEUROLOGY CAREPRESENTER & CONTRIBUTING AUTHORS: Nouralhoda Dehdashti, BS, Medical Student, Ana Maria Lopez, MD, MPH, FACP, Bruce Coull, MD,Angela Valencia, MPH, Phyllis Webster, BS.University of Arizona, Tucson, AZ, USA.769 INFECTIOUS DISEASE TELE-CLINICS IN ADULT DETENTION CENTERSPRESENTER & CONTRIBUTING AUTHORS: Ana Maria Lopez, MD, MPH, FACP, Medical Director, Arizona Telemedicine Program,Stephen Klotz, MD, Phyllis Webster, BS, Kameron Hanson, BA, Ronald Weinstein, MD.University of Arizona, Tucson, AZ, USA.785 TRIAL OF A TWO-WAY SMS BEHAVIORAL SUPPORT SYSTEM FOR TYPE 2 DIABETES: LESSIONS FROM THE UTAH BEACON COMMUNITYPRESENTER & CONTRIBUTING AUTHORS: Cheryl Simpkiss, EP, MS, Project Coordinator.HealthInsight, Salt Lake City, UT, USA.786 LESSONS LEARNED OF A PARTNERSHIP FOR MONITORING HTA PATIENTS WITH SEVERE DERMATOLOGICAL LESIONSPRESENTER & CONTRIBUTING AUTHORS: Xavier R. Urtubey, MD, CEO, Rodrigo Vasquez Saldia, MSN, Noelia E. Espinoza Aguilera, MSN,Ricardo Quezada Aliste, MD.AccuHealth Virtual Hospital Center, Santiago, Chile.809 ED COST AVOIDANCE IN PEDIATRIC MEDICAID RECIPIENTSPRESENTER & CONTRIBUTING AUTHORS: Dana Houle, RN, BSN, MHM, CCM, CPHQ, Director, Quality and Compliance.Nurse Response, Saint Louis, MO, USA.840 TELEMEDICINE & TELEHEALTH IN INDIA - PROMISING A RAY OF HOPE TO THE REMOTE AND DISTANT POPULATIONSPRESENTER & CONTRIBUTING AUTHORS: Murthy Remilla, BE, MBA, PhD, Department of Space.Indian Space Research Organisation (ISRO), Bangalore, India.946 MEASURING THE RETURN ON INVESTMENT OF REMOTE PATIENT MONITORING PROGRAMSPRESENTER & CONTRIBUTING AUTHORS: Misbah Mohammed.Center for Connected Health, Partners Healthcare, Boston, MA, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-93

Poster Presentations AbstractsThe American Telemedicine Association EighteenthAnnual International Meeting and ExpositionMay 5–7, 2013 Austin, TX4 th Floor Foyer, Austin Convention Center87 CHANGE MANAGEMENT ENABLED BY TELEMEDICINE:FOCUS THE ICUPRESENTER & CONTRIBUTING AUTHORS:Mary Jo Gorman, MD, Chief Executive Officer.Advanced ICU Care, St. Louis, MO, USA.This presentation addresses the application of change management processesenabled by telemedicine that improve physician productivity andclinical outcomes in the ICU. The aging of America is creating unprecedenteddemands for intensive care services. With new ICU beds costing upwards of$1.5 million each, meeting this growing need by capital expansion is a veryexpensive proposition. Already, the ICUs in most hospitals are not operating atoptimal levels. If their performance can be strengthened, patient outcomeswill improve AND throughput will increase, creating additional capacity inour current facilities. The most significant barrier that exists for hospitals tooptimize ICU performance and to improve throughput is the current severeshortage of intensivist physicians. This shortage keeps hospitals from providingthe 24/7 intensivist patient monitoring that is today’s recommendedlevel of care, and which is the foundation of best practice adherence. Inaddition, most hospitals lack accurate tools to measure their risk-adjustedperformance; consequently, they cannot successfully craft, implement andevaluate programs for change. Tele-ICUs are a rapidly growing solution tothese two challenges. Recent studies have demonstrated that the success oftelemedicine to deliver the expected results depends on effective introductionand management of the change process. Without a collaborative processimprovement initiative, hospitals cannot drive positive change throughout theICU, or other service areas. Successful tele-ICU models motivate and managechange by incorporating factors like interdisciplinary teams, education, andregular reporting of metrics with recommendations for improvement. Withseven years of experience using the tele-ICU model, data now exists todemonstrate the results of these programs in improving clinical, operational,and financial results. An analysis of more than 10,000 ICU patients in a varietyof hospitals settings with tele-ICUs found that these hospitals on averageachieved:- 40% reduction in mortality in the ICU- 25% reduction in ICU length of stay- 17% increase in ICU casesIn 2011, The Journal of the American Medical Association published resultsshowing the positive impact of the tele-ICU on patient care. That sameyear, the New England Healthcare Institute (NEHI) confirmed the positivecontributions made by tele-ICU programs in reducing mortality rates andlength of stay, increasing volume and case margins, and improving bestpractice compliance. According to their findings, hospitals achieved paybackfor these programs within the first year of operation. In addition to thisresearch, hospitals have reported results from the best practice-driven tele-ICU such as:- Elimination of ICU diversions- Improved adherence to best practices for a wide range of clinical areasincluding DVT prevention, stress/pressure ulcer prevention, sepsisbundle, beta blocker usage, red blood cell transfusion parameters, andlow tidal volume ventilation.- Improved ability to recruit physicians and nurses- Higher nurse retention and satisfactionIn conclusion, the benefit of the comprehensive tele-ICU model that includeschange management extends far beyond leveraging the availability ofscarce intensivist resources. They hold the key to critically needed changes inICUs that will reverberate throughout the hospital, driving performance nowand in the future.Objectives1. To identify the factors that are leading to an emerging crisis in ICUmedicine.2. To demonstrate the impact of a tele-ICU program on the clinical, operationaland financial success of the hospital and in meeting theburgeoning demand for additional ICU capacity and performance.3. To demonstrate how a tele-ICU combined with a rigorous best practicesinitiative can serve as a change agent throughout the entire hospital.90 EBEHAVIORAL HEALTH SUPPORT FOR THE RURAL EMERGENCYROOMPRESENTER & CONTRIBUTING AUTHORS:Donald Kosiak, MD, MBA, FACEP, eCARE Medical Director,Tammy Hatting, MPA.Avera Health, Sioux Falls, SD, USA.Availability and accessibility of mental health services in rural areas isdesperately lacking due to many barriers such as a shortage of trained mentalhealth professionals, shortage of psychiatric beds, lack of affordable healthinsurance coverage as well as the social stigma that goes with mental healthtreatment. For some patients, the emergency room is the first stop for issuesrelated to behavioral health such as alcoholism, drug abuse, chronic illnesseswith underlying depression, and atypical chest pain brought on by panicattacks. The Avera eCARE assessment counselor states the greatest challengein supporting rural areas is the difference in the types of holds and regulationsfor each state and county when assisting people with mental illness. Civilcommitment occurs in all states, but the standards vary. Several costs areassociated with treating behavioral health issues in the emergency room suchas assessment, possible restraint and security, tests, diagnosis, hold protocols,placement services and final medical clearance and release. Physicians statethe average stay of psychiatric patients in an emergency department is over 12hours and is often up to two days. Telemedicine is a solution to removingbarriers and reducing cost for behavioral health problems. Avera Health hasbeen supporting rural emergency room physicians with the eEmergencyprogram and has successfully incorporated a psychiatric counselor into thevideo calls that require behavioral health support. This model is a team efforton both sides of the camera to stabilize the patient clinically while the as-Boldface indicates presenting author(s).A-94 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTSsessment counselor interfaces with the patient, behavioral health specialistsand/or the hospital, and law enforcement if needed, as a procedural conduit toproper placement of the patient when they are released from the emergencyroom. As state budgets shrink and mental health services are cut, more andmore patients are going to the emergency room for help. In the last year (Aug2011 to July 2012), Avera’s eEmergency program handled 152 behavioralhealth video encounters for 35 rural hospitals in 6 states. In these cases, amaster-level counselor is brought in for an assessment when requested by thelocal emergency provider and the eEmergency provider. The counselor conductstheir assessment following a standardized form that becomes a part ofthe patient’s chart. The counselor consults with a psychiatrist for advice, fororders of medication, or for admission to a hospital. After the counselor hasdone the research on the resources and requirements in that county and state,arrangements are made for transportation or for a hold by the local provider.Prior to eEmergency, numerous hours were spent by doctors and nursing staffin the rural ED sites making arrangements for their behavioral health patient.Today, thanks to telemedicine and assessment counselor availability, stafftime is reduced and patients are getting timely assessments and appropriateplacement. In some cases, when hospitalization is not needed, patients are ableto avoid a lengthy trip for their initial assessment.Objectives1. Describe the unique challenges of providing behavioral health coverageand support in rural areas.2. Describe Avera Health’s unique, low-cost practice of utilizing a mentalhealth counselor to effectively support and assist emergency roomproviders, staff and patients in rural, critical access hospitals in seekingappropriate referrals.3. Describe the benefits of using telemedicine to assess, counsel and placeor commit patients with behavioral health issues.91 CARE BEYOND WALLS & WIRES: IMPORTANCE OF PUBLIC PRIVATEPARTNERSHIPSPRESENTER & CONTRIBUTING AUTHORS:Gisele (Gigi) Sorenson, RN, MSN, Director, Telemedicine.Flagstaff Medical Center, Flagstaff, AZ, USA.With limited resources of finances, technical support, clinical skill, andother needed components for program development many new or small telehealthprograms are unable to achieve full scale rollout of projects on theirown accord. Identification of the need to form a public private partnership inorder to achieve a programmatic goal can be a daunting idea. Public-privatepartnerships offer an opportunity to better steward scarce resources, leverageexisting capabilities, and take advantage of complementary skills amongpartners that help to accomplish shared aims and goals. Starting with developmentof a clear goal set and an understanding of the individual program’sstrengths and weaknesses will aid in identification of what level or type ofpartnership is needed. When approaching potential partners knowing whateach could bring to the project will assist in forming the early dialogues.Understanding the value proposition for each of the participants assists inconstructing the terms and conditions of the partnership so that everyone’sneeds are met. Taking time and efforts toward relationship development atfirst assists the team in coming to an understanding of each unit’s diversebackground and purpose; this than allows for the initial coming together for acommon work purpose. Bringing together stakeholders provides synergies butis challenging and complicated. Stakeholders must have internal alignment(organizational buy-in and support) in order to generate external alignmentamong diverse stakeholders. The Care Beyond Walls & Wires project broughttogether a rural nonprofit hospital, two large telecommunications companies,a software company, and two federal agencies in order to undertake a pilotcare delivery model for congestive heart failure patients. Many of the patientscared for in this pilot project are Native Americans living in ultra-remote areasof northern Arizona. The challenges faced by this population surroundingaccess to care and lack of basic infrastructure of water and electricity posedmultiple challenges. Having a diverse set of stakeholders involved in theproject helped to identify ways to overcome or mitigate those challenges anddevelops an innovative and sustainable model of care delivery that can now beextended to a host of chronic medical conditions.Objectives1. Identify benefits of seeking partnership in program development2. Identify three challenges to partnership development3. Identify potential sources of public private partnership96 VIDEOCONFERENCING FOR PEDIATRIC DIABETES CAREIN WYOMINGPRESENTER & CONTRIBUTING AUTHORS:Scott A. Clements, MD, Physician 1 , Darla J. VanEssen, MS, RN, NEA-BC 2 ,John F. Thomas, PhD, LCSW 2 , James F. Bush, MD 3 , Jay H. Shore, MD, MPH 1 ,Robert H. Slover, MD 4 , Raj P. Wadwa, MD 4 .1 University of Colorado Anschutz Medical Campus, Aurora, CO, USA,2 Children’s Hospital Colorado, Aurora, CO, USA, 3 Wyoming Department ofHealth, Cheyenne, WY, USA, 4 Barbara Davis Center for Childhood Diabetes,Aurora, CO, USA.Background: Type 1 diabetes (T1D) affects more than 1.4 million people inthe United States and is the second most common chronic medical illness inchildren. The American Diabetes Association (ADA) recommends that allyouth with T1D be seen by pediatric endocrinology specialists to receive thenecessary care to prevent acute and chronic complications of diabetes.However, there are a limited number of pediatric endocrinologists, and mostare located at large academic medical centers. This creates a geographicalbarrier for patients living in rural areas, making it difficult to receive routinediabetes care. Most established diabetes telemedicine programs focus on diabetesself-management education for adults with type 2 diabetes. Littlepublished data exist regarding videoconferencing with pediatric diabetespatients. It is unclear if substituting face-to-face routine diabetes care visitswith videoconferencing will improve diabetes control and adherence to ADAguidelines for youth with T1D.Hypotheses: Using telemedicine to remove geographical barriers will lead toimproved blood sugar control, increased accessibility to diabetes care, decreasedhospitalizations and emergency department visits, and increasedadherence to ADA guidelines.Methods: In May 2012, the Barbara Davis Center for Childhood Diabetes(BDC), in collaboration with Children’s Hospital Colorado, the University ofColorado School of Medicine, and the Wyoming Department of Health, initiateda telemedicine program for pediatric diabetes patients in Wyoming.Approximately twice per month, a diabetes specialist from the BDC conductsroutine diabetes care visits with patients and families in Casper or Cheyenne,Wyoming using telemedicine. Patients and families then have the opportunityto meet with a local diabetes nurse or dietician to review their specific diabetescare needs. After each telemedicine visit, patients and families who haveagreed to participate in our study fill out a questionnaire regarding theirexperience with telemedicine, travel costs associated with previous diabetescare, and within the past year: number of hospitalizations, emergency departmentvisits, episodes of severe hypoglycemia, diabetic eye exam by an eyespecialist, and regular screening blood and urine tests. Patients and familieswill then be seen every 3 months by telemedicine, with face-to-face visits tothe BDC at least one to two times per year.Results: From May to September 2012, the BDC diabetes telemedicine programhas seen 17 patients, with an additional 12 patients scheduled throughDecember 2012. Patients were 7–20 years old (mean age 13.3 – 3.2 years) and76% male. Mean hemoglobin A1c was 9.2% – 1.5% (normal < 6%). 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POSTER PRESENTATIONS ABSTRACTSquestionnaires received to date, 73% (n = 8) of families were ‘‘very satisfied’’with their visit, and the remaining 27% (n = 3) were ‘‘satisfied’’, using a 5-point Likert scale. And, 91% (n = 10) of families indicated less time missedfrom school or work as a result of utilizing telemedicine.Conclusions: The BDC diabetes telemedicine program is increasing access tospecialized care for pediatric type 1 diabetes patients in Wyoming. Overall,feedback from patients and families has been very positive. Further evaluationwill determine if the BDC diabetes telemedicine program is improving diabetescontrol and adherence to ADA standards of care.Objectives1. Recognize the geographical barriers facing pediatric patients with type1 diabetes.2. Understand the importance of a diabetes telemedicine program to reachrural patients.3. Describe how diabetes telemedicine is improving diabetes care in pediatricpatients with type 1 diabetes.117 MY AVATAR IS PREGNANT! THE POTENTIAL OF VIRTUAL WORLDSFOR IMPROVING PRENATAL HEALTHCAREPRESENTER & CONTRIBUTING AUTHORS:Anna M. Lomanowska, PhD, Postdoctoral Fellow, Matthieu J. Guitton, PhD.Laval University, Quebec, QC, Canada.Background: The Internet can be a valuable tool in prenatal healthcare,providing both educational content and a means of obtaining social support.In particular, this medium can be useful in reaching pregnant adolescents andyoung adults who are at higher risk of receiving poor prenatal care informationand support in their immediate community and social network.However, the existing educational and pregnancy support sites rely onasynchronous and unimodal methods of content delivery and social interactions,which may limit the degree of participation and engagement by thisdemographic.Aim: The aim of this study was to examine the potential of immersive multiuservirtual worlds as a means of delivering educational content and fostering asense of online social support to promote better prenatal and perinatal health.Methods: Second Life (www.secondlife.com) is a popular online threedimensionalvirtual world where individuals can interact via their human-likegraphical representations, or avatars. The activities of various spontaneouslyemerging common-interest communities and role-play settings can be observedin this context, including those related to pregnancy and maternity. Inorder to assess what factors promote participation and social engagement inthese pregnancy and maternity communities, we conducted quantitative andqualitative observations of the activities and behaviors of their members andcontributors, and of the design of related virtual spaces.Results: Pregnancy and maternity in Second Life are related to several interestareas including: romantic relationship progression, avatar customization,sexual role-play, medical role-play, support groups, as well as provisionof health-related information. Pregnancy and maternity-related activities aresupported by a wide range of user-generated avatar customization items suchas body shapes, clothing, and accessories. There are a number of frequentlyvisited virtual shops and clinics that provide a sense of realism related to thevirtual experience of pregnancy and delivery. Pregnancy in the virtual worldis also a collective experience, as indicated by the participation of a number ofindividuals in the virtual process of prenatal care and delivery. Overall, a highdegree of realism and customization with respect to avatars and the environmentappears to promote participation and social engagement in the virtualexperience of pregnancy and maternity.Conclusions: Existing virtual world communities related to pregnancy andmaternity provide valuable insight into the factors that may promote activeengagement and participation in Internet-based prenatal health programsaimed at adolescents and young adults. The development of such resources inthe context of a virtual world could facilitate the delivery of prenatal healthrelatedcontent and social support for this demographic.Objectives1. Attendees will be able to identify ways to use virtual worlds in prenatalhealthcare-related education and social support.2. Attendees will have a greater understanding of pregnancy-relatedbehaviors in virtual worlds.3. Attendees will be able to discuss new alternative approaches to onlinetools for prenatal healthcare in adolescents and young adults.122 EXPANDING TELEMEDICINE IN A MULTI-NATIONAL COMBAT ZONEPRESENTER & CONTRIBUTING AUTHORS:Jeffrey A. Faulkner, MD, CMR 402.Landstuhl Regional Medical Center, APO, AE, USA.The United States Military fields combatants throughout austere environmentswith varying levels of medical support. Recent numbers indicate between200–300 service members per month are evacuated to a higher level ofcare for medical concerns. These evacuations are often difficult to organize;take weeks to return the soldier to duty and in some cases can prove dangerousto the life of the soldier due to increased exposure to enemy fire duringtransport. This project demonstrated the challenges and rewards of providinga full-spectrum multi-disciplinary real-time telemedicine support to thoseaustere locations. The lessons can be adapted to rural medical care in theUnited States positively affecting access to care for those in underserved areas.Objectives1. Attendees will be able to identify opportunities within their rural oraustere environments to provide better and more timely healthcare2. Plan implementation of a multi-disciplinary telemedicine system forrural and austere environments3. The attendee will have insight into the advantages and pitfalls of implementingtelemedicine into rural and austere environments131 VIDEOCONFERENCING AND DEPRESSION: A SYSTEMATIC REVIEWOF THE EVIDENCE BASEPRESENTER & CONTRIBUTING AUTHORS:Erica A. Abel, PhD, Telemental Health and Medical Informatics Fellow 1,2 ,Linda Godleski, MD 1,2 , Cynthia Brandt, MD, MPH 1,2 .1 VA Connecticut Healthcare System, West Haven, CT, USA, 2 Yale School ofMedicine, New Haven, CT, USA.Depression, a serious mood disorder, affects an estimated 9.1% of thepopulation (CDC, n.d.) in the United States, yet fewer than 25% of individualsworldwide have access to effective treatments (WHO, n.d.). Over the last decade,telemental health services have been used to improve access to depressiontreatment and have been shown to be comparable to face-to-faceencounters in improving outcomes (Fortney et al., 2006, Nelson, Barnard &Cain, 2003 & Ruskin et al, 2004). The Yale University Department of Psychiatry,Yale Center for Medical Informatics and Yale Library Services conducteda systematic review of the literature, using the rigorous PRISMAprotocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses,Moher, Liberati, Tezlaff, Altman & The PRISMA Group, 2009). Ours isthe first comprehensive review of the evidence base of videoconferencing fordepression and took into account population-based, cross-sectional studies,and case studies. The study goals included: addressing the ways in whichvideoconferencing has been used in the assessment, and treatment of depression,identifying and evaluating the comprehensive results of relevantreports and studies of videoconferencing for depression, describing strengthsA-96 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTSand gaps in the literature published to date, identifying best practices, anddeveloping recommendations for future research. The search criteria consistedof keywords commonly used in the telemental health, videoconferencing anddepression evidence base such as ‘videoconferencing’, ‘depression’, ‘telementalhealth’, ‘remote consultation’, ‘telehealth’, and ‘telemedicine’ and resultedin 47-terms. This search was executed in the following electronicdatabases: Medline and PsycInfo (using the OvidSP platform) for journal articlespublished between 1950 and October 1, 2012. The identification ofstudies included supplementary approaches such as: a) manually searchingthe Journal of Telemedicine & Telecare (from Vol. 1 1996 thru Vol. 18(6) 2012and Telemedicine Journal and e-Health (from Vol. 1 1995 thru Vol. 18(7)2012); b) searching trials registries (e.g. Clinical Trials.gov and the CochraneClinical Trials Register; c) checking source article reference lists; and d)contacting subject experts and authors via direct email and posting on relevantorganizational listservs such as the American Telemedicine Associationand the American Psychological Association). The aforementioned searchprocess for videoconferencing and depression yielded over 500 journal articles.The number of records retrieved from each source, those screened, assessedfor eligibility and excluded as well as the number of duplicate recordswill also be presented in a PRISMA flow diagram. These study characteristicswill be summarized and reported:- Demographic information (e.g. population studied, gender, age and totalnumber of participants- Interventions (e.g. assessment, treatment such as medication managementor psychotherapy)- Primary (Clinical) Outcomes (e.g. depression symptom changes, globalfunctioning)- Secondary Outcomes (e.g. patient satisfaction, clinician satisfaction,patient treatment adherence & dropout rates and economic outcomes)- Treatment settings and program (e.g. outpatient community or hospitalclinic)- Technology used (e.g. equipment, modality/bandwidth)- Geographic location (e.g. urban, rural) and, if possible, distance in milesbetween clinician and patient sites- Study quality will be assessed using the U.S. Preventive Services TaskForce’s Quality of Evidence criteria (USPTF, 1989).Objectives1. To address the ways in which videoconferencing has been used in theassessment, and treatment of depression.2. To identify and evaluate the comprehensive results of relevant studiesof videoconferencing and depression.3. To describe strengths and gaps in the literature published to date.139 TECHNOLOGY SUPPORTED EFFECTIVE AND UBIQUITOUS CLINICALEDUCATION FOR OT AND ALLIED HEALTH SCIENCE PROGRAMSPRESENTER & CONTRIBUTING AUTHORS:Masako Miyazaki, PhD, Associate Professor, Lili Liu, PhD.University of Alberta, Edmonton, AB, Canada.There are a series of emerging trends in clinical supervision which aresupported through the eHealth platform. Some of these trends are administrative;others refer to models of supervision. Many include informationsystems and how supervision services are to be evaluated. New administrativeparadigms have emerged moving away from one-to-one discipline specificsupervision to inter professional supervision and the integrated deliveryof supervision with eHealth options. These options permit the use of interactivesupervision with therapists or academic faculty at a distance to assurethat students receive the expertise and guidance in their clinical supervisionalong with their in vivo supervision on site. Similarly, the use of the innovativeinformation systems of the 21st century, preceptors and superviseeshave access to electronic medical records and the options for more efficientsystems of information processing.The overall aims of the evaluation are to ensure:1. The program achieves its aims and objectives;2. Program outputs are wanted by the community and meet the needs ofstakeholders;3. Program outcomes have an impact on the community and facilitate/enable positive change;4. The program can respond flexibly to changes in the technical andpolitical environment and is not overtaken by events.As with any project, in principle many aspects could be evaluated. For theeLearning project, the focus is on the achievements and outcomes and ensuringthey are useful to the clinical community at large. The evaluation willreview evidence of this framework is successful or not based on several focusgroups and learners’ performance. Observations and recommendations will bediscussed at this presentation.Objectives1. Evaluate new methods of field supervision for students and preceptorssupported by information technology.2. Evaluate if the supporting technology for field placements would beuseful for administrative workloads.3. Assess the quality of fieldwork supervision when provided in rural ordifficult placement environments.140 USING INTERACTIVE VOICE RESPONSE TO IMPROVE COMPLIANCEWITH BEST PRACTICE GUIDELINESPRESENTER & CONTRIBUTING AUTHORS:Christine Struthers, MScN, Advanced Practice Nurse Cardiac Telehealth,Sharon Ann Kearns, BScN, Heather Sherrard, MHA.University of Ottawa Heart Institute, Ottawa, ON, Canada.Acute coronary syndrome (ACS) is a significant public-health problem inCanada and worldwide with many patients dying of an acute myocardialinfarction (heart attack) and ischemic heart disease. Large clinical trials haveprovided evidence for the development of standardized best practice guidelines(BPG) and compliance with these guidelines have significantly improvedsurvival. Every 10% increase in guideline adherence produces a 10% reductionin mortality. Despite the development and dissemination of BPG, theirapplication in patients with acute coronary syndrome (ACS) is suboptimal.Additionally, research indicates that patients fall off their medication regimensat about 6 months. As a result of favorable research outcomes A, all ACSpatients discharged home from our center are now followed for 1 year toassess compliance with BPGs. The purpose of this presentation is to describethe implementation of an ACS /Interactive Voice ResponseVR (IVR) program,and share our results, challenges and key learning’s to date. The IVR systemwas used to call, by land-line or mobile telephone, all English or Frenchspeaking ACS patients at 1, 3, 6, 9 and 12 months after discharge home sinceJanuary 1, 2011. The 5 automated calls consisting of predetermined questionsrelated to symptom control, medication management, smoking cessation, diet,exercise and education as recommended by the ACC/AHA BPG for ACS. Thesystem uses a branching logic based on patient responses. Responses arecaptured in a database as ‘‘complete’’ meaning no action is required or‘‘callback’’ requiring a provider contact for further assessment and interventionto maintain patients on BPG. From January 1, 2011 to September 6, 2012,1677 ACS patients (average age 64 years; 73% male) were followed by IVR. Atotal of 5403 calls were made by the IVR system resulting in 2079 ‘‘completecalls’’, 1348 ‘‘callbacks’’, 1859 ‘‘no contact’’ and 117 requests for additionaleducational material. Results of compliance with BPG medications were: ACE/ARB 75%, antiplatelet 96%, ASA 95%, betablocker 80%, and statins 93%.Patient satisfaction was high with 80% responding that IVR is a good way tofollow patients after discharge. At 1 year, 4% of patients had been readmittedª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-97

