Telemedicine

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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
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