Abstracts from The American Telemedicine Association Sixteenth Annual International Meeting and Exposition

1 United States Army, Fort Bragg, NC, USA 2 United States Air Force, Landstuhl Regional Medical Center, AE, USA 3 Landstuhl Regional Medical Center, Landstuhl, AE, USA 4 University of Nebraska, Omaha, NE, USA 5 United States Army; ERMC, Heidelberg, AE, USA 6 United States Army, ERMC, Heidelberg, AE, USA 113 Tele-Orthopaedics; United States Army European Regional Medical Command

Abstract Withdrawn

1 Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada 2 Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada 3 Divisions of Cardiology and Transplant, University Health Network, Toronto, ON, Canada 4 Department of Medicine, University of Toronto, Toronto, ON, Canada 5 Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada 278 mHealth Remote Patient Monitoring Improves Heart Failure Management and Outcomes: A Randomized Controlled Trial

Introduction: Remote patient monitoring of heart failure patients has been shown to improve health outcomes. However, the efficacy of a mobile phone-based remote patient monitoring system for heart failure is unknown.

Methods: The remote monitoring (RM) group (N = 50) took daily weight and blood pressure readings, weekly single-lead ECGs, and answered daily yes/no symptom questions on a mobile phone. Readings were automatically transmitted wirelessly to the mobile phone and then to data servers. Alerts were sent to the patients and clinicians as required. The control group (N = 50) was provided with standard of care. Patients were followed for 6 months. Paired Student t-tests were performed on baseline and post-study blood tests and survey data.

Results: Approximately 70% of RM patients completed at least 80% of their daily readings over the 6 months. The Brain Natriuretic Peptide (BNP) blood tests improved significantly only for the RM group (decrease of 186 pg/mL, p = 0.01). Quality of life (Minnesota Living with Heart Failure Questionnaire) also improved only for the RM group (decrease of 14 points, p = 0.006). Self-care maintenance (Self-Care of Heart Failure Index) had a clinically significant change for the RM group (p = 0.004). No significant decrease in hospitalization was found in the RM (decrease of 0.2 times, p = 0.4) likely due to several patients in the RM group being instructed by their healthcare providers to go to the emergency department, which led to hospital admissions.

Conclusions: mHealth systems are a scalable and cost-effective form of remote patient monitoring. In this study, we showed that a mobile phone-based remote monitoring system improved heart function (as measured through BNP), quality of life, and self-care. To achieve these positive outcomes, we hypothesize that an initial increase in hospitalization may be required to realize long-term savings.

Objectives

Mobile phone-based remote monitoring improves heart function (i.e. Brain Natriuretic Peptid blood values), quality of life, and self-care for heart failure patients.

1 Saint Alphonsus Regional Medical Center, Boise, ID, USA 2 Boise State University, Boise, ID, USA 287 The Emergency Specialist Program: Delivering Emergent Care to Rural Communities: Year 1 Results and Lessons Learned

Introduction: In medical emergencies, critically ill or injured patients presenting in rural community hospitals are more likely to be treated by a general practice physician, physician's assistant, or nurse practitioner. In these emergent cases providers must stabilize patients, provide an accurate diagnosis, and decide to transfer or admit and treat critical conditions within minutes, most often without guidance from specialists typically available in urban facilities. Studies have shown that access to board-certified specialists may significantly reduce morbidity and mortality among critically ill and injured patients.

Methods: We developed an Emergency Specialist Program (ESP) to provide emergent specialty care consultations, from board certified emergency physicians and sub-specialists, via the Remote Presence (RP) System. The program works in conjunction with the Saint Alphonsus Medical Access Center, which serves as a single point of contact for admissions. It is continuously staffed by registered nurses and Life Flight Network dispatch to coordinate consultation requests, accept patients, arrange appropriate transport, and manage bed control for the hospital. Through the use of multiPresence, an Access Center nurse, the ED physician, and sub-specialist are able to connect to one RP device simultaneously to direct appropriate treatment.

Results: To date, 38 ESP consultations have been completed. Four patients who received consultations were able to remain in their communities while 34 were transferred expeditiously. While the ESP program was initially designed to assist rural sites with high-acuity cases, such as stroke, stemi, sepsis and trauma, the majority of requested consultations (41%) were for general medical conditions.

Conclusion: The use of telemedicine increases access to emergency specialty care in rural settings and improves communication between tertiary and rural hospitals.

Objectives

Examine year 1 outcomes and lessons learned of an emergency based program that provides emergency telemedicine consults to patients presenting in rural emergency department.

1 Ontario Telemedicine Network, Toronto, ON, Canada 2 Ontario Telemedicine Network, London, ON, Canada 584 Scalable Expansion of Telestroke: A Provincial Solution

Since 2002 Telestroke in Ontario has provided over 1,500 stroke patients emergent access to neurologists with stroke expertise. This has enabled more than 400 patients in more remote areas of the province to receive tissue plasminogen activator (t-PA), the only effective treatment for ischemic stroke. Telestroke services were initiated through four regionally based pilot projects, each taking a different approach to the development and delivery of the service. Although the pilots were successful, the multiple models for service delivery resulted in fragmented technical solutions and an inefficient use of a limited number of neurologists. A provincial approach to the delivery of Telestroke was instituted to ensure an effective and efficient use of the technical and human resources that would meet the growing demand for the service. The Ontario Telemedicine Network (OTN) provided standardized technology solutions for the network infrastructure, videoconferencing, teleradiology solution for CT image access and 24/7 technical support. The provincial Telestroke program provided the opportunity to revisit the associated regional clinical and operational supports with a view to provincial harmonization and standardization. A consistent clinical model, supporting governance, and operational components to support a provincial model including a single neurologist on-call rotation were established. Arrangements for remuneration associated with on-call activities were secured. This provincial standardized technical and operational solution has allowed the program to expand from an initial 9 referral sites to 19. The number of Telestroke consults increased 55% in the second year of the provincial program with t-PA being administered 29% of the time. The establishment of a provincial telemedicine infrastructure can support a sustainable and scalable Telestroke program that promotes more effective use of scarce stroke resources, eliminates geographic barriers to specialized emergency services and service providers, and ultimately increase the capacity to treat acute stroke patients.

Objectives

To review change management techniques to create sustainable telemedicine services.

1 University of Virginia, Charlottesville, VA, USA 2 Intel, Washington, DC, USA 3 Center for Connected Health Policy, Sacramento, CA, USA

Some states are models for telemedicine. Every state can improve. This session will provide new information on needs and opportunities to improve each state's telemedicine regulations and reimbursement for Medicaid and other regulated payors.

Presentation Panel Session Number 7 Session Title: 98 ROI BUSINESS CASE STUDIES: SHOWING CASH AND RETAINED EARNINGS FROM TELEHEALTH

Track: Operations, Business & Finance   Room Number: 13/14

MODERATOR: Debbie Landau Corlin, MHA, Director, Clinical and Business Services, Mattel Children's Hospital UCLA, UCLA Department of Family Medicine, Los Angeles, CA, USA

Corlin Debbie Landau MHA

Director, Clinical and Business Services

Antoniotti Nina RN, MBA, PhD 2

Telehealth Director

Shinnebarger David MBA 3

Chief Marketing Officer

Blanchard Peter MHL 4

Corporate Strategist

1 Mattel Children's Hospital UCLA, UCLA Department of Family Medicine, Los Angeles, CA, USA 2 SystemsOne, LLC, Stuart, FL, USA 3 Intel Corp., Santa Clara, CA, USA 4 Innovative Capital Management, Okmulgee, OK, USA

Justifying a TeleHealth initiative with ROI financials is sometimes a difficult proposition. The panel will present ROI business concepts, focusing on the generation of cash dollars with revenue or cost savings. Content includes CEO/CFO objectives when determining the financial merit of a new venture, the revenue models preferred, and presents case studies from several large telemedicine programs with successful financial models that generate revenue and reduce internal costs. Highlighted are cost categories and methods for making financial projections 3–5 years out.To assist the learner in understanding what CEO/CFOs look for as return on investing in TeleHealth.

Objectives

To assist the learner in understanding what CEO/CFOs look for as return on investing in TeleHealth.

Understanding how to project start-up, operational, and facilities costs to project three to five year capital requirements.