POSTER PRESENTATIONS ABSTRACTSto hospital responded to an admission again for their heart. Of the 145smokers, 40 requested a contact from a smoking cessation counselor and 109patients requested a contact from a cardiac rehabilitation provider despitehaving refused these services during their index admission. Been approachedduring their index admission by each provider respectively and refusingservices. Despite having been instructed in hospital, 323 patients did not havea supply of nitroglycerin for angina chest pain relief and 139 did not knowhow to use this eir medication and requiring further education. Importantmessaging was delivered at 1 year reminding patients to make an appointmentfor a regular annual physical exam, electrocardiogram and cholesterol checkand to obtain prescription refills. Follow-up by IVR is easy, broad in scope anda relatively inexpensive. It offers opportunities for re-education, longitudinalmedication compliance monitoring at several time points, and interventionsto prevent and decrease potential adverse events.Objectives1. The use of an IVR system for patient follow-up2. Describe the development of a novel delivery system3. Describe the integration of best practice outcomes using IVRObjective 4 - Value for dollars investedIn the August 2012 North West Local Health Integration Network newsletter‘LINKages’, the following observations were made. ‘‘In 2011/12, the use oftelemedicine in the North West LHIN resulted in more than $21 million inavoided travel costs, and more than 50 million kilometres in avoided patienttravel.’’The future of Telemedicine at TBRHSCNotable successes, measured 5 years after ‘construction’ began, are the depthof penetration into existing programs, and the adoption of a virtual providerpractice model. We are leaders in the delivery of telemedicine services andstrive to move forward and meet the challenges that new and exciting technologyadvancements offer.Objectives1. Identify a vision for their Telemedicine programs that is organizationwide2. structure a model of service delivery that is cost effective and deliversquality care3. create strategies to increase provider adoption150 UNDER CONSTRUCTION: A PARALLEL VIRTUAL HOSPITALPRESENTER & CONTRIBUTING AUTHORS:Anne Cryderman, RN, Telemedicine Program Development,Trina Diner, IT (Mgt).Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada.Our Vision: ‘The full integration of telemedicine into existing services resultingin the creation of a Parallel Virtual Hospital’. Telemedicine uses twowayvideoconferencing systems and related diagnostic equipment to deliverclinical care. Our goal was to imbed telemedicine technology into every serviceoffered at the Thunder Bay Regional Health Sciences Centre (TBRHSC)resulting in a high quality, virtual, clinical experience valuable to both clientand provider. In 2007 the concept of a Parallel Virtual Hospital was launchedat TBRHSC. This 375 bed regional facility is located on the north shore of LakeSuperior in Ontario, Canada. TBRHSC is the major health service provider andreferral centre for Northwestern Ontario, with a geographic catchment areaover half a million square kilometers, a close comparator would be the countryof France. The population of the region is sparse (235,000 pop.) with 122,000people within and around the city of Thunder Bay and the remainder in smallcommunities. This includes many First Nations communities, 24 with accessonly by air or winter ice road. Barriers including weather, distance and lack ofspecialists offered a unique opportunity to deliver health services by telemedicineby fully integrating telemedicine into clinical practice across disciplinesand programs. Program Design Objectives and Successes:Objective 1 - Access to care as close to home as possibleIn 2006–07 prior to ‘construction’, 52 providers in 22 areas of specialtyprovided care to 3,078 patients in their home communities, using Telemedicinefrom TBRHSC. In 2011–12, more than 100 providers in 35 specialtiesprovided care to 7,886 patients via Telemedicine.Objective 2 - Care delivery centered on patients’ needs as they identify themWe continually survey our patients to track the quality of the service weprovide. From Jan/2010-Dec/2011 we surveyed 1,788 users of our telemedicineservice. 1,293 patients completed these surveys (response rate72.32%). 99.44% of patients using Telemedicine indicated they were satisfiedwith their Telemedicine visit and 99.35% would use it again. An additional99.52% indicated they would recommend this service to family and friends.Objective 3 - Evidence informed practiceTBRHSC has met the Canadian National Accreditation Standards for Telehealth(2011) and was awarded a leading practice designation for our Televisitationprogram.153 OVERVIEW OF STATES’ USE OF TELEHEALTH FOR THE DELIVERYOF EARLY INTERVENTION (IDEA PART C) SERVICESPRESENTER & CONTRIBUTING AUTHORS:Jana Cason, DHS, OTR/L, Associate Professor 1 , Diane Behl, MEd 2 ,Sharon Ringwalt, PhD 3 .1 Spalding University, Louisville, KY, USA, 2 National Center for HearingAssessment and Management; Utah State University, Logan, UT, USA,3 National Early Childhood Technical Assistance Center (NECTAC), ChapelHill, NC, USA.Early intervention (EI) services are designed to promote development ofskills and enhance the quality of life of infants and toddlers who have beenidentified as having a disability or developmental delay. EI services aremandated by Part C of the Individuals with Disabilities Education ImprovementAct (IDEA), however, personnel shortages, particularly in rural areas,limit access for children who qualify. Telehealth is an emerging deliverymodel demonstrating potential to deliver EI services effectively and efficiently,thereby ameliorating the impact of provider shortages in underservedareas (Cason, 2009, 2011; Heimerl & Rasch, 2009; Kelso, Fiechtl, Olsen, &Rule, 2009). Telehealth facilitates discussion of evaluation results, treatmentrecommendations, coordinated care, and collaboration with specialists notavailable within a local community. This poster will highlight the results of asurvey sent by the National Early Childhood Technical Assistance Center(NECTAC) to IDEA Part C coordinators to assess their utilization of telehealthwithin their state’s IDEA Part C programming. Reimbursement for providertype and services and barriers with implementing a telehealth service deliverymodel are outlined. Representatives from twenty-seven states and Guam respondedto the NECTAC telehealth survey. Of these, 30% (n = 9) indicated thatthey are either currently using telehealth as an adjunct service delivery model(n = 6) or plan to incorporate telehealth within the next 1–2 years (n = 3).Identified telehealth providers included developmental specialists, teachers ofthe Deaf/Hard of Hearing (DHH), speech-language pathologists, occupationaltherapists, physical therapists, behavior specialists, audiologists, and interpreters.Reimbursement was variable and included use of IDEA Part C funding,Medicaid, and private insurance. Expressed barriers and concerns for theimplementation of telehealth as a delivery model within Part C programmingincluded security issues (40%; n = 11); privacy issues (44%; n = 12); concernsabout quality of services delivered via telehealth (40%; n = 11); and lack ofevidence to support the effectiveness of a telehealth service delivery modelwithin IDEA Part C programming (3%; n = 1). Reimbursement policy andbilling processes and technology infrastructure were also identified as barriersA-98 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTSimpacting the implementation of telehealth programming. Provider shortagesimpact the quantity and quality of services available for children with disabilitiesand developmental delay, particularly in rural areas. While manystates are incorporating telehealth within their Early Intervention (IDEA PartC) services in order to improve access and overcome personnel shortages,barriers persist. Policy development, education of stakeholders, research,utilization of secure and private delivery platforms, and advocacy may facilitatemore widespread adoption of telehealth within IDEA Part C programsacross the country.REFERENCES:Cason, J. (2009). A pilot telerehabilitation program: Delivering early intervention services torural families. International Journal of Telerehabilitation, 1, 29–37.Heimerl, S., & Rasch, N. (2009). Delivering developmental occupational therapy consultationservices through telehealth. Developmental Disabilities Special Interest Section Quarterly, 32(3),1–4.Kelso, G., Fiechtl, B., Olsen, S., & Rule, S. (2009). The feasibility of virtual home visits to provideearly intervention: A pilot study. Infants & Young Children, 22, 332–340.Objectives1. Identify states currently using telehealth within their Early Intervention/Individualswith Disabilities Education Improvement Act (IDEA)Part C services.2. Describe which providers (i.e. occupational therapists, physical therapists,speech-language pathologists, teachers of the deaf/hard ofhearing) are using telehealth and what services are delivered via telehealthwithin IDEA Part C programs.3. Articulate strategies to overcome barriers and concerns identified bystates that are not yet using telehealth within their IDEA Part C programs.164 MOBILE TELEDERMATOLOGY AS A TEACHING TOOL FOR PRIMARYCARE PROVIDERS IN-TRAININGPRESENTER & CONTRIBUTING AUTHORS:Ivy Ann Lee, MD, Assistant Clinical Professor of Dermatology,Toby Maurer, MD, Kieron Leslie, MD.University of California San Francisco, San Francisco, CA, USA.Prior studies have shown that primary care physicians report uncertainty inmanagement of more than one in three patients with dermatology conditionsand that only one tenth of these patients are sent for referral. 1 Not only maythis lead to inaccurate and delayed diagnoses and treatment plans, but thesepatients represent lost potential learning opportunities for the primary carephysicians. Teledermatology provides an opportunity to engage learners atthe point-of-care and is easily incorporated into busy clinic schedules Teledermatologyoffers practice-based learning opportunities where learners candevelop their dermatology fund of knowledge, hone communication skillswith their dermatology colleagues, coordinate care in an integrated healthcaresystem, and see firsthand the health policy implications of expanded access totimely care. Few prior studies support the educational value of teledermatologyand there are no studies, to our knowledge, that quantitativelyand qualitatively evaluate the educational value of teledermatology in aprimary care residency program. 2,3,4 This descriptive pilot study and teledermatologyservice at the University of California San Francisco assessed theexisting dermatology knowledge and practice gaps for family practice residents,teledermatology’s impact on their learning of dermatology, and theirsatisfaction and acceptance of this innovative healthcare service. This investigationconsisted of a pre-intervention survey and quiz, a store-andforwardteledermatology consultation service, and post-intervention surveyand quiz. Preliminary findings support teledermatology as a powerful, engagingteaching tool that improves diagnostic accuracy and confidence overtime. Primary care providers in-training appreciate this learning opportunitywhile providing efficient, effective patient care. Mobile teledermatology offersan easy way to integrate telehealth and technology into daily practice. Thisstudy also supports introducing this innovation in healthcare delivery at animportant point in the physician’s career, residency, when practice philosophyand habits form and medical educators can hopefully inspire adoption andintegration of telehealth.REFERENCES1. Perednia DA. Store-and-forward teledermatology. Telemed Today 1996; 4:18–21.]2. Shaikh N, Lehrmann CU, Kaleida PH, Cohen BA. Efficacy and feasibility of teledermatologyfor paediatric medical education. J Telemed Telecare 2008; 14: 204–7.3. Thind CK, Brooker I, Ormerod AD. Teledermatology: a tool for remote superision of ageneral practitioner with special interest in dermatology. Clin and Experimental Dermatol2011; 36: 489–94.4. Akker TW, Reker Ch, Knol A, Post J, Wilbrink J, Veen JP. Teledermatology as a tool forcommunication between general practitioners and dermatologists. J Telemed Telecare2001; 7: 193–8.Objectives1. Describe the educational benefit of teledermatology for providers intraining2. Discuss how teledermatology can be integrated into medical education3. List specific teledermatology practices that target and enhance learning165 OPTIMIZING NETWORK CONNECTIVITY FOR REAL-TIME MOBILEHEALTH TECHNOLOGIES IN SUB-SAHARAN AFRICAPRESENTER & CONTRIBUTING AUTHORS:Mark J. Siedner, MD, MPH, Clinical and Research Fellow 1 ,Alexander Lankowski, MA 2 , Derrick Musinga, BS 3 ,Jonathon Jackson, BS MEng 4 , Conrad Muzoora, MD 3 , Peter W. Hunt, MD 5 ,Jeffrey N. Martin, MD, MPH 5 , David R. Bangsberg, MD, MPH 1 ,Jessica E. Haberer, MD, MS 1 .1 Massachusetts General Hospital, Boston, MA, USA, 2 Boston University,Boston, MA, USA, 3 Mbarara University of Science and Technology, Mbarara,Uganda, 4 Dimagi Inc, Boston, MA, USA, 5 University of California,San Francisco, San Francisco, CA, USA.ABSTRACT WITHDRAWNª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-99

POSTER PRESENTATIONS ABSTRACTSConclusions: Addition of SMS compatibility can significantly reduce connectionfailures for mHealth applications in remote areas. Projects dependingon real-time data in rural settings should consider this upgrade to optimizeuse.Objectives1. Optimize design and conduct of remote monitoring projects in resourcelimited settings2. Differentiate between short messaging service and general packet radioservice modalities3. Understand the usability and practice of real-time medication adherencemonitoringWe used real-time interactive videoconferencing systems, all Tandberg Edge95 MXP’s, with high definition video cameras and high quality microphones.The patient is able to receive video calls on their laptop through the TandbergMovi video conferencing PC client. A typical Movi to Movi call in which oneMovi client is on the internal network (UNCG) and the other Move client (PDpatient) is using the public Internet. Pre-therapy assessments conducted viatelespeech with the clinician involved an interview/questionnaire, the Assessmentof Intelligibility of Dysarthric Speech (ASSIDS), the ConsensusAuditory-Perceptual Evaluation of Voice (CAPE-V), a stimulability assessmentfor the Lee Silverman Voice Therapy program (LSVT), and pre-therapylevels of loudness and pitch as specified by LSVT in order to assess progress.Clients were asked to complete the Voice Handicap Index-10 and to have afrequent communication partner complete the Perceptual Rating Form.Therapy was conducted in 45–60 minute sessions, four days a week for fourweeks as specified in the LSVT protocol. High effort intensity and vocalloudness was emphasized throughout each session. The focus of treatmentacross all measures was to increase vocal loudness and duration whilemaintaining good quality speech. Clients were asked to complete homeworkonce on days when therapy took place and twice on days where therapy didnot take place. Post-therapy assessments conducted via telespeech involved asassessment of the loudness and pitch levels of the client as specified by LSVT,the ASSIDS, and the CAPE-V. Clients were asked to complete the TelerehabilitationParticipant Satisfaction Questionnaire and to have the PerceptualRating Form completed by the same communication partner whocompleted the initial form. PD patient outcomes appear to be consistent withthose seen in traditional in-person LSVT LOUD sessions. Satisfaction levelswere extremely high with participants engaged with this project. We experienceda few challenges with this project. Most of the difficulties encounteredcenter around inconsistent audio and visual quality within the videoconferencingsession. Additionally we have experienced some minor technicalproblems with the LSVT COMPANIONÔ software. Telespeech certainly has thepotential to allow PD individuals to access LSVT LOUD services where theymight otherwise not have had access.Objectives1. Describe the technology and software solutions utilized to deliver asecure and effective TeleSpeech intervention for PD individuals.2. Discuss the process of patient selection, as well as assessment andtreatment protocols employed.3. Review outcome results, satisfaction levels, as well as challenges involvedin delivery of TeleSpeech services.172 REMOTE DELIVERY OF THE LEE SILVERMAN VOICE TREATMENTTO INDIVIUDALS WITH PARKINSON DISEASEPRESENTER & CONTRIBUTING AUTHORS:Michael Campbell, MS, MBA, CCC-SLP, Assistant Chief, Audiology andSpeech Pathology Service.Gulf Coast Veterans Health Care System, Biloxi, MS, USA.The primary purpose of this project is to determine the clinical effectiveness,of speech and language services when they are delivered through securevideoconferencing to PD adults living in North Carolina. In this pilot project,the effectiveness of services, delivered securely via the high speed Internet toindividuals with PD is examined. Participants for this pilot project receivetelespeech, in their homes located both in urban and rural areas. In addition tosynchronous telespeech sessions, the LSVT COMPANIONÔ, Home Edition isused to increase the intensity of treatment through recording of the patients’home practice assignments. The LSVT COMPANIONÔ, Clinician Edition isused to make adjustments to treatment targets as well as stimulus materials.GoToMyPC is use to gain remote access to the PD patients laptop and manipulatethe LSVT COMPANIONÔ, Home Edition software program.186 GLOBAL TRENDS IN INTERNET SEARCH VOLUME FORTELEMEDICINE-RELATED TERMINOLOGYPRESENTER & CONTRIBUTING AUTHORS:Venessa Pena-Robichaux, MD, Resident Physician, Melody Eide, MD, MPH.Henry Ford Health System, Detroit, MI, USA.Introduction: Examining regional Internet searches has become a popularway to gather information about a geographic location. Such passive crowdsourcing can provide us with a window into the interests or needs of a population.The language of telemedicine has evolved to adopt new terms over thelast few years. Exploring telemedicine terms that are being searched on theInternet by different geographic regions may help to give insight into wherethese differences lie and what needs populations have with regard to telemedicineservices.Methods: The online tool, Google Trends (Google, Inc.), was used to evaluatethe relative Internet search volume of the following terms across variousregions of the world from 2004 to 2012: ‘‘telemedicine’’, ‘‘telehealth’’,‘‘ehealth’’, ‘‘mobile health’’, and ‘‘mhealth’’. Google Trends provides a queryindex, which is based on the total query volume within a geographic regiondivided by the total number of queries during the period of interest. All dataA-100 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTSwas normalized and scaled to the average search traffic for the searched terms.Google searches by geographic region were reported as a ratio in relation tothe region with the most number of searches (represented at 1.0).Results: From 2004–2012 the most commonly searched term using Googlethroughout the world and United States was ‘‘telemedicine’’. By geographicregion ‘‘telemedicine’’ is most frequently searched in India (1.0), followed byPakistan (0.63) and South Africa (0.53). ‘‘Telehealth’’ is most frequentlysearched by Canada (1.0), followed by Australia (0.08) and the United States(0.065). ‘‘Ehealth’’ is most frequently searched by Canada (1.0), followed byAustralia (0.335) and Belgium (0.280). ‘‘Mobile health’’ is most frequentlysearched by South Africa (1.0), followed by India (0.89) and the United States(0.815). ‘‘Mhealth’’ is most frequently searched by Egypt (1.0) followed bySouth Africa (0.335) and Russia (0.285). Of all countries in the world, Canada(1.0) has most frequently searched telemedicine related terms in Google,followed by India (0.225) and the United States (0.185).Conclusion: While the term ‘‘telemedicine’’ currently remains the mostcommonly searched term in the United States, over the last 5 years the terms‘‘telehealth’’ and ‘‘ehealth’’ have become the two most frequently searchedterms throughout the world. The language of telemedicine is evolving, anddifferences in global search trends highlight areas of global demand for services.This may reflect that we might not have a common language in ourterminology, but this could also mean different geographic areas have differentneeds (i.e. differences in use of mobile handheld devices).Objectives1. Discuss how the trends of global telemedicine-related Internet searchesmay reflect the needs of a geographic region.2. Realize the impact that advancing technologies is having on telemedicine-relatedterminology.3. Emphasize the importance of a universal telemedicine language.197 TELEMEDICINE AND REMOTE PATIENT MONITORING TRAININGBEST PRACTICESPRESENTER & CONTRIBUTING AUTHORS:Hasan Sapci, MD, Assistant Professor of Health Informatics,Aylin Sapci, MD.Northern Kentucky University, Highland Heights, KY, USA.Health informatics education has been going through a rapid evolution.Several new programs were launched over the last decade around the worldand the current trends of including evidence-based learning in the healthinformatics curriculum falls short of what students need to know. This posterpresents a case report that describes a unique experience of establishing anapplied medical informatics laboratory that focuses on telemedicine and remotepatient monitoring training. The transition from ‘‘clinical-centric’’ to‘‘patient-centric systems’’, the redefinition of treatment and operational policies,and evolving definitions of ‘‘primary prevention’’, ‘‘medical homes’’ and‘‘disease management’’ changed the healthcare remarkably during the lastdecade. Innovations in educational tools also led to significant changes, supervisedpractice is not the only option anymore. American Medical Associationrecently recommended adding new competencies into teachingprograms to train skilled students. In order to teach critical components ofconnected health and innovative healthcare system design, we founded aHealth Informatics Laboratory that focuses on telemedicine, remote patientmonitoring, medical device design and mobile health. In this presentation wewill share our lessons learned from this unique experience, share our evaluationdata, provide tips about the curriculum design and recommend aguideline to develop best practices to found a hands-on telemedicine andmobile health training laboratory.Objectives1. To understand best practices in telemedicine training2. To evaluate the importance of hands-on training laboratory in academicinstitutions3. To understand latest trends in medical informatics education198 CLINICAL CONSIDERATIONS IN DEVELOPING A SYSTEMTO SUPPORT SELF-MANAGEMENTPRESENTER & CONTRIBUTING AUTHORS:Andrea D. Fairman, PhDc, OTR/L, CPRP, PhD Candidate & Adjunct FacultyMember 1,2 .1 University of Pittsburgh, Pittsburgh, PA, USA, 2 Philadelphia University,Philadelphia, PA, USA.Usability testing was conducted to create apps to meet the needs of apopulation of persons with spina bifida (SB).Objective: Development of specialized smartphone applications to supportself-care and self-management skills of persons with SB.Methods: Applications were uniquely tailored to meet the needs of thispatient population. Clinical considerations (i.e. cognitive, sensory and physicalneeds) were taken into account when designing apps and can be generalizedto other disability populations. Usability testing methods followeddesign principles of human-computer interaction. Accessibility outcomesmeasures included:- Visual, auditory and tactile interfaces and application structure forenhancing ease of operation, effective and motivating interaction- Automatic tailoring, context awareness and self-configuration of the userinterface as determined by cognitive and physical motor abilities andpreferences.Participants: Nine subjects were enrolled and participated in testing resultingin the creation of five apps. Usability testing was completed June 2011 - March2012. Testing was conducted within subjects’ homes. Subjects were encouragedto utilize these apps wherever they perform self-care activities over a month ormore. A unique portal system, called iMHere is utilized to view subject usageinformation of the system and to send feedback. Information is displayed inlayers allowing the clinician to monitor a caseload of patients and reviewinformation specific to each individual’s completion of self-care tasks.(Figures)This project is on-going with the system providing remote clinical support topersons with SB. A RCT (n = 28) is currently in process. Preliminary results ofthis clinical phase will also be shared.Objectives1. Apply information from this clinical research study their own clinicalor research practice2. Understand the challenges which exist in conducting research in theemerging area of Telerehabilitation3. Understand the clinical impact of providing a remote wellness programfor persons with spina bifidaª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-101

POSTER PRESENTATIONS ABSTRACTS216 EFFICACY OF TELEREHABILITATION FOR THE DELIVERY OF AREMOTE COGNITIVE REHABILITATION PROGRAMPRESENTER & CONTRIBUTING AUTHORS:Michelle L. Sporner, MS, Instructor, Michael McCue, PhD,Bambang Parmanto, PhD, David Brienza, PhD.University of Pittsburgh, Pittsburgh, PA, USA.The Ecologically Oriented Neurorehabilitation of Memory (EON-MEM) is asystematic and manualized approach to delivering cognitive rehabilitationto individuals with memory deficits. The EON-MEM trains clients to compensatefor memory impairments by placing focus on everyday memoryproblems and practicing exercises in naturalistic environments, whichprovide ecological validity to the program, and lends itself telerehabilitation(TR). The EON-MEM is a 21-week intervention requiring the client attendweekly clinical sessions and complete daily homework activities betweensessions. An abbreviated EON-MEM protocol was selected for application inan efficacy study evaluating the use of telerehabilitation for the delivery ofcognitive rehabilitation. Telerehabilitation systems that include a videoconferencingsystem, as well as a web portal to store daily homework activities,and are accessed using a tablet PC, have been developed andtechnical and clinical usability assessed. A quasi-experimental study wasconducted to evaluate the efficacy of telerehabilitation for the delivery ofcognitive rehabilitation. It was hypothesized that both standard (face-toface)delivery and remote delivery of cognitive rehabilitation would result insimilar changes in memory and client self-awareness of their disability.Telerehabilitation satisfaction and usability data were also collected. If TRresulted in similar memory changes, additional implications for the use oftelerehabilitation were analyzed. Institutional Review Board approval wasobtained through the University of Pittsburgh. Participants were youngadults with a cognitive disability, including traumatic brain injury, autismspectrum disorders, learning disability, and attention deficit hyperactivitydisorder. Twenty-four participants were recruited. Participants underwentbaseline testing and then were randomly assigned to a face-to-face interventionor a telerehabilitation intervention. After completion of the 10-weekmemory intervention, participants completed follow-up testing. Outcomeresults will be presented, and implications for both cognitive rehabilitationand telerehabilitation will be discussed.Objectives1. Attendees will be able to describe a quasi-experimental design used toevaluate the efficacy of telerehabilitation for the delivery of cognitiverehabilitation.2. Attendees will be able to identify and discuss implications for cognitiverehabilitation delivered using telerehabilitation.3. Attendees will be able to describe the efficacy of remote cognitiverehabilitation program delivered through telerehabilitation.Methodology: After setting up the system and training of personnel andpatients, a randomized controlled trial was performed, including two patientgroups, one receiving conventional healthcare and another home telehealth,with 30 patients in each group. The trial was performed by the PneumologyDepartment of the Hospital Universitario La Princesa (Madrid, Spain) andcoordinated with four local primary care centers. Home service, technicalassistance and specialized telehealth triage center was provided by LindeHealthcare (Madrid, Spain), using technology and technical support servicesprovided by Aerotel Medical Systems (Holon, Israel). Patients included in thetrial suffered severe COPD, and where on home oxygen therapy. Additionally,they had experienced at least one exacerbation episode that leaded to hospitalizationin the year prior to the trial. Vital signs (blood pressure, heart rate,blood oxygen saturation and peak-flow) where monitored on a daily basis andtransmitted automatically using the home telehealth system to the triagecenter for analysis. Nurses of the telehealth triage center received automaticalerts when measured values strayed from normal levels pre-specified individuallyfor each patient. Upon confirmation of the alerts through directtelephone contact with the patients to administer a clinical questionnaire, thenurses escalated the confirmed alerts to the clinical responsible in the hospital.Remote viewing and analysis of patients’ monitored values was done via aWeb interface. Emphasis was made on designing an intuitive and easy to usetelehealth solution, as well as on adequate preparations and training of bothpatients and caregivers prior to the start of the service and throughout the trialperiod. The clinical response was the result of a coordinated effort between thefollowing agents: the telehealth triage center, the specialist in respiratorymedicine and the primary care centers.Results: The home telehealth group experienced 60% less days of hospitalizations,65% less A&E visits, and over 60% less hospitalizations due toCOPD exacerbations, than the control group. The control group experienced 1hospitalization in Intensive Care Unit (ICU), and 8 patients required furthertreatment with non-invasive ventilation, while none of these occurred in thetelehealth group. The acceptance of the home telehealth service was very highamong both patients and caregivers.Conclusions: Home telehealth services are effective in the follow-up of patientswith severe COPD, and considerably reduce the number of hospitaladmissions, days of hospital stay and A&E visits. Patients adapted well to thetelehealth service and to the use of the technology at home. An expansion ofthe service is planned with additional outcomes to be presented if they becomeavailable by the time of this presentation.Objectives1. Understand the basics of developing successful managed home-telehealthservices2. Understand how to use telehealth for monitoring COPD patients andprevent hospital admissions3. Understand the effectiveness and benefits of home telehealth services235 A MANAGED HOME TELEHEALTH SERVICE FOR SEVERE COPDPATIENTS IN SPAINPRESENTER & CONTRIBUTING AUTHORS:Ofer Atzmon, BSc, VP Business Development and Marketing 1 ,Cristina Gómez Suárez, PhD 2 .1 Aerotel Medical Systems, Holon, Israel, 2 Air Products Healthcare, Madrid,Spain.Introduction: A new service for monitoring of severe Chronic ObstructivePulmonary Disease (COPD) patients at home using telehealth technology wasintroduced by Linde Healthcare in Spain. A study was conducted in order toestablish the efficacy of a the service, measured as the reduction in (a) thenumber of hospitalizations; (b) the length of hospital stays; and (c) number ofAccident & Emergency (A&E) visits.238 INTRODUCING THE TELE-INTERVENTION RESOURCE GUIDEPRESENTER & CONTRIBUTING AUTHORS:Diane Behl, MEd, Senior Research Scientist.Utah State University, Logan, UT, USA.The National Center for Hearing Assessment and Management at Utah StateUniversity has been investigating the role of ‘‘tele-intervention’’ as a mechanismof delivering services to children with hearing loss who otherwisewould go without needed services. The term ‘‘tele-intervention’’ (TI) wascoined to emphasize the use of tele-rehabilitation methods in the provision offamily-centered early intervention services for children ages birth to threeyears. NCHAM invited professionals from across the country who were alreadyusing this technology to provide EI services to form a ‘‘learning community’’to share their experiences, address current challenges, andsystematically address relevant issues. A resource guide was developed basedA-102 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTSon the learning community knowledge base as a way to provide practicalinformation to the growing number of programs and individuals interested inusing tele-intervention to provide family-centered early intervention tofamilies of children with hearing loss. The resource guide reflects the collectiveknowledge of the group, exploring ‘‘what we know now,’’ reflecting onlessons we have learned from being a TI early adapters, with the goal beingto promote TI as a viable service provision option to reach more childrenand families and to improve outcomes for children with hearing loss. Theinformation presented in this guide is based on practical experience usingtele-intervention and reflects the participants’ consensus on recommendedpractices. The guide offers state-of-the-art information on the benefits andchallenges of TI, how to plan and implement TI sessions, technology considerations,privacy and security issues, licensure, reimbursement, and strategiesto evaluate outcomes of TI. The objectives of this poster are to enhanceparticipant awareness of this service delivery system by ensuring participantswill be able to:1. Explain the value of tele-intervention in serving young children withhearing loss.2. Gain an opportunity to join a learning community interested in teleintervention.3. Access resources and understand issues in the use of tele-intervention.Handouts will feature an executive summary describing the learningcommunity and directions to access the resource guide. Additionally, participantswill be able to express interest in joining the TI learning community,providing the opportunity to exchange information and foster new knowledgeregarding TI.Objectives1. Explain the value of tele-intervention in serving young children withhearing loss.2. Gain an opportunity to join a learning community interested in teleintervention.3. Access resources and understand challenges in the use of tele-intervention.245 MEDICAL INFORMATION EXCHANGE AND TELEMENTORING WITHROTARY WING MEDEVAC AIRCRAFT OVER TACTICAL RADIONETWORKSPRESENTER & CONTRIBUTING AUTHORS:Gary R. Gilbert, MS, PhD, IPA, Army Telemedicine and AdvancedTechnology Research Center (TATRC).Georgetown University Department of Radiology, Frederick, MD, USA.Within the United States military forces, practical medical informationexchange and telemedicine support to first responder medics has been anelusive goal. Providing useful telemedicine and medical informatics assistanceto combat medics, capturing accurate records of first responder patientencounters, and communicating relevant patient information up the medicalevacuation and treatment chain without negatively impacting the medics’primary mission foci are among the most challenging aspects of that goal.Last year we discussed collaboration between the US Army TelemedicineAdvanced Technologies Research Center (TATRC) and the US Army Communications& Electronics Research Development & Engineering Center(CERDEC) to test and evaluate integration of telemedicine & medical informationexchange technologies over current and future force tactical radionetworks between ground ambulance vehicles and forward deployed medicalfacilities. During the past year that work has been extended to include AirMEDEVAC to ground medical information and telementoring exchange overthe same secure tactical radio networks. Medical information exchanges attemptedin the field during tactical user evaluation exercises with mixedresults included full duplex UDP (User Datagram Protocol) streaming datafrom live telementoring sessions with voice-over-Internet protocol (VOIP) andvideo, as well as a digital tactical combat casualty care (TCCC) card, whiteboardmark-up enabled, still imaging, and physiological monitoring data andvital signs transmitted via TCP (Transmission Control Protocol) and/or FDP(File Data Protocol). We discuss the technologies employed, the integrationmethods used, analysis of the technical data collected, the results of the operationaluser assessments, and continuing implementation challenges.Objectives1. Explain medical information exchange over military radios and tactical4G networks2. Know about new medical encounter information capture and telemedicinedevices3. Tell how devices were integrated for use on rotary wing MEDEVACaircraft249 FROM LOCAL TO GLOBAL: ECG TELECONSULTATION ON THECLOUDPRESENTER & CONTRIBUTING AUTHORS:Jui-chien Hsieh, PhD, Assistant Professor 1 , Ai-Hsien Li, MD, PhD 2 ,Yi-hsing Chiu, PhD 3 , Hsiu Chiung Lo, MS 1 .1 Yuan Ze University, Chungli, Taoyuan, Taiwan, 2 Far East Memorial Hospital,Taipei, Taiwan, 3 Hsun Chuan University, Hsin-chu, Taiwan.Emergency telecardiology has always been in great demand, especially inrural areas. It remains a challenge for physicians in rural clinics to consult anexperienced cardiologist who can interpret 12-lead ECG in a timely manner.To date, there is no effective public platform which provides clinicians withubiquitous 12-lead ECG tele-diagnosis services. The major objective of thisstudy is to create a global service of ECG teleconsultation on a cloud computingenvironment, which can be accessed by clinicians anytime and anywhere.In this study, we setup a Hyrper-V clustering infrastructure, whicheffectively guarantees the running ECG service highly accessible and available.This ECG teleconsultation service implemented in Hyper-V can realizetelecardiology practice through the following steps: (1) Cardiologists acrossregions or nations are invited to register and list their available time forteleconsultation on this platform. (2) Physicians can get online and consultexperienced cardiologists as they redirect ECG to the cardiologists ‘cell phonesvia this cloud service. (3) After directly denoting ECG findings on the receivedECG files, remote cardiologists transfer the files back to the consulting physicians’cell phones or computers. In conclusion, this service is easy to use,ubiquitous, and effective, as it provides ECG tele-consultation via a commonplatform and offers timely 12-lead ECG tele-diagnosis. Most importantly, thisservice effectively overcomes the challenge of 12-lead ECG tele-consultationand facilitates global collaboration of ECG teleconsultation for both clinicalpractice and research purposes.Objectives1. Realize the challenges of ECG telemedicine in the clinical practices.2. Understand ECG medical informatics.3. Understand cloud computing technology.251 CLINICAL AND POLICY GUIDELINES TO TELEHEALTHAPPLICATIONS FOR OCCUPATIONAL THERAPY SERVICES.PRESENTER & CONTRIBUTING AUTHORS:Tammy Richmond, MS, OTR/L, FAOTA, Chair of Telehealth Ad Hoc.Occupational Therapy Association of California, Los Angeles, CA, USA.The emerging use of telehealth technology to deliver healthcare services israpidly growing, therefore, there is a need to educate healthcare practitioners onthe clinical, administrative and technical principles, standards and guidelines ofª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-103

