- 1. AFHCAN Project Stewart Ferguson, Ph.D Associate Project
Director Director of Technology AFHCAN Project Office Alaska Native
Tribal Health Consortium 907-729-2260 www.afhcan.org
2. AFHCAN Sites 3. AFHCAN Partners
- IHS- 194 sites - 97,000 beneficiaries
- VA- 1 site - 65,000 beneficiaries
- US Army, US Air Force- 9 sites - 47,000 military and
dependents
- USCG- 4 sites - 3,000 beneficiaries
4. Remoteness by Access 5. Cost of Travel 6. Types of Sites by
Staffing 7. NLM - Maniilaq Data
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- 3393 Video otoscope (40%)
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- 5061 Digital camera (60%)
8. Lessons Learned from NLM...
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- If you dont use it regularly, then you will forget how to use
it
9. Radio Medical Traffic
- Telemedicine facilitates this process
10. What is Telemedicine? Telemedicine involves the transfer of
health data over a telecommunications system. Ask-a-Doc Home Health
Store & Forward RMT Radio/Phone/Fax Remote RPMS VideoConference
Remote Surgery Single Provider Multiple Providers 11. Workload
Distribution 12. What are your key organizational goals for
telehealth applications? Please rank in order of importance to your
organization:
13. 14. AFHCAN Referrals 15. 16. AFHCANet
- Alaska Native Medical Center (1)
- Veterans Administration Medical Center (1)
- Maniilaq Health Corporation (13)
- SouthEast Regional Health Consortium (12)
- Kodiak Area Native Association (6)
- Eastern Aleutian Tribes (8)
- Norton Sound Health Corporation (15)
- Public Health Nursing (?)
- Yukon Kuskokwim Health Corporation (47)
- Bristol Bay Area Health Corporation (30)
- Dialup connectivity (up to 23)
17. 18. 19. VoIP - Anchorage Dial Tone
- Provide 24 dial tones in Anchorage
- Integrate T1 into PBX at sites:
- Monitor traffic and cost savings:
-
- 24 dial tones ~$25/mo each
20. CLINIC NETWORK AFHCAN SYSTEM CART Otoscope ECG Scanner
Touchscreen CPU UPS LAN Access Point Hub PRINTER Print Server
Printer SERVER AFHCAN Cold Fusion SQL Server Web Server O/S CPU
BASIC COMPUTER Monitor CPU WAN Router AFHCANet 21. AFHCANet
POTS/WAN Facility C CHA #3 CHA #4 Router C Facility B CHA #1 CHA #2
Server B Facility A M.D. #1 M.D. #2 Server A HTTPS/XML
22. Sustainability
- Organization owns equipment
-
- Assembly, testing, burnin
-
- Software installation / management
23. 1) Keep it Simple.
- High turnover rates (re-training)
-
- Few choices per screen, color coded
-
- Very selective word choice
- Disparate educational levels
-
- Reduce complexity to few components
24. 2) Make it Sustainable and Supportable.
-
- Open source design (.CFM)
- Centralize Point of update or Point of Code
-
- Web solution - NO custom clients
- Minimize initial and recurring costs
25. So many organizations so many software issues!
- WinNT, Win2000, Unix, Linux
- IE3, IE4, IE5, Netscape, Xwindows
- Different patient encounter forms
- RPMS / CHCS / VISTA / Meditech
- Funds disappear in 2 more years
26. Aproperly designedsystem can improve the quality of health
care deliverywithout savingor sending a single byte. 27.
Satellites
- Add 0.6 seconds to roundtrip delay
- Cause web pages to load in 5 - 40 seconds
-
- Remove need for frame sets
-
- IE (http) registry tweaks
-
- 3rd party software (e.g. Flash Networks) - mostly
proxy/spoofing techniques
28. 29. Effect of Proxy / SSL 30. Alaska Federal Health Data
Sharing Planned Project Relationships What the AFHCAN software is
not ... VISTA CHCS T2P2 ? GCPR MFI Telerad AFHCAN PACS Integrator
HIS Telehealth CPRS ANMC 1/02-6/03, field start 9/03 CPRS Phase
Ideploy 7/00 RPMS Alpha 3/01-7/01 Beta 7/01-12/01 Phase III 2/02
RAHALL 4/00 version4 ANMC billing 6/00-10/00 Adding lab & meds
Adding 10 yr data existing planned possible Going to CHCSII NPIRS/
ORYX 31. AFHCAN Evaluation
- Evaluation questions - all
- Voice over IP- SEARHC, KANA, NSHC, MHC
- Video Conferencing - SEARHC
32. FAS Clinic (SCF)
- Team Approach - based on University of Washingtons nationally
recognized model
-
- Speech and Language Therapist
-
- Parent Navigator / Advocate
33. FAS Clinic (SCF)
- Purpose - Develop diagnosis and treatment plan for FAS
- Method - Interviews with parent and child
-
- VtC (digital one way mirror)
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- Nikon 990 (dysmorphology)
- Future - travel team, travel equipment
34. PE Tubes 35. PE Tube Followup
- National standard - 4 month followups
- Reality - 8 month or longer
- Expect up to 90% of followups can be accomplished with reverse
telemedicine
- Is an image as good as an on site visit?
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- Two independent on site, in person assessments.Take images
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- 6 and 12 weeks later, conduct assessments from images
alone.
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- Compare inter-provider variability, on site versus image
assessment and treatment plans
36. Develop standards to ENHANCE the interoperability of
disparatetelehealth systems and applications. IMPROVE the
sustainability and usability of suchsystems in future years.
Provide a mechanism for meeting current andprojected FUTURE needs
for data security www.hss.state.ak.us/atac Core Principles Alaska
Telehealth Advisory Council - Technical Standards Workgroup 37.
ACKNOWLEDGEMENTS
- Technical Expertise and Design
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- AFHCAN Statewide Committees