Individual Oral Panel Session Number 8 Session Title: INTERNATIONAL PROGRAMS AND THE ECONOMICS OF TELEHEALTH

Track: Operations, Business & Finance   Room Number: 15/16

MODERATOR: John Howe, III, MD, President and CEO, Project Hope, Millwood, VA, USA

Latifi Kalterina MS 1

Director, Advancement and Outreach Operations

Lecaj Ismet MD 1 2 Bekteshi Flamur 1 2 Doarn Charles R. MBA 1 3 Merrell Ronald C. MD 1 4 Latifi Rifat MD 1 2 5 1 International Virtual e-Hospital, Anchorage, AK, USA 2 Telemedicine Program of Kosova, Prishtina, Albania 3 Public Health Sciences, University of Cincinnati, Cincinnati, OH, USA 4 Virginia Commonwealth University, Richmond, VA, USA 5 Department of Surgery, University of Arizona, Tucson, AZ, USA 300 Cost-Benefit Analysis of the Telemedicine Program of Kosova - A Sustainable and Efficient Model

Background: The International Virtual e-Hospital (IVeH) (www.iveh.org) has established a robust Telemedicine Program in the Republic of Kosova (TMPK) (www.telemedks.org). This program was developed in the aftermath of war and the application of innovative technology filled an unmet need. Using TMPK as a model, IVeH is establishing similar programs in Albania, Macedonia, Montenegro and other developing countries. Although there is a wide perception of great benefits of telemedicine programs (TMP) for developing countries, there are a lack of studies on Cost-Benefit Analysis (CBA) and other economic evaluations of TMP, in particular the financial value of Continuous Medical Education (CME) offered through TMP. In addition, there is lack of prospective studies on Monitoring & Evaluation (M&E) of TMP.

Objective: The goal of this study was to conduct a retrospective CBA of prospective data collected at TMPK over 6 years period (2004–2010) in order to determine the efficiency of this model for developing countries whose healthcare systems are in disarray.

Materials and Methods: We reviewed data on the number of participants in virtual lectures both at the Telemedicine Center of Kosova (TCK) as well as the number of participants at six Regional Telemedicine Centers, the number of lectures broadcasted, the cases reviewed and the transmitted for international consultation, and other quantitative data.

Results: Only in 2009, approximately 2,000 CME Certificates were awarded to physicians and nurses of Kosova, 18 international teleconsultations were conducted, 138 videoconferences, lectures and seminars were held, and there were over 9,000 visitors in the E-library in TCK. Data analysis is underway, but preliminary results show that the TMPK has been an efficient mechanism for CME and sustainable model for rebuilding the medical system. TMPK has been successful in offering physicians, nurses and other medical professions access to electronic information.

Conclusion: TMP is an efficient mechanism to ensure CME and rebuilding medical systems in developing countries. There is a need for prospective CBA of any TMP and the establishment of M&E programs in any future telemedicine initiatives in developing countries.

Objectives

Learn about the application of telemedicine in the Balkans.

Understand the importance and utility of telemedicine in a developing country.

Mars Maurice MBChB, MD University of KwaZulu-Natal, Nelson R Mandela School of Medicine, Durban, South Africa

241 eHealth Economics: An African Perspective

The developing world is striving to improve access to and quality of care. eHealth is a possible solution but requires significant communication infrastructure and is costly. On average, the WHO Africa Region nations spend 6.2% of GDP on health; $34 per capita, per annum. Based on international norms, African Governments would be expected to spend $0.70 to $1 per capita, per annum on ICT for health. Their dilemma is finding the most effective use of their limited budgets. Advice is difficult to give, as there is a paucity of solid economic data on eHealth, especially in the developing world. Review of 2,174 papers from health databases, reports and the grey literature reveals no literature on the comparison of the economic benefits of different eHealth solutions such as telemedicine, electronic district health information systems, electronic medical records, etc. Indeed, there is little strong economic data for any eHealth solution. Sound economic analyses of eHealth programmes are uncommon as they are complex and not merely a simple accounting exercise. Costs and benefits need to be examined from the perspectives of the patient, provider, tax-payer, employer, and funder or insurer. Effective analysis requires advance planning, choice of appropriate metrics and ascribing monetary values to social and health benefits. Analysis should, ideally, also be undertaken during each of the three phases of the life cycle of a programme, planning, implementation and routine use. For a variety of eHealth programmes, the time to net cumulative benefit has been shown to range from 3 to 13 years. Frameworks for the economic analysis of the different aspects of eHealth are required together with standardized metrics. Only once this has occurred is it likely that developing nations will be able to make informed decisions on the implementation and choice of eHealth solutions.

Objectives

Understand the disparities in budgets for eHealth.

Be aware of the need for comparative economic analyses.

Ali Qasim MCPS, FCPS, MRCS 1

Senior Registrar

Murad Muhammad F. MBBS,MCPS, FCPS 1 Jehan Farhat MBBS 1 Khan Mussarat HA MBBS 2 Gondal Zafar I. 3 Zafar Asif FCPS, FRCS 1

1 Rawalpindi Medical College, Rawalpindi, Pakistan 2 Ministry of Health, Attock, Pakistan 3 Ministry of Health, Rawalpindi, Pakistan 657 Impact of Pak-US Collaboration on Telemedicine Implementation in Pakistan

Introduction: The history of Pak-US Collaboration in telemedicine starts back in 2004. It was the time when Telemedicine was identified as the key component of Pakistan-US Science & Technology Cooperation Program. Two Pakistani Doctors were selected for advanced training in US telemedicine centers under the supervision of the State department & TATRC. The idea was to train the master trainers so that the human resource in the field can be enhanced. This was followed by several joint telemedicine projects between different institutions of both countries. This study is the evaluation of the impact of this collaboration on the current status of telemedicine in Pakistan.

Materials and Methods: Literature was reviewed through Internet & published journals. Data was collected from all the Pakistani organizations & institutions involved in telemedicine projects. The current status was compared with pre-collaboration time (before 2004) and the association of each program with this collaboration was evaluated.

Results: Seven Joint Projects have been initiated under this collaboration. More than 100 healthcare professionals have been trained in telemedicine applications while in pre collaborative period this number was only 3. There were four functional telemedicine centers in whole country before 2004 which were using only store & forward telemedicine applications while currently more than 30 centers are actively involved in telemedicine activities utilizing satellite, GSM, DSL & WIMAX technologies for live interactions. All clinical specialties are being focused. More than 60 % of these activities had direct association with Pak-US collaboration while remaining had indirect association. Telemedicine has frequently been used during disaster situations especially during earthquake of 2005 & internal displacements during 2009 & 2010. EHealth association of Pakistan (eHAP) after its formation is working for broader implementation of eHealth programs across the country.

Conclusion: Pak-US Collaboration was a key factor to establish telemedicine on strong footings in Pakistan.

Objectives

To examine the impact of International collaboration on telemedicine programs of developing countries.

To discuss the telemedicine implementation roadmap.

10:45 am–11:45 am  Monday, May 2

Individual Oral Panel Session Number 9 Session Title: MAINTAINING QUALITY ASSURANCE AND CLINICAL EFFICACY FOR REMOTE SPECIALTY SERVICES

Track: Clinical Services   Room Number: 19

MODERATOR: Elizabeth Cowboy, MD, Medical Director, Advanced ICU Care, St. Louis, MO, USA

Welsh Cindy M. BSN, MBA

Vice President

Adult Critical Care, Advocate Health Care, Oak Brook, IL, USA

571 CLABSI Prevention: Implementing Strategies to Move off the Mark

Advocate Health Care, a nine hospital integrated delivery network, has monitored adult ICU Central Line Associated Blood Stream Infections (CLABSI) for several years with good patient outcomes (0.8 CLABSIs/1000 line days) at the system level. In 2010, the CDC published new benchmarks citing a central line infection rate of 0.39 as the 75th percentile. Advocate determined a renewed focus needed to be placed on this complication that has significant impact on patient outcomes and length of stay. Several initiatives were undertaken to affect the overall rate including remote observation by the electronic ICU (eICU) for compliance to the central line insertion checklist, standardization across the system of the central line insertion tray and standardization of the line insertion, line maintenance and central line blood draw policy and procedure. This initiative involved several key stakeholder groups including, among others, the ICU management team, the eICU (monitoring 260 adult ICU beds from a remote location), the infection control practioner group and the supply chain critical care council. Data will be shared that demonstrate the discrepancies between perceived and actual checklist compliance as well as year to date impact on CLABSI.

Objectives

The participant will verbalize the value of collecting data on compliance with the central line insertion checklist.

The participant will understand intervention options that impact CLABSI rates in the ICU.