POSTER PRESENTATIONS ABSTRACTSOccupational Therapy services in telerehabilitation. The utilization of communicationand information technologies to educate and deliver healthcareservices has quickly emerged as a changing force in how occupational therapypractitioners can provide services to wherever the client lives, works, and playswithout being physically present (AOTA, 2010). Evidence supports the use oftelehealth technologies across the six areas of OT practice (Cason and Richmond,pending Springer publication). This ATA roundtable will foster discussionaround key policy documents, emerging policy trends, current servicedelivery models and ways to expand telehealth program to include occupationaltherapy services across various healthcare settings.REFERENCESChapter 10: Telehealth Opportunities in Occupational Therapy. Telerehabilitation. SpringerPublishing, Inc. Corrigan, J,D., Smith-Knapp, K, and Carl V. (1998).AOTA Telehealth Position Paper 2012 (pending Fall release), AOTA Ethics in Telehealth: http://www.aota.org/Practitioners/Ethics/Advisory/51024.aspx?FT=.pdf,Brennan D. Lyn Tindall, Deborah Theodoros, Janet Brown, Michael Campbell, Diana Christiana,David Smith, Jana Cason, Alan Lee A Blueprint for Telerehabilitation Guidelines. InternationalJournal of Telerehabilitation. A Blueprint for Telerehabilitation Guidelines. Vol. 2, No. 2, Fall 2010.http://telerehab.pitt.edu/ojs/index.php/Telerehab/article/view/6063,Cason and BrannonTelehealth Regulatory and Legal Considerations: Frequently Asked Questions. InternationalJournal of Telerehabilitation. Vol. 3, No. 2, Fall 2011. doi: 10.5195/ijt.2011.6077.http://telerehab.pitt.edu/ojs/index.php/Telerehab/article/view/6077. OTAC Telehealth Ad Hocupdates on Legislative policy and AOTA Model State Regs for Telehealth (pending release).Objectives1. Discuss key policy documents related to the use of telehealth withinoccupational therapy and resources for continued guidance.2. Identify emerging policy trends in the areas of reimbursement, privacy,and licensure and implications for occupational therapy.3. Discuss how to expand current telehealth programs to include telerehabilitationservices.263 COMMUNITY-ENGAGED DEVELOPMENT OF A TELEMEDICINEPILOTPRESENTER & CONTRIBUTING AUTHORS:Deborah Meyer, PhD, RN, Assistant Professor 1 , Albert Lai, PhD 2 .1 Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA,2 The Ohio State University, Columbus, OH, USA.We describe a community-engaged pilot study designed to determine thefeasibility of recruiting and retaining elderly individuals for a longitudinalstudy that tests the efficacy of an evidence-based chronic disease interventionto improve management of type 2 diabetes (T2DM) in individuals age ‡ 60living in Appalachian Ohio, a high risk population for this condition. The goalof this multi-professional community-based program is to reduce healthcareutilization, facilitate self-management skills, and improve quality of life byempowering seniors and tightly monitoring their disease. This study tackles agrowing problem of community-based chronic disease management, especiallyamong the elderly in rural areas, by employing technology to augmentthe limited resources of a rural Appalachian community. Dr. Meyer workedwith the Appalachian Community Visiting Nurse Association (ACVNA) toidentify healthcare needs among the elderly in this rural region. ACVNA’sstaff, who cover a large rural area, believe that access to remote patientmonitoring (RPM) will improve patient outcomes and their ability to providetimely care. The Ohio State University (OSU) and Ohio University HeritageCollege of Osteopathic Medicine (HCOM) partners have access to resourcesthat a small agency such as ACVNA does not have: funding for RPM devices,research expertise, and diabetes specialists. Findings from the study will notonly help with future funding of a larger project, but also give ACVNA informationthey can use to make changes to how they provide care to elderlyindividuals with chronic diseases. In our partnership, we meet weekly viateleconference as a team and communicate regularly via email. All threepartners participate in all major decisions/changes and all aspects of the studyprocess, including defining/redefining the problem(s), methodology, datacollection, dissemination of results and application to of finings to better meetthe needs of rural elderly. This small feasibility study will provide data onattrition rates for this population, the amount of missing data that we canexpect, and the ability of the designated visiting nurse association to participateeffectively in a project of this length. We will test the hypothesis thatindividuals will experience significant improvements in medical outcomesand emergent care in individuals from baseline to post-assessment. A secondarygoal is to develop a collaborative relationship between researchers atOSU and HCOM. This will not only encourage future research, but alsostrengthen applications to funding agencies, such as NIH. Successfullymeeting the goals of this pilot would provide evidence that we can recruit andretain elderly individuals, work as a collaborative team, and obtain results thatlead to improved quality of life for individuals with chronic disease as well ascut medical costs. To date, our partnership has been very successful. Our earlysuccess have already led to further developments and based on ACVNA’s areasof interest, we are beginning to examine congestive heart failure as an additionalfocus area for remote patient monitoring.Objectives1. Gain a better understanding of pros and cons of university/communityagency partnering.2. Describe the pros and cons of home monitoring of rural elderly withchronic disease.3. Discuss the feasibility of long-term in-home monitoring of rural elderlywith chronic disease.270 LEVERAGING MOBILE DEVICES TO SUPPORT COGNITIVEBEHAVIORAL THERAPY FOR STRESS AND ANGER MANAGEMENTPRESENTER & CONTRIBUTING AUTHORS:David L. Jones, MS, Director, Medical Innovations 1 ,Sara Dechmerowski, MS 1 , Kelly Hale, PhD 1 , Courtney L. Crooks, PhD 2 ,Leanne West, MS 2 , Philip Gehrman, PhD 3 .1 Design Interactive, Inc., Oviedo, FL, USA, 2 Georgia Tech Research Institute,Atlanta, GA, USA, 3 University of Pennsylvania, Philadelphia, PA, USA.Given the prevalence of PTSD, and the associated effects on stress, anger, andaggression, there is an increasing need for support tools to counter these effects.One commonly used evidence-based and validated treatment technique forstress and anger therapy is cognitive behavioral therapy (CBT). The premise ofCBT is that maladaptive patterns of thinking and behaving are responsible formaintaining psychological difficulties, and CBT aims to change such maladaptivepatterns through a series of strategies in order to promote healthierpatterns of cognition and action. The CBT process is a therapist-driven approachwhere therapists provide tools to support the real-time mitigation of conditionssuch as anger and stress while guiding patients to modify their thought process.Although CBT is an effective approach to support stress and anger therapy, itrelies heavily on patient input in order to evaluate progress and it does notprovide real-time support to patients between therapy sessions. In order todevelop methods to address these issues and improve the CBT process, a needsanalysis was conducted to summarize the current support gaps for both patientsand providers. The results of this analysis characterized patient and providerneeds at four stages of the CBT process including initial evaluation and assessment,education and evaluation, change and restructure, and reinforce andreview stages. Based on this analysis, patient and provider gaps were characterizedinto six critical CBT expansion needs. These needs include the capabilityto: 1) unobtrusively and objectively record patient stress and anger levels andcontext; 2) provide stress and anger mitigations in real time; 3) summarize andpresent patient stress/anger patterns to providers; 4) allow customization; 5)support end of day reflections and homework; and 6) compare patient ratingswith objective measures of stress and anger. The six CBT expansion needsA-104 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTSoutlined under this research were used to drive the development of the MobileStress and Anger management Tool (MSAT) that links a mobile patient supportcomponent and a provider portal targeted at optimizing the CBT process. Thetool meets the most critical needs of patients by providing real-time supportwhen anger and stress triggers are encountered during their day to day life bycontinuously tracking their stress/anger levels using a combination of wirelessheart rate and galvanic skin response sensors. An integrated provider portalprovides information to support practitioners in what they have deemed theirmost difficult task in CBT, determining the patterns that trigger anger and stressin patients. By objectively tracking anger and stress and presenting patterns toproviders prior to meetings, they no longer have to rely on patient-provideddata in-session, and can analyze the information prior to patients arriving,allowing them to spend more time during sessions, supporting patients andproviding additional tools for them to use during their therapy. The needs andsolutions provided in this presentation are applicable to healthcare practitionersas well as technology developers focused on creating mobile CBT support tools.Objectives1. Describe the needs of providers who apply cognitive behavioral therapyto address stress and anger disorders2. Describe the needs of patients who are following cognitive behavioraltherapy to address stress and anger disorders3. Describe a set of novel ways to leverage mobile technology to supportthe needs of CBT providers and patients273 THE WORLD OF TELEMEDICINE PUBLICATIONS - POINTERS TO THEDEVELOPMENTS IN TELEMEDICINE AND TELEHEALTHPRESENTER & CONTRIBUTING AUTHORS:Murthy Remilla, BE, MBA, PhD, Executive Committee Member.Telemedicine Society of India, Hyderabad, India.Telemedicine has outshined technical definition it was given and has nowreached new frontiers in all aspects of life. On one side there are severalarticles/original research works being published about the advances andbenefits in embracing Telemedicine/Telehealth. On the other, several conferencesand events take place through the year in several parts of the worldenabling the personal presentation and sharing of the experiences, bothstimulating and trying. While Telemedicine and e-Health journal of ATA is thehighly regarded journal by industry/faculty, there are many other periodicalscoming up from different organizations/ universities and academia which alsoserve as a pointer to the developments in the field. In the midst of so manyjournals, publications and events; it is highly difficult to keep a watch on thedevelopments in all aspects in all parts of the world. This is felt as a gap in thearea for the curious professionals to have a bird’s eye view of these happeningsand gauge the developments. To fill this perceived gap, literature survey of thefollowing 20 journals/magazines (both pint and electronics versions) is takenup over a period of about 5 years starting from January 2008. (Selection ofjournals & period are based on the web search and accessibility/conveniencewhich do not represent any rating of the publications as such). The world ofTelemedicine Publications - Pointers to the developments in Telemedicine andTelehealth The presentation will provide an overview of the articles/researchfindings in multiple dimensions like Technology, adoption, Delivery modelsand awareness building etc. More specifically the study is directed towards thefollowing streams.a) Innovative applications/treatment initiativesb) Telehealth in Primary/Rural healthcarec) Path breaking technologies in Telehealthd) Applications in Home care/aged population monitoringe) Advances in Technology aiding Telemedicine/Telehealthf) Studies/efforts on spreading the awareness and more importantlyallaying the apprehensions/fearsg) Cost and business aspectsh) Literature on Telehealth, Resources and Publicationsi) Applications in Emergency/Disaster managementj) Use in Very special situationsk) Telementoring/teaching/trainingl) Increasing Geographic coverage and spreadm) Policy and Management issuesn) Medical records and web based servicesThe presentation highlights the promising areas and helps in encouragingthe non-takers to embrace the telemedicine root in healthcare. The review alsoprovides the summary of pointers from the literature survey, which shouldserve in identifying the issues, their prioritizing and the means to address themin the times to come.Objectives1. Provide a snapshot of the literature in Telehealth Services2. Presenting a review of the innovations in Technology, Delivery modelsand awareness building3. Summarizing the issues that need attention and direction for future276 TELEMEDICINE - ANOTHER POWERFUL TOOL IN EMERGENCYMANAGEMENT - PROSPECTS FOR INDIAPRESENTER & CONTRIBUTING AUTHORS:Murthy Remilla, BE, MBA, PhD, Department of Space, Bhanumurthy V, BE.Indian Space Research Organisation (ISRO), Hyderabad, India.Emergencies, Disasters, and Catastrophes are distinct evils that requiredistinct strategies of response and recovery. While the definitions and effectsvary in degree, one common factor among all is the need for strategic management.Emergency Management is a strategic process, and not a tacticalprocess. More coordinated public sector/private sector relationships andcommunity participation are required in effecting management of all thesetribulations. Be it a natural or human-made, the hazards cause loss anddamage to living & non-living things and may also lead to cultural or economicimpacts in certain cases. The entire strategic management process ofthese disasters/emergencies needs focus on four distinct but interlinked professionalactivities-Mitigation, Preparedness, Response and Recovery. Indiahas been traditionally vulnerable to natural disaster on account of its geoclimaticconditions. Floods, droughts, cyclones, earthquakes and landslideshave been recurrent phenomena. Apart from natural disasters, the technological/man-madedisasters such as industrial, chemical, biological, nuclear,fire, transport accidents, power failures, explosions, etc. pose a serious threatto the nation’s economic growth and loss of lives. With an impressive record ofachievements in space technology covering satellites, launch vehicle servicesand applications by the Indian Space Agency (Indian Space Research Organization-ISRO),India utilizes its advanced Remote Sensing and operationalexpertise in geospatial aspects of dealing with emergencies. National Databasefor Emergency Management (NDEM), a national project of the government ofIndia is being implemented by ISRO with participation from several ministries/departments/agencies of the central and state governments. The projectNDEM employs the use of GIS/digital maps of States/districts and urbancenters with spatial and non-spatial data at appropriate scales to be useful inthe decision support system for emergency response managers at all levels.On the other hand, Indian Telemedicine program primarily spearheaded byISRO and supplemented by other Government, Private and Trust agencieshelped in augmenting the healthcare delivery system of the country to take thebenefits of modern medical care to the citizens at grassroots level. ISRO hasmore about 400 Telemedicine nodes of its own network while there are severalother networks in operation in the country. Literature survey on globalpractices suggests the Application of Telemedicine in Acute-Onset DisasterSituations, and the use of Telepresence in trauma and emergency care managementetc. In tune with the new vision of emergency management in India’sfocus on change from a government-centred approach to decentralized andª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-105

POSTER PRESENTATIONS ABSTRACTScommunity participation approach, there lies a scope for integrating theTelemedicine networks into the National Disaster Management and EmergencyManagement plans. The paper will discuss the approaches of India inEmergency Management, the status of activities as well the achievements inthe field of Telemedicine and the prospects for India. The roadmap ahead forderiving the maximum benefit of synergy and synchronization will be usefulas guidelines for other nations in meeting the needs of the society through theadvanced technologies.Objectives1. Understand the Role of space technologies in Emergency Management2. Understand the progress of India in Space Technology3. Estimate the steps involved in applying technology for the benefit ofmankindemployed tool in neurocritical care. Because PTV and ICH represent significantevents in a high proportion of patients after wartime TBI, close dailyTCD monitoring is recommended for the management of such patients.AcknowledgmentsThe opinions and views expressed herein belong solely to those of the authors.This paper supported in part, by the US Army Medical Research and MaterialCommand’s Telemedicine and Advanced Technology Research Center (FortDetrick, MD, USA).Objectives1. Understand clinical value of transcranial Doppler for patients afterwartime TBI2. Will be familiar with major TCD findings in patient with TBI3. Understand role of TCD for management of patients with TBI282 ROLE OF TRANSCRANIAL DOPPLER ULTRASOUND IN EVALUATIONOF PATIENTS AFTER WARTIME TRAUMATIC BRAIN INJURYPRESENTER & CONTRIBUTING AUTHORS:Alexander Razumovsky, PhD, Director 1 ,Francis L. McVeigh, OD, FAAO, MS 2 .1 Sentient NeuroCare, Hunt Valley, MD, USA, 2 Senior Clinical Consultant-Telehealth and Vision Telemedicine and Advanced Technology Research CenterUSA Medical Research and Materiel Command, Frederick, MD, USA.Critical care management of patients with traumatic brain injury (TBI) hasundergone tremendous advances. Military neurosurgeons and neurointensivistshave a large armamentarium of invasive monitoring devicesavailable to detect secondary brain injury and guide therapy. The primarygoal is to prevent secondary insults to the brain, primarily cerebral ischemiadue to the posttraumatic vasospasm (PTV), and intracranial hypertension(ICH). This paper summarizes the advantages and the specific roles oftranscranial Doppler (TCD) ultrasound to establish and monitor the presenceof PTV and ICH after wartime TBI for patients admitted to Walter ReedNational Military Medical Center. TBI is associated with the severest casualtiesfrom Operation Iraqi Freedom and Operation Enduring Freedom. FromOct. 1, 2008 the US Army Medical Department initiated a transcranialDoppler (TCD) ultrasound service for TBI; included patients were retrospectivelyevaluated for TCD-determined incidence of PTV and ICH afterwartime TBI. Patients were identified using a computerized registry and aprospective TCD database maintained on secured web-site in the SentientNeuroCare Services. Ninety patients were investigated with daily TCDstudies and comprehensive TCD protocol and published diagnostic criteriafor PTV and ICH were applied. TCD signs of mild, moderate and severe PTVwere observed in 37%, 22% and 12% of patients, respectively. TCD signs ofICH were recorded in 62.2% and five patients (4.5%) underwent transluminalangioplasty for post-traumatic clinical vasospasm treatment. These findingsdemonstrate that cerebral arterial PTV and ICH are frequent and significantcomplications of combat TBI, therefore daily TCD monitoring is recommendedfor their recognition and subsequent management. Recently,there have been many research results in early judgment of PTV, and TCDstudies are particularly prominent in this area. The prognosis is affectedseverely with regard to quality of life of patients, and earlier determinationof the PTV becomes very important. Review of literature demonstrate thatTCD is valid in predicting the patient’s outcome and correlates significantlywith ICH when it is performed in the first 24 hours after event. TCD is noninvasive,fast, and reliable as an efficient ultrasound technology, especiallyin critically ill patients with PTV in an urgent examination. This means itthat TCD has greater value and helps to improve the management of patientswith TBI. Too often, the first sign is a neurologic deficit, which may be toolate to reverse. However, use of TCD may predict PTV before clinical sequelae.TCD assists in the clinical decision-making regarding further diagnosticevaluation and therapeutic interventions and has become a regularly296 THE DEVELOPMENT OF AN INEXPENSIVE MOBILE-BASEDTELESTROKE NETWORKPRESENTER & CONTRIBUTING AUTHORS:Carolyn Lauckner, BA, Doctoral Student 1 , Syed Hussain, MD 1,2 ,Anmar Razak, MD 1,2 .1 Michigan State University, East Lansing, MI, USA, 2 Sparrow Hospital,Lansing, MI, USA.Telestroke networks are becoming increasingly common and have beenshown to be a valuable tool for delivering stroke care to rural or understaffedmedical facilities. Research has demonstrated that such networks canimprove care for stroke patients and facilitate more productive interactionamong hospitals. However, a consistent challenge to developing andmaintaining these networks over time is the associated cost. A recent costanalysis of telestroke found that, on average, a telestroke network costsapproximately $28,000 for each year in equipment, fees, and maintenancealone (Nelson et al., 2011). This, combined with additional employee workrequired for training and performing consultations, results in a significantamount of expenditures over time. In an effort to address these high costsand reduce barriers to telestroke, the authors have developed an infrastructurefor an inexpensive mobile-based telestroke network. This networkrelies on mobile videoconferencing software housed on tablets and smartphonesas a means of transmitting images and connecting remote patients tostroke specialists. Each spoke hospital is equipped with an iPad containing asecure videoconferencing app and a dedicated virtual room for connectingto stroke neurologists at the hub site. These neurologists, in turn, performconsultations from either a dedicated iPad at the hospital or using their ownmobile devices. Costs for this network are comparatively low, as initial startupfees for three spoke sites are under $2000 and monthly software fees total$250. Altogether, this approach to telestroke, in addition to being inexpensive,has the benefit of allowing flexibility in videoconferencing interactions,due to the nature of the mobile technologies. In this presentation, wewill discuss the development of this network, highlighting the process ofdeveloping an infrastructure, recruiting hospitals to serve as spokes, purchasingsoftware and equipment, and performing employee training. As thisproject is still in its early stages, the focus will be on the front-end workrequired to get the telestroke network in place, the feasibility of using mobiledevices for telestroke, and some preliminary experiences with the network.Overall, this presentation will aim to provide a candid perspective of theprocess involved in developing this network while also providing the audiencewith valuable information about how to implement this new approachto telestroke.Objectives1. Understand the pros and cons of a mobile-based telestroke network2. Develop a budget for a mobile-based telestroke network3. Develop a basic infrastructure for a mobile-based telestroke networkA-106 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTS298 BATTLEFIELD POINT OF INJURY PHYSIOLOGICAL MONITORINGWITH TELEMEDICINE CAPABILITYPRESENTER & CONTRIBUTING AUTHORS:Carl H. Manemeit, Masters of Arts, Medical R&D Project Manager/COR.Telemedicine and Advance Technology Research Center, Ft Detrick, MD, USA.The United States Army Medical Research & Materiel Command (MRMC)Telemedicine & Advanced Technology Research Center (TATRC) has beenconducting tests, evaluations and demonstrations with the objective to integratemature technologies to provide reliable pre-hospital combat casualty carephysiological monitoring capability with telemedicine and capturing medicaltreatment data on an electronic Tactical Combat Casualty Care (eTCCC) card onthe battlefield at the Point of Injury. TATRC is addressing the military medicalfirst responders need for these capabilities in highly mobile environments andhastily established treatment sites in remote areas. TATRC conducted developmentalwork to transition first responder medic patient encounter record to aeTCCC card that can be transmitted over tactical radios, tactical cell phones and/or the patient encounter is stored on a gumstix microprocessor. The TEMPUS-ICPRO physiological monitoring device was used in the Operational Demonstration;Network Integration Evaluation (NIE) 12.2 exercise, to demonstrate theneed for a physiological monitoring with telemedicine capability at the BattlefieldPoint of Injury. During the CAPSTONE portion of the NIE 12.2 exercisethe Medical Company from 1 st Battalion, 6 th Infantry Regiment evaluated theneed for physiological monitoring on M113 Ambulances. At the Point of Injuryand during enroute, the ambulance crews monitored the serious casualties andmade a telemedicine connection back to the Battalion Aid Station (BAS)Medical Officer. The medical crews transmitted vital signs data, still pictures,voice over Internet protocols, and an electronic TCCC card over SRW/ANW2PRC-117 and SINCGARS tactical radios. I will discuss the results, conclusions,lessons learned and the path forward from this exercise from the medics’ assessmentof this capability on the battlefield. The U.S. Army is not alone inevaluating physiological monitoring with telemedicine capability; the U.S.Marine Corps Warfighting Laboratory completed a similar evaluation duringtheir Limited Objective Experiment 12.2.Objectives1. The need for physiological monitoring at the point of injury on thebattlefield2. The capability to transmit medical data over tactical radios3. Capturing medical treatment data on a electronic TCCC card303 EVOLUTION OF A TELEMEDICINE APPLICATION IN THE NATION’S3RD LARGEST EMS SYSTEM, HOUSTON, TEXASPRESENTER & CONTRIBUTING AUTHORS:David Persse, MD, Physician Director, EMS 1,2 .1 City of Houston, Houston, TX, USA, 2 Baylor College of Medicine, Houston,TX, USA.Objective: Non-emergency 911 calls are being managed utilizing municipalemergency resources, ambulances, and emergency departments. These nonemergencycalls place a burden on the emergency resources resulting in aninefficient use of expensive and limited resources. In 2009, 49% of Houstonemergency center visits were primary care related. Utilization of less expensive,more accurate telemedicine techniques and resources may result in costsavings and quality improvement.Methods: 9-1-1 callers were triaged initially at the 9-1-1 call center andlater by emergency personnel on scene to a telehealth resource for higher leveltriage and alternative resolutions to ambulance transportation and emergencycenter evaluation. A community collaboration coordinated by a not-for-profithealthcare facilitator enabled linking emergency medical services (EMS) withtelehealth evaluation, local community clinics and a not-for-profit transportationprogram.Results: Triage to telehealth nursing resources from the 9-1-1 call centerresulted in 84.4% of calls getting ambulance dispatch. This was consideredunsuccessful. Field personnel referral to telehealth nursing resources resultedin 78.6% of cases utilizing cab transportation to either an emergency center ora clinic. This was considered successful. Financial limitations forced the migrationof telehealth services from being provided by nurses to paramedicswith no appreciable reduction is success rate, but a significant improvement inreturn on investment. Patients reported 96% of patients in this program reportedthey were either Satisfied or Very Satisfied. Utilization of this serviceby field personnel has deteriorated decreased due to poor acceptance by thepublic, and EMS’s personnel perception that perceived prolonged duration oftelehealth intervention is time consuming, and does not satisfactorily result inand perceived high failure rate of program to result in alternative transportation/dispositionof the call. Overall, the program averted in four years a totalcost of $11 million. This saving resulted from avoiding 4,600 ED visits, and5,500 ambulance dispatches.Conclusion: A telemedicine application in an urban fire-based EMS systemcan be successful in terms of averting ambulance transportation of nonemergencycases. Perceptions on the part of both the public and EMS personnellead to poor compliance and missed opportunities for cost avoidancefor the healthcare system. Efforts to more accurately define and understandthese obstacles may lead to solutions allowing for significant savings tohealthcare.Objectives1. Describe an application of telemedicine in an urban emergency medicalservices system.2. Assess the types of problems to be expected when instituting a telemedicineapplication in an urban EMS system3. Measure successes and failures as they relate to an EMS telemedicineapplication, both clinical and financial310 INSTITUTION SPECIFIC PATIENT READINESS TO CONNECT ATHOME WITH A PROVIDER IN A VIDEO APPOINTMENT: A SURVEYPRESENTER & CONTRIBUTING AUTHORS:Matthew Gardner, MDes, MBA, Service Designer/Design Researcher,Daniel O’Neil, MSIE/MBA, Sarah Jenkins, MS.Mayo Clinic, Rochester, MN, USA.We make assumptions about patient willingness to engage with theirmedical providers via telemedicine and often those assumptions aren’tjustified. Age, experience with video conference, access to a family memberwith technological ability, cost of and distance to travel may all factor into apatient’s willingness to accept an invitation to video conference with amedical provider. To validate or disprove current assumptions, we areconducting phone surveys of 500 patients who have received outpatient carein the last year (July 1 2011 through July 31, 2012). Survey responses will besummarized with frequencies and percentages for categorical measures(bulk of the survey), and with means and standard deviations (or mediansand interquartile ranges where appropriate) for continuous measures. Thepercentage of patients willing to accept an invitation to meet with theirprovider via video call will be estimated along with a 95% confidence interval.P-values less than 0.05 will be considered statistically significant. Wehypothesize we will see a correlation between distance traveled and willingnessto accept an invitation to a video appointment with a medicalprovider. We also hypothesize we will see a correlation between patientwillingness and age; patient willingness and previous experience with videoconference; and personal belief about the efficacy of a video appointmentand willingness to accept.Objectives1. Apply findings to help decide how to offer at home telemedicine offeringsª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-107

