Innovations in Health Care · Alaska Native Tribal Health Consortium Estimated Travel Savings from...

AFHCAN Telehealth Innovations in Health Care

Stewart Ferguson, PhD Chief Information Officer (CIO)

Alaska Native Tribal Health Consortium

Alaska Native Tribal Health Consortium 2

“Telemedicine is the use of medical information exchanged from one site to another via

electronic communications to improve patients' health status.”

“… Telehealth ... is often used to encompass a broader definition of remote healthcare that

does not always involve clinical services. “

American Telemedicine Association


Alaska Tribal Health System Medical Care Service Levels

• Alaska Native Medical Center tertiary care – Referrals to private medical

providers and other states for complex care

• 6 regional hospitals

• 4 multi-physician health centers

• 25 subregional mid-level care centers

• 180 small community primary care centers

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ANTHC Vision: Alaska Natives are the healthiest people in the world.

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• Alaska- 27 MUAs within the state – in 1998 Alaska ranked 48th among the states in the ratio of doctors to residents

• Hawaii – 17 MUAs within the islands • Idaho – 48 MUAs within the state • Montana – 63 MUAs within the state – all or parts of Montana’s 56

counties are Federally identified Health Professional Shortage Areas (HPSA’s), Medically Underserved Areas (MUA’s) or Dental Shortage Areas (DSA’s)

• Oregon – 66 MUAs within the state • Utah – 23 MUAs within the state – 20 of Utah’s counties are designated as

Primary Care Health Professional Shortage Areas (HPSAs), 25 are designated as Mental Health HPSAs, 21 are designated as Dental HPSAs.

• Washington – 53 MUAs within the state • Wyoming – 14 MUAs within the state – 18 of 23 Wyoming counties have

HPSA designation; all 23 counties designated mental health PSA’s.

Northwest/Pacific States

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Telemedicine is one STRATEGY to

improve access, quality & performance

and to manage

costs & risk


AFHCAN - by the numbers …

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199,562

82,274

3,953

2,335

Cases created

Patients served

Providers involved

Providers creating

ATHS (Alaska Tribal Health System) (1/1/2000 to 3/31/2014)

Since 2001 2013

36,229

22,982

1,686

914


INCREASE ACCESS TO CARE BEST FOR PATIENT CARE REDUCES COST

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Telehealth Impact on Extended Waiting Times (> 4 months)

Data courtesy of Phil

Hofstetter

47%

8%

3%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Pre-Telemed1991-2001(n=1216)

With Telemed

2002-2004

(n=276)

With Telemed

2005-2007

(n=210)

Pe

rce

nt

Ap

po

intm

en

t A

vaila

bil

ity

Wit

h 5

M

on

th o

r Lo

nge

r W

ait

Tim

e

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ANMC Turnaround Time

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40% of cases are turned around in

60 minutes


2 hours


the same day


• Diabetic Retinopathy is the leading cause of new blindness among adults

• Blindness due to diabetes can be eliminated by timely Dx and Tx

• ~ 4% of AI/AN’s with DM need laser tx to prevent vision loss


Deployment of the IHS-JVN in Alaska using a portable

platform reversed a seven year decline in rates for the state

Joslin Vision Network (JVN) Portable JVN Pilot

0%

10%

20%

30%

40%

50%

60%

70%

DR

Exa

m R

ate

15% Increase

25% Decrease Portable JVN

implemented


Pre-Operative Planning for Ear Surgery Using Store-and-Forward Telemedicine John Kokesh M.D., A. Stewart Ferguson Ph.D., Chris Patricoski M.D.

Comparison of surgical time (actual surgical time – estimated

surgical time) for telehealth and non-telehealth cases. Values in the

right half of the plot represent cases which took longer than planned (42% of telehealth

cases and 47% of non-telehealth cases); values in the left half represent cases that took

less time than planned (58% of telehealth cases and 53% of non-telehealth cases)

0%

5%

10%

15%

20%

25%

30%

35%

40%

-3 -2.5 -2 -1.5 -1 -0.5 0.5 1 1.5 2 2.5 3

Pe

rce

nt

of P

atie

nts

Actual Surgical Time - Planned Surgical Time (hrs)

NonTelemed

Telemed

The average

difference was not

statistically

different between

the two groups:

32 minutes for the

telemedicine

evaluation group

and 35 minutes

for the in-person

evaluation group


Estimated Travel Savings from Telehealth for ALL Patients

Estimated annual savings from telehealth for all patients amounts to

about $8.3m with a total savings of $37.8m since 2003.

$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

$7,000,000

$8,000,000

$9,000,000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Specialty Care

Primary Care

Alaska Native Tribal Health Consortium 15 ATHS (Alaska Tribal Health System) (1/1/2000 to 12/31/2013)

0%

5%

10%

15%

20%

25%

30%

% C

ase

sTravel CAUSED (by Case Role)

Primary Care Specialty Care


WHERE ARE WE HEADED?

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The questions have changed … 10 Years Ago

“Should we do telemedicine”

“Will patients be satisfied”

“How do we do telemedicine”

Now “How do we integrate telehealth with the care environment”

“How can we support and expand telehealth capability”

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The Clinician’s Perspective … the New Limiting Step


The Keys to the Future

Partnerships

Preparing and Supporting Rapid Growth

Integration with Health Care

Leveraging new Informatics Technologies

Continuing to demonstrate Value Proposition

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Stewart Ferguson, PhD

Chief Information Officer


4000 Ambassador Drive

Anchorage, AK 99508

(907) 729-2262

[email protected]

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