Lopez Ana Maria 1 2

University of Arizona

Richter Lynne MT(ASCP)SH 2 Kory Evelia MPH 1 2 McMillan Dennis 2 Myers Thomas 2

1 Arizona Telemedicine Program, Tucson, AZ, USA 2 University of Arizona, Tucson, AZ, USA 545 Assessment of Clinical Efficacy Utilizing Telecytology for Pap Smears

Our purpose was to assess the diagnostic efficacy of telecytology in pap smear evaluation via digitized pap smear images. Data generated from this study will serve as a foundation for a multi-disciplinary study that would assess the feasibility of digitized images of the pap smear glass slide in underserved, rural and remote populations. This effort may improve the accessibility and reliability of pap smear interpretation and may significantly impact the health of women and the healthcare costs associated with cervical dysplasia and cervical cancer worldwide. Three cytologists reviewed and diagnosed a sample of 100 pre-screened pap smears using the store-and-forward, D-Metrix technology. The D-Metrix diagnosis, confidence in diagnosis, image quality and color, and time required to diagnose each slide, was recorded. Slides were selected from an archive, thus slides were all marked with points of interest prior to their review. The time required to diagnose one slide, averaged 3.69 minutes. Most reviewers reported feeling “mildly confident” in their assessment, with the exception of the pathologist, who leaned towards feeling “very confident”. Image quality was reported as “fair”, with one reviewer often rating them as “excellent”. Image color was commonly rated “fair” and “good”. Diagnostic categories of the slides included: normal = 1, mild dysplasia = 2, moderate dysplasia = 3, severe dysplasia/CIS = 4, and invasive malignancy = 5. Diagnostic concordance was measured using the kappa statistic, with the conventional glass slide diagnosis as the reference. Individually, reviewers had the highest concordance within the “invasive malignancy” category (K = 0.718, 0.759, 0.969). Reviewers also had the highest concordance within the “normal” category (K = 0.819, 0.940, 1.00). We hope to expand this study, by including an assessment of real-time digitizing technology (Apollo), by including unmarked slides, and by applying one or both (D-Metrix/Apollo) digitizing technologies in a real-world setting.

Objectives

To learn about a telecytology assessment using D-Metrix technology.

To learn about the feasibility of distance diagnosis.

Discussion Panel Session Number 10 Session Title: 73 ENSURING TELEMENTAL HEALTH ACCEPTANCE AND SUSTAINMENT THROUGH A STANDARD METRICS MODEL

Track: Telemental Health   Room Number: 24/25

MODERATOR: Matt Mishkind, PhD, Acting Chief, Clinical Telehealth Division, National Center for Telehealth and Technology, Fort Lewis, Tacoma, WA, USA

Mishkind Matt PhD 1 Chief Acting

Clinical Telehealth Division

Shore Jay MD, MPH 2

Associate Professor

Godleski Linda MD 3

Associate Professor of Psychiatry

Roberts Lisa PhD 4

Global Clinical & Innovations Manager

1 National Center for Telehealth and Technology, Fort Lewis, Tacoma, WA, USA 2 University of Colorado, Aurora, CO, USA 3 Yale University, West Haven, CT, USA 4 Viterion TeleHealthcare, A Business of Bayer Healthcare, Bellevue, WA, USA

The Federal Government and Private Industry have invested heavily in the development of telemental health programs and initiatives. Organizational leaders are justifiably interested in the impact of these investments as they determine how to focus future healthcare spending. Several models exist to measure telehealth outcomes ranging from basic outcome analysis to cost-benefit analysis. Unfortunately, the ever advancing nature of technology and healthcare delivery has made it difficult to develop a wide-spread and standard approach to evaluate program achievement. While many efforts do exist, the majority focus on evaluating metrics for one or a limited number of outcome variables rather than an entire program. In addition, few, if any, standard approaches exist to demonstrate cross-program success. This discussion panel will be comprised of telemedicine experts with experience defining and delivering on program effectiveness data. Each panelist will briefly present a model for demonstrating effectiveness with specific emphasis placed on applicability to other programs. This will be followed by a broad spectrum discussion on the development of a generalized model for telemental health effectiveness focused on, but not limited to, the following: 1) Is a generalized model possible? If so, does it help or hurt the field? 2) What criteria best demonstrate success for telehealth? 3) What metrics are organizational leaders most interested in assessing? 4) Are the criteria and metrics that we need to assess in 5 or 10 years the same as today? 5) What steps must we undertake to better illustrate overall success? 6) Is success the same for Federal Government and Private Industry? The panel will conclude by opening up questions to the audience and a final summary of the considered questions. To understand current and emerging best practices for demonstrating telemental health program effectiveness.

Objectives

To understand current and emerging best practices for demonstrating telemental health program effectiveness.

Identify areas of consensus and divergence in the evaluation of telemental health programs.

Individual Oral Panel Session Number 11 Session Title: THE USE OF MOBILE TECHNOLOGIES FOR DIABETES MANAGEMENT

Track: Mobile Health   Room Number: Ballroom A

MODERATOR: Donald Jones, JD, Vice President, Business Development Health and Life Sciences, Qualcomm, San Diego, CA, USA

Holtz Bree MSc, PhD 1 Researcher Post-Doctorate LaPlante Carolyn BA 2 1 Ann Arbor VA HSR&D Center of Excellence, Ann Arbor, MI, USA 2 College of Communication Arts & Sciences, Michigan State University, East Lansing, MI, USA 451 The Use of Mobile Phones for Diabetes Management: A Systematic Review of the Literature

Diabetes, a complex chronic disease, was the seventh leading cause of death in the United States in 2006 and is associated with many health complications. It is important that diabetics take steps to manage their disease in order to have a high quality of life. One technology that may assist people in effectively managing diabetes is mobile phones. Numerous interventions have utilized mobile phones for this purpose, testing if they provide health benefits or induce positive behavior change among diabetic patients. This systematic review sought to determine the current knowledge base of research using mobile phones for diabetes and to identify any gaps. The following research questions were posed:

RQ1: What types of interventions were used (medication reminders, diary, awareness, etc.)?.

RQ2: How were the mobile phones used?.

RQ3: What outcomes were reported?

After developing inclusion and exclusion criteria and searching relevant databases, more than 20 research articles were selected for review. A coding scheme for the articles was developed using a Grounded Theory approach. The results of this research indicate that 58% of the studies focused on Type 1 diabetes, the majority provided mobile phones to subjects and the participant ages ranged from 13 to 65 years. The number of subjects in the studies ranged from six to 100 (M = 32) and the duration of the studies spanned from two weeks to one year (M = six months). Utilizing the phone as a diary was the most common intervention of mobile phones. Additionally, over 60% reported clinical outcomes as measures, with most measuring HbA1c levels. While the majority of studies reported overall improvement, statistically significant results were reported in only two studies. Findings will help to determine the effectiveness of mobile phones in managing diabetes, demonstrate areas for additional research, and guide future mobile phone interventions.

Objectives

Understand the current state of mobile phones in diabetes management.

Recognize the gaps in the research.

Cafazzo Joseph A. PhD, PEng 1 2

Senior Director, eHealth Innovation

McIsaac Warren MD FRCP(C) 2 3 Tisler Andras 3 Irvine M J. PhD 4 Feig Denice S. MD FRCP(C) 2 3 Logan Alexander G. MD FRCP(C) 2 2

1 University Health Network, Toronto, ON, Canada 2 University of Toronto, Toronto, ON, Canada 3 Mount Sinai Hospital, Department of Medicine, Toronto, ON, Canada 4 York University, Department of Psychology, Toronto, ON, Canada 243 mHealth Remote Patient Monitoring Improves Hypertension in Diabetes: A 1-year Randomized Controlled Trial

Background: An mHealth intervention was developed to automate the capture of blood pressure (BP) readings through a mobile phone-based system, providing actionable messages to patients and critical alerts to physicians. We tested the hypothesis that this system would enhance antihypertensive treatment compared to usual practice of home BP monitoring.

Methods: Adult type II diabetes patients (n = 110) with uncontrolled systolic hypertension were randomly assigned to monitor their BP at home with a standard home BP monitor (n = 55) or using a Bluetooth-enabled BP monitor that transmitted readings through a mobile phone-based RPM system (n = 55). Family physicians provided care for all patients. The primary outcome measure was the mean between-group difference in daytime systolic BP change from baseline to 12-months.