POSTER PRESENTATIONS ABSTRACTS2. Understand patient decision making about video based telemedicineappointments as a substitute for in person appointments.3. Understand magnitude of concern that patients have with a telemedicineappointment.315 THE ESSENTIAL COMPONENT: INTEGRATING EDUCATION INTOTELEHEALTH NETWORKSPRESENTER & CONTRIBUTING AUTHORS:Ragan A. DuBose-Morris, MA, Director of Learning Services.South Carolina AHEC/Medical University of South Carolina, Charleston, SC,USA.‘‘Build it, and they will come’’, but without a strong educational componentto your telehealth activities, successful adoption can be delayed.Educational programs are important to supporting providers who are implementingnew initiatives and for those with limited access to services thatare traditionally found on the campuses of academic medical centers. For ahalf century, distance learning technologies have developed to supportgovernment, healthcare, educational and private learning initiatives.Clinicians need real-time access to evidence-based guidelines and innovativeresearch findings. Organizations (e.g. hospitals and long-term carefacilities) need timely support to address specific challenges includingmanagement of life-threatening emergencies, readmission rates and hospital-acquiredinfections. Effective ‘‘tele-education’’ serves as the gatewayfor other telemedicine initiatives. As telemedicine efforts gain traction andare integrated throughout various healthcare settings, the need for quality,tailored educational interventions are essential to launching clinical activitiesand supporting healthcare professionals undergoing practicechanges. In order to implement a sustainable telehealth system, educationand training has to occur at all personnel levels and multiple content areas.Administrators, clinicians, educators, and patients need instruction notonly to use the equipment properly, but also to successfully conductsessions and incorporate video etiquette. During the past two years, theeducational offerings provided via a statewide, hospital-based videoconferencingnetwork known as South Carolina Health Occupations OutreachLearning System (SCHOOLS) has effectively spread the adoption of telemedicine.When SCHOOLS sites joined networks, received equipment andput processes in place to take advantage of health provider training, theybecame more open to integrating clinical telehealth activities into theirpractices and facilities. In conjunction with grants and programs taskedwith providing remote stroke assessments, providers and patients havebeen educated about diabetes prevention and treatments, and supportingprimary care practitioners who are responsible for HIV/AIDS patients. Allof these activities are done with support of clinical telemedicine servicesand the resulting partnerships with educational programs and telehealth(clinical, educational and research) initiatives have expanded the networkof participating institutions within SCHOOLS network by 48%. Overwhelminglypositive results (93% affirmative) from healthcare professionalsindicate that they are intending to make changes in their practicesfollowing participation in programs. Learner proposed changes includedconducting better patient assessment, reviewing medication profile prior toprescribing and utilizing nationally developed standards of care. The implementationand processes used to support telehealth initiatives are ableto be replicated and can be used to creatively expand and launch newtelehealth activities. These efforts are incorporated into statewide efforts topositively affect reimbursement and licensure requirements related to telehealth.Ongoing education for legislators, policy makers and organizationalleaders remains essential. Current efforts continue to focus onsupporting new telehealth applications as a result of partnerships developmentthrough education programs. Additional opportunities areemerging to provide direct patient education, clinical research projects inrural settings and health condition specific interventions that will helppractices meet the meaningful use requirements that accompany electronichealth records.Objectives1. Describe the benefits of integrating education into telehealth activities.2. Recognize areas where education can help advance new and existingnetworks.3. List areas in which tele-education can open the door to other telehealthinitiatives.318 DEVELOPMENT OF A PROVIDER INTERFACE FOR BEHAVIORALTAGGING DURING AUTISM SPECTRUM DISORDER SERVICEDELIVERYPRESENTER & CONTRIBUTING AUTHORS:Keith Kline, PhD, Research Scientist II, Courtney Crooks, PhD.Georgia Tech Research Institute, Atlanta, GA, USA.Background: Licensed providers who are trained to provide services forAutism Spectrum Disorder (ASD) are less prevalent in rural than urban areas.As a result, it is thought that ASD may be underdiagnosed in rural children.Telemedicine is increasingly being utilized in the behavioral health domain asan efficient means of furthering the reach of otherwise inaccessible services torural populations. The overall objective of the current project is to develop, inpartnership with the Marcus Autism Center (MAC), a state-of-the-art telemedicinesystem to deliver screening and continuing care services. The purposesof the preliminary trade studies were to develop and evaluate designoptions for a provider interface that will be used to manage and review telemedicinesessions. Two formative design studies were conducted to ensurethat providers will be able to use the interfaces as intended. The first studyexamined design options for remote camera control. The second study examineddesign options for an interface to tag behaviors in live or recordedvideo.Methods: Design options for the camera controls included a 3D mouse and atablet interface. Four clinical staff from MAC used the system under simulatedclinical conditions. After using each interface, they completed usability andworkload scales, and provided design feedback based on their clinical expertise.Automated video-based eye tracking was used to assess direction ofgaze. It was expected that participants would prefer the tablet interface, butthe tablet interface was expected to divert the user’s attention from the livevideo more than the 3D mouse. For the behavioral tagging interface, designoptions included a keyboard and a tablet. Four participants watched recordedtherapy sessions while tagging key therapist and patient behaviors.Results: For camera control, participants reported higher usability scoresand lower workload when using the tablet (M = 56.88, SD = 18.41 andM = 61.41, SD = 14.20) than when using the 3D mouse (M = 43.75, SD =12.67 and M = 73, SD = 14, respectively). As expected, participants’ gazeswere directed toward the video less with the tablet interface than the 3D mouseinterface (M = 53.70%, SD = 44.26%, and M = 62.22%, SD = 35.29%, respectively).For the behavioral tagging interface, response latency was anaverage of 358 milliseconds shorter for the keyboard than the tablet, butresponse accuracy (correct detections) was only 0.5% higher for the keyboard.Subjective workload was lower for the keyboard than the tablet (M = 55.25,SD = 16.14 and M = 67.99, SD = 14.70, respectively), but usability scoreswere not substantially different.Conclusion: The tablet was unanimously favored for camera control, althoughit was thought that the 3D mouse might be better with extendedpractice. The primary problem with the 3D mouse was that participants couldnot remember which buttons performed which functions. However, the tabletinterface may come with a tradeoff - improving usability and workload, butdiverting the provider’s gaze from the caregiver and patient. For behavioralA-108 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTStagging, the keyboard interface might enable slightly faster response timeswith lower workload. Workload is an important consideration for both cameracontrol and behavioral tagging, because providers should be free to focus theirattention on the patient rather than the technology.Objectives1. Be familiar with Human Engineering Development and Testing practicesin the telehealth domain2. Be familiar with unique applied problems in the field of autism telehealth3. Be exposed to how emerging telehealth/telecommunications technologycan improve service delivery for autism spectrum disorder325 NONMYDRIATIC ULTRAWIDE FIELD IMAGES IMPROVE GRADABLERATE AND RETINOPATHY IDENTIFICATION IN TELEHEALTHPROGRAMSPRESENTER & CONTRIBUTING AUTHORS:Paolo S. Silva, MD, Assistant Chief of Telemedicine 1,2 ,Jerry D. Cavallerano, OD, PhD 1,2 , Dorothy Tolls, OD 1 , Komal Thakore, OD 1 ,Bina Patel, MD 1 , Mina Sahizadeh, OD 1 , Jennifer K. Sun, MD 1,2 ,Ann M. Tolson, BS 1 , Lloyd M. Aiello, MD 1,2 , Lloyd P. Aiello, MD, PhD 1,2 .1 Joslin Diabetes Center, Boston, MA, USA, 2 Harvard Medical School, Boston,MA, USA.The American Telemedicine Association has published evidence-basedrecommendations for Ocular Telehealth Programs for Diabetic Retinopathy(DR). Such programs rely on the acquisition of retinal images to determine thepresence and severity level of DR and diabetic macular edema (DME). Retinalimaging devices are key components of any ocular telehealth program and thecurrent gold standard is mydriatic stereoscopic Early Treatment DiabeticRetinopathy (ETDRS) protocol 7-standard 30 0 fundus photography. Recently,ultrawide field (UWF) retinal imaging scanning laser ophthalmoscopes havebeen shown to compare favorably with ETDRS photography. UWF withoutpupillary dilation imaging allows the acquisition of more than double theretinal field captured with ETDRS photography. We reviewed the outcomes ofthe Joslin Vision Network (JVN) program from January 1, 2012 to September9, 2012 deployed at the Joslin Diabetes Center, Boston, MA. Beginning April 1,2012, the JVN has transitioned to using UWF imaging for all patients. Prior toApril 1, patients were imaged using lowlight adapted nonmydriatic digitalfundus photography which acquired stereoscopic pairs of three-45 0 , two-30 0retinal fields. UWF imaging was performed following a previously validatedimage acquisition protocol of stereoscopic pairs of 100 0 and 200 0 retinalimages for each eye. JVN imagers are trained to identify ungradable images atthe time of imaging and images are retaken up to three times if image qualityis poor. All JVN images were evaluated following a standard validated protocolin identical color calibrated LCD high resolution computer monitors bytrained licensed graders under the retina specialist supervision. A total of2,633 patients were imaged with a mean age of 54.5 years ( – 16.4), 56% male,mean diabetes duration of 13 years ( – 10.8); 81% were white and 63% wereusing insulin. 1,027 patients were imaged before and 1,606 were imaged afterUWF implementation. Patient age, gender, diabetes duration, ethnicity andinsulin use were not significantly different before or after implementation ofUWF imaging. The ungradable rate before and after implementation of UWFfor DR was 9.9% and 2.7% (p < 0.0001) and for DME was 7.8% and 3.9%(p < 0.0001) respectively. After the implementation of UWF imaging, numberof patients identified with DR and vision threatening DR increased from 30.9%to 36.9% (p = 0.001) and 10.4% to 14.0% (p = 0.008) respectively. In a subgroupof patients (N = 247, 494 eyes), the distribution of retinal lesions outsidethe ETDRS standard fields were evaluated in a standardized fashion bytrained graders. Peripheral lesions outside ETDRS standard fields were observedin 8.5% (42 eyes). Peripheral retinal degeneration or vitreous changeswere observed in 36 eyes (7.3%) and retinal tears in 2 eyes (0.4%). In thisprogram following a standardized image acquisition and evaluation protocol,the implementation of the UWF imaging reduced the ungradable rate by 73%for DR (9.9% to 2.7%) and 50% for DME (7.8% to 3.9%). An additional 20% ofpatients with DR and 34% of patients with vision threatening DR might beidentified using UWF imaging due to the lower ungradable rate and the abilityto assess peripheral retinal fields.Objectives1. To describe the impact of the ultrawide field retinal imaging on anocular telehealth program for diabetic retinopathy.2. To compare the proportion of patients identified with diabetic retinopathybetween multi-field nonmydriatic fundus photography andultrawide field scanning laser ophthalmoscopic imaging.3. To compare the ungradable rates between multi-field nonmydriaticfundus photography and ultrawide field scanning laser ophthalmoscopicimaging.327 RURAL HOSPITALS PROVIDE ACCESS TO HIGH QUALITY ACUTESTROKE CARE THROUGH TELEMEDICINEPRESENTER & CONTRIBUTING AUTHORS:Martin Tremwel, BA, Student Volunteer 1 , Duane Birky, MD 2 ,Bob Carter, RN 3 , Eric Carter, RN 4 , Debbie Dill, RN 5 , Mellissa Gamer, RN 6 ,Jon Gustafson, MD 2 , Susan McCartt, RN 2 , Stephanie Parsons, RN 2 ,Margaret F. Tremwel, MD PhD FAHA 2 , Carolyn Turrentine, RN 7 .1 Arkansas-Oklahoma Healthcare Consortium, Van Buren, AR, USA, 2 SparksHealth System, Fort Smith, AR, USA, 3 Eastern Oklahoma Medical Center,Poteau, OK, USA, 4 Sequoyah Memorial Hospital, Sallisaw, OK, USA,5 Choctaw Nation Health Services Authority, Talihina, OK, USA, 6 MemorialHospital, Stilwell, OK, USA, 7 Haskell County Community Hospital, Stigler,OK, USA.Introduction: Arkansas and Eastern Oklahoma have the second higheststroke incidence in the United States. Tissue Plasminogen Activator (t-PA),can minimize disability caused by stroke. Administered safely, t-PA must begiven within 4.5 hours of symptom onset by trained professionals and underthe direction of a neurologist. To provide this service in rural areas of westernArkansas and Eastern Oklahoma, a consortium of nine rural hospitals and oneJoint Commission certified Primary Stroke Center developed a telemedicineprogram to treat stroke through delivery of t-PA at the rural hospital. ThePrimary Stroke Center provides telemedicine consultations. Our hypothesis isthat telemedicine services for stroke improves patient access to stroketreatment with the same high level of quality as provided by Joint Commissioncertified Primary Stroke Centers.Methods: Data was collected from individual medical records and transferintake forms between January, 2009 and July, 2012. Patients are divided intotwo groups for this study. 1) Rural telemedicine- linked stroke program(TSP): Fifty-one patients who collectively presented to twelve rural hospitalswithin 4.5 hours of stroke onset and received t-PA through telemedicineconsultation with a neurologist from the Primary Stroke Center. 2) CertifiedStroke Center(CSC): Seventy-five patients who presented to the PrimaryStroke Center within 4.5 hours of stroke onset and received t-PA at the PrimaryStoke Center. Quality and outcome comparisons were made between thepatients treated at the TSP and the CSC. The primary outcome was accessibilityto treatment as measured by time from onset of symptoms to arrival at thetreating hospital and time from arrival at the treating hospital to delivery of t-PA thrombolysis. Patient outcomes comparisons of mean National Institutesof Health Stroke Scale (NIHSS) score, mean Rankin score, and t-PA relatedcomplication rates were made at hospital discharge. Statistical comparisonswere made using a one-tailed t-test.Results: There was no difference in age, gender, or severity of incident strokebetween the TSP and the CSC. The primary outcome measure of time fromsymptom onset to arrival at the treating hospital was shorter for the TSP (1.00ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-109

POSTER PRESENTATIONS ABSTRACTShours – 0.02 SD TSP vs 1.19 hours – 0.01 SD CSC; T-Test 0.007). The timefrom hospital arrival to delivery of t-PA was not statistically different betweenthe two groups (1.15hours – 0.02 SD TSP vs 1.11 hours – 0.09 SD CSC; T-Test0.147). Neurologic recovery following t-PA for patients in the two groupsdemonstrated similar NIHSS improvement of 5.0 – 7.9 SD TSP vs. 6.1 – 12.0SD CSC; T-Test 0.227. Rankin score at the time of hospital discharge was alsosimilar (mean 2.5 – 2.1 SD TSP vs. 2.3 – 2.1 SD CSC; T-Test 0.282). Therewere no t-PA related serious complications.Conclusions: Patients presenting to rural hospitals for acute stroke treatmentarrived earlier than those presenting to the urban Primary Stroke Center. Therewas no difference in the quality of treatment or outcomes between telemedicinehospitals and the Primary Stroke Center. Telemedicine delivery ofstroke care improves access to this life-saving treatment without compromisingquality of care.Objectives1. Describe the effect of telemedicine on access to emergency care fortreatment of acute stroke symptoms2. Compare the quality of services utilized in the delivery of thrombolytictherapy to acute stroke patients in rural hospitals via telemedicineversus quality of same services in a Joint Commission certified strokecenter3. Compare patient outcomes of stroke recovery when initial thrombolytictherapy is received through telemedicine consultation in rural hospitalsversus when initial thrombolytic therapy is given at a Joint Commissioncertified stroke center.332 TELERETINAL SURVEILLANCE AND TELEHEALTH IN PRIMARYCAREPRESENTER & CONTRIBUTING AUTHORS:Sven E. Bursell, PhD, Dir, Telehealth Programs 1 , Joseph Humphry, MD 1 ,Alicia Jenkins, MD 2 , Laima Brazionis, PhD 3 , Mark B. Horton, MD OD 4 .1 University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA,2 Melbourne University, Melbourne, Australia, 3 University of Melbourne,Melbourne, Australia, 4 Phoenix Indian Medical Center, Phoenix, AZ, USA.Over the past 15 years we have developed and utilized a robust teleretinalsurveillance program as part of our Comprehensive Disease ManagementProgram (CDMP), a Health Information Technology (HIT) solutionfor increasing access for patients with diabetes into appropriate eye andrelated diabetes care. The system provides an affordable open sourcesoftware platform for chronic disease management, a platform for wirelessenabled home monitoring devices, and the use of smart phones or smartpads in the rapidly expanding mobile health (mHealth) arena. The datademonstrate that teleretinal surveillance leads to improved adherence tosubsequent eye care, regular clinical appointments and improvements inmajor vascular risk factors for control of glycemia and lipid levels. Thesedata indicate that the act of taking ocular images and then having thepatient review the images of their own eyes with the (purpose-trained)imager improves self-management behaviors. In some settings this can bedone at lower cost and with improved vision outcomes compared tostandard eyecare. Cost-effective and sustainable teleretinal surveillance fordetection of diabetic retinopathy requires a combination of an inexpensiveportable device for taking low light level retinal images without the use ofpharmacological dilation of the pupil, and a computer assisted methodologyfor rapidly detecting and diagnosing diabetic retinopathy A moreholistic telehealth care paradigm augmented with the use of HIT, monitoringdevices, mobile phone and mobile health (mHealth) applications,and software applications to improve and promote healthcare coordination,self-care management and education can significantly impact a broadrange of health outcomes, including prevention of diabetes-associatedvision loss. This approach requires a collaborative, transformational,patient-centred healthcare program that integrates data from medical recordsystems and combines these data with data from remote monitoring toform a richer longitudinal health record. The inclusion of data associatedwith social media applications and personal mHealth technology supportsmore continuous interactions between the patient, healthcare team, and thepatient’s social environment. Taken together, applications such as this candeliver contextually and temporally relevant decision support to patients inorder to facilitate their wellbeing and to reduce risk of diabetes relatedcomplications. This novel approach to telehealth in diabetes care is in theprocess of being implemented in four Aboriginal communities in theNorthern Territory of Australia. The project aims to reduce preventableblindness and adverse chronic disease outcomes among Indigenous Australiansthrough integrated telehealth enabled retinal imaging and multidisciplinarydiabetes and cardiovascular care. The program incorporatesteleretinal surveillance as a module within our diabetes and cardiovasculardisease management open-source, Web-based CDMP telehealth tool. Theapplication will also proactively engage community health workers whowill use a mobile tablet based CDMP application for self-managementcoaching and education in diabetes and cardiovascular disease that can beprovided outside the clinic environment. Also, retinal images acquired herewill undergo retinal vessel analysis to determine vascular geometry parameterssuch as retinal vessel diameters. Prior analyses have demonstratedthat changes in retinal vessel diameters are predictive of increased risk forcardiovascular disease and progression of diabetic retinopathy.Objectives1. Understand the intersection between ocular telehealth and diseasemanagement2. How remote retinal imaging impacts on self management3. the use of mobile platforms for community health workers334 USING TELEMEDICINE TO PREVENT REHOSPITALIZATION IN VERYHIGH RISK PATIENTS WITH ESRDPRESENTER & CONTRIBUTING AUTHORS:Patricia J. Jordan, PhD, Principal Investigator 1,2,3 , Steven J. Berman, MD 4,3 ,Dayna Minatodani, PhD, RN 4,3 , Timothy Halliday, PhD 3 .1 Pacific Health Research and Education Institute, Honolulu, HI, USA, 2 VAPacific Islands Healthcare System, Honolulu, HI, USA, 3 University of Hawaii,Honolulu, HI, USA, 4 St. Francis Healthcare Foundation, Honolulu, HI, USA.The care of patients disabled by chronic disease is costly in terms ofincreased medical expenditures and loss of productivity. In addition, caregivers,who are more likely to report increased levels of stress and healthproblems, feel the burden of caring for chronically ill patients. Telehealthtechnologies have been used to monitor the dialysis procedure at remotelocations but there are no published studies that specifically target high-riskdialysis patients with ESRD with a home-based telemedicine intervention.Although improved health outcomes using remote technologies have beendemonstrated, convincing cost-effective analyses are lacking, and relief ofcaregiver burden is uncertain. This three-year randomized control pilotstudy examined the potential for home-based preventative care to improvehealthcare outcomes by evaluating factors, economies, and innovations thatcould ease the burdens being placed on patients and their families. Findingsarereportedforthosepatients(n= 101) who completed the study; howeverdata describing reasons for attrition will also be reported. Participants wererandomized into one of two groups of dialysis patients: 1) those receivingusual care (UC, n = 57); and 2) those using remote technology (RT, n = 44) toself-monitor their health. There were no statistically significant differencesin baseline measures for the two groups. At baseline, the sample was a mean61.0 years (SD = 11.9), 55% male, 42% Native Hawaiian/Pacific Islander,26% Asian, and 25% Filipino. Mean number of days in the study were 510(UC, SD = 30.4) and 505.3 (RT, SD = 51.6) (p > 0.05). At the study’sA-110 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTSconclusion, significant mean differences were found between the two groupsin number of hospital visits (2.9 UC vs. 1.5 RT, p = .02), number of hospitaldays (22.2 UC vs. 9.5 RT, p = 0.03), and hospital charges ($142,698 UC vs.$55,153 RT, p = 0.016). After the subtraction of capital costs for equipmentand personnel (oversight by one nurse clinician), the RT intervention constituteda cost savings of $58,316 per patient, per year. In addition, satisfactionratings for both patients and caregivers in the RT group were high.One notable finding was that Quality Adjusted Life Years (QALY) did notimprove in the RT group, and did not deteriorate in the UC group, despite thedisparity in clinical outcomes. Although the sample size is too small to drawdefinitive conclusions, this may suggest that the impact of RT on patientswith severe chronic disease can only delay the inevitable deterioration. Thisstudy demonstrated with an economics and patient outcomes analysis thatremote technology with nurse clinician support results in cost efficienciesthat translate into improved patient care. Results suggest that the use ofhome telehealth monitoring equipment with nurse clinician managementresults in fewer hospitalization, fewer days of the hospitalizations and alower expenditure per patient compared to a group of study participantswithout this intervention.Objectives1. Describe the needs of patients with ESRD.2. Describe issues with current standards of care.3. Describe importance of reduced hospitalizations in this population.346 MAXIMIZING PROFITS BY INTEGRATING TELEMEDICINECONSULTATIONS IN PRIVATE PRACTICESPRESENTER & CONTRIBUTING AUTHORS:Raj Devasigamani, MS, MBA, Doctoral Student, John McCracken, PhD,Lakshman S. Tamil, PhD.University of Texas at Dallas, Richardson, TX, USA.Waiting times to get appointments are getting longer than ever whilephysicians are challenged with scheduling appointments to optimize resourceutilization and profitability. Albeit generic scheduling systems enablephysicians‘ offices to overbook appointments to offset no-shows andcancellations, these systems have an inherent limitation that lead to idletimes or overtime costs. We present a novel way to efficiently utilize physicianconsultation hours by incorporating remote consultation of additionalpatients using telemedicine. In the existing approach, mostphysicians’ office implement patient scheduling that is based on very simpleoverbooking models typically used in the hospitality and airline industries.Unfortunately, these models do not bode well in the healthcare industry,since medical resources are not comparable to a room in a hotel or a seat onan airplane. Hence such models cannot be used for optimizing profitabilityin scheduling patient appointments. The goal of our presentation is todemonstrate a viable telemedicine system that can be easily incorporatedinto a physician’s existing practice to increase revenue, reduce operationscost and expand their accessibility to underserved patients. In our proposedapproach, the current utilization in the physician’s office is modeled usingempirical data to determine idle times. The combined idle times from severalparticipating physicians is then used to model the telemedicine patientqueue. The common telemedicine queue is modeled to schedule the optimalnumber of patients just enough to sate the needs of all the participatingphysicians. In this approach, the physician’s office schedule appointments tocapacity without overbooking and then sign up to fill in idle times arisingfrom no-show and cancellations with patients scheduled in real-time fromtelemedicine queues. The average utilization in the physician’s office isestimated based on the survey data collected from primary care physicians.The survey data including average consultation time, average patient arrivalrates and overtime collected from both physicians who are interested inemploying the telemedicine solution and those not interested in the telemedicineprogram. The empirical data collected from the survey is used toestimate the average service time and utilization. The simulation is run tocalculate the average length of queue, the average wait times and theprobability of the number of patients N in the queue. It also yields the arrivalrate which is used to model the patient appointment scheduling system at thetelemedicine center. The rate of patient arrival at the telemedicine center is afunction of the number of participating physicians, S and their idle times.Using the probability of physician idle times and the number of participatingphysicians, the number of patients served at the telemedicine center is calculatedusing the probability of N patients waiting in an M/M/S queuingsystem.Objectives1. Learn how to increase physician’s profit using telemedicine2. Learn how to integrate telemedicine to an existing practice3. Learn how to reduce appointment waiting period by integrating telemedicine350 PARENT READINESS FOR TELEHOME CONSULTATIONS INPERIOPERATIVE PEDIATRIC SURGICAL CAREPRESENTER & CONTRIBUTING AUTHORS:Stacey L. Cole, MBA, Medical Student, Heidi White, MSN,Jaymus Lee, Catherine deVries, MD.University of Utah, Salt Lake City, UT, USA.Introduction: In the last several years high-speed broadband connectionsextending beyond the office or clinic and into the home have made highquality live-interactive video communication with good quality possible. Asdifferent methods of providing medical care are investigated in healthcarereform, medical care to the home such as using video-conferencing is oneoption to consider. Telehome consults for pediatric perioperative surgical carecould have several benefits to families including no travel, no risk of acquiringa transmittable illness at the clinic during the critical follow-up period, andimproved comfort. This study evaluates the interest and readiness of parents ofchildren presenting to Primary Children’s Medical Center (PCMC) for surgicalservices in such a model.Methods: Over a two-month period parents of children presenting in varioussurgical settings at Primary Children’s Medical Center were surveyed abouttheir interest in telehome consults for follow-up after surgery, challenges toin-person appointments at PCMC and their availability and usage of technologyin the home.Results: Participants included 237 individuals from seven different states.Their travel distance to PCMC ranged from 2 to 700 miles with an averageof 65.3 miles (SD = 95.8). Based on a 5-pt Likert-scale 46.9 % of parentswere either extremely or very interested in telehome surgical follow-upconsultations, only 5.5% were not interested. While parents from both ruraland urban areas were interested in telemedicine, parents from rural areasexpressed a higher interest more frequently 67.4% rural vs. 44.6% urban(p < 0.05). Challenges to in-person visits included obtaining child care forother children (59%) and having to leave work (50.9%) to attend themedical appointment. Parents had access to several electronic devices includingsmart phones (62.7%), tablets (37.7 %), computers with Internet(89.2%), and gaming consoles with Internet (42%). Parents also frequentlyused multimedia applications including the following: YouTube (74.5%),Facebook (72.6%), iTunes (62.3%), Skype (40%), and Hulu (19.8%). Thelarge majority of parents had access to the Internet at their home (89.6%)and the majority of parents (54.7%) were found to spend 1–4 hrs dailyusing electronic media.Conclusion: Parents frequently encounter several challenges to in-personsurgical appointments for their children. The majority of parents 93.8%expressed interest in pediatric surgical telehome follow-up consultations,ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-111

POSTER PRESENTATIONS ABSTRACTS46.9 % expressed high interest. Parents appear to have the basic tools fortelehome consults available to them, although further investigation ofspecific technical capabilities would be required prior to implementation oftelehome consultations.Objectives1. To investigate parent readiness for teleconsultations in pediatric surgicalcare2. To assess potential barriers to in-person surgical consultations3. To identify availability and use of home technologyplan, implementation, and evaluation, will be shared. Participants will takeaway knowledge and understanding of the use of mobile apps in pediatriconcology patients, selection of technology, development of training resources,and implementation of evaluation components for the program.Objectives1. Understand the use of PAT2 in identifying children at risk for deterioratingpsychological functioning in children with cancer.2. Identify key steps in evaluating and implementing android tablets andapps for use in pediatric populations.3. Relate the clinical outcomes and patient satisfaction in children withcancer who use android tablets and apps for psychological support.351 THE USE OF ANDROID APPS FOR IMPROVING PSYCHOLOGICALFUNCTIONING IN CHILDREN WITH CANCERPRESENTER & CONTRIBUTING AUTHORS:Nina M. Antoniotti, RN, MBA, PhD, Director of TeleHealth Business.Marshfield Clinic, Marshfield, WI, USA.Over 10,000 children received a diagnosis of cancer each year, impactingpsychological functioning in a myriad of ways, including mood, adjustment,and health behaviors. Well documented is the fact that pediatric cancerpatients undergo many stressors as a result of their disease, treatment, andpotential late effects, and are at risk for developing symptoms of depression,anxiety, and PTSD. This presentation covers the use of mobile computingapplications to assess, evaluate, support, and guide pediatric oncology patients,families, and caregivers, in providing psychological and social supportto deal with and alleviate the stressors associated pediatric cancer.Interventions aimed at increasing psychological functioning also impactadherence, patient satisfaction with medical care, and healthcare costs.Psychological distress, such as depression, can as much as triple the likelihoodof non-adherence to medical treatment recommendations, increasingrisk of future illness. However, the nature a pediatric oncology cohort oftenprecludes the clinicians from being able to provide consistent ongoingpsycho-social interventions. Many patients travel large distances for oncologyservices, and are not able to return on a routine basis for supportiveservices. Cognitive behavioral interventions have been found effective forchildren to use during painful procedures associated with cancer treatment,including breathing exercises. When children are coached, supported, andreminded, to use cognitive behavioral interventions, stress from proceduresand illness is reduced. Gaming technologies have led to improvements inremission, medication adherence, mood, and eating habits in children whohave cancer. The program implemented android tablets and mobile apps toprovide real-time and asynchronous support to pediatric cancer patients,their families, and caregivers, through TeleHealth visits, remote monitoring,mobile applications, and personal computer-based gaming. Mobile appswere initially evaluated based on the apps list generated through a comprehensiveevaluation by clinical psychologists specializing in pediatriconcology, for appropriateness for pediatric patients of ages 3–18. The projectevaluated 25 mobile applications for stress reduction, worrying, anxiety,sleeplessness, and diaries, coloring activities, and relaxation techniques.Fifteen apps were selected for the program. Tracking systems were put inplace. Program tools were developed including a referral sheet, patient homeassessment, and evaluation forms. Additional tablets were deployed to thePediatric Oncology department for use by children in the clinic not participatingin the at-home program. Evaluation results of the program indicatethe use of TeleHealth and mobile apps on android tablets improves localcommunity-based psychological and social support and increases psychologicalfunctioning, improves adherence to treatment regimens, increasespatient control of stressors, and improves patient satisfaction with medicalcare. The presentation reviews the use of PAT2, program development,evaluation, and results. Program evaluation shows that the use of therapeuticapps in children with cancer positively impacts the health and wellness,as well as psychological functioning. All components of the project352 TELESURGERY: REMOTE VIRTUAL PRESENCE IN ORTHOPAEDICEDUCATIONPRESENTER & CONTRIBUTING AUTHORS:Brent Ponce, BA, MD, Associate Professor 1 , Evan Sheppard, BS 2 ,Jonathan K. Jennings, MD, BS 1 , Matthew May, BA 3 , Terry B. Clay, BS 4 ,Joseph Kundukulam, BS 1 .1 University of Alabama, Birmingham, Birmingham, AL, USA, 2 UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA, 3 VIPAAR,Birmingham, AL, USA, 4 University of Alabama, Birmingham School ofMedicine, Birmingham, AL, USA.Purpose: Surgical telementoring is the use of technology to allow an expertsurgeon, at a remote location, to mentor a geographically separated secondsurgeon performing surgery. Breakthroughs in augmented and virtual realityhave created new modalities for interactive training. These technologies havethe potential to provide monitored yet meaningful surgical experience tosurgeons learning new techniques, devices, or procedures. Virtual InteractivePresence (VIP) technology allows a proctoring surgeon to superimpose a handor tool directly into the arthroscopic image. The purpose of this case series is toevaluate surgical telementoring using the VIP technology as a way to transferexpertise.Methods: A total of 15 patients scheduled to undergo arthroscopic shouldersurgery at a Veterans Affair (VA) hospital were enrolled in the study. TwoVirtual Interactive Presence (VIP) stations with an IP-based connection wereutilized, with one positioned in the operating room and the other in the surgicaldictation room outside the operating room suite. The VIP technology issoftware that creates an interface in which a physically remote surgeon canvirtually ‘‘reach into’’ an arthroscopic field, in real-time, allowing the proctoringsurgeon to superimpose a hand or tool directly into the video image. Forthis study, an attending surgeon proctored operating resident surgeons fromthe surgical dictation room. Following each procedure, the attending surgeon,resident surgeons, and operating room staff were administered Likert-scalequestionnaires querying their opinion on the performance of the system.Patient safety was assessed via the VA’s NSQUIP system after a post-operationperiod of 30 days.Results: Attending and resident surgeon’s questionnaires indicated thesystem increased resident autonomy, maintained sufficient oversight andsafety, optimized communication, and increased the attending physician’seffectiveness as a mentor. All surgical staff agreed that use of the technologydid not pose an additional safety threat to the patient or procedure. Rotatorcuff repairs and instability cases performed using the VIP system averagedsimilar operative times compared to those performed prior to its use and nocomplications were experienced.Conclusion: An increasing number of procedures in orthopaedics use arthroscopictechniques which do not offer the same opportunity for traditionalside-by-side training as do open approaches. The development of VIP technologyhas created the potential for surgeons to effectively share their expertiseregardless of geographic location. Our study found that the use of theA-112 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTSVIP technology is effective in allowing the attending surgeon the ability toremotely proctor resident surgeons. Residents were able to complete more ofthe case on their own, potentially enhancing resident training. The attendingsurgeon was able to increase his efficiency and effectiveness as a proctor.These results are promising and further objective quantification will be neededto establish this technology’s place as a powerful skills transfer tool. Thistechnology may be applicable to broader domains involving real-timeknowledge transfer and active skill acquisition without the limitation ofgeographic proximity.Objectives1. Define what virtual presence is.2. Appreciate the utility of virtual presence in surgery3. Establish virtual presence as a safe method in education.378 MHEALTH, AFRICA AND THE DIGITAL DIVIDE: A SOLUTIONOR A PROBLEM?PRESENTER & CONTRIBUTING AUTHORS:Maurice Mars, MBChB, MD, University of KwaZulu-Natal.Nelson R Mandela School of Medicine, Durban, South Africa.The digital divide describes the gap between people with effective access to,and the ability to use digital and information technologies, and those without.It is influenced by poverty, geographic location, education, language, culture,religion and politics. Healthcare delivery in the developing World faces manyproblems such as high burden of disease, extreme shortages of healthcareprofessionals and limited government spending on health. e-Health and inparticular mHealth is seen as a means of improving healthcare delivery in thedeveloping World. The digital divide can be a barrier to eHealth and lead to afurther health divide. There is a perception that the divide is narrowing asmobile phones and computers become more common in the developingWorld. But is this supported by evidence? The aim of this study was to examinethe current status of the digital divide and the uptake of mobile phonesin Africa and the developing World in general.Methods: Data on mobile phone penetration, fixed phone line access, proportionof households with Internet access, Internet use, fixed and mobilebroadband access, ICT costs, population age distribution, and poverty indiceswere obtained from reputable international sources including the WorldHealth Organization, the International Telecommunications Union, the WorldBank and United Nations Population Division.Results: Mobile phone penetration for the developing World is 77.8% butin Africa is 53.1%, and this figure is skewed by four countries where penetrationis over 100%. Life expectancy at birth in Africa is 54 years and themedian age is 19 years. With 42% of people living on less than US$1 per day,purchasing power parity, it is unlikely that many of the children and teenagershave or will have mobile phones. The cost of a bundle of basic ICTservices exceeds 25% of the monthly, per capita, gross national income inhalf of sub-Saharan African countries. Over a ten year period, the gap betweenthe developed and developing World for fixed phone line penetration,Internet penetration, the proportion of households with Internet access,fixed broadband penetration and mobile broadband penetration continuesto increase.Conclusion: While mobile telephony will improve current levels of communication,poverty and the high relative costs of mobile phone use,bandwidth and data use, will maintain and even continue to widen thedigital divide in Africa. The poverty gap is driving the digital divide and maylead to a growing health gap as eHealth and mHealth solutions remain out ofreach of the poor who are most in need of better access to and quality ofhealthcare. Technology is constantly evolving and new technology is usuallyexpensive. Care must be taken to plan and implement mHealth solutionsthat can be used successfully on low cost, simple mobile phones and at low orno cost to the patient if the potential benefits of mHealth are to be realizedin Africa.Objectives1. Understand the factors influencing the digital divide.2. See the need for cheap mHealth solutions using simple phones3. See the role of poverty in driving the digital dive381 EVALUATION OF NORMAL HUMAN INFRA-RED (IR) IMAGES TOIMPROVE THE REMOTE CLINICAL EXAMINATIONPRESENTER & CONTRIBUTING AUTHORS:Howard N. Reynolds, MD, Associate Professor of Medicine, University ofMaryland School of Medicine 1 , Eliza M. Reynolds, BS 2 , Marco Pinter, BS 3 .1 University of Maryland Shock Trauma Center, Baltimore, MD, USA,2 University of Maryland School of Medicine, Baltimore, MD, USA, 3 InTouchHealth, Santa Barbara, CA, USA.Background: Telemedicine examinations lack clinical information gainedvia tactile contact, including palpation of hands, feet, etc for variable temperaturepatterns. Increased regional temperatures could suggest inflammationwhile decreased could suggest altered blood flow, etc. IR imaging, agraphic representation of thermal patterns, is non-invasive, risk free, can bedigitized and transmitted electronically. IR imaging has a long history ofsuccess in veterinarian medicine. Regarding human medicine, there are reportsof screening during pandemics and focused clinical indications. As IRcameras are becoming compact and less expensive, their incorporation intotelemedicine equipment could thereby act as a surrogate for the tactile examination.To understand the value of IR imaging, a database of normalswould help to recognize abnormals. This early report of human IR imaging ismeant to begin the development of a base of normals with subsequent evaluationof symmetric and asymmetric human temperature patterns in diseaseand health.Process: As part of a disparities of healthcare grant, a Flir E-60 Infra-Red camera (FLIR, Wilsonville, OR, USA) was obtained. The camerawas used to image faces, hands, upper and lower extremities of normalvolunteers. Focused temperature analysis was performed with internal‘‘spotmeters’’.Results: IR images were obtained of 88 normal faces. There was wide intraindividualvariation of facial temperatures but strong symmetry from right toleft. Maximum forehead-to-nose differential was 17.8 0 F but with high levelsof right to left symmetry. IR images of legs were obtained in 10 normals. Kneeswere always cooler than either adjacent thigh or calf. Average differencebetween calves and knees was 6.7 0 F left and 7.0 0 F right. However, comparativeright and left body parts had very symmetric heat patterns: the temperaturedifferences between right-to-left knees and right-to-left calves was1.3 0 F for both. Areas of greater muscle mass were always warmer than joints:thighs and calves are warmer than knees.Discussion: Patients are typically described as having a single temperature.In fact, normal humans have a wide array of temperatures. Despite physiciansreferring to ‘‘the temperature’’, clinicians do recognize value of generalpalpation in search of temperature variations. If, with larger study, it isfound that normal humans essentially always have symmetric heat patterns,this would suggest that ASSYMMETRIC heat patterns must be pathologic. Infact, there are clinical reports of compartment syndromes, local trauma,breast carcinomas, and spasmodic vascular disease with very asymmetric IRpatterns.Conclusion: IR imaging provides a complimentary view of patients thatcould replace the lost tactile elements of a telemedicine physical examination.This early study suggests a wide variation of body temperatures but a highdegree of right-to-left symmetry. Pending further proof of concept, IR camerascould greatly supplement the remote examination.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-113

POSTER PRESENTATIONS ABSTRACTSObjectives1. Understand value of human thermal imaging2. Appreciate symmetry of human thermal imaging3. Begin the learning process to understand the potential value of enhancedremote examination with thermal imaging398 COMMUNITY HOSPITAL BASED ICU TELEMEDICINE PROGRAM-CLINICAL CHARACTERISTICS AND PATIENT OUTCOMES 3 YEARCASEPRESENTER & CONTRIBUTING AUTHORS:P. William Ludwig, MD, FCCP, President, Bryan Ludwig, MBA,Jonathan Marcus, MD, FCCP, Michael Marquez, FACHE.NuVIEW Health, Boca Raton, FL, USA.J. Marcus, MD, FCCP, B. Ludwig, MBA, M. Marquez, P.W. Ludwig, MD, FCCPNuVIEW Health and ICC Healthcare Intensivist Group.Introduction: ICU telemedicine is useful in evaluating and treating criticallyill patients during the time period when it is not feasible to have in houseintensivist coverage. This study details the 3 year follow up of a telemedicineprogram at a community hospital with a 12 hour/day intensivist program and12 hour/night telemedicine coverage.Method: The subject hospital has a combined medical and surgical ICU with16 beds staffed with a 12 hour/day intensivist program. The ICU has a policythat requires mandatory consultation and management of all patients by theintensivist. During off hours, coverage is provided by a telemedicine intensivistalso with mandatory evaluation and treatment of all admissions tothe ICU. The telemedicine system utilizes a portable cart that allows visualizationof the patient and also allows connectivity to the EMR and PACSsystem. Patients seen via telemedicine are managed by direct communicationwith nursing and by order entry to the CPOE and documentation into the EMRsystem. Documentation is similar to that of a daytime encounter. Data wascollected for a three year period in order to analyze the spectrum of patientsseen and managed by the telemedicine intensivist, and the outcomes oftreatment.Results: During a three year period from April 2009 to March 2012, 297patient consultations were performed by the Teleintensivist. On a monthlybasis the number of encounters ranged from 3/month to 16/month dependingon patient volume and acuity. The most common diagnoses were related torespiratory compromise with 31% patients with respiratory failure, 10% withrespiratory distress, 7.6% with abnormal ABGs, and 8.7% with pneumonia.The next most common category of patients was 12% with sepsis or septicshock. Patients with renal disease were seen in 6.6% of cases during the studyperiod. Cardiac problems were seen in 12.4% of total patients and includedcardiac arrhythmias 30% of the cardiac cases (3.6% of total), congestive heartfailure in 22% (2.7% of total) and cardiac arrest 27% of cases (3.4% total.) 10%of total cases involved a primary neurologic diagnoses. Mortality rate for allpatients initially seen by telemedicine was 8%, this was not significantlydifferent from the overall ICU mortality rate for all admissions both day andnight during the study period.Conclusions: During a three year period our telemedicine group saw almost300 patients via telemedicine in one community hospital ICU. The spectrum ofpatients seen and managed by the telemedicine intensivist was similar to thoseseen during daytime hours. Outcomes of patients seen by telemedicine are notdifferent from those seen during daytime hours by the in person intensivist.Objectives1. Learn Clinical Outcomes2. Understand care model3. Learn value of TeleICU400 QUALITATIVE AND QUANTITATIVE OUTCOMES OF A WEB-BASEDAND PILL ORGANIZER APPROACH TO IMPROVE MEDICATIONADHERENCEPRESENTER & CONTRIBUTING AUTHORS:Nathaniel M. Rickles, PharmD, PhD, Associate Professor of PharmacyPractice & Administration, Jennifer Wilson, PharmD Candidate,Deena Magdy, PharmD Candidate.Northeastern University, Boston, MA, USA.. Final medication list including nutraceuticalsBackground: The effectiveness of medications requires in large part that patientstake them as prescribed. However, existing research indicates that patientsadhere to their medication regimens less than approximately 50% of the time.When patients do not adhere to their regimens, they are risk for poor outcomesincluding increased hospitalizations, Emergency Department visits, worseningdisease, and poorer quality of life. Such negative outcomes from medicationnon-adherence cost the United States an estimated $290 billion annually. Asmall subset of the population is believed to be contributing to most of the costs.These are often patients who are quite sick, on multiple therapies and at great riskof medication non-adherence. Medication non-adherence is a significant publichealth concern getting the attention of key stakeholders both within and outsideof pharmacy. There are numerous adherence interventions that have been exploredand some with mixed success. There appears to be great need to explorethe use of multi-modal technologies (web and pill reminder) and personalcontact as a way to remind and engage patients in more consistent medicationuse. The PillStation program reminds patients to take their medications, providesaudio personalized wellness and discharge instructions, and displays messagesthat provide support to patients including reminders of upcoming appointmentsand when to exercise. The PillStation has a camera under the pill try that capturesan image after loading to ensure the correct medication is placed in the correctbin. It also gently reminds patients to take their medications on time. An Advisorcalls the patient if he/she is delayed in the following the reminder, if the medicationis missing, or the drugs are incorrectly placed in the bins.Methods: A convenience sample of patients recruited to use a PillStation.Retrospective medication use data will also be collected on each of the patientsto determine baseline adherence prior to the use of PillStation. Surveys haveand will continue to be administered to evaluate patient attitudes/satisfactiontoward the PillStation. Descriptive and bivariate statistics will be utilized todescribe patient responses and report differences between baseline and postPill-Station use.Results: 60 patients have been continually enrolled for 100 days or moreyielding 60,000 patient days of adherence data. Average age is 75 years andcommon illnesses included CHF, transplant, and diabetes. Results show greaterthan 90% adherence since using PillStations. Comparisons to baseline stillpending analysis. Patients report liking the immediate access to an Advisor,and allowing families to access a portal for checking medication adherence.Conclusions: While some results are still pending, it appears a Web-basedand pill reminder adherence management system is an effective way to sustainmedication adherence and maintain patient satisfaction. Future researchshould explore the amount of dollars saved by the combined use of suchtechnologies and personal contact especially among patients who are ill, onmultiple medications, and/or at great risk of medication non-adherence.Objectives1. To identify the impact of a combined web-based and pill organizeradherence management system approach on patient outcomes.2. To describe facilitators and barriers of implementation of a combinedweb-based and pill organizer adherence management system.3. To analyze patient attitudes towards a combined web-based and pillorganizer adherence management system.A-114 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTS409 ONTARIO TELESTROKE PROGRAM - ENSURING ONGOINGAND FUTURE SUCCESSPRESENTER & CONTRIBUTING AUTHORS:Angela Nickoloff, RN, BNSc, MHS, Program Lead Emergency Services 1 ,Linda Kelloway, RN, MN, CNN(c) 2 , Darren Jermyn, BScPT, MBA 3 ,Christina O’Callaghan, BAppSc (PT) 2 .1 Ontario Telemedicine Network, Toronto, ON, Canada, 2 Ontario StrokeNetwork, Toronto, ON, Canada, 3 Northeastern Ontario Stroke Network,Sudbury, ON, Canada.ABSTRACT WITHDRAWN415 SATELLITE-SUPPLEMENTED TELE - MEDICAL OUTREACH CLINICS:OBSTACLES, SOLUTIONS AND NEEDSPRESENTER & CONTRIBUTING AUTHORS:Blake M. Fechtel, N/A, MD/PhD Student 1 , Bart Demaerschalk, MD, MSc 2 .1 The Mayo Clinic, Rochester, MN, USA, 2 The Mayo Clinic, Phoenix, AZ, USA.Volunteers from America annually take part abroad in approximately 6000short-term medical outreach clinics (MOC’s) for an estimated cost of at least$250 million per year. These clinics tend to be significantly understaffed byvolunteer physicians, who find it difficult to take the time and money necessaryto volunteer abroad. This project reports initial observations of technical andlogistical hurdles and solutions developed in the pilot use of Very SmallAperture Terminal (VSAT) satellite Internet and videoconference software toconnect with volunteer physicians in the U.S., in order to examine patients inclinics run by Global Brigades in rural Honduras. Technical obstacles includesecure transport of equipment, optimization of subscription bandwidth andantenna targeting. Each is addressable with reliable alternative methods ofcommunications, short training in equipment set-up, technical support fromthe receiving satellite Internet company, in-country partners to help facilitatetransport and careful packing to protect vulnerable equipment. The interactionsthemselves are prone to confusion, patient anxiety and restrained topics ofconversation, due to exposure to new technologies, delayed audio and videosignals and the need for a translator. Finally, access to in-person doctors isnecessary for secondary consultation, medical translation and facilitation ofadditional physical examination. By demonstrating the technical feasibility,expected hurdles and needs associate with such a project, we aim to encouragefurther exploration into the use of tele-health to facilitate medical volunteeringboth for the treatment of patients and for the exchange of information andskills across the globe, at significantly reduced cost compared to physical travel.Objectives1. To understand some of the technical hurdles to implementing satellite-Internet videoconference patient-interactions in medical outreachclinics2. To understand some of the logistical hurdles and possible solutions toimplementing satellite-Internet videoconference patient interactions inthe setting of medical outreach clinics3. To list and understand necessary factors for supporting satellite-Internet videoconference patient-interactions in medical outreach clinics420 STRENGTHENING CLINICAL CARE THROUGH THE IHVN E-HEALTHPLATFORM IN NASARAWA STATEPRESENTER & CONTRIBUTING AUTHORS:Genevieve N. Eke, MD, MPH, Regional Program Coordinator.Institute of Human Virology Nigeria, Abuja, Nigeria.Eke Genevieve (1) , Mendy Gabou (1) , Joseph Aghatise (2) , Gibril Gomez (2),Patrick Dakum (1)Institute of Human Virology, Nigeria (1); eHealth Nigeria (2).Background: The Nigeria Federal Ministry of Health emphasizes decentralizationof health services to local communities to provide optimal care. Currentpaper based medical record system has limitations in evaluating healthservice delivery due to its lack of systematic data collection, integration andinterpretation. Robust health management information system is crucial forefficient delivery of quality health services. Open Medical Record System(OpenMRS), user-driven open source electronic medical record system platform,was piloted at 27 health facilities, 2 tertiary,11 secondary,13 primary, inNasarawa State by Institute of Human Virology.Methods: Moving from paper based system to electronic platform, assessmentwas conducted for EMR readiness. It captured existing systems (policiesª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-115

POSTER PRESENTATIONS ABSTRACTS& procedures; current data collection and communication; reporting requirements;HR), power supply, network connectivity. Implementation includedHMIS deployment- hardware, software configuration and installation;on site, hands-on user training; legacy data migration.Results: From the results,70% of facilities were ready based on managementsupport and infrastructure readiness. 81% sites had stable power supply gaps;24% had computer access. At 8 months, the 18 sites have enrolled 16,330patients (4891 are males,11439 are women);816 pediatric. Cohort lists automaticallygenerated reduce out of care/loss to follow-up. Clinical and immunologicalmarkers are reviewed on site by clinician with significantimprovement in decision making, patient follow-up and monitoring.Conclusion: OpenMRS was deployed in Nasarawa State.It is possible to implementan eHealth platform to provide and support an evidence-based primaryhealth system in Nigeria. Healthcare and service delivery can beimproved through towards quality of care and greater efficiency throughconnectivity and better information.Objectives1. Interact and learn about Telemedicine globally2. Inform other countries about IHVN ehealth platform and its positiveimpact.3. Promote research, innovation and education.423 EFFECT OF PROVIDER INTERVENTION AND SCORECARDREPORTING ON BP AND GLUCOSE TELEMONITORING:RESEARCH INTO PRACTICEPRESENTER & CONTRIBUTING AUTHORS:Donato Borrillo, MD, JD, MS, Collaborating Physician 1,2 ,Thomas Schwann, MD, MBA 2 , Sonny Ariss, PhD 2 .1 Northeast Surgical Associates of OH, Independence, OH, USA, 2 University ofToledo Medical Center, Toledo, OH, USA.Introduction: Healthcare systems are placing increasing emphasis on themanagement of chronic diseases. Despite the increasing numbers of patientswith multimorbidity (two or more chronic conditions, such as HTN or DM), thedelivery of care is usually built around single diseases. Lowering bloodpressure reduces cardiovascular risk, yet hypertension is often poorly controlledin diabetic patients. In a pilot study we demonstrated that providerintervention with a home blood pressure telemonitoring system, in addition toself-care messages on the smartphone of hypertensive diabetic patients immediatelyafter each reading, improved blood pressure and glucose control.Scorecard issuance frequency was also assessed; and monthly intervals weredeemed to be insufficient.Materials & Methods: The present study tests the system’s effectiveness ina randomized controlled trial of diabetic patients with poorly controlledhypertension. Of forty five (45) subjects, thirty five (35) subjects werescreened for eligibility and randomly allocated to the intervention (n = 16)or control (n = 19) group and the remaining ten subjects (10) were followedwith monthly scorecards. One hundred percent (100%) completed the6-month outcome visit regimen and telemonitoring. Outcomes: In the intention-to-treatanalysis, mean daytime (first and last month average) ambulatorysystolic blood pressure, the primary end point, decreasedsignificantly only in the intervention group by 9.0 – 16.0 mmHg (SD).Furthermore, the overall average patient-day-weighted mean blood glucose(PDWMBG) was below the currently recommended maximum of 180 mg/dLin patients with diabetes and hyperglycemia, with a significant decrease inPDWMBG of 34.1 mg/dL in patients with hyperglycemia. These findingswere confirmed with A1C levels in four (4) of the sixteen (16) subjects, with adecrease of 4.1 – 1.6 %, to a mean of 8.4% – 1.6 (SD). Monthly follow-up ofscorecards, without significant provider intervention, failed to significantlyimprove PDWMBG by only 0.5 mg/dL – 17.7. Lastly, intention to treatdemonstrated a positive odds ratio of 76 (SE 1.16, 95% CI 7.69) and relativerisk of 16 (SE 0.98, 95% CI 2.3).Discussion and Conclusions: Evidence on the care of patients with multimorbidityis limited, despite its prevalence and impact on patients andhealthcare systems. A need exists to clearly identify patients with multimorbidityand to develop cost effective and specifically targeted interventionsthat can improve health outcomes. This limited pilot study demonstrated thathome blood pressure telemonitoring combined with automated self-caresupport reduced the blood pressure of diabetic patients with hypertension.Similarly, PDWMBG improved as confirmed by A1C in a small (4 of 10) sampleof the intervention population. Monthly scorecard and home blood pressuremonitoring alone had no effect on blood pressure; promoting patient self-carewith telemonitoring may have negative effects on patient outcome. Furtherresearch and larger studies of patients with multimorbidity are encouraged.Objectives1. Understand the importance of comorbidity intervention2. Understand the importance of intervention upon biometrics3. Base future research upon pilot study data444 ENHANCING REMOTE EXAMINATION WITH INFRA RED (IR)IMAGING USE OF IR IN THE INTENSIVE CARE UNIT ENVIRONMENTPRESENTER & CONTRIBUTING AUTHORS:Howard N. Reynolds, MD, Associate Professor of Medicine, University ofMaryland School of Medicine 1 , Eliza M. Reynolds, BS 2 , Marco Pinter, BS 3 .1 University of Maryland Shock Trauma Center, Baltimore, MD, USA,2 University of Maryland School of Medicine, Baltimore, MD, USA, 3 InTouchHealth, Santa Barbara, CA, USA.Background: Remote telemedicine examinations may be considered suboptimalbecause the clinician cannot directly touch patients. One element ofthe tactile examination is assessment of local or regional body temperatures.IR imaging is a graphic representation of thermal patterns with a long historyof success in veterinarian medicine. IR cameras create digitized images thatcan be transmitted electronically; as they get smaller and less expensive itwould be easy to add IR imaging to the telemedicine armamentarium. There isincreasing deployment of Tele-ICUs with on-going efforts to determine thebest models and technology. The purpose of this report is to examine barriersand potential values of using IR imaging in the ICU. This NIMHD grant supportedstudy included initial evaluation of the ICU environment, establishmentof normals (reported elsewhere) with future evaluation of humantemperature patterns in disease states.Process: As part of a disparities of healthcare grant, a Flir E-60 Infra-Redcamera, (FLIR, Wilsonville, OR, USA) was obtained. The camera was used toimage standard ICU rooms, hallway environments, and ICU equipment. Focusedtemperature analysis was performed with ‘‘spotmeters’’ incorporatedinto the camera. This report is primarily a graphical report of findings in theICU environment.Results: Observational results include:1. The thermal camera is exquisitely sensitive (hand heat prints after< 1 sec hand contact).2. Patient ICU rooms are ‘‘heat-signal-noisy’’ environments.3. Sliding glass doors in the ICU reflect/block heat signals via the greenhouseeffect.4. Standard ICU curtains and bed linens diffuse the heat signal.5. Patients are poorly visualized with camera oriented parallel to thepatient long- axis, but well seen with camera oriented perpendicularly.6. There is significant heat loss from life support equipment.7. The heat signal from a typical human can be distinguished from that ofthe ‘‘Heat-signal-noisy’’ ICU environment with relatively low resolutionIR cameras.A-116 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTSFigure: Left image; ‘‘Heat-signal-noisy’’ environment. Right images: No heatseen through closed glass doors which act to block the heat image from insidethe room and reflect heat signals of the researchers outside the room.Discussion: If IR imaging is to be used in an ICU, glass doors, obscuringcurtains and linens will need to be opened or removed in advance. For certainapplications, cameras may need to be located overhead of the patient bed.With ‘‘spotmeters’’ very focused examinations can be performed. There may besignificant gain in understanding heat (caloric) losses from support devices.Conclusion: IR imaging provides an entirely different view of environmentsand patients. Utilization will require certain elements of planning. Since thetechnology of IR imaging has become less expensive and images can bedigitized, an IR camera could be incorporated into the remote examinationtechnology. Proof of value will require further investigation.Objectives1. Attendee should be able to understand some of the Barriers to implementationof IR imaging in the ICU2. The Attendee should begin to appreciate the different spectrum of informationprovided by IR imaging in the ICU3. The Attendee should consider some of the preparatory arrangementsnecessary for the implementation of IR imaging in the ICU470 FROM BIG TO GIGANTIC: LESSONS LEARNED FROM A STATEWIDETELEMEDICINE EXPANSIONPRESENTER & CONTRIBUTING AUTHORS:Roy Kitchen, MBA, Business Administrator.University of Arkansas for Medical Sciences, Little Rock, AR, USA.The University of Arkansas for Medical Sciences’ (UAMS) Center for DistanceHealth (CDH) has created, launched and sustained a telehealth networkfor over 19 years. Since the inception of providing clinical consultations toArkansas residents, the network ultimately aimed to expand so that it wouldallow more health-related activities to be available to all healthcare providersand the patients they serve. As network implementers, developers and sustainers,we have never been closer to that goal than we are today! In the lastyear, the Arkansas Telehealth Network, managed by the CDH, has grown froma 60-site network 10 years ago to a network serving close to 1,000 endpointstoday. In the coming months, we will add 600 more licensed endpoints forunified communications. This ten-fold rapid growth has proven to be bothexciting and daunting. This latest network expansion will be complete in2013. With any and all expansions come growing pains, barriers, mistakes andsuccesses. This presentation will provide an overview of the key criticalmanagement areas that the CDH has encountered along the way, including:. Securing funding for sustainability. Increasing personnel. Assessing current and future infrastructure. Purchasing and maintenance of telehealth equipment. Training and education of community members, healthcare providers,patients and those internal to the networkThe expanded network now provides access points to and partnership with. Every acute care hospital, county health clinic, and center on aging. Every four-year university and two-year college. All state human development centers. A majority of the federally qualified community health centers. A majority of mental health clinics and home health agencies. Eight public libraries. Two transport services. Other clinics, centers and educational unitsThis connectivity has begun to and will continue to change the face ofhealthcare in Arkansas. Sustaining the program is our primary goal at thistime. A description of the sustainability plan will be discussed at the conclusionof the presentation.Objectives1. The participant will be able to understand the planning and complexprocesses of expanding services to cover all of the major healthcareinstitutions in a rural state.2. The participant will be able to discuss the importance of both providingand sustaining a network that serves private, not-for-profit andconnectivity-only customers.3. The participant will be able to describe the successes and barriers ofcreating a healthcare network that extends from the hospital, clinic,home, community college and libraries.477 THE WARM HANDOFF - USING TELEMEDICINE FOR TRANSITIONALCARE FROM A UNIVERSITY HOSPITAL TO A SKILLED NURSINGFACILITYPRESENTER & CONTRIBUTING AUTHORS:Jean McCormick, RN, MSN, Telehealth Services Clinical Nurse Educator,Miles Ellenby, MD.Oregon Health & Science University, Portland, OR, USA.Innovation is key to improving patient care while reducing costs and enhancingthe health of patients. Telemedicine is an effective tool for meetingthese three goals particularly when transferring a patient from a hospital to askilled nursing facility. Discharging a patient to a skilled nursing facility is allabout coordination and timing: Interventions. Care plans. Paperwork. Prescriptions.Video technology can be used to enhance the discharge processfrom one facility to another and has been proven to be vital in facilitatingtransition and maintenance in the continuum of care for a patient. The ‘‘warmvideo handoff’’ is a video discharge report between nurses, conducted 15minutes prior to transporting a patient to the receiving facility, using a secureteleconferencing platform. The initial pilot project involved 16 patients thatwere to be discharged to a Skilled Nursing Facility (SNF), the use of a secureteleconferencing platform on either an iPad or a laptop, the collaboration witha preferred Skilled Nursing Facility (SNF) and a university hospital’s caremanagement team of nurses. The nurses giving the report were not only ableto discuss the normal discharge history, status, care plan and goals for thepatient, but also able to visually demonstrate any potential problems (e.g.,wound care, new equipment, etc.) and/or include an educational componentto the process. The entire report process was conducted with the patient’s and/or family’s participation, when possible. The contributions to the new processwere two-fold - learning about the benefits and challenges of new technologyintegrated into a set nursing workflow and application of this technology mayassist in improving patient and provider satisfaction, reductions in length ofhospital stay and 30 day re-admissions, however, further research is needed.Objectives1. To discuss and demonstrate the effects of the new form of handoffupon the providers at both facilities.2. To examine the impact of the video technology surrounding thepatient – alleviation of patient and family anxiety, provide patientempowerment and most importantly, patient satisfaction.3. To demonstrate the cost benefit for both facilities with the emergingchanges in healthcare.478 USABILITY AND FEASIBILITY OF SMARTPHONE TWO-WAY VIDEOTECHNOLOGY FOR TELEHEALTH APPLICATIONSPRESENTER & CONTRIBUTING AUTHORS:David D. Luxton, PhD, Research Psychologist & Program Manager.National Center for Telehealth & Technology, Tacoma, WA, USA.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-117