Results: The mean age and weight (±standard deviation) were 62.2 ± 8.2 years and 90.2 ± 24.1 kg respectively; 37.3% were women. Overall, the baseline mean daytime systolic and diastolic BP were 142.7 ± 10.5 and 77.1 ± 9.9 mm Hg, respectively. At 12 months the within-group change in mean daytime systolic BP was − 9.1 ± 15.6 mmHg in the telemonitored group (n = 54; p < 0.0001) and − 1.5 ± 12.2 mmHg in the control group (n = 51; p = 0.38) and for daytime diastolic BP, − 4.6 ± 9.2 (p < 0.001) in the telemonitored group and − 1.3 ± 6.6 (p = 0.16) in the control group. Mean between-group difference in systolic and diastolic BP changes was 7.6 ± 14.0 (p < 0.007) and 3.3 ± 8.1 mm Hg (p < 0.04), respectively with telemonitoring group being lower. Finally, 50% of patients in the telemonitoring group had their BP under good control (BP < 130/80) compared to only 29% in the control group (P < 0.05).

Conclusion: An mHealth RPM system, designed to actively engage patients in self-care, significantly improved uncontrolled systolic hypertension in patients with diabetes.

Objectives

To present the results of an RCT of an mHealth RPM intervention for diabetic hypertension.

To discuss the implications of using mobile-phone based remote monitoring on large populations of those that are chronically ill.

Sultan Salys S. PhD

Student

Mohan Permanand The University of The West Indies, St. Augustine, Trinidad and Tobago

634 A Framework for Collaborative Disease Management Using Mobile Technologies

Diabetes is a chronic non-communicable disease that affects many people throughout the world. Diabetics usually have to take medication and adopt better self-management behaviours to control their blood glucose level. Diabetes Self-Management Support (DSMS) emphasizes that without sustained support, diabetics will not succeed in their disease management process. In some countries, however, existing DSMS initiatives are not easily accessible to the larger diabetic population and are not as effective in the long term because they lack regular follow up and feedback. This paper introduces a framework for Collaborative Disease Management (CDM) using mobile technologies. The objective of the framework is to demonstrate how CDM using mobile technologies allow users with similar disease management interests to virtually gather and share experiences, ask questions and provide support and problem-solve remotely through the use of mobile devices. The research describes the design of a mobile application called Mobile DSMS, or simply mDSMS that is based on the framework. MDSMS is a social-networking tool that allows diabetics to better record their self-management behaviours and learn from each others' experience. The hypothesis is - CDM will improve the self-management practices of people living with the disease. A focus group consisting of ten diabetics was selected from the target population to review the system. All participants found the use of the mobile phone to be a convenient platform for DSMS as they used the device on a daily basis but some concern was shown as to the security of the data shared and the familiarity with the other members of the group. The next stage in the deployment of the mDSMS application is a large scale user trial expected to begin in November 2010. This will involve a double-blind experiment with a patient sample of 50 Type 2 diabetics between the ages of 45–65 years.

Objectives

To demonstrate how Collaborative Disease Management using mobile technologies allow users with similar disease management interests to virtually gather and share experiences, ask questions and provide support and problem-solve remotely.

To identify and demonstrate which features of the mobile phone are effective in the delivery of healthcare services.

Discussion Panel Session Number 12 Session Title: 21 CHALLENGES IMPLEMENTING TELEHOSPICE: OUTCOMES AND LESSONS LEARNED FROM INTERVENTION STUDIES

Track: Remote Monitoring   Room Number: 20/21

MODERATOR: Deborah Randall, JD, Health Attorney & Telehealth Consultant, Law Office of Deborah Randall, Chevy Chase, MD, USA

Randall Deborah JD 1 Attorney Demiris George PhD 2

Associate Professor

Oliver Debra Parker MSW, PhD 3

Associate Professor

1 Law Office of Deborah Randall, Chevy Chase, MD, USA 2 University of Washington, Seattle, WA, USA 3 University of Missouri, Columbia, MO, USA

Hospice care is delivered to more than one million terminally ill patients and families each year in the United States. The National Hospice and Palliative Care Organization (NHPCO) estimates that more than 38% of all deaths in the US now receive hospice services. While 49% of hospices in the US remain as not-for-profit providers, another 47% are now declared for-profit. Despite the tax status, management of a per diem fixed federal reimbursement payment requires all providers to carefully manage costs while delivering care to a geographically disperse, often isolated, and always clinically fragile population. Hospice care in the US is primarily delivered in the home setting. This home environment creates many similarities to home healthcare, including large geographic distribution of the patient population. The cost considerations and geographic challenges make telehealth technology an interesting solution for both home health and hospice populations. While both the technology and research for telehealth technology has grown dramatically over the last decade in home healthcare, there has been less focus on the use of such technology in hospice care. The use of telehealth technologies to overcome the geographic distances in the delivery of hospice care has been termed telehospice. The Telehospice Project Team has conducted three intervention studies using different types of telehealth technology to bridge geographic distances between staff and caregivers of terminally ill hospice patients. These studies have been funded by the National Cancer Institute and the National Institute of Nursing Research and have laid the foundation for a recently initiated Randomized Controlled Trial. This discussion will center around the experiences and results of these three studies and the lessons learned by the research team in an effort to inform additional research. The intervention studies occurred over the past six years in six unique hospice settings, five rural and one urban. These projects have totaled more than 200 participants. Specific measurement instruments have been used to evaluate clinical outcomes such as anxiety, quality of life, reaction to caregiving, perceptions of pain management, pain, and problem solving. The results of all studies have shown these instruments to be appropriate measures and, while not individually statistically significant, they do indicate that interventions using telehospice have the potential to impact clinical outcomes for hospice patients. These researchers will share their experiences in implementing and evaluating telehospice interventions. In addition to sharing the results of clinical outcomes, discussion will reveal the strategies used to improve recruitment in telehospice intervention studies and the challenges faced in the management of telehospice research. Finally, panelists will identify how they have obtained funding and advocate for additional research findings related to the effectiveness of telehospice. Participants will be able to articulate the unique challenges for telehospice intervention research.

Objectives

Participants will be able to articulate the unique challenges for telehospice intervention research.

Participants will be able to discuss solutions to telehospice research challenges.

Presentation Panel Session Number 13 Session Title: 72 INTERNATIONAL EMERGENCY/DISASTER RESPONSE: THE ROLE OF TELEMEDICINE AND THE STRATEGIC PATH FORWARD

Track: Emergency & Disaster Response   Room Number: 22/23

MODERATOR: Asif Zafar, MD, FCPS, FRCS, Professor of Surgery, Rawalpindi Medical College, Rawalpindi, Pakistan

Zafar Asif MD, FCPS, FRCS 1

Professor of Surgery

Merrell Ronald C. MD, FACS 2

Professor of Surgery

Alverson Dale MD 3

Professor of Pediatrics

1 Rawalpindi Medical College, Rawalpindi, Pakistan 2 Virginia Commonwealth University, Richmond, VA, USA 3 University of New Mexico, Albuquerque, NM, USA

In the last decade the world has seen major disasters of unprecedented nature. There are numerous examples of natural disasters: Earthquake in Pakistan, Chile & Haiti, tsunami, Katrina, and most recently the floods in Pakistan and China. Emergency preparedness and disaster response to these natural disasters have varied from country to country. International agencies like UN, WHO & ITU play a major role in Rescue, Relief and Rehabilitation. Coordination amongst National organizations and NGOs is often lacking. Role of ICT & Telemedicine in particular in disaster situations with examples and case studies in such events is well known. We must learn from experiences of such disasters, and put mechanisms in place to deal with them much more efficiently.

Objectives

To discuss major International disasters & response lessons learned.

To review the role of telemedicine during these International disasters.