POSTER PRESENTATIONS ABSTRACTSThe advanced two-way video capability of smartphones has potential forthe entire range of telehealth applications including treatment, consultation,education, coaching, and medication management. The popularity,low cost, convenience, and simplicity of this technology may provide someadvantages over conventional video teleconferencing technologies. Thephysical form, video/audio technology, and network connectivity characteristicsof smartphones, however, are different from conventional videoteleconferencing equipment. Evaluation of the usability and feasibility ofsmarthones for telehealth use is therefore required to inform broader applicationof the technology. The objective of the present study was to testthe basic usability and feasibility of smartphone two-way video capabilitiesfor potential telehealth use in the U.S. military. Seven servicemember volunteer participants communicated with research staff at a largemilitary installation via Apple’s FaceTime app on the iPhone 4 smartphoneplatform with hot-spot Wi-Fi-to-cellular connections. Brief synchronoustelehealth sessions were simulated and structured usability tests wereconducted. The findings generally supported the feasibility of the technologyalthough variance in the quality of wireless network connectivityinfluenced results. Overall study results showed that the technology hasboth limitations as well as potential for telehealth applications that warrantadditional evaluation. Practical considerations, user preferences, and datasecurity considerations are discussed. The information presented should beuseful to clinicians, researchers, and healthcare administrators who areinterested in applying this technology.Objectives1. Become familiar with the advantages and limitations of smartphonetechnologies for telehealth applications.2. Gain an understanding of technical considerations, user preferences,and data security issues associated with the use of smartphones intelehealth applications.3. Become familiar with best practices for applying two-way smartphonevideo technology in clinical practice.482 NURSE PRACTITIONERS: ADVANCING PRACTICE THROUGHTELEMEDICINEPRESENTER & CONTRIBUTING AUTHORS:Margaret Horie, RN, Clinical Coordinator, Telemedicine Program,Karen Fontana Chow, RN, BScN, MN,Cathy Daniels, RN(EC), MS, NP-Paediatrics.The Hospital for Sick Children, Toronto, ON, Canada.The progressive role of Nurse Practitioners and their advancing scope ofpractice has supported the inclusion of nurses in expanded roles, supportingand broadening traditional physician centric models. The College of Nurses ofOntario emphasizes that Nurse Practitioner practice is committed to healthpromotion and illness prevention. They recognize and support that NursePractitioners care for a diverse population ‘‘in a variety of contexts andpractice settings across the health-illness continuum’’ (Retrieved from http://www.cno.org/Global/docs/prac/41038_StrdRnec.pdf on September 13, 2012).The development of Nurse Practitioners to lead in innovative approaches toexpanding nursing care models is supported by the vision statement of theNurse Practitioner Association of Ontario: ‘‘Transforming healthcare for Ontariansthrough Nurse Practitioner innovations’’ (Retrieved from http://npao.org/about/vision-mission on September 13, 2012). New avenues ofhealthcare delivery including telemedicine allow Nurse Practitioners to providecare to a diverse client population. Providing patient care through telemedicineis both enhanced and championed by Nurse Practitioners at SickKidshospital in Toronto, Ontario. The use of videoconferencing to provide clinicalconsults by Nurse Practitioners has increased exponentially over the pastthree years. Many have moved from accompanying physicians to leading theirown telemedicine clinics. Nurse Practitioners at SickKids are innovators inchild health, championing the development of an accessible, comprehensiveand sustainable child health system.Objectives1. To discuss the advantages of an interprofessional, team based telemedicineapproach to patient care.2. To demonstrate how Nurse Practitioner telemedicine clinics lead toimproved efficiencies of care.3. To identify how Nurse Practitioner telemedicine clinics enhance thefamily centred approach to paediatric care.484 AN OVERVIEW OF TELEMEDICINE IN IRANPRESENTER & CONTRIBUTING AUTHORS:Milad S. Makkie, PhD Student.University of Georgia, Athens, GA, USA.Telemedicine as an interdisciplinary technology which use informationtechnology, telecommunication and electronics sciences, has an importantrole in reducing final fees of healthcare and medical care services and increasingthe workgroup discipline and removing distances in all around theworld. In this way, Iran is not exempt from this law and in the last years,obtained many improvements in implementation of the healthcare from longdistance.In this article, we will study these improvements and review telemedicineservices which has been used in different positions from oil-industryto social security and from general hospitals to NGOs in universities. We willhave a significant overview to application of telemedicine in industry especiallyin the petroleum industry health organization and then we will study thesteps taken by the Ministry of Health on this Road. And in conclusion, ingeneral we will review the achievement of Iran in telemedicineObjectives1. Understand the Progress of Iran in Telemedicine2. Notified about Iran‘s activities in telemedicine3. Iearn Iran‘s approaches in Telemedicine503 TELE REHABILITATION FOR RURAL VETERANS WITH MULTIPLESCLEROSISPRESENTER & CONTRIBUTING AUTHORS:Sean C. McCoy, PhD, Veterans Rural Health Resource Center-EasternRegion 1 , Huanguang Jia, PhD 1 , David L. Omura, DPT, MHA, MS 2 ,David Charland, MS, PT 1 , Toni Chiara, MS, PT, PhD 3 ,Paul M. Hoffman, MD 3 , Charles Levy, MD 1 .1 VAMC, Gainesville, FL, USA, 2 William Jennings Bryan Dorn VAMC,Columbia, SC, USA, 3 Veterans Rural Health Resource Center-Eastern Region,Gainesville, FL, USA.Background: Multiple sclerosis (MS) is the most common cause of nontraumaticdisability in young adults. MS can affect both sensory and motorsystems and results in a wide variety of symptoms including numbness,weakness, and fatigue that reduce functional capacity. Participation instructured and monitored physical activity programs found improvements inthe functional capacity of persons with MS. However, access to such programsis limited for MS patients due to their geographic locations and/or mobilityrestraint. Recent research showed that 28,352 Veterans enrolled in the VeteransHealth Administration (VHA) were diagnosed with MS. Furthermore,about 45% of these patients lived in rural or highly rural areas requiringgreater than a 2.5 hour drive time to the closest VHA medical center. Distancetechnology provides the opportunity for rehabilitation specialists to havedirect patient access in the comfort and safety of the participant’s residence.This interventional approach allows for instant correction of technique,monitoring and prescription of appropriate progression, and the opportunityA-118 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTSto suggest alternative exercises based upon spasticity, balance, or mobilitylimitations while reducing travel time and cost associated with face to faceclinic visits.Purpose: To evaluate the efficacy of a televideo healthcare delivery model tomaintain functional capacity in persons with MS while providing a high degreeof patient satisfaction.Methods: This is a retrospective evaluation of the Rural Veterans TelerehabilitationInitiative (RVTRI). All participants of the RVTRI were referredby local VA primary care providers. The Veterans’ participated in the telerehabilitationprogram were assessed by allied health providers using thefollowing outcome measures: Montreal Cognitive Assessment (MOCA),Functional Independence Measure (FIM), Quick DASH, and health-relatedquality of life (VR 12) the Lake City Medical Center, FL. These outcomes werecollected both at baseline/admission and discharge. In addition, patientprovidersatisfaction on the use of the tele-rehabilitation program was alsocollected. Descriptive statistics were obtained for all participants. TheWilCoxon signed rank test was applied to compare each outcome measurebetween baseline and follow-up scores.Results: The RVTRI included 9 participants with MS (8 male/1 female) agedbetween 50–65 years. These participants lived an average 71 miles away fromthe VA Medical Center. On the average, they spent 116 days in the programwith an average of 10 visits by the allied professionals (PT, OT, and RT). Withthe RVTRI program, the travel time saved was an average of 22 hours drivingtime, 1,300 road miles, and $537 of reimbursable travel per patient. The RVTRIprogram showed a significant (p < 0.05) improvement in patients’ FIM andMoca outcomes. Veterans satisfaction surveys reported on several positiveoutcomes in televideo: 1) rated time spent with their specialist using televideoas, ‘‘very satisfied’’ (100%); 2) opportunity to ask questions, ‘‘stronglyagreed’’(100%); 3) overall telehealth experience and understanding yourprovider, ‘‘very satisfied’’ (92%).Conclusions: Rehabilitative therapy administered by televideo is a cost effectivestrategy that results in high levels of patient satisfaction, providesimprovements in some functional outcome measures, and significantly reducespatient travel time.Objectives1. Recognize the applicability of telehealth to rural populations2. Identify target areas to offer comprehensive rehabilitative services3. Evaluate potential functional improvements using telehealth504 IMPLEMENTATION OF TELEHEALTH INNOVATIONS IN PRIMARYCARE TO IMPROVE THE PARADIGM FOR SPECIALTY CAREINTERACTIONPRESENTER & CONTRIBUTING AUTHORS:Khushbu Khatri, BS, Research Assistant 1 , Nicole Jepeal, BA 1 ,Daren Anderson, MD 2 , Jacqueline Olayiwola, MD, MPH, FAAFP 2 .1 Community Health Center, Inc., Weitzman Center for Research andInnovation, Middletown, CT, USA, 2 Community Health Center, Inc.,Middletown, CT, USA.Primary care providers (PCPs) in safety net practices struggle to obtainspecialty care for their patients. The growing paucity of specialists who arewilling to see uninsured and publicly insured patients leads to major imbalancesin supply and demand, and the variance of social dispositionsexacerbates these barriers to care. In addition, PCPs have limited access tospecialists for consultation, and communication between these providers isoften inadequate. Novel approaches are needed to ensure that all patientscan access specialty care and treatment options. Community Health Center,Inc. (CHCI), a state-wide, multi-site Federally Qualified Health Center, implementedtwo independent evidence-based telehealth interventions to addressthese gaps in specialty care access: one focused on cardiology, and theother on hepatitis C (HCV) and HIV care. Of the 1,128 cardiology referralsrequested prior to this study, only 40% were ‘‘completed’’, defined as havingdocumentation of a cardiology appointment. Of the 1,004 patients withactive HCV, only 4% were currently receiving or had received treatment. Toaddress the need for improved cardiology consultation, CHCI adapted theeConsult model to become an EHR-based platform that allows for collaborationbetween PCPs and cardiologists at the University of ConnecticutHealth Center. Data collected during the first two months of the study showthat of the 21 eConsults sent, only two required a subsequent in-personcardiology visit, and one required a consult with a pulmonologist. The remaining18 received appropriate care from the PCP with the guidance providedvia the eConsult. Some chronic conditions, which could potentially bemanaged in primary care require more specialty guidance. HCV and HIV areillnesses that often require input from a multidisciplinary team includingmental health providers, gastroenterologists, and others. Project Extensionfor Community Health Outcomes (Project ECHO TM ) accomplishes this bybringing together specialists and PCPs via videoconference, allowing themto create personalized care plans for HCV and HIV patients. CHCI adapted theProject ECHO model by developing its internal expert capacity, implementingtechnological infrastructure, and capitalizing on its EHR. EightPCPs were recruited to participate in the sessions and after eight months ofoperation, CHCI Project ECHO has conducted 16 HCV and 13 HIV sessions,and PCPs have presented and created care plans for 54 unique HCV and 28HIV patients. Survey responses showed an improvement in participant’sknowledge, skill, learning, and competence in both HCV and HIV treatmentafter 6 months of active participation. New technologies are providing opportunitiesto re-think the way specialists and primary care providers interact.The current system, characterized by disjointed, poorly coordinatedcare delivers high cost and poor outcomes. As the Patient Centered MedicalHome model begins to take root, innovations such as ours, emphasizingtechnology, access, and enhanced coordination, can play a significant role inimproving outcomes. The preliminary success of both of these models hasshown that PCPs can manage many conditions in a patient centered environmentwith support while improving continuity of care. Furthermore, itdoes so in a way that it financially viable, and more convenient for thepatient.Objectives1. Understand the need for new methods of specialty care deliverysystems2. Understand the Project ECHO and eConsults models3. Understand the ways in which the Community Health Center, Inc. hadadapted these models into a FQHC532 INFRASTRUCTURE MANAGEMENT OF E-HEALTH ENVIRONMENTSPRESENTER & CONTRIBUTING AUTHORS:Jeanette R. Little, MS, mCare Technical Director, Mike Bairas, BS.TATRC, Fort Detrick, MD, USA.The US Army Medical Command has experienced a myriad of lessonslearned regarding the implementation of mHealth projects, and is developingan overarching concept of operations for current and future mobile healthenvironments within the Army Medical Department. This includes a classificationof the types and complexities of various mHealth architectures, rangingfrom ad hoc, micro, meso and macro level eHealth environments. The presentationwill define these classifications and give examples of how currentmHealth projects and future efforts will align with this classification system.This will include examples from SMS gateway centric, application centric andmore complex, enterprise level system integration mHealth solutions. CurrentArmy and DoD mHealth solutions including the military version of Text4-Babies, DCoE Mood Tracker and TATRC’s mCare system will all be highlightedin the context of these classifications. Furthermore, these classes of mHealthª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-119

POSTER PRESENTATIONS ABSTRACTSenvironments will be stratified, with their respective capabilities and limitationshighlighted. This will include support for various mobile device types,information exchange mechanisms, response capabilities, escalation triggers,redundancy and security options. Specific lessons learned to date about effectivesystem management by healthcare professionals, system workloadcapacity considerations, security, privacy and auditing solutions will also bepresented. The challenges and innovation demonstrated by mobile devicesusers to obtain access to mHealth solutions will also be showcased withspecific case studies. In addition, external factors including wireless carriercredentialing/approvals, the wide variety of mHealth application distributionmechanisms for both runtime environment and operating systems will bediscussed in the context of coordinated mHealth updates and revisions. SMSgateway policies and provisioning challenges will also be highlighted. Finally,strategies for testing and validating current and future mHealth solutions withenterprise level systems, including EHRs and PHRs in a formalized Armytesting environment will be introduced as a model for further efforts.Objectives1. Discuss the functional capabilities across the 5 classes of AMEDDmHealth environments2. Describe the security capabilities and limitations across the 5 classes ofAMEDD mHealth environments3. Discuss the information exchange capabilities across the 5 classes ofAMEDD mHealth environments574 OCEANS APART: A TELEMEDICINE CONNECTION AWAY.REMOVING THE DISTANCE FROM DISTANCE EDUCATIONPRESENTER & CONTRIBUTING AUTHORS:Agnes Cheng Tsallis, Education Coordinator - Telemedicine 1 ,Shelly K. Weiss, MD, FRCPC 1 , Manish Parakh, MD 2 .1 The Hospital for Sick Children, Toronto, ON, Canada, 2 Umaid Hospital forWomen and Children, Jodhpur, India.On August 7, 2012 The Hospital for Sick Children (SickKids) in Toronto,Canada and the Dr. Sampurnand Medical College in Jodhpur, India connectedvia videoconference to conduct the first Indo - Canadian Tele-ContinuingMedical Education (CME). This session was in support of a post fellowshipproject between the two institutions. The two topics covered were ‘‘Visions forPreparing Physicians to Practice in a Globalized World’’ and ‘‘Interesting CaseDiscussions in Pediatric Neurology’’. Jodhpur is a district in the rural state ofRajasthan. It has become a major education centre for advanced studies inIndia. This abstract will demonstrate how telemedicine is being used as a toolto deliver distance education to a large audience. It will advise that despite alarge distance between two countries, best practices are able to be sharedglobally and that training specialist from one continent to another in thisformat will increase clinician skill set. Dr. Manish Parakh is a pediatric neurologistfrom Jodhpur. He spent one year as a clinical fellow at SickKids withsupport from the HealthyKids International Fellowship project under theguidance of Dr. Shelly Weiss, a pediatric neurologist at SickKids. Drs’ Parakhand Weiss initiated this educational research project to develop enhancedpediatric neuroscience clinical care through international partnership byproviding and evaluating best practice for both on site (short term) and distance(long term) continuing medical education. With Dr. Parakh’s fellowshipending and the continuing need for long term education of specialists inJodhpur; a ‘‘train the trainer’’ program was developed under the CMEframework. The first session was conducted on January 14 and 15, 2012 inJodhpur with faculty from SickKids on site. The second session was to beconducted via distance education. However, there were no appropriate facilitiesor equipment in Jodhpur to support this. Several web based optionsincluding Skype and WebEx were explored but security and image qualitywere of a concern. After meeting with the Telemedicine program at SickKids,the idea of videoconferencing with dedicated endpoints was determined to bethe most appropriate solution. With support from the National InformaticsCentre; Government of India, a dedicated high speed 1GB Internet line wasinstalled at the Dr. Sampurnand Medical College and a Polycom 7000 HDXwas purchased for the college as well. 150 delegates attended the first Tele-CME; faculty including 3 speakers from SickKids and 1 from Dr. SampurnandMedical College. There were also 5 panelists from each institution. Acquiringvideoconferencing equipment has led to opportunities for the Dr. SampurnandMedical College to expand their distance learning agenda. The Tele-CMEs withSickKids will be held on a quarterly basis for 1 year. The sessions will beevaluated and feedback will be used to enhance future sessions. Feedbackfrom the previous session has been positive as one participant stated: ‘‘None ofthe invited doctors would wish to miss such a golden chance to attend a globalneuro discussion’’.Objectives1. Determine how telemedicine is being used as a tool to deliver distanceeducation to a large audience2. Summarize why geography is no longer a reason to be unable to sharebest practices globally3. Agree that training specialists from one continent to another in thisformat can increase clinician skillset595 USING SECURE MOBILE TECHNOLOGY TO SUPPORT SOLDIERREINTEGRATION AND REHABILITATIONPRESENTER & CONTRIBUTING AUTHORS:Holly Pavliscsak, BS, MHSA, mCare Program Manager, James Tong, BS.TATRC, Fort Detrick, MD, USA.The US Army Medical Command provides medical care to a contingentof geographically dispersed wounded warriors through Community BasedWarrior Transition Units (CBWTU). These units are regionally located andprovide remote case management services for those wounded warriors whoare eligible to recover and rehabilitate in their home communities. Fromranges up to several hundred miles, CBWTU care teams coordinate themedical appointments, track recovery progress, support administrativeArmy tasks, and facilitate transition to civilian life. Primary challenges tothis complex environment include long distance communication, supportinga clinically heterogeneous caseload, and coordination with non-DOD providers. Leveraging the ubiquity of cell phones with a commercialoff the shelf secure messaging platform, the US Army has been able to fieldtest a HIPAA-compliant messaging application called mCare on a widerange of smartphones and feature phones. The mCare application has enrichedthe care team’s capability to interact with patients in real-time,during windows between appointments and phone conversations. From themCare web portal, care teams can send announcements, personalizedmessages, health and wellness tips, appointment information, post-deploymentresources, and questionnaires to patients. Patients receive andrespond to this information securely on their cell phones. Their responsesare monitored from the web portal, and can be trended graphically overtime to assess pattern behaviors and assist in triaging caseload. The successof the mCare pilot project demonstrates the feasibility of reaching a geographicallydispersed population using secure mHealth technologies, tocomplement clinical events with relevant and timely information. Furthermore,mCare demonstrates the capability of distributing specializedinformation to patients where and when it would not have otherwise beenavailable. The lessons learned from this program have informed the militarycase management community on how both providers and patients canbenefit from mobile communications, and suggest broader potential forsecure mobile communications.Objectives1. Explore the feasibility of reaching a geographically dispersed populationusing secure mHealth technologies.A-120 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTS2. Discuss of how mobile health technologies can complement clinicalevents with relevant and timely information.3. Expand on how both providers and patients can benefit from mobilecommunications.601 KIDSAFE TELENET - OUR RETURN ON INVESTMENT AFTER 2 YRSPRESENTER & CONTRIBUTING AUTHORS:Candace Shaw, Bachelor of Science, Assistant Vice Provost 1 ,Sherri Snyder, Bachelor of Science 2 , Janet Wilson, PhD, RN 1 ,Cynthia Scheideman-Miller, BS, MS 1 .1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA,2 Children’s Advocacy Centers of Oklahoma, Ardmore, OK, USA.The KidSafe Telenet was developed as a Public/Private partnership in 2006between the University of Oklahoma Health Sciences Center and the Children’sAdvocacy Centers of Oklahoma. This partnership was to address the needsacross Oklahoma 1) To provide more timely exams and investigations forabused children 2) Allow children to be medically examined in their localcommunities 3) Provide local medical forensic examiners with consultation,continuing education from university forensic experts and 4) Develop statewidetelecommunications infrastructure to enhance multidisciplinary childabuse investigations and evaluations. From 2006 through 2009 the KidSafeTelenet used existing technology in the state. In 2009 CACO received FederalFunding to purchase and install technology at each of the 18 CACs acrossOklahoma. In 2010 the technology was installed and became fully operational.In 2011, the CACOs saved $2,341.92 in mileage reimbursement, 104. 28 laborhours at a minimal labor cost savings of $1,042.80. In January thru June 2012,the mileage reimbursement savings has been $15,000 with the labor hourssaved equaling 3,092.8 hrs with a minimal labor cost savings of $30,920. Withan 85% satisfaction rate indicated by participants, ranging from physicians tolaw enforcement, the six peer reviews (1 forensic interview, 3 medical and 1therapy), four trainings (CLEET Physical Abuse and Pediatric Sexual AssaultNurse Examiner) and four organizational meetings in the first six months of2012, have been highly successful. The additional of expert testimony andexpert trainers from across the US to rural and isolated areas is being calculated.Objectives1. Calculate return on investment/cost savings for distance education andtraining2. Understand the Public/Private partnership benefits3. Understand the use of technology in the field of Child Abuse andNeglect621 AN ECONOMIC EVALUATION OF HOME MONITORING IN COPDPATIENTSPRESENTER & CONTRIBUTING AUTHORS:Malcolm Clarke, PhD, Reader 1 , Joanna Fursse, BSc 2 , Russell W. Jones, MD 2 ,Nancy Connolly-Brown, BSc 1 , Shirley Large, PhD 3 .1 Brunel University, Uxbridge, United Kingdom, 2 Chorleywood Health Centre,Chorleywood, United Kingdom, 3 NHS Direct, London, United Kingdom.Introduction: We describe results of an evaluation of the home monitoringservice for COPD patients launched in November 2010 in the UK by NHS Direct.321 patients were enrolled. Of these, 221 remained on monitoring for at least 88consecutive days and were included in our statistical analysis. The patients wererecruited from two separate Primary Care Trusts (PCTs). All patients were underthe care of specialist nurses in the community and who had liaison to hospitaland the general practitioner (GP). Each patient received the Bosch Health Buddyhome monitoring system and was given full instruction on use. Health resourcedata was obtained from the data records of the PCT for hospital admission,emergency room visits and attendance at outpatient clinics. Notional costs wereapplied to each activity. Each PCT provided information on additional costsincurred in establishing and managing the service.Results: There were no statistically relevant changes to emergency roomvisits and attendance at outpatient clinics, with similar changes being seen forCOPD and non COPD causes, and between the equivalent period 12 monthsprior to the monitoring and during monitoring. In PCT 1 47 of 107 patients hadat least 1 hospital in-stay, and 13 were identified as high users. There was a62% reduction in bed days between the equivalent period 12 months prior tothe monitoring and during monitoring, and this amounted to a saving of£140k. In PCT 2 88 of 120 patients had at least 1 hospital in-stay, and 34 wereidentified as high users. There was a 15% increase in bed days between theequivalent period 12 months prior to the monitoring and during monitoring,and this amounted to an increase of £53k. We also compared an equivalentperiod immediately prior to monitoring, and this yielded a 25% reduction inbed days, with reduction in cost of £132k. The total cost of monitoring for PCT1 was £180k and for PCT 2 was £215k. Costs were primarily for equipment.Conclusions: Our data identified hospital admission was by far the largestcomponent of cost and the only component that exhibited significant change;the other categories could almost be ignored for first order analysis of economicbenefit. Although there was a decrease in bed days, the cost of monitoringand other costs far outweighed the savings from hospital resources sothat there were no overall savings. This finding might be due to either inaccurateor incomplete financial data. The data offered was from PAS and itsrepresentation of the overall health costs might be partial. There were assumptionsmade about PCT costs. There were differences in results betweenthe two PCTs, with one having significant reduction in bed days, and the otherhaving a small increase. Further study of clinical protocol and use would berequired to understand this phenomenon. Alternatively, we might utilise theresource cost to infer that future patient monitoring systems will need to costaround £15 per patient per month to result in overall cost savings.Objectives1. Cost effectiveness2. COPD management3. Operationalization635 JOSLIN VISION NETWORK PEDIATRIC DIABETES EYE CAREPROGRAM IN CARACAS, VENEZUELA: FIVE YEAR FOLLOW-UPPRESENTER & CONTRIBUTING AUTHORS:Kristen M. Hock, OD, Optometrist 1 , Paolo S. Silva, MD 1,2 ,Andreina Millan, BS 1 , Morella Mendoza Grossmann, BS 1,3 ,Jerry D. Cavallerano, OD, PhD 1,2 , Jennifer K. Sun, MD, MPH 1,2 ,Lloyd M. Aiello, MD 1,2 .ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-121

POSTER PRESENTATIONS ABSTRACTS1 Joslin Diabetes Center, Boston, MA, USA, 2 Harvard Medical School, Boston,MA, USA, 3 Fundación M.M.G., Caracas, Venezuela, Bolivarian Republic of.The Joslin Vision Network (JVN) Pediatric Diabetes Eye Care Program, anATA category 3 ocular telehealth program for the evaluation and managementof diabetic retinopathy, was initiated at the Pediatric EndocrinologyClinic at the Hospital de Niños in Caracas, Venezuela in November 2006.Stereoscopic nonmydriatic digital retinal images encompassing three 45-degreefields, two 30-degree fields and an external image of each eye wereobtained and evaluated using validated JVN protocol to assess clinical level ofdiabetic retinopathy (DR). Patient demographic data, diabetes and medicalhistory including recent hemoglobin A1c (HbA1c), blood glucose at time ofimaging, and DR and macular edema (DME) severity levels were obtained.Observations of retinal vascular changes in the form of capillary dilation,shunting and drop-out in the mid-periphery of the retina, recorded as smallretinal vessel stress (RVS), were also reviewed. Follow-up and treatmentrecommendations based on evidence-based care guidelines were provided.Between November 2006 to January 2012, 432 patients £18 years were imagedwith 947 patient encounters. At initial imaging, the cohort was 55.2%female, mean age 11 – 3.7 years, mean DM duration 3.0 – 3.5 years, mean ageat DM diagnosis 8.0 – 3.9 years, and 90% type 1 DM. Mean HbA1c was9.6 – 2.6% with 71% of measurements (N = 207) > 8.0%. RVS was present in114 (26.4%) patients at the initial visit. Nonproliferative DR was present ineither eye of 23 (5.4%) of patients. Referable nondiabetic eye findingsincluded presumed ocular toxoplasmosis, glaucoma suspect, rubella retinopathy,iris atrophy, hyperpigmented caruncle lesions and pterygium.Technical and clinical infrastructure limitations at program inceptionincluded: no Internet access in the participating hospital; the Venezuelannational telecommunications infrastructure limited Internet connectionspeeds to 75–97kbps with study transmission time of 15–20 minutes; andInternet service experienced substantial interruptions. Additional considerationsincluded significant patient travel distances and time for clinicappointments (up to several hours), limited resources for diabetes lab tests(including HbA1c testing reagents), and limited number of ophthalmologiststo care for the pediatric diabetes patients. Current and future developments tosustain and expand the program include: enhancing patient and provideraccess to culturally and linguistically appropriate education; developing anew imaging device that is affordable, portable, self-administered and capableof capturing high quality images through ‡ 2.5 mm pupil; developing computerassisted lesion detection and grading with auto-reporting capabilities;and establishing a Venezuelan reading center. In summary, RVS and DR werepresent in this pediatric patient cohort, reinforcing the benefit of eye care inthis population. Our goal is to develop cost efficient, high quality eye careprograms that provide access to care for all patients with diabetes acrossgeographic, socioeconomic and cultural boundaries. The education programsaim to increase patient awareness of diabetic ocular complications, to preservevision and to prevent other complications of diabetes mellitus.Objectives1. To describe the design and implementation of pediatric diabetes oculartelehealth program in an inner city hospital in Caracas, Venezuela2. To characterize the population cared for with the Joslin Vision NetworkPediatric Diabetes Eye Care Program in Caracas, Venezuela3. To describe the lessons learned from the development of the pediatricdiabetes eye care program and define the next steps in the enhancementand expansion of the program646 WHY TELEMEDICINE IS NOT JUST AN ACCESS TO CARE ISSUE INRURAL COMMUNITIESPRESENTER & CONTRIBUTING AUTHORS:Debbie Voyles, BS, MBA, Director of Telemedicine, Laura Lappe, BS.TTUHSC, Lubbock, TX, USA.El Paso, Texas, is a remote border city of 750,000 + residents located in farWest Texas. Access to care is a constant issue not only as far as actualavailability but also by decreasing rates of reimbursement by Medicaid inrecent years. Burn patients from this area must either be cared for locally ortransported via air ambulance to the only Level I Burn Unit between Dallas andPhoenix. Located in Lubbock, Texas, the journey is 343 miles one way for burnvictims from El Paso, Eastern New Mexico, and at times the Ciudad Juarez,Mexico, area. In addition, until October 2002 burn patients and their familiesalso had to travel back to Lubbock for follow-up care, sometimes for a 30-minute visit after the 6-hour drive to get there. Imagine riding in a car,through the desert, with open wounds, great pain, itching, and possibly posttraumaticstress for a total of 12 hours. The car’s driver is probably missingwork, if children are involved they are probably missing school, the family ishaving to buy food, fuel, find a place to stay, and the trip overall can bestressful and exhausting. Another specialty greatly impacted by telemedicineis pediatric dermatology. For the past several years, dermatologists in El Pasohave declined to accept Medicaid patients. Instead, Texas Medicaid carrierswere either flying a parent and child to Lubbock to be seen or providingfunding so the family could drive to Lubbock. That meant two plane tickets, ahotel room for at least one night, taxi or car rental and food reimbursement.Eventually, the plane trip was made even more tedious when SouthwestAirlines stopped all direct flights between El Paso and Lubbock, adding aconnecting flight through Albuquerque. Since the implementation of telemedicineclinics at TTUHSC El Paso Department of Pediatrics, Medicaid carriershave not had to pay out travel costs at an estimated $500 to $1200 foreach visit to Lubbock. And many of these cases were lower-complexity rashes,nevi (birthmarks), acne, and alopecia. Since telemedicine reimbursement hastraditionally been limited to patients in rural communities, TTUHSC Telemedicinehas worked with TTUHSC Department of Dermatology, Lubbock,TTUHSC El Paso Department of Pediatrics, and El Paso Medicaid carriers toensure reimbursement for both the Lubbock provider as well as the Pediatricnurse presenter’s time for these services. TTUHSC will present an analysis ofthe cost savings through the use of telemedicine for both the burn and dermatologypatients as well as provide indications of the benefit to El Paso areapatients.Objectives1. Learn about the cost savings for patients and Medicaid through the useof telemedicine2. Learn how remote an urban community can be and how telemedicinecan be used to increase access to care3. Learn how providing care "closest to home" can have a mental andemotional impact on patient care664 THE REACTION PROJECT - TOTAL MANAGEMENT OF A WHOLEPOPULATION OF DIABETES PATIENTS IN PRIMARY CAREPRESENTER & CONTRIBUTING AUTHORS:Malcolm Clarke, PhD, Reader 1 , Joanna Fursse, BSc 1 , Russell W. Jones, MD 2 .1 Brunel University, Uxbridge, United Kingdom, 2 Chorleywood Health Centre,Chorleywood, United Kingdom.Introduction: We describe the Reaction project, which is established in theUK to develop and evaluate new methods to manage the whole population ofdiabetes patients using a primary care model and exploiting an innovativemonitoring platform. The objective is to understand the needs of primarycare to undertake effective management of diabetes patients at all stages ofthe disease, and to manage effectively their comorbidities and complications,with the intent of reducing risk of developing further complications ofthe disease. The can be accomplished by effective control of blood glucosethough short term management (spot measurements) and long term control(HbA1C). However the issues within primary care are usually to manage theissues that arise from managing many health issues at the same time, and theA-122 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTSmany psychological issues that arise in patients managing their chronicdisease. Our approach was to instigate a monitoring protocol to complementthe existing routine 6 monthly check up for all diabetes patients in the UK,with a home monitoring protocol aimed at obtained physiological and environmentaldata pertinent to all the needs of the individual patient in advanceof the check to have the data for use with the patient. The needs formonitoring were varied and many, from juvenile type I to very elderly withmany co-morbidities, complications and other health issues. We identified arequirement for up to 20 types of sensors that might be required in such asituation. End goal was to establish control of glucose and all other physiologicalparameters.Results: We could not identify any commercial system capable of providingall the sensors we have identified, and so a system has been developed withinthe project for this purpose. To date 7 separate types of devices are availablefor use with any patient. All the devices are based on standards and Continuacompliant and therefore operate through a single platform. It is also designedto be simple to use and can be installed by the patient, thereby reducing systemcost and allowing us to cycle equipment between patients on a very short termbasis. The platform also includes a patient portal where patient own data maybe viewed, educational information presented and questionnaire type datacollected. Feedback by users has been good. Our project is intended to run forat least 3 cycles of 6 month checks, and so we are only able to present preliminaryfindings on clinical outcome and impact on healthcare delivery inprimary care at this stage.Conclusions: We have embarked on developing a new healthcare deliverymodel for primary care to manage chronic disease. We have identified thatcurrent monitoring systems lack the range of sensors that are required andhave developed a platform to support the work. Initial findings are encouraging,and data collection is ongoing.Objectives1. Innovation2. New models of healthcare delivery3. Diabetestranstheoretical model framework (TTM), and provided interventions atbaseline, one and three-months. More importantly, both studies were successfulin recruiting veterans who were not ready to engage in treatment,were not ready to change negative health behaviors, and who had not previouslysought treatment. ‘‘Cell Phone-Based Expert Systems for SmokingCessation’’ was a randomized control pilot that compared the CTI alone (Tx)with the CTI and tailored text messages (Tx-plus). A total of 235 veteranscompleted the one- and three-month timepoints. At three months, 32.8% ofveterans in the Tx group had quit smoking and 43.2% of those in the Tx-plusgroup had quit smoking; far exceeding the 20–24% quit rates often seen inthis area. Participants also demonstrated multiple behavior change, despiteintervention on only one behavior. ‘‘STR2IVE’’ was a feasibility trialdesigned to examine multiple behavior change in veterans screened formild-moderate PTSD and depressive symptoms. The CTI adapted for thispopulation included intervention programs for smoking cessation, stressmanagement, and depression prevention. Fifty-seven veterans completedbaseline, one- and three-month timepoints. Behavioral outcomes at threemonths indicated that 27.5% of those who smoked cigarettes at baseline hadquit; 72.4% were practicing effective stress management; and 66.7% usedeffective depression prevention strategies. More importantly with this targetpopulation, however, are the self-reported clinical outcomes. For example,PTSD symptoms, as measured by the PCL-M decreased by 12% (Cohen’sd = .43). CTIs have several advantages over traditional behavioral andmental health programs, including immediate delivery of tailored feedback,interactive feedback, cost-effectiveness, and privacy. Web-based CTIs alsooffer anonymity, reduce fear of stigma, and it has been shown that individualswith health risk behavior problems tend to report more sensitiveinformation to computers than to human clinicians. Utilization of CTIs inpopulations that are hard to reach or resistant to treatment can reducebarriers to care and improve mental and behavioral health outcomes.Objectives1. To describe barriers associated with seeking mental healthcare in veterans.2. To describe advantages of computerized, tailored interventions.3. To describe the advantages of the transtheoretical model.670 COMPUTERIZED, TAILORED INTERVENTIONS IMPROVE OUTCOMESAND REDUCE BARRIERS TO CAREPRESENTER & CONTRIBUTING AUTHORS:Patricia Jordan, PhD, Principal Investigator 1,2 , Kerry E. Evers, PhD 3 ,James L. Spira, PhD 4,2 , Laurel King, PhD 1,2 , Viil Lid, MA 1 .1 Pacific Health Research and Education Institute, Honolulu, HI, USA, 2 VAPacific Islands Healthcare System, Honolulu, HI, USA, 3 Pro-Change BehaviorSystems, Inc., Kingston, RI, USA, 4 National Center for PTSD, Pacific IslandsDivision, Honolulu, HI, USA.In military/veteran populations, there are unique factors that contribute toresistance to seeking treatment for mental and behavioral healthcare.Among military personnel who report experiencing mental health problems,only 38–45% indicate an interest in receiving help, and only 23–40% actuallyseek it. In addition to low rates of treatment engagement, prematuretermination among those who do engage in treatment exceeds 50%. Concernabout stigma is greatest among those most in need of mental health services;however, research also suggests that ambivalence to treatment may resultfrom perceptions that unhealthy behaviors or coping strategies are functionalapproaches to dealing with problems. The majority of those at risk arenot ready to change, resulting in low recruitment and retention rates fortraditional programs. Research suggests that programs that can offer support,anonymity, and multidisciplinary approaches to treatment _ such ascomputerized, tailored interventions (CTIs) are more likely to reach veteransin need of help. Two recent studies examined the effectiveness of evidencebasedCTIs to help address barriers to care for veterans who were not ready toquit smoking and veterans with PTSD. Both studies utilized CTIs based on a699 SLOVENIA’S NATIONAL TELEMEDICINE PROGRAM: TELEMEDICINEAS A BASIS FOR THE HEALTHCARE REFORMPRESENTER & CONTRIBUTING AUTHORS:Mateja de Leonni Stanonik, MA, MD, PhD, Fellow in EndovascularNeurology.MUSC Department of Neurosciences, Charleston, SC, USA.E-health (information and communication technology that facilitates healthand healthcare) is expanding in developed, developing, and least-developedcountries. E-health’s ability to transcend sociopolitical boundaries holds thepotential to create a borderless world for health systems and healthcaredelivery. But the policy needed to guide e-health as well as telehealth developmentis limited and just now emerging in developed countries. What’sneeded to foster e-health growth in the developing world is thoughtfulpolicy to facilitate patient mobility and data exchange, across both internationalborders and regional boundaries within countries. Strategies for thedeveloping world include discovering how science and innovation can influencedevelopment, helping local researchers conduct economic analysesof environmental problems, and practices where telemedicine can be seen asa paradigm shift in international relations. An example of usable, ubiquitous,wearable, real-time, multi-channel solutions for health managementand monitoring have been developed in Slovenia with the intended use inSlovenia and Italy. Such an example may prove to be the answer to thegrowing challenges posed by the impact of chronic diseases and old agerelated disabilities in the US. The focus is moving from technology inno-ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-123

POSTER PRESENTATIONS ABSTRACTSvation to process innovation: the quality of outcomes has to be linked witheconomic sustainability and easy scalability of Telehealth and Telecareprojects. The e-health center as stepping stone for large scale service solutionswill be presented: from emergency response services, 24/7 medicalsupport to home rehabilitation, chronic disease management and assistedliving solutions for the elderly, a single point of access solution is answeringto the needs of a large number of patients with different needs. InteroperableICT platforms, biomedical and environmental sensor technologies and callcenters infrastructures and operators allow tailored responses based on theconditions of single patients.Objectives1. Identify the country of Slovenia2. identify type of healthcare system3. recognize need for healthcare reformlocal provider and patient satisfaction. We are now expanding our telehealthofferings into the ambulatory and in-place monitoring arenas. Additionally,we are piloting its use in care transitions, from hospital to skilled nurseryfacilities for example. Telemedicine is instrumental in creating access to highquality care and decreasing the cost of that care. With the realities ofhealthcare reform and shortages of specialists particularly in rural locations,telemedicine can improve our reach. Developing a telemedicine network,while challenging, has been well worth the effort.Objectives1. Understand how to increase access to care through telemedicine.2. Discuss the challenges and opportunities in the development of astatewide network.3. Identify future uses for telehealth, including outpatient and in-placemonitoring.708 FROM PILOT TO PROGRAM: GROWTH OF A STATEWIDETELEMEDICINE NETWORK - THE OREGON EXPERIENCEPRESENTER & CONTRIBUTING AUTHORS:Miles S. Ellenby, MD, MS, Associate Professor, Pediatric Critical CareMedicine, Medical Director, Telemedicine Program.Oregon Health & Science University, Portland, OR, USA.Background: Oregon, like many regions of the country, has a concentrationof specialists at the large medical centers in its metropolitan center (Portland)and a large rural geographic area as a referral base. This geography greatlyreduces access to care and as a result, thousands of patients per year aretransported from their community hospital to our academic medical center foremergent specialty intervention. In an effort to support a higher level of careand to decrease what are often unnecessary, expensive, and potentiallydangerous transports, Oregon Health & Science University (OHSU), the state’sonly academic medical center, created a telemedicine program to provideacute care consults across the state.Objectives: We will describe how telemedicine is transforming the deliveryof care in our state. Through the development of our telemedicine network, wehave successfully increased access to acute care consultation, improved thequality of those consultations, and safely decreased the number of patientswho require transport.Findings: In 2007, we developed a telemedicine program as a pilot with acommunity hospital in Eugene, Oregon, located 120 miles away from OHSU.The goal was to provide 24/7 pediatric intensive care consultations via videotechnology as a means to support their developing hospitalist program.Utilizing telemedicine carts in their emergency department and inpatientunit over five years, we were able to reduce transfers by 24%. Building on thesuccess of the pilot, OHSU expanded its acute care telemedicine offerings to10 sites around the state and have expanded service line offerings to includeneurologists for stroke care and neonatologists for newborn resuscitations.Since the network’s inception, OHSU physicians have performed 339 acutecare consults for patients around the state. 33% of all patients avoidedtransport, resulting in an estimated cost savings of $1.1 million. Avoidedtransports were greatest in the adult stroke population (43%), followed bypediatric critical care (22%), then in neonatology (9%). For those transported,significant changes in care were facilitated by the telemedicine interactions.Families continue to report great comfort from seeing thereceiving physicians and nurses prior to transport. We have met with anumber of challenges in growing our program, including reimbursement,credentialing, infrastructure development, equipment and technical costs,and provider adoption.Conclusions: Our program has allowed us to increase access by removing thetime and distance barriers to care. We have decreased unnecessary and costlytransports, keeping healthcare dollars in the local community, and increasing719 AN OUTCOME STUDY OF THE CLINICAL IMPACT OF A FULL STROKEMANAGEMENT PLAN WITHIN A HUB AND SPOKE NETWORKPRESENTER & CONTRIBUTING AUTHORS:Rachelle Longo, RN, Telestroke Program Coordinator, Elizabeth Cothren,APRN, Aaron Bridges, MPH.Ochsner Medical Center New Orleans, Jefferson, LA, USA.Background: Telestroke programs have been initiated in almost every statein the continental United States, but with varying stroke treatment andreferral relationships. Implementation of Telestroke programs at hospitalswithout on-site stroke specialists has been proven to increase the ability ofthese hospitals to have alteplase utilization rates on par with tertiary facilities.Yet, stroke remains the number one cause of adult disability. Keycomponents of successful stroke treatment include rapid identification, earlyintervention, and proper inpatient management. This study measures thedirect and indirect impact of a comprehensive Telestroke management planwith ongoing process improvement assessments on the overall impact ofstroke management across the continuum that looks beyond a single point inthe patient’s episode of care.Methods: We compared pre-implementation data with data collected oneach of the 14 sites in the Acute Stroke System for Emergent Regional Telestroke(ASSERT) network to review the impact of the interventions of thestroke management team. The comparison included number of acute strokeconsults, time from arrival to stroke team call, time from arrival to alteplaseadministration, alteplase utilization rates, number of transfers, and number ofadvanced stroke interventions.Results:- Increased in number of acute stroke consults through the Telestrokesystem- Decreased time from arrival to stroke team call- Decreased time from arrival to alteplase administration- Increased alteplase utilization rates- Decreased transfer of mild strokes- Increased number of advanced stroke interventionsConclusion: For maximum impact on stroke treatment and disability, acomprehensive approach to the relationship of a Telestroke program should beutilized. This relationship will improve healthcare utilization, adherence toevidence based practice and improve quality of life for patients served at eachpartnering facility.Objectives1. State the impact of a Telestroke network on evaluation by Strokespecialist.2. Describe 3 elements of a comprehensive telestroke management plan.3. State impact of telestroke network on door to needle times.A-124 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTS722 NEW PROGRESS ON A CLIENT-SERVER BASED TELEAUDIOLOGYSYSTEMPRESENTER & CONTRIBUTING AUTHORS:Daoyuan Yao, PhD, Gregg Givens, PhD, Professor and Chair,Jianchu Yao, PhD.East Carolina University, Greenville, NC, USA.While telemedicine systems that support remote pure-tone audiogram testhave been reported by several groups, speech test, another important hearingmodality, has not been fully investigated due to its level of complexity. Althoughefforts using remote-desktop or video-conferences tools have beentried by industry and academic researchers, speech tests do not usually gosmoothly, because (1) they involve more advanced audio/video data exchanges(in addtion to pure data transmission involved in audiogram tests)between the remote and local sites; and (2) current technology does not havethe capacity to support necessary coordination required to proceed testingsessions. This presentation reports East Carolina University TeleaudiologyTeam’s recent progress on developing and testing new technologies to resolvethese issues. Hardware and software developed will be introduced. Testingresults will be shown to demostrate the effectiveness of the system.Objectives1. Describe benefits of teleaudiology2. Identify difficulties in teleaudiology3. Be aware of recent progress in teleaudiologyof remote patient monitoring for improving glycemic control relative to routinecare alone in high-risk adolescents with suboptimal T1D control in an unblinded,randomized controlled trial. We will further determine the degree towhich remote monitoring and coordination, when added to routine care,changes adherence to the diabetes regimen, as well as self-efficacy in diabetesmanagement, relative to routine care alone. Our work is expected to result in aneconomically viable and clinically deployable approach to the management ofhigh-risk adolescents with T1D. In addition, the developed remote monitoringand coordination system offers a framework for T1D management that is highlyamenable to future content enhancements. Delivery of behavioral health interventionsthat have shown promise in other research will become more feasibleto deploy with our system, which can aid in the identification of high-riskpatients who should receive more intensive intervention, as well as in the deliveryof the interventions themselves. Our long-term goal is to perform riskpredictions and risk stratification in order to tailor treatment protocols andimprove diabetes self-management in at risk adolescents with T1D and reducetheir risks for diabetes-related complications.Objectives1. Describe the barriers to adherence and to good glycemic control amongadolescents with type 1 diabetes2. Describe a remote monitoring system that integrates home bloodglucose data (automatically pushed from glucometers); as well as informationfrom patient surveys and the electronic health record3. Describe how a remote monitoring system can deliver population-levelhealthcare through the use of risk prediction models and risk stratification727 REMOTE MONITORING AND SELF-CARE MANAGEMENT OF TYPE 1DIABETES PATIENTSPRESENTER & CONTRIBUTING AUTHORS:Mark A. Clements, MD, PhD, CPI, FAAP, Assistant Professor, Pediatrics 1 ,Abhi Ray, MBA, MS, MHA 2 .1 Children’s Mercy Hospitals & Clinics, Kansas City, MO, USA, 2 Heart To HeartNetwork Inc., Kansas City, MO, USA.Type 1 diabetes (T1D) is the second most common chronic illness of childhood,with 150,000 youth affected in the United States, and approximately15,000 children newly diagnosed each year. Unfortunately, many teens withT1D do not adhere to a standard diabetes treatment regimen, and do not achievetargets for good blood sugar control. Alternate approaches utilizing caremanagement and technology have demonstrated limited success. Remotemonitoring of T1D patients offers a unique, cost-effective approach to achievinggood blood sugar control. The technology we developed is a comprehensive andanticipatory monitoring, reporting and alerting system that helps a care coordinatorproactively manage the patient. The system integrates real-time patientdata (automatically pushed from glucometers), data on psychosocial health,adherence and activities of daily living (ADL) from structured patient surveys,medical history, laboratory test results and current problems and medicationsfrom electronic health records, and creates a personal health profile of thepatient. The system analyzes data, risk-stratifies patients, and reports clinicallyuseful, actionable information back to the healthcare team, enabling them tointervene and modify treatment plans as indicated. Patients and their familymembers, and care providers are alerted based on certain parameters establishedby individual providers. The objective of the study is to fully evaluate the impactof a technology and team-driven patient-centered medical home on glycemiccontrol in teens with poorly controlled T1D. We are focusing on the efficacy ofintegration of remote patient monitoring in the patient’s daily diabetes careresults on improving glycemic control by improving the processes of adherenceand self-management. We believe incorporation of our system and protocol intothe daily care of high-risk teens with T1D will lead to sustained improvements inglycemic control, self-efficacy, and adherence among adolescents with poorlycontrolled T1D when compared to routine clinical care in a pediatric diabetesclinic at a tertiary care referral center. We will specifically determine the efficacy731 VALIDATION OF A CANCER SCREENING MESSAGING SYSTEMDESIGNED TO INCORPORATE INDIVIDUALIZED GENOMIC DATAPRESENTER & CONTRIBUTING AUTHORS:Michael J. Yuan, PhD, CEO.Ringful Health, Austin, TX, USA.Adherence with prostate cancer screening (such as PSA tests, and physicianfollow-ups), is less than perfect. In large part, this is because members of atriskpopulations need to keep track of which tests are required and at whattime. As screening guidelines and timetables become more personalized (e.g.different recommendations for follow-up intervals depending on past historyof PSA levels), such problems are likely to be exacerbated. Yet, there is a greatdeal of evidence that early screening and detection are key to better prognoses,lower mortality rates, and lower health-care expenditures. In this NIH fundedclinical study (R43TR000364), we recruited patients from a large rural healthsystem (CHRSITUS St Michael’s) in an area with high cancer occurrence rates.The patients are randomized into control and intervention groups. All of themhave access to a new web application designed to help them analyze risk andcreate individualized prostate cancer screening scheduled. But interventiongroup also receives rich two-way mobile messages on their phones as reminderswith educational content. Participants are asked to report the resultsof tests (for example PSA levels), by replying to the message on their mobilephone or by visiting a portal web site. While we used prostate cancer as a testcase in this study, the application can be widely used in different kind ofcancers and populations. In this presentation, we will present outcome fromthe trial that shows the efficacy of mobile health interventions in promotingcancer screening, as well as the effects of patient education campaigns inpromoting understanding of new cancer screening guidelines.Objectives1. Understand key challenges in cancer screening, and why genetic-basedand individualized guidelines are needed2. Understand new adherence challenges brought on by individualizedguidelines3. Learn how mHealth solutions can improve dissemination and adherenceof new guidelinesª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-125

POSTER PRESENTATIONS ABSTRACTS737 SCALE OF SERVICES AND PROPOSED SCOPE FOR TELEHEALTH INPAKISTANPRESENTER & CONTRIBUTING AUTHORS:Asif Zafar, MBBS, MCPS, FCPS, FRCS, Surgical Unit II.Rawalpindi Medical College, Rawalpindi, Pakistan.Pakistan’s population today stands over 173 million; a fourfold increase inlast 50 years. With scarce resources and geo-political and environmentalchallenges a comprehensive healthcare to all the population is not likely tobe achieved in near future with existing resources. Innovative new strategyof utilizing information communication technology to reach out to far flungareas offers one solution. The experience of telehealth initiatives by Governmentand private sector in last decade is invaluable. The health sectorneeds to take advantage of this and use ICT to achieve its goals and objective.Pakistan has the need, available technology and experience to scale up theuse of Telehealth to reach out to the remote populations deprived of qualityhealthcare. In the mountainous and security challenged Khyber Pakhtunkhwaand Baluchistan province, telehealth offers the opportunity toprovide quality health services to areas where either due to difficult terrainor security reasons or both, it is not possible to establish comprehensivehealthcare services. This paper reviews past and ongoing telehealth initiativesin Pakistan, analysis of challenges and barriers, and propose a strategyto scale up the existing services to the National level and clear plan to utilizeICT in disaster situations.Objectives1. Scope of Telehealth in Pakistan2. Need assessment3. National Plan to Implement741 TELERHEUMATOLOGY: THE ARIZONA TELEMEDICINE PROGRAMEXPERIENCEPRESENTER & CONTRIBUTING AUTHORS:Ana Maria Lopez, MD, MPH, FACP, Medical Director, ArizonaTelemedicine Program 1 , Nouralhoda Dehdashti, BA 1 , Jeffrey Lisse, MD 1 ,Phyllis Webster, BS 2 , Angela Valencia, MPH 3 .1 University of Arizona College of Medicine, Tucson, AZ, USA, 2 ArizonaTelemedicine Program, Tucson, AZ, USA, 3 University of Arizona CancerCenter, Tucson, AZ, USA.Background: The Arizona Telemedicine Program (ATP) is a statewide telecommunicationsnetwork that increases access to specialty care includingrheumatology. Telerheumatology is provided to inmates in the Department ofCorrections and to rural populations.Methods: A retrospective review of telerheumatology consultations fromJanuary 2011 to April 2012 is presented. Demographic and clinic visit data,e.g. chief complaint, diagnostic question and teleconsultation outcome weredeidentified, coded and analyzed with Stata Statistical Software. Cost savingestimates for inmate care were calculated based on historical transportationcosts ($320. per medical consultation).Results: 115 telerheumatology visits were reviewed: 59% new and 41%follow-up; 93% were for inmates; 89% male and 11% were female; mean age47 years old. All patients were seen within 1 month of appointment request.Nearly 66% self-defined race/ethnicity: 51% white, non-Latino, 36% Latino,9% African American and 4% as Native American. Less than a third definedmarital status: 68% single, 14% married. Past medical history was notable for:75% chronic pain, 45% hepatitis, 42% gastrointestinal disease, and hypertension.Just over half of all visits (51%) carried the chief complaint of arthralgias,stiffness, pain or swelling; 9% presented with a cutaneousmanifestation of rheumatologic disease; 4% were notable for ‘‘muscle locking’’or weakness, and 34% were follow-up visits without a new chief complaint.Referrals came from: primary care physicians (44%), mid-levelproviders–physician assistants or nurse practitioners, and specialists andsubspecialists (16%). Most common diagnoses were: rheumatoid arthritis(27%), osteoarthritis and gout (24%) each. Fully 51% of visits recommendedadditional diagnostic studies and a change in treatment; 18% recommendedadditional diagnostic studies, and 16% resulted in a treatment change.Transportation savings in the inmate population were estimated to be$34,224.Conclusion: Access to rheumatological care is largely limited to Arizona’surban centers. Access to telerheumatology is accomplished in a timely manner,impacts health outcomes with treatment adjustments in nearly threefourthsof all consultations and improves cost efficiencies with decreasedtransportation costs.Objectives1. Assess the impact of a telerheumatology2. Describe the predominate rheumatologic in this population3. Outline the outcome of telerheumatology and prevention746 EVALUATION OF MOBILE TABLET DEVICES FOR ON-CALLCOVERAGE IN A COMPREHENSIVE ADULT CARE FACILITYPRESENTER & CONTRIBUTING AUTHORS:Sarah E. Velasquez, MS, MAB, Senior Coordinator 1 ,Eve-Lynn Nelson, PhD 1 , Joseph G. Schlageck, MD 2 , Mariah Jones, CNA 3 .1 University of Kansas Medical Center, Kansas City, KS, USA, 2 MeadowlarkHills, Manhattan, KS, USA, 3 Kansas State University, Manhattan,KS, USA.Emergency situations at comprehensive adult care nursing home facilitiesare normally limited to phone conversations between the on-callphysician and the nursing staff. The project, piloted at a rural comprehensiveadult care facility in Kansas in partnership with the University ofKansas Medical Center, aimed to facilitate an innovative approach to improvingon-call assessment and care by implementing mobile tablettechnology and real time videoconferencing in place of telephone communication.The vision was that the mobility of the tablets and the visualimage of the real-time videoconferencing would enhance the on-callcourse of action, assessment, and resident care by increasing understandingof the situation by the provider to allow him to make more informeddecisions about care. Additionally, the team hypothesized that reducedEmergency Department visits and appropriate use of resources would decreasethe cost of care for residents. The processes used to develop, implement,and track the enhancement of care will be discussed. Initially, theteam worked with the on-call provider to determine his perception of thefeasibility and acceptance of the mobile tablets for on-call use. Next, iPadmobile tablets were selected for their functionality and array of applicationsand peripheral equipment, and a digital stethoscope was purchased toenhance the ability of the provider to accurately assess the situation. Thereal-time videoconferencing PolyCom application for the iPad was chosenas the communication method. After the equipment was chosen, a protocolwas developed to assist with data collection during the assessments. Theteam then worked with nursing staff and the on-call provider to train themon the iPads, stethoscope, and PolyCom real-time videoconferencing applicationto ensure smooth operation during the assessments and clearunderstanding of roles in the emergency situation. Both a nurse and CNAwere trained to assist with the assessment, with the nurse determiningwhen the on-call provider should be contacted and collecting assessmentdata, and the CNA operating the mobile tablet and stethoscope. The on-callprovider was trained on how to answer incoming emergency calls andgiven practice in directing the CNA for assessments. Lastly, the number ofEmergency Department visits and diagnoses of disorders baselines wereobtained through chart reviews. Presenters will discuss the results ofA-126 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTSbaseline chart reviews in comparison to the pilot data, as well as efficiencyand feasibility of mobile tablet technology implementation. Outcome goalsof this initiative included a decrease in Emergency Department visits, anincrease in specific diagnoses by the on-call provider, and an increase offollow-up care preparedness. Presenters will describe the impact of themobile tablet and real-time videoconferencing usage on these goals andwill discuss possible future directions for on-call mobile tablet use.Objectives1. To explain the core components involved in providing on-call serviceswith mobile tablet and real-time videoconferencing based technology.2. Present an enhanced and effective on-call program in comprehensiveadult care facilities based on key goals and processes.3. Present challenges and limitations associated with the use of a mobiletablet device in on-call emergency situations.763 AN ELECTRONIC PROCESS MANAGEMENT CHECKLIST TO IMPROVETHE EFFICIENCY AND SAFETY OF SURGERYPRESENTER & CONTRIBUTING AUTHORS:Matthew J. Hadfield, BS, Clinical Research Coordinator,Homero Rivas, MD, MBA, Eric Leroux, MD, MBA candidate,Drew Hart, MBA.Healthcheck Systems Inc., Brighton, MA, USA.Surgical Checklists are known to decrease complications and improvepatient outcomes. Although their implementation is increasingly widespreadin the United States, there is little consistency between or evenwithin hospitals about how this life-saving safety measure is performed.Utilization of the electronic medical record (EMR) has not provided a solutionto this challenge because the Surgical Checklist remains largelyidiosyncratic and paper-based. Through a customizable but standardizeddigital and mobile process-management solution, optimal peri-operativepatient care can be delivered with greater reliability. The HealthCheckSystem Checklist (HCS) was designed by surgeons and health IT entrepreneursto track and help manage pre-operative patient care, intra-operativesafety measures, and customized post-operative patient support.EMR integration, voice recording, and a user-friendly dashboard withprocess reminders and alerts ensure reliable execution of pre-operative bestpractice. Mobile-compatibility of these features increases pre-operativeefficiency by permitting coordinated task allocation and tracking. Postoperativepatient satisfaction may increase as a result of receiving autogeneratedprocedure-specific discharge education. Not accounting for thecost of system implementation and maintenance, the digital perioperativeprocess management system saves USD $91 per surgery through a reductionin post-operative complications. Through using a digital system suchas HCS, each surgeon or facility achieves increased resolution about thecause of deviations from standard protocol so that site-specific processimprovements can be more quickly identified and implemented. For thehealth system at large, digitizing the checklist and integrating it with theEMR will not only make it easier to follow best practice guidelines, but willalso permit a clearer relationship between perioperative protocol andhospital readmissions. Digital checklist implementation can improve clinicaloutcomes for patients, increase the simplicity of safety protocolcompliance for healthcare providers, and ensure cost-effectiveness forhospitals or health systems.Objectives1. Realize the potential for e-checklists in reducing surgical errors2. Understand the ability of hospitals to utilize e-checklists to capturelarge amounts of data to improve patient safety3. Have an understanding of how E-checklists offer a more user friendlyand paperless way to perform time-out procedures.765 UTILIZING TELENEUROLOGY TO ADDRESS GENERAL NEUROLOGYCAREPRESENTER & CONTRIBUTING AUTHORS:Nouralhoda Dehdashti, BS, Medical Student,Ana Maria Lopez, MD, MPH, FACP, Bruce Coull, MD,Angela Valencia, MPH, Phyllis Webster, BS.University of Arizona, Tucson, AZ, USA.Background: The Arizona Telemedicine Program is a statewide protectedtelecommunications which virtually brings clinical care to remote and/orunderserved populations. Although most teleneurology approaches focus onacute neurological care needs i.e. stroke management, this retrospective reviewsummarizes our experience with the provision of general, non-acuteteleneurology care.Methods: Clinical data (new/follow-up appointment, referring professional,age, marital status, gender, chief complaint, diagnoses, teleneurology recommendations)were collected, deidentified, coded and analyzed (Stata StatisticalSoftware).Results: Chief complaint: movement disorder (42%), refractory seizure (33%),and refractory headaches (17%). Past medical history: hypertension (58%),endocrine abnormality (50%)– diabetes or thyroid disease, coronary arterydisease (42%), hyperlipidemia (33%), mental illness (17%). All of the referralscame from primary care physicians. Teleneurology recommendations: treatmentchange (66%), maintenance of current treatment (25%), and diagnostictesting and treatment change (8%). Updated demographics will be presented.Conclusions: Teleneurology effectively improves the management ofchronic general neurological problems and results in treatment changes in74% of all consultations.Objectives1. Describe the predominate teleneurology2. Describe the impact of teleneurology3. Describe effective management of teleneurology769 INFECTIOUS DISEASE TELE-CLINICS IN ADULT DETENTIONCENTERSPRESENTER & CONTRIBUTING AUTHORS:Ana Maria Lopez, MD, MPH, FACP, Medical Director, ArizonaTelemedicine Program, Stephen Klotz, MD, Phyllis Webster, BS,Kameron Hanson, BA, Ronald Weinstein, MD.University of Arizona, Tucson, AZ, USA.The prevalence and disease burden of infectious diseases for persons incorrectional facilities is disproportionately high compared to the generalpopulation. Instead of relying on models for infectious disease healthcaredelivery that largely rely on specialist travel to communities in need; a teleinfectiousdisease initiative was launched. We present an update on nearly 400tele-infectious disease consultations of which approximately one quarter werefollow-up consults. The large majority of consultations were for HIV orhepatitis care. Management of coccidiomycosis and ostemyelitis were alsoaddressed. Several patients presented with multiple infectious disease complaints.We estimate a cost savings of approximately $120,000 in transportationcosts alone. The tele-infectious disease initiative facilitated theprovision of infectious disease services, supported continuity of care withavailability that a physical presence could not always provide. In this presentation,the infectious disease tele-consultative service will be describedalong with a summary of the demographics, type of infectious disease questionsaddressed and clinical outcomes.Objectives1. To assess the impact of tele-infectious disease clinics in adult detentioncentersª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-127