Presentation Panel Session Number 14 Session Title: 108 TELEHEALTH PRACTICE STANDARDS AND GUIDELINES: ANALYZING AND VALIDATING EVIDENCE-BASED TELEHEALTH

Track: Public Policy   Room Number: Ballroom D

MODERATOR: Elizabeth Krupinski, PhD, Professor and Vice-Chair, Department of Radiology, University of Arizona, AZ, USA

Krupinski Elizabeth PhD 1

Professor and Vice-Chair, Department of Radiology

Brennan David MBE 2

Senior Research Engineer

1 University of Arizona, Tucson, AZ, USA 2 National Rehabilitation Hospital, Washington, DC, USA

Standards and guidelines have supported clinical practice in all specialty areas for years and typically are drafted, published, and adopted by professional practice organizations. The American Telemedicine Association has taken the lead on developing and publishing standards and guidelines for clinical practice via TeleHealth. Over the last five years, ATA's Standards and Guidelines Committee has worked on and published several set of practice standards and guidelines for seven areas of clinical practice via TeleHealth. The issue with the development of any standards or guideline is the amount of published research that can be used as ‘evidence’ to support a particular method of practice via TeleHealth. When little or no evidence exists, yet a certain manner of practicing via TeleHealth is widespread, the burden of proof is on the experts in the field. From white papers, to expert consensus documents, to clinical practice guidelines and recommendations, all the way to clinical standards, the development of standards and guidelines is based on a combination of expert opinion, research, and published articles. This presentation will cover the existing standards and guidelines in TeleHealth, the role of clinical research in driving the publication of standards, and the role of adoption of standards and guidelines in the development of public policy. Standards and guidelines in TeleMental Health, TeleDermatology, TeleOphthalmology for Diabetic Retinopathy, Core Standards for TeleHealth, TelePresenting, Remote Data Management, and the use of consumer-based networks for healthcare delivery will be covered. The panel will review current standards, current research needs to support the development of new standards, and an implementation plan to enhance the adoption of published standards and guidelines by professional organizations, government agencies, and payers. The legal and regulatory impact of standards and guidelines will also be covered. Participants will understand the minimum standards for clinical practice in specialties using TeleHealth.

Objectives

Participants will understand the minimum standards for clinical practice in specialties using TeleHealth.

The participant will be able to identify practice standards and guidelines and outline an adoption strategy for their practice.

Presentation Panel Session Number 15 Session Title: 125 REIMBURSEMENT FOR TELEMEDICINE: TIPS FOR CODING AND BILLING

Track: Operations, Business & Finance   Room Number: 13/14

MODERATOR: Sunil Hazaray, Viterion TeleHealthcare, a Business of Bayer Healthcare, Chicago, IL, USA

Hazaray Sunil 1 Antoniotti Nina RN, MBA, PhD 2

Director of Telehealth

Martin Christine MBA, PMP 3

Executive Director

1 Viterion TeleHealthcare, a Business of Bayer Healthcare, Chicago, IL, USA 2 Marshfield Clinic, Marshfield, WI, USA 3 California Telemedicine & eHealth Center, Sacramento, CA, USA

This “how” to session will cover practical tips for reimbursement of telehealth services answer questions regarding specific requirements for billing and coding. Panelists will cover topics including Medicare, Medicaid, private pay, online services, contracts, remote monitoring and home telehealth. Actual case examples will be discussed.

Presentation Panel Session Number 16 Session Title: 129 USING TELEMEDICINE TO DELIVER CARE IN OTHER COUNTRIES: APPROACHES AND STRATEGIES

Track: Operations, Business & Finance   Room Number: 15/16

MODERATOR: Yulun Wang, PhD, Chairman and CEO, InTouch Health, Santa Barbara, CA, USA

Wang Yulun PhD 1

Chairman and CEO

Swinfen Roger 2

Co-Founder and Co-Director

Reyna Molly 3

Executive Director, Telehealth Services & Videoconferencing

1 InTouch Health, Santa Barbara, CA, USA 2 The Swinfen Charitable Trust, Canterbury, United Kingdom 3 Children's National Medical Center, Washington, DC, USA

Leading medical centers, non-governmental organizations and individual physicians are using telemedicine to reach out and provide services to residents in other nations. Such cross-border initiatives are used for charitable services to underdeveloped nations and as part of business plans to expand services to wealthier areas. This “How To” session will cover the unique challenges and opportunities for using telemedicine to deliver healthcare in other countries.

1:00 pm–2:00 pm  Monday, May 2

Presentation Panel Session Number 17 Session Title: 101 PERFORMANCE INDICATORS, SERVICE OBJECTIVES AND QUALITY ASSURANCE GUIDELINES FOR DIABETIC RETINOPATHY TELEHEALTH PROGRAMS

Track: Clinical Services   Room Number: 19

MODERATOR: Helen K. Li, MD, Adjunct Associate Professor, School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA

Li Helen K. MD 1

Adjunct Associate Professor, School of Biomedical Informatics

Scanlon Peter H. MD, FRCP, MRCOphth 2

Program Director, Gloucestershire Eye Unit

Zimmer-Galler Ingrid E. MD 3

Associate Professor

Horton Mark OD, MD 4

Chief, Eye Department

1 University of Texas Health Science Center, Houston, TX, USA 2 Gloucestershire Eye Unit, Cheltenham, United Kingdom 3 Johns Hopkins Wilmer Eye Institution, Baltimore, MD, USA 4 Indian Health Service, Phoenix, AZ, USA

Numerous diabetic retinopathy assessment programs have been established worldwide. The American Telemedicine Association was instrumental in developing what are now well-accepted recommendations for designing and implementing such telemedicine programs. Key to successful implementation and sustainability of telehealth diabetic retinopathy programs is monitoring their performance against a set of standards or guidelines for outcomes. Defining outcome measures and quality assurance standards, however, has been limited. The United Kingdom National Health Service has delineated key performance indicators, service objectives, and quality assurance standards for their National Diabetic Retinopathy Screening Programme. Their comprehensive program and its defined outcomes are specifically tailored for the English healthcare system. Given the unique complexity of the United States healthcare system, the United Kingdom program metrics cannot be directly applied to diabetic retinopathy assessment programs in the United States. This presentation panel will introduce the United Kingdom National Diabetic Retinopathy Screening Programme as a framework to begin developing the essential elements of outcome measures and performance guidelines specifically for programs in the United States. Audience participation will be encouraged and we will plan for future meetings to complete guidelines for ocular telehealth programs in the United States.

Objectives

To review the United Kingdom National Diabetic Retinopathy Screening Programme's outcome measures.

To develop a framework of essential elements for measuring outcomes of diabetic retinopathy assessment programs in the United States.

Discussion Panel Session Number 18 Session Title: 78 USING TECHNOLOGY TO BRIDGE ISOLATION FOR GEOGRAPHICALLY REMOTE MENTAL HEALTH PROVIDERS

Track: Telemental Health   Room Number: 24/25

MODERATOR: Jenna Ermold, PhD, Online Content Coordinator, Center for Deployment Psychology, Olympia, WA, USA

Ermold Jenna PhD 1

Online Content Coordinator

Stuart Peter MD 2

National IHS Psychiatry Consultant

Hirsch Phil PhD 3

Director

Brim William PsyD 4

Deputy Director

Jay Hoffman Kenneth MD, MPH 5

Office of Medical Services

1 Center for Deployment Psychology, Olympia, WA, USA 2 Mental Health Services, Indian Health Services, Santa Rosa, CA, USA 3 Access Psychiatry LLC, Seattle, WA, USA 4 Center for Deployment Psychology, Bethesda, MD, USA 5 US Department of State, Washington, DC, USA

Over the past decade, our nation has faced numerous stressors and potentially traumatic events here and abroad such as terrorist attacks, wars in Iraq and Afghanistan, natural disasters, and a serious economic recession. The impact has been that healthcare providers have experienced an increased demand for competent, timely, and often specialized mental healthcare for those impacted individuals. This increased demand can put providers at risk for negative outcomes resulting from compassion fatigue, burnout, and practicing beyond one's competency level. While these outcomes can be mitigated through training and support networks, increasingly mental health providers are being asked to deliver services to geographically remote or isolated areas with little or no peer connections. It is imperative that the field develop innovative strategies that 1. Support continuing education in evidence-based practice, 2. Provide opportunities for provider-to-provider consultation and supervision, 3. Promote treatment fidelity. This discussion panel will be comprised of Federal and civilian sector mental health experts with experience utilizing telehealth technologies to support geographically remote mental health providers. Each panelist will briefly present how technology has been used to improve training and support programs for their provider populations to include remote DoD, State Department, Indian Health Service, and civilian locations. This will be followed by a broad discussion on the use of technology to support isolated mental health providers. This discussion will also focus on the following: 1) Does technology bridge the isolation gap? Is it necessary? 2) What are best practices for delivering provider-to-provider support to remote locations? What criteria best demonstrate program success? 3) What are the main concerns for supporting isolated providers? 4) Is the use of technology sustainable for these purposes? 5) Are there policy or operational constraints to consider? The panel will conclude by opening up questions to the audience and a final summary of the considered questions.

Objectives

To understand innovative approaches to providing peer and training support to remote and isolated mental health providers.

To identify areas of consensus and divergence for delivering peer support to geographically distant mental health providers.

Discussion Panel Session Number 19 Session Title: 19 USING MHEALTH SOLUTIONS TO IMPROVE CLINICAL OUTCOMES WHILE REDUCING COSTS

Track: Mobile Health   Room Number: Ballroom A

MODERATOR: Richard C. Strobridge, BS, Chief Executive, Entra Health Systems, San Diego, CA, USA

Strobridge Richard C. BS 1

Chief Executive

Dolan Brian 2

Editor & Co-Founder

McKnight Lisa 3

Senior Manager, Services and Solutions

Lane Arthur W. III 4

Associate Director, Healthcare Strategy & New Market Development

1 Entra Health Systems, San Diego, CA, USA 2 mobihealthnews.com, Boston, MA, USA 3 Nokia AT&T Product Group, San Diego, CA, USA 4 Verizon Wireless, Nashville, TN, USA

The rapid adoption of smartphones, data-rich phones and graphically enhanced personal and professional health applications have created a significant opportunity for the use of mHealth to connect patients to family, caregivers and clinicians to monitor day to day status. In most cases, better connected care can and will result in improved clinical outcomes and in turn, reduce the overall cost of care. Stumbling blocks to implementation of mHealth aren't significant, but present an obstacle to widespread acceptance. The population that can benefit from better connected care and closer monitoring is generally senior citizens. However, acceptance of mobile phones and computers, as well as the ability to adapt to change and technology is limited. Simplified, automated background solutions may be the best hope for increasing adoption. mHealth applications, related monitoring technology and services have received only limited acknowledgement from insurance payors, Medicare and clinicians due to its inability to be reimbursed. The current system of reimbursement codes restricts new technologies and makes adoption of them a personal expense, even though ultimately better monitoring and connected care will save the payer networks and Medicare billions. Looking at diabetes management, there is no question that a diabetic patient who tests regularly can better manage their diabetes. A patient in control of their diabetes cost a little as 1/10 as much to care for as a patient who is not adequately monitoring their blood sugar. This can be a difference of spending $6,000 a year for a patient in control versus $60,000 a year for one not in control. Using an mHealth application and smartphone connects a patient with family and caregivers, as well as clinicians. It provides text messages and alerts, reminders to test plus a visual log of their hourly status to their phone. Reimbursement for these added services and cost saving capabilities is not currently available in the US.

Objectives

Discuss clinically-accepted, FDA cleared applications that have the ability to reduce the overall cost of care employing a connected care practice using mobile phones.

Look at upcoming applications that have the potential to reduce cost while improving outcomes. Disc.

Individual Oral Panel Session Number 20 Session Title: RESULTS FROM LARGE-SCALE STUDIES OF REMOTE MONITORING FOR CHRONIC DISEASE MANAGEMENT

Track: Remote Monitoring   Room Number: 20/21

MODERATOR: Bonnie Britton, MSN, RN, C, Telehealth Clinical Network Director/Development Director, Roanoke Chowan Community Health Center, Ahoskie, NC, USA

Range Peter E.

CEO

Home Telehealth Limited, Chipping Sodbury, United Kingdom 684 Outcomes For The Remote Patient Monitoring Of 1,000 Patients In The UK

Over a period of three years HTL Telehealth nurses have delivered a full ‘end to end’ clinical managed Telehealth service and monitored over 1,000 people from two NHS Trusts in Northern Ireland with one or more long-term conditions, the patients main health conditions were COPD, CHF and Diabetes. During this period the nurses developed an activity database and Telehealth management system software in order to gather additional data from and about the patients in order to determine more accurate data, patient utilisation, ROI and outcomes not usually derived from most Telehealth systems. (In the process the HTL nursing team won two National Awards for Innovation and Partnering with the NHS). A number of outcomes and goals have been achieved during the service delivery model and clear evidence suggests that Telehealth home patient monitoring can be used as a method of reducing hospital admissions, it appears to promote patients to become better managers of their long term condition and ultimately enjoy a better quality of life, whilst delivering cost efficiencies to the healthcare provider. During the Telehealth Project it was found the use of the home monitoring systems improved patient knowledge about their COPD, CHF and Diabetes conditions. This directly resulted in fewer unnecessary appointments with their GP. In essence patients themselves had become ultimately better self managers. Some of the interesting findings and outcome data and information analysed surprised NHS clinicians;

High cost Telehealth monitors that measured vital signs as well as asking the patient a series of questions sets via a screen were being used for 49% of their time providing the Telehealth nurses with ‘vitals only’ data.

29% of patients required a re-test.

unplanned hospital admissions were reduced by 56%.

16% of patients escalated to community nurses resulted in planned hospital admissions

Objectives

To share outcomes data.

To review 4 plus years of patient monitoring experiences.

Peters Dave T. MEPE, BSEE, MCE

Senior Program Manager

Alaska Federal Health Care Partnership, Anchorage, AK, USA

358 HTM Enables Intelligent Intervention, Improves lives and Reduces Costs

The Alaska Federal Health Care Partnership (AFHCP) Home Telehealth Monitoring (HTM) program will present health and cost outcomes, and progress toward self-sustainment. The data we have accumulated on actual outcomes is phenomenal and will be of great interest to nationwide telehealth managers and funding activities. The AFHCP HTM Program is currently serving 58 communities and growing. Our preliminary analyses of actual costs avoided shows 1,500% ROI. Health outcomes are just as astounding. One community with 29 participants has reduced its average Glucose 45 mg/dl in just 30 months. The HTM Program is increasing access to care, reducing patient and specialist travel, decreasing lost work times, avoiding clinical referrals and acute episodes, and is widely accepted by patient populations. We will present progress metrics such as, telehealth encounters; specific quantitative health outcomes; and cost avoidance. We will also present our progress towards self-sustainment and lessons learned. The AFHCP Executive Committee members are the senior leader from every federally funded health agency in Alaska including; IHS, Alaska Native and Tribal Health Consortium, Alaska Native Medical Center, VA, DOD, and DHS. The HTM program includes all Alaska's Federal healthcare beneficiaries representing 40% of the state's population. Providers need only identify patients and work with our staff to enroll them, and then use the data provided for intelligent interventions (pre-emptive education, feedback, and medication modifications) to preclude acute episodes and improve patient quality of life. The 39 independent regional Native Health Agencies and their 6 Hospitals and 203 community health clinics participate in the AFHCP through the ANTHC. The anticipated beneficiary population with chronic health conditions targeted by the HTM Program is estimated at 27,000. As we continue to grow by adding health agencies, communities and beneficiaries who are convinced of the benefits they will realize, we are creating the basis for self-sustainment.

Objectives

How HTM enables Intelligent Interventions that improve health and reduce costs.

Lessons learned from on-going path to self-sustainment.

Williams Randall E. MD, FACC

CEO

Pharos Innovations, Chicago, IL, USA

255 NIH-sponsored Randomized Trial of Remote Patient Monitoring to Improve Outcomes in Heart Failure Populations

Background: The Tele-HF study is the first multi-centered remote patient monitoring trial and only active disease management study funded by the National Heart Lung and Blood Institute (NHLBI), a division of the National Institutes of Health (NIH). Tele-HF is a randomized controlled trial to test the effectiveness of telemonitoring in positively impacting outcomes in heart failure (HF) populations. Yale University coordinated the four-year study.

Methods: Tele-HF is a randomized, controlled study that compared 1,650 HF patients across 30 + provider organizations across the country with usual care. The purpose was to study the impact of collecting information about symptoms, clinical status and weight and engaging participants in their own self-care on reducing all-cause hospital readmissions and mortality among patients recently hospitalized with decompensated HF. Participants were recruited from general cardiology, heart failure specialty and primary care practices across the United States. Patients were asked to complete a series of pre-programmed questions regarding their immediate HF symptoms and body weight daily, by way of home landline, cellular telephones, PDAs or home computers. From this information, provider site clinicians determined if the reporting patient's current status was acceptable or, in the case when clinical variances are detected, the patient needed immediate care. If it is the latter, the clinician offered live consultation about modifications to the patient's daily therapy regimen or advised the patient to proceed to their clinic or hospital for a physician visit.

Outcomes and Conclusions: The results of the study are being compiled and analyzed by the Yale University Medical Center and was published in November 2010. During this presentation, the presenters will share these freshly published outcomes, lessons learned and implications to the future of telemonitoring policy.

Objectives

Be one of the first to hear the results of the first and only NIH sponsored randomized prospective study of remote monitoring.

Discover lessons learned from the study.

Presentation Panel Session Number 21 Session Title: 84 USING HEALTH INFORMATION TECHNOLOGY TO SUPPORT PATIENT CENTERED CARE

Track: Technology & Telecommunications   Room Number: 22/23

MODERATOR: Pamela Whitten, PhD, Dean, College of Communication Arts & Sciences, East Lansing, MI, USA

Whitten Pamela PhD 1

Dean

Holtz Bree PhD 2

Post-doctorate Researcher

Brennan David MBE 3

Senior Research Engineer

Agha Zia MD, MS 4

Director of Health Services Research

1 College of Communication Arts & Sciences, East Lansing, MI, USA 2 Ann Arbor VA HSR&D Center of Excellence, Ann Arbor, MI, USA 3 MedStar Health Research Institute, Washington, DC, USA 4 VA San Diego Healthcare System and University of California San Diego, San Diego, CA, USA

Patient-centered care is an approach of providing high-quality, cost-effective healthcare that empowers patients. It acknowledges that each patient has unique needs, values, goals, preferences and cultures and involves the patients and their family caregivers in a shared plan of care. The shift towards patient-centered care has gained significant momentum in recent years, as a result of healthcare reform efforts and the rapid growth of telehealth and other health information technologies. Remote monitoring devices, online patient portals, electronic medical records, and decision support systems can be used by members of a patient's care team to exchange information, improve access, facilitate interaction, lower costs and increase satisfaction. This panel will overview and discuss several different types of technologies and how they can be used to support and promote patient-centered care in a variety of settings. Three topics will be presented. Bree Holtz will review research findings based on the development and implementation of a navigational tool for nurses used to recommend technology-based self-management programs within a VA Health System. Aspects of nurse perceptions including utilization, usefulness and adoption will be examined. David Brennan will discuss telenavigation for persons with chronic disabling conditions, an approach that automates the monitoring of health status, provides education on self-management, secondary prevention behaviors and facilitates communication between patients and healthcare providers. Claudia Tessier will address how mHealth supports patient-centered care, particularly how the use of mHealth can be a catalyst for participatory care and enhance patient-provider communication. An emphasis on how mHealth applications support patient-centered care will be highlighted. This forum will also include an opportunity for the audience to create a dialogue with the speakers on possible future directions of technology-enabled patient-centered care, and to develop new networks, partnerships, and information exchanges.

Objectives

Learn about patient centered medical care.

Learn about technologies being used in patient centered medical care.

Presentation Panel Session Number 22 Session Title: 131 EHRS AND TELEMEDICINE

Track: Public Policy   Room Number: Ballroom D

MODERATOR: Neul Neuberger, CISSP, President, Health Tech Strategies, LLC, McLean, VA, USA

Neuberger Neul CISSP 1

President

Harris Yael PhD, MHS 2

Director, Office of Health IT & Quality

Thielst Christina FACHE 3

Consultant

1 Health Tech Strategies, LLC, McLean, VA, USA 2 Health Resources & Services Administration, Rockville, MD, USA 3 Santa Barbara, CA, USA

Billions of federal dollars are flowing to providers to make meaningful use of patient's electronic health records, for health information exchanges and Beacon Communities. This session will assess roles and opportunities to use electronic records for telemedicine as part of meaningful use.

Presentation Panel Session Number 23 Session Title: 89 HEALTHCARE REFORM AND TELEMEDICINE: ACCOUNTABLE CARE ORGANIZATIONS TO PAY FOR PERFORMANCE

Track: Operations, Business & Finance   Room Number: 13/14

MODERATOR: Julie Hall-Barrow, EdD, Assistant Professor and Education Director, University of Arkansas for Medical Sciences, Little Rock, AR, USA

Hall-Barrow Julie EdD 1

Assistant Professor and Education Director

Lowery Curtis MD 1

Department Chairperson

Gessow Eugene JD 2

Director for the Division of Medical Services

Hogan William MD, MS 1

Director of Division of Biomedical Informatics

1 University of Arkansas for Medical Sciences, Little Rock, AR, USA 2 Arkansas Department of Human Services, Little Rock, AR, USA

As healthcare reform continues to take a front seat in the political arena, healthcare practitioners are busily determining their role in the potentially chaotic system. More covered lives and less money will only lead to larger gaps in care and lack of regionalization of care. The expert panel will discuss the vision for telemedicine and what role it will play in healthcare reform. The panel discussions will be: “A Vision for Telemedicine and Health Care Reform”, “Can physicians and Hospitals be Accountable Together” and “Achieving the Vision – Payment and Data Reform”. Attendees will learn the role telemedicine will potentially play in healthcare reform.

Objectives

Attendees will learn the role telemedicine will potentially play in healthcare reform.

Attendees will learn how telemedicine can play an integral role in healthcare reform.

Presentation Panel Session Number 24 Session Title: 114 OUTCOMES OF THE UK KENT TELEHEALTH PILOT

Track: Operations, Business & Finance   Room Number: 15/16

MODERATOR: Lisa J. Roberts, PhD, Global and Clinical Innovations Manager, Viterion TeleHealthcare, A Business of Bayer HealthCare, Bellevue, WA, USA

Roberts Lisa J. PhD 1

Global and Clinical Innovations Manager

Price Hazel 2

Whole System Demonstrator Program Manager

Lee Sharon 3

Clinical Development Community Matron

Lee Kim BSc 3

Specialist Community Matron

1 Viterion TeleHealthcare, A Business of Bayer HealthCare, Bellevue, WA, USA 2 Kent County Council, Kent, United Kingdom 3 Eastern/Coastal Kent Community Health NHS Trust, Kent, United Kingdom

Kent County Council in Partnership with NHS West Kent and NHS Eastern and Coastal Kent undertook this telehealth pilot study. This presentation will address four key topics: 1) The overall model and design of the telehealth programme, as well as systemic changes that had to be made due to changes within the NHS and structures of the Primary Care Trusts; 2) Clinical Telehealth competency measures; 3) Process and outcome data, satisfaction, quality of life as measured by the SF-12, and 4) Steps toward mainstreaming for both participation in the largest randomized controlled trial (Whole System Demonstrator with a total sample size of N = 6,000) and ways to engage successful Pilot participants in volunteer roles to serve as champions for Telehealth adoption within their communities. This study included 250 participants with long term conditions including CHF, COPD, and Diabetes. There was even recruitment Region West Kent N = 93, (46%), East Kent N = 109, (54%). There was a larger number of male participants Male N = 113, (55.9%), Female N = 89 (44.1%). Services were organized in three models of care: Specialist Matron N = 53 (26.2%), GP/DN N = 35, (17.3%), Community Matron N = 114, (56.4%) and two types of monitoring: Regular N = 143 (70.8%) and Sporadic N = 59 (29.2%). Results indicated an overall reduction in A&E visits (-88 to − 536). Regular monitoring superior to sporadic as measured by A&E visits (Regular range from − 77 to − 849, sporadic − 11 to + 313). QOL measured by the SF-12v2 (N = 97) with baseline, 6 week and 6 month follow up demonstrated statistically significant reductions in physical component summary scores with improvement most pronounced in East Kent and a decline in mental component scores of less than 1 point (ns). Satisfaction ratings were high and 98% would recommend to others. Cost savings estimated that over the 6 month intervention saved £1,878/ patient in 2006/7 (CI £2,718 to £1,038). Extrapolation across 3 LTC's using HESEA data for 2006/7 results in savings in the order between £10,942.00 and £4,180,000 (stat sig p < 0.05). As a result of the groundwork laid for this pilot, Kent was selected to participate in the largest RCT of telehealth in the UK, referred to as Whole System Demonstrator. Results from WSD will not be released until March 2011, but will also be included in this presentation.

Objectives

Describe the overall model and design of the telehealth programme, as well as systemic changes made due to changes within the NHS and structures of the Primary Care Trusts.

Present process and outcome data, in particular with regard to satisfaction, quality of life as measured by the SF-12, and utilization.

3:00 pm–4:00 pm  Monday, May 2

Individual Oral Panel Session Number 25 Session Title: SUCCESSFUL APPROACHES IN THE USE OF TELEMEDICINE FOR DIABETIC RETINOPATHY

Track: Clinical Services   Room Number: 19

MODERATOR: Giselle Ricur, MD, Director of the Telemedicine Program, Instituto Zaldivar, Mendoza, Argentina

Kanagasingam Yogesan 1

National Research Director

Ting Daniel MBBS 1 2 Constable Ian MBBS 3 Lim Liam MBBS, FRAZCO 4 Preen David PhD 5 Tay-Kearney Mei-Ling MBBS, FRANZCO 2 1 Australian e-Health Research Centre, Perth, Australia 2 Royal Perth Hospital/ University of Western Australia, Perth, Australia 3 Lions Eye Institute, Perth, Australia 4 Royal Perth Hospital, Perth, Australia 5 University of Western Australia, Perth, Australia 560 Low Cost Technology With Video Recording For The Telemedicine-Based Screening Of Diabetic Retinopathy

In this study we have validated a new low cost imaging device with retinal video recording as a new way to perform telemedicine based diabetic retinopathy screening. The new system is validated against gold standard face to face diagnosis by an ophthalmologist. We have imaged a total of 100 patients (200 eyes) attending the diabetic eye clinic. Each patient was imaged using standard retinal still photography (Zeiss FF 450 plus) and retinal video (OIS EyeScan), followed by a ‘gold-standard’ slit lamp biomicroscopy examination by an ophthalmologist. All videos and still images were de-identified, randomized and interpreted by an ophthalmologist according to the International Clinical Diabetic Retinopathy Severity Scales for diabetic retinopathy grading. Kappa statistics, sensitivity and specificity for all the diabetic retinopathy signs and grades were calculated with reference to slit lamp examination. For detection of any grade of diabetic retinopathy, the sensitivity and specificity of the retinal video imaging technique were 93.9% and 98.5% respectively, while retinal photography had a sensitivity of 92.4% and specificity of 98.5%. Both imaging modes had 100% sensitivity and specificity in detecting sight threatening diabetic retinopathy. For overall diabetic retinopathy, the Kappa statistic for retinal video and retinal photography versus the slit lamp were 0.97 and 0.90 respectively. The results indicate that the retinal video recording is a new and effective diabetic retinopathy screening technique which possesses high sensitivity and specificity. Given that it is quick and easy to perform, both medical and non-medical personnel would be able to utilize it with minimal training. The video recording give us the option to obtain wide angle imaging of the retina similar to the 7 field fundus imaging. By making it easier to screen and monitor diabetic retinopathy in the community, particularly in remote areas, this potentially sight-threatening condition may be diagnosed earlier and treated appropriately.

Objectives

To discuss a new way to screen for diabetic retinopathy.

To review low cost and easy-to-operate technologies.

Silva Paolo S. MD 1 2

Assistant Chief of Telemedicine

Cavallerano Jerry D. OD, PhD 1 2 Toson Ann M. BS 1 Tolls Dorothy OD 1 Patel Bina OD 1 Sehizadeh Mina OD 1 Thakore Komal OD 1 Torres Yoanna 1 Rodriguez Jessica 1 Sun Jennifer K. MD, MPH 1 2 Aiello Lloyd M. MD 1 2 Aiello Lloyd Paul MD, PhD 1 2

1 Joslin Diabetes Center, Boston, MA, USA 2 Harvard Medical School, Boston, MA, USA 566 Lack Of Diabetic Retinopathy Awareness And Timely Follow-up Among Patients With Diabetes

Purpose: To evaluate unawareness of diabetic retinopathy (DR) and timeliness of scheduled follow-up among patients evaluated by the Joslin Vision Network (JVN) teleophthalmology program.

Methods: Prospective cross-sectional survey of JVN patients from 12/15/2009-8/31/2010. Patient self-reported history of DR, time since last eye exam, and timing of next scheduled eye exam were recorded prior to retinal imaging and compared with DR severity determined by imaging.

Results: 2,043 patients were evaluated. [Median age 56 years (Q1:44,Q2:66), 54.7% male, 74.5% white, median diabetes duration 9.0 years (Q1:3,Q3:16), median HbA1C 7.7% (Q1:7.0,Q3:9.0)] 1,559 (77.1%) had no or mild nonproliferative DR (NDPR), 463 (22.7%) had moderate or worse NPDR or proliferative DR, 21 (1%) had images ungradable for level of DR. 1,737 (85.0%) had no DME, 136 (6.6%) had DME, 170 (8.3%) had ungradable images for DME. 493 (24.1%) had vision threatening DR (vtDR; moderate NPDR or worse or DME). 594 (77.1%) with any DR and 344 (69.8%) with vtDR were unaware of the presence of DR. Among patients with vtDR, those unaware of their status were older (60.5y vs 56.6y, p = 0.003) and had shorter diabetes duration (14.7y vs 24.1y, p < 0.0001). Among patients with vtDR, 348 (73.5%) had eye examination within 1 year; 213 (45.13%) had either no scheduled follow-up or follow-up interval longer than recommended for the severity of DR found on imaging. Eye care provider type was associated with patient awareness of DR and appropriateness of follow-up with better results associated with more specialized providers.

Conclusions: A large percentage of patients with DR or vtDR remain unaware of their DR. Increased awareness is associated with retinal specialist providers. These data suggest that efforts to increase patient education and access to specialized diabetes eye care are urgently needed. A telemedicine approach, even in patients with self-reported ongoing eye care, might help address these needs.

Objectives

Patient unawareness of diabetic retinopathy despite documented presence.

Importance of diabetes telemedicine eye care program focus on education and access to specialized retinal care.

Zimmer-Galler Ingrid E. MD

Associate Professor of Ophthalmology

Johns Hopkins University Medical Institutions, Baltimore, MD, USA

703 Comparison of Delivery Models with an Established Telemedicine Diabetic Retinopathy Assessment Program

Background: Multiple different models have been described for delivery of care in telemedicine diabetic retinopathy assessment programs. Each model must be tailored to the program's specific goals and objectives. Equally important, the program must be flexible enough to maximize outcomes.

Methods: A well-established diabetic retinopathy program with a dedicated automated fundus camera has been implemented in over 300 primary care practices over the past 8 years. For this program, the traditional delivery model uses trained office staff from each practice to acquire retinal images which are transmitted to a remote reading center for review. A new delivery model using the same fundus camera with specifically trained and certified imagers who travel to individual practices was implemented. With the original testing procedure, patients with diabetes are imaged as they come in for a scheduled visit with their primary care physician. In the new delivery model, patients are specifically scheduled for only an imaging encounter in their primary care physician's office. Outcomes were compared for number of ungradeable images and number of imaging encounters per practice.

Results: Over a 2-month study period, 152 imaging encounters were completed with the new service platform implemented in 5 practices compared to 1,818 encounters completed with the traditional delivery model in 101 practices. The ungradeable rate was 3.8% for the new model compared to 12.4% for the traditional model. Additionally, the number of encounters per practice per month was 15 for the new model and only 9 for the traditional model.

Conclusions: Telemedicine diabetic retinopathy assessment programs are an important adjunct to improve compliance with recommendations for eye evaluation in patients with diabetes. Testing practices can significantly impact outcomes of telemedicine diabetic retinopathy assessment programs. Training and certifying imagers may result in a substantial decrease in the ungradeable rate. Additionally, scheduling patients specifically for retinal imaging may increase the overall capture rate.

Objectives

To review outcome measures and delivery models for telemedicine diabetic retinopathy assessment.

To review differences in outcomes with two different delivery models within an established diabetic retinopathy assessment program.

Discussion Panel Session Number 26 Session Title: 75 BRINGING TELEPSYCHIATRY TO RURAL COMMUNITIES: A MODEL GRANT COLLABORATION IN MARYLAND

Track: Telemental Health   Room Number: 24/25

MODERATOR: Brian Joseph Grady, MD, Director of TeleMental Health, University of Maryland, Department of Psychiatry, Baltimore, MD, USA

Grady Brian Joseph MD 1

Director of TeleMental Health

Honey Jean Nora MBA 2

Telepsychiatry Project Coordinator

Moaney Cherry BS 3

Lead Office Assistant

Pinn Nancy BS 1

Project Manager for TeleMental Health Services

Stammer Tracey 3

Client

1 University of Maryland, Department of Psychiatry, Baltimore, MD, USA 2 Mid Shore Mental Health Systems, Inc, Easton, MD, USA 3 Caroline County Mental Health Clinic, Denton, MD, USA

During 2008 the Maryland Rural Health Care Network Development Grant Program, an integrated urban-rural partnership, launched telemental health services