POSTER PRESENTATIONS ABSTRACTS2. To describe the predominant infectious disease concerns in this population.3. To outline the outcomes of a tele-infectious disease intervention inadult detention centers785 TRIAL OF A TWO-WAY SMS BEHAVIORAL SUPPORT SYSTEMFOR TYPE 2 DIABETES: LESSONS FROM THE UTAH BEACONCOMMUNITYPRESENTER & CONTRIBUTING AUTHORS:Cheryl Simpkiss, EP, MS, Project Coordinator.HealthInsight, Salt Lake City, UT, USA.The Utah Beacon Community is one of 17 ONC-funded communities buildingand strengthening local health IT infrastructure and testing innovative approachesto make measurable improvements in the delivery of healthcare servicesfor patients with diabetes. The Utah Beacon works with local careproviders to improve the quality and efficiency of care patients receive throughbetter disease management and care coordination, while reducing avoidablehospital stays and emergency department visits for people with diabetes. Recognizingthat much of ‘‘diabetes care’’ occurs outside the clinic walls and underthe direction of the patient, our community effort has piloted several innovativemHealth tools to help patients engage in their own disease management. One ofthese is Care4Life, a two-way SMS/text messaging coaching and educationservice for type 2 diabetes. We have deployed this tool in 16 primary care clinicsparticipating in a three-county geographic focus area surrounding Salt LakeCounty. In this presentation, we will describe strategies for recruiting primarycare clinics for novel mHealth interventions, offer lessons on deployment of atwo-way SMS-protocol for DM management in the unaffiliated independentprimary care clinic setting, and present results on patient experience andclinical outcomes from this randomized control trial of 157 patients.Objectives1. Understand how an SMS behavioral support program for diabetes canbe deployed in the primary care setting2. Learn about results related to a RCT of an SMS tool for behavioralsupport3. Understand why such tools are valuable to patients786 LESSONS LEARNED OF A PARTNERSHIP FOR MONITORING HTAPATIENTS WITH SEVERE DERMATOLOGICAL LESIONSPRESENTER & CONTRIBUTING AUTHORS:Xavier R. Urtubey, MD, CEO, Rodrigo Vasquez Saldia, MSN,Noelia E. Espinoza Aguilera, MSN, Ricardo Quezada Aliste, MD.AccuHealth Virtual Hospital Center, Santiago, Chile.Background: Up to September 2012, 34 HTA patients with very low incomes ofan acute dermatological care facility in Santiago (Chile) were home-monitored(measurement BP and clinical protocoled self-survey 3 times a day) by a Telehealthnurse; feedback and Tele-intervention was restrained by partner to onlyeducational content for patients and entourage, most of them family members.Results: After 2 months, 50% patients couldn’t afford the dermatologicaltreatment. From the 50% remaining in treatment, 75% continued their homemonitoring. All of them lowered their Diastolic BP (average of 5 mmHg reduction)and Systolic BP (average of 7mmHg reduction), narrowing BP rangethe first month followed by a 2-month stabilization. Discussion: HTA drugtreatment and clinical follow up was not part of the dermatological clinic’sresponsibilities and depended of third party institutions that did not participateto the monitoring program; some of them even recommended to theirpatients not to continue the remote-monitoring. Though BP average decreasedin home-monitored patients group seems clinically attractive, these results aresignificantly above all other standards reached by the Virtual Clinical Hospitalin Chile since its creation in 2010. Patterns and Lessons Learned regardinghome-monitoring itself, patient’s feedback and partnership conditions will bepresented and analyzed.Conclusions: Complex Chronic Disease home-monitoring can improveclinical aspects but requires active participation from all players of the patient’shealthcare value-chain community.Objectives1. Understand key requirements for productive Telehealth partnership2. Know international Telehealth monitoring experience3. Share outcomes regarding Hyper Tension Telehealth Nurse HomeMonitoring809 ED COST AVOIDANCE IN PEDIATRIC MEDICAID RECIPIENTSPRESENTER & CONTRIBUTING AUTHORS:Dana Houle, RN, BSN, MHM, CCM, CPHQ, Director, Quality andCompliance.Nurse Response, Saint Louis, MO, USA.It has been widely reported that many uninsured individuals and Medicaidmembers enter the healthcare system by pursuing treatment in the EmergencyDepartment (ED). Utilizing this level of service, despite the actual acuity of theinjury or illness, has resulted in inflated and unnecessary healthcare costs acrossthe nation. In the interest of combating inappropriate use of the ED, NurseResponse, a wholly owned subsidiary of Centene Corporation, is partnering withMedicaid MCOs in an Emergency Department Education (EDE) program tocombat this unnecessary and costly trend. From 7-1-2010 through 6-30-2011,Nurse Response staff performed live, telephonic outreach to the parents or legalguardians of newly eligible Managed Care Organization (MCO) members in orderto educate members and combat inappropriate use of the ED. For the purposes ofanalyzing results, Nurse Response divided this member set into two groups:Unassessed (control group) and Assessed. Assessed members totaled 3,394 individualsand are defined as members who completed an assessment as a result oflive telephonic outreach. Nurse Response correlated assessment completion toactual ED claims data for these two member sets and analyzed the respectiveoutcomes. The percentage of administrative ED visits for those lower acuityclaims was then extrapolated from each group. A total of 36,177 members wereidentified as eligible to receive outreach, with Nurse Response successfullyreaching, assessing, and educating 3,394 of those members. Of the successfullyassessed members, only 85% of their ED visits post-assessment were considered‘‘Administrative’’ in nature, or of an acuity level which could have been served byan alternate level of care. The control group, totaling 32,783 individuals, isdefined as members who did not complete an assessment following multiple livetelephonic outreach attempts. Among the control group, 91% of the total numberof ED visits was considered ‘‘Administrative.’’ The administrative visit to memberratio was 0.34 among unassessed members but only 0.20 among memberssuccessfully assessed by Nurse Response. These ratios further demonstrate thatassessed members were less likely to visit the ED for health needs that could havebeen addressed at a non-emergency level of care. Individuals who underwentassessment had statistically significant lower numbers of administrative claimsper member (p < 0.001), and there was also a statistically significant reduction(p < 0.001) in the number of administrative visits out of total claims. By providingproactive and informative outreach to the parents and legal guardians ofnew Medicaid members ages birth to 10 years old, Nurse Response achievessignificant reduction in inappropriate ED visits. Members complete a comprehensivehealth screening during which Nurse Response provides education to theparents/legal guardians on the appropriate use of urgent care centers in theirarea. Nurse Response further informs the parents/legal guardians on how toaccess the Nurse Advice Line. Nurse Response has decreased wasteful spendingby encouraging members to go to their doctor rather than the ED, when appropriate.This proactive approach assists the members in making educated decisionsrelated to how and where they access care.A-128 TELEMEDICINE and e-HEALTH 2013

POSTER PRESENTATIONS ABSTRACTSObjectives1. Gain ideas as to how to reduce unnecessary healthcare expenditures viaimproved care resource utilization and ED cost avoidance.2. Plan how to enhance the experience of new healthplan members andtheir parents or guardians (including care quality, access and reliability)via education of available healthcare resources.3. Report back to their team with ideas to control or reduce the per capitacost of care and to increase efficiency.840 TELEMEDICINE & TELEHEALTH IN INDIA - PROMISING A RAYOF HOPE TO THE REMOTE AND DISTANT POPULATIONSPRESENTER & CONTRIBUTING AUTHORS:Murthy Remilla, BE, MBA, PhD, Department of Space.Indian Space Research Organisation (ISRO), Bangalore, India.The poster will showcase and present the origin, growth and current state ofTelemedicine and TeleHealth in India. The poster will bring out the differentinitiatives by several players and the networks, technologies and service deliverymodels being followed. it will also display the way-forward for integrationand deriving the synergistic benefit out of these efforts which can be amodel for others to adopt and adapt as per the needs and resources.Objectives1. Understand the role of technologies in healthcare delivery2. Understand the different networks and delivery models in India3. Understand the benefits of TeleHealth for reaching the unreached946 MEASURING THE RETURN ON INVESTMENT OF REMOTE PATIENTMONITORING PROGRAMSPRESENTER & CONTRIBUTING AUTHORS:Misbah Mohammed.3Center for Connected Health, Partners Healthcare, Boston, MA, USA.Objective: Remote patient monitoring (RPM) technologies that collect clinicaldata from individuals for review by a healthcare provider have beendemonstrated to improve patient care and patient outcomes. The objective ofthe return on investment (ROI) tool for remote monitoring programs is toprovide organizations a way to evaluate intrinsic financial benefits of theseprograms with or without reimbursement.Method: The ROI of RPM tool was developed in conjunction with five diversehealthcare organizations and input from other stakeholders. The resultingmodel was applied by each of the five healthcare organizations to test andvalidate the ROI of RPM tool, as well as to evaluate the individual ROIs of eachorganization.Result: The benefits of using RPM to more closely monitor patients withserious chronic health conditions were shown to outweigh the costs of RPM inall five healthcare organizations. In two organizations, the ROI was greaterthan 0 but less than 1, which means that although they may yield a positive netreturn, the amount was smaller than the cost of the program. In the other threeorganizations, the ROI was greater than 1. Return on RPM investment can beattributed to reduced hospitalization rates in four of the five organizations.Returns on RPM investment for the fifth organization, the only home healthagency in the study group, can be attributed to both a reduction in hospitalizationrates and a reduction in the number of home care visits that wererequired per patient. The ROI ranged from 0.2 to 2 in year 1, and 0.8 to 55 inyear 5 in these five organizations. Qualitative analysis of the five organizations’experience with the engagement to compute their ROI showed that thedeveloped tool was able to capture all relevant costs and outcomes for theprograms.Conclusion: Results from this project indicate that the ROI of RPM toolwas able to accurately capture all the inputs and outcomes for the programs,and provide a framework for organizations to examine the value ofthese programs. The tool was not only useful for program managers toevaluate the return from the program in terms of dollars, but also to easilysee where the program could be made more efficient. Going forward, itappears that this analysis will be useful in helping healthcare organizationsimprove care, improve health outcomes, and lower costs, aligning with theTriple Aims of the National Quality Strategy.ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-129

Abstract Author IndexThe American Telemedicine Association EighteenthAnnual International Meeting and ExpositionAAbel, Erica A., P131, S058Ackerman, Michael, S028Adler, Jamie, S056Agha, Zia, S028Aghatise, Joseph, P420Aguilera, Noelia E. Espinoza, P786Aiello, Lloyd M., P325, P635Aiello, Lloyd P., P325Akematsu, Yuji, S001Ali, Qasim, S068Aliste, Ricardo Quezada, P786Alverson, Dale C., S010, S061Anderson, Daren, P503Antoniotti, Nina M., P351, S018, S020, S040Ariss, Sonny, P423Armfield, Nigel R., S065Armstrong, April W., S025, S006Atzmon, Ofer, P235Au, Sylvia, S063BBaba, Oussama El, S063Bairas, Mike, P532Barlow, James, S055Barlow, Jeffrey M., S065Barsotti, Ryan, S028Barthelemy, Joel E., S038Bashshur, Rashid, S001Batshaw, Mark A., S063Bauer, Mark, S058Bechtle, Perry S., S070Beck, Christopher A., S050Behl, Diane, P153, P238, S018Belcher, Nora, S053Belzile, Étienne, S050Benabio, Jeffrey, S025Benton, Tina, S057Berman, Steven J., P334Bhanumurthy, V,, P276Biglan, Kevin M., S050Birky, Duane, P327Bleakley, Kenneth W., S034Blum, John D., S008Boada, Katheryn L., S018Boissy, Patrick, S050Bojanowski, John, S029Borrillo, Donato, P423Boukadi, Yassine, S063Boumzebra, Drissi, S063Bouressa, Paul, S027Boyle, Cathy, S072Brandt, Cynthia, P131Brannon, Janice A., S017Brazionis, Laima, P332Bridges, Aaron, S011Brienza, David, P216Brooks, Elizabeth, S022Brown, Ed, S039Budhrani, Sunil, S032Bull, Michael T., S050Burdick, Anne E., S015Burke, Bryan, S073, S074Burrell, Jill, S027Bursell, Sven E., P332Bush, James F., P96Butler, Tina, S038CCabana, François, S050Cady, Rhonda G., S036Cafazzo, Joseph A., S003Campbell, Michael, P172Capistrant, Gary, S017, S008Carrasco, Carlos, S039Carter, Bob, P327Carter, Eric, P327Cartwright, Martin, S055Cason, Jana, P153, S017Cavallerano, Jerry D., P325, P635Charland, David, P503Chiara, Toni, P503Chiu, Yi-hsing, P249Chmelnitsky, Dana, S039Chmenitsky, Dana, S003Chodor, Ben, S004Chow, Karen Fontana, P482Choy, Garry, S042Clark, Maureen, S027Clarke, Malcolm, P621, P664Clay, Terry B., P352Clements, Mark A., P727Clements, Scott A., P96Cochran, Amalia L., S039Cochran, John, S012Cohen, Michael H., S008Cohn, Ellen R., S017Cole, Stacey L., P350Connolly-Brown, Nancy, P621Connors, Helen, S062Conway, Anne, S063Corriveau, Hélène, S050Cothren, Elizabeth, P719, S011Coull, Bruce, P765Coye, Molly, S011Creel, Liza M., S063Crooks, Courtney L., P270, P315Cryderman, Anne, P150Cullum, C. Munro, S005Cuyler, Robert N., S021DDakum Patrick, P420Damji, Karim, S024Daniels, Cathy, P482Dapul, Heda, S027Darkins, Adam, S003Davis, Theresa, S012, S032, S041Dean, Steven, S012Dechmerowski, Sara, P270Dehdashti, Nouralhoda, P741, P765Deibert, Wendy, S071de Leonni Stanonik, Mateja, P699P indicates Poster abstracts with associated Poster numbers; S indicates Oral abstracts with associated Session numbers.A-130 TELEMEDICINE and e-HEALTH 2013

ABSTRACT AUTHOR INDEXDemaerschalk, Bart, P415Desai, Nirav, S047Devasigamani, Raj, P346deVries, Catherine, P350Dharmar, Madan, S009, S027, S054,S072, S074Dill, Debbie, P327Dimentberg, Ronald, S050Diner, Trina, P150Dixon, Ron, S063Dorsey, E. Ray, S050Drude, Kenneth, S040DuBose-Morris, Ragan A., P315Duckett, Kathy, S060Duong, Tran N., S068EEide, Melody, P186Eke, Genevieve N., P420Elkarimi, Soloua, S063Ellenby, Miles, P477, P708, S027Erickson, Cathy, S036Erickson, Mary M., S036Esparza, Ovet, S051Evans, Brian, S057Evans, Kelley, S030Evans, Sarah, S063Evers, Kerry E., P670FFairman, Andrea D., P198Fanberg, Hank, S053Farrell, Shawn, S072Faulkner, Jeffrey A., P122, S064Fechtel, Blake M., P415Ferguson, Stewart, S001, S061Fernandez, Francisco, S068Fidler, Janel, S028Finkelstein, Stanley M., S036Flori, Heidi, S027Floto, Elizabeth, S028Friese, Randall S., S004Fursse, Joanna, P621, P664Fuska, Mary, S063GGabou, Mendy, P420Gamer, Mellissa, P327Gantenbein, Rex E., S047Gardner, Matthew, P310Garwick, Ann, S036Gavish, Amnon, S029Gehrman, Philip, P270, S058Genevieve Eke, P420George, Ben P., S050Giarrizzi, Dana P., S052Gilbert, Gary R., P245Gilroy, Alexis, S071Givens, Gregg, P722Glass, Penny, S063Godleski, Linda, P131, S058Goldschmidt, Leonard, S024Goldstein, Felissa P., S072Goldyne, Marc E., S035Gomez, Gibril, P420Gomory, Andrew, S004Gorman, Mary Jo, P87Gough, Frances, S023Grana, Matthew, S050Gray, Leonard C., S065Green, Benjamin, S002Gropman, Andrea, S063Grossmann, Morella Mendoza, P635Ground, Jan, S048Guitton, Matthieu J., P117Guo, Hongfei, S036Gustafson, Jon, P327Gutierrez, Mario, S037HHadfield, Matthew J., P763Hale, Kelly, P270Hale, Tom, S056Hall-Barrow, Julie, S074Halliday, Timothy, P334Hambley, Ryan, S025Hanson, Kameron, P769Harnarine, Susan, S060Hart, Drew, P763Hatting, Tammy, P90Havasy, Robert, S061Henderson, Kristi, S056Herendeen, Neil, S009, S074Herrera-Perdigon, Jennifer, S015, S036Hirsch, Phil, S059Hitchcock, Carla, S028Hitt, Wilbur C., S050Hock, Kristen M., P635Hoffman, Paul M., P503Hoistad, Jonathan, S059Holland, Dutch, S021Hopkins, Philip, S063Horie, Margaret, P482Horton, Mark B., P332, S024Houle, Dana, P809Howe, John P., S019, S031Hsieh, Jui-chien, P249Humphry, Joseph, P332Hunt, Megan, S031Hussain, Syed, P296IImus, Terri, S073JJanos, Ellen, S026Jansen, Matthew, S045Jenkins, Alicia, P332Jenkins, Sarah, P310Jennings, Jonathan K., P352Jepeal, Nicole, P503Jia, Huanguang, P503Johnson, Julia, S062Johnston, Barb, S059Jones, David L., P270Jones, Donald, S026Jones, Mariah, P746Jones, Russell W., P621, P664Jordan, Patricia J., P334, P670Jordan, Trish, S046Joseph, Bellal, S004KKanagasingam, Yogesan, S024Kane, Robert L., S005Kappel, Sarah E., S028Keane, Dana, S033Kearns, Sharon Ann, P140Keldie, Carl, S067Khatri, Khushbu, P503Kifle, Mengistu, S031Kilgore, Paul E., S068Killcommons, Peter, S019Kim, Thomas, S046King, Laurel, P670Kitchen, Roy, P470Kline, Keith, P315Klotz, Stephen, P769Knight, Joseph, S063ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-131

ABSTRACT AUTHOR INDEXKodali, Srini, S061Kokesh, John, S001Kolosky, Jerry, S070Kolzowski, Maureen, S071Kosiak, Donald, P90, S028Krupinski, Elizabeth A., S032Kuchkarian, Fernanda, S016Kulvatunyou, Narong, S004Kundukulam, Joseph, P352Kung, Peter, S048LLaBarbera, Jaclin, S027Lachner, Juliette, S066Lai, Albert, P263Lane, Mark, S017Lappe, Laura, P646Large, Shirley, P621Larochelle, Pascale, S050Lauckner, Carolyn, P296Lauerman, Valerie, S036Lee, Ivy Ann, P164Lee, Jaymus, P350Leroux, Eric, P763, S051Leslie, Kieron, P164Levi, Matt, S023Levy, Charles, P503Lewis, Terrence, S026Li, Ai-Hsien, P249Lid, Viil, P670Lim, Louis, S023Lindsay, Jan A., S022Lisse, Jeffrey, P741Little, Jeanette R., P532Liu, Lili, P139Liu, Lin, S028Lo, Hsiu Chiung, P249Loevner, Evan, S075Lomanowska, Anna M., P117Lombardo, Kathryn, S069Longo, Rachelle, P719, S011Loo, Edward, S012Looman, Wendy, S036Lopez, Ana Maria, P741, P765, P769Low, Gordon, S050Lowery, Curtis, S002, S057Lowery, Kyle, S028Ludwig, Bryan, P398Ludwig, P. William, P398Lunos, Scott, S036Luxton, David D., P478Lynch, Michael D., S005, S046MMack, Jamile, S066Magdy, Deena, P400Maheu, Marlene M., S044Makkie, Milad S., P484Malik, Tania S., S044Manemeit, Carl H., P298Manley, Michael, S038Marcin, James P., S009, S027, S072, S074Marciscno, Ivette, S075Marcus, Jonathan, P398Markwick, Laura, S051Marquez, Michael, P398Marquis, François, S050Mars, Maurice, P378Marttos, Antonio, S016Masino, Caterina, S039Maurer, Toby, P164May, Matthew, P352McCafferty, Dan, S064McCartt, Susan, P327McCormick, Jean, P477McCoy, Sean C., P503McCracken, John, P346McCue, Michael, P216McElligott, James, S036McKoy, Karen, S006McLendon, Megan, S039McVeigh, Francis L., P282, S046Mérette, Chantal, S050Merrell, Ronald C., S050Meyer, Brett C., S037Meyer, Deborah, P263Milaster, Christian, S069Millan, Andreina, P635Mills, John, S071Minatodani, Dayna, P334Minton, Stephen, S073Mishkind, Matt, S046Miyamoto, Sheridan, S072Miyazaki, Masako, P139Moffet, Helene, S050Mohammed Misbah, P946Moreno, Lucy, S028Morris, Stephen E., S039Muller, Mathew, S033Murad, Faisal, S068Murphy, Sarah, S027NNadeau, Sylvie, S050Nayyar, Geeta, S013Nelson, Eve-Lynn, P746Nesbitt, Thomas S., S002, S010, S037Newman, Stanton, S055Nicholis, G. Ronald, S027, S038Notaroberto, Neil F., S024Noviski, Natan, S027OO’Keeffe, Terence, S004O’Neil, Daniel, P310Oh, Dennis H., S035Olayiwola, Jacqueline, P503Omura, David L., P503Orlowski, Anna, S035PPacker, Robert J., S063Palmer, Stephen, S053Pandit, Viraj, S004Paniagua, Arthur G., S013Parakh, Manish, P574Parker, Chuck, S062, S067Parmanto, Bambang, P216Parsons, Stephanie, P327Pasquale, Louis, S024Patel, Bina, P325Patricoski, Chris, S001Pavliscsak, Holly, P595Pawlovich, John, S031Pearl, Phillip L., S063Pena-Robichaux, Venessa, P186Persse, David, P303Peterson, Joe, S002Pinter, Marco, P381, P444Pitt, Alan, S011Pletcher, Sarah, S048Ponce, Brent, P352Poole, Laurie, S028Purdy, Brendan, S003Pursley, James, S029QQuashie, Rene Y., S044RRajan, Balaraman, S050Ramadan, Issam, S063Ranger, Pierre, S050A-132 TELEMEDICINE and e-HEALTH 2013

ABSTRACT AUTHOR INDEXRay, Abhi, P727Razak, Anmar, P296Razumovsky, Alexander, P282Reader, Annie, S028Reis, Howard, S064Remilla, Murthy, P273, P276, P840Repp, Andrea, S028Reyna, Molly, S063, S063, S064Reynolds, Eliza M., P381, P444Reynolds, Howard N., P381, P444Reynolds, Neal, S041Rhea, Kenneth E., S071Richmond, Tammy, P251Rickles, Nathaniel M., P400Riesenbach, Ron, S003Ringwalt, Sharon, P153Rivas, Homero, P763, S051Roberts, Rachel, S063Robertson, Angela, S028Robertson, Cliff, S023Robertson, Michelle, S015Roe, Kimberly, S043Rogove, Herb, S041, S052Romer, Doug, S052Ross, Bridgett, S028Rossos, Peter G., S003, S039Rothenberg, Steven S, S007Rowe, Nancy, S065Ruppar, Daniel, S029Russell, Katie, S039SSable, Craig, S063Sadowsky, Jeffrey, S039Saffle, Jeffrey R., S039Sahizadeh, Mina, P325Saldia, Rodrigo Vasquez, P786Sanders, Caroline, S055Sanders, Richard B., S052Sapci, Aylin, P197Sapci, Hasan, P197Scheideman-Miller, Cynthia, P601Schlageck, Joseph G., P746Schlegel, Sherene, S066Schwann, Thomas, P423Seale, Deborah E., S010Seidmann, Abraham, S050Seraly, Mark, S025Seto, Edmund, S054Shah, Anish, S003Shah, Nilesh, S028Shane-McWhorter, Laura, S004Shatzel, Alan, S030Shaw, Candace, P601Sheppard, Evan, P352Sherrard, Heather, P140Shimkin, Anthony, S029Shore, Jay, P96, S046, S005Shore, Peter, S060Siegel, Stuart, S075Sikka, Neal, S051Silva, Dora, S051Silva, Paolo S., P325, P635, S033Simeonov, Iana, S051Simmons, Scott C., S015Simon, Anne, S018Simpkiss, Cheryl, P785Sinykin, Svetlana, S063Slaney, Charlene, S034Slover, Robert H., P96Smith, Anthony C., S065Smolek, Michael K., S024Snyder, Sherri, P601Sorenson, Gisele (Gigi), P91Sossong, Sarah, S042, S048Spaulding, Ryan, S062Spira, James L., P670Sporner, Michelle L., P216Sprang, Rob, S043Stetina, Kory, S049Struthers, Christine, P140Stuart, Sheela, S063Suárez, Cristina Gómez, P235Sun, Jennifer K., P325, P635Swank, Sarah E., S062Swinfen, Roger, S019, S068TTabbara, Nader, S063Tamil, Lakshman S., P346Tang, Andrew, S004Tauben, David J., S015Ternullo, Joseph, S038Teyhen, Deydre S., S004Thakore, Komal, P325Theurer, Louanna, S039Thiem, Vu D., S068Thomas, John F., P96Thorp, Steven, S028Toenjes, Carol, S003Tolls, Dorothy, P325Tolson, Ann M., P325Tong, James, P595Tousignant, Michel, S050Towle, Cara, S015Tracy, Joseph, S056Tremwel, Margaret F., P327Tremwel, Martin, P327Tsallis, Agnes Cheng, P574Tsao, Jack W., S014Tsuji, Masatsugu, S001Turner, Troy A., S070Turrentine, Carolyn, P327Turvey, Carolyn, S032Urtubey, Xavier R., P786UUthke, Lorraine, S003VValencia, Angela, P741, P765Vance, Dustin, S038VanEssen, Darla J., P96Vega, Silvio, S063, S075Velasquez, Sarah E., P746Venkataraman, Vinayak, S050Veremakis, Chris, S071Versel, Neil, S047Vo, Alexander, S046Voyles, Debbie, P646, S010WWadwa, Raj P., P96Wai, Becky, S051Waisman, Thais, S068Waite, Karen, S031Walsh, Alexander, S033Wang, Yulan, S007Wasfy, Jason H., S042Watson, Andrew R, S007, S011Webster, Arvie, S004Webster, Kathleen, S009, S072Webster, Phyllis, P741, P765, P769Wechsler, Lawrence, S014Weinstein, Ronald, P769Weinstein, Ronald S., S004Weiss, Shelly K., P574Wells, Raymond, S043Wesloh, Janelle Jones, S022West, Leanne, P270White, Heidi, P350Wilbur, David, S042Wilhelm, Charles, S007ª MARY ANN LIEBERT, INC. 2013 TELEMEDICINE and e-HEALTH A-133

ABSTRACT AUTHOR INDEXWilliams, Dave L., S067Williams, Donna, S001Williams, Sherrie, S045Wilson, Janet, P601Wilson, Jennifer, P400Winslow, Dan, S044Wong, David J., S025Woulfe, Alyssa, S061Wynne, Julie, S004YYager, Phoebe, S027Yang, Nikki H., S027, S072Yao, Daoyuan, P722Yao, Jianchu, P722Yellowlees, Peter, S015, S059Yoo, Byung-Kwang, S027Yoon, Jin Ho, S022Yuan, Michael J., P731ZZafar, Asif, P737, S068Zakir, Sikder M., S031Zamora, Tania, S028Zheng, Hui, S027Ziadlou, Dina, S067Zierath, Stacey, S023Zimmer-Galler, Ingrid E., S024A-134 TELEMEDICINE and e-HEALTH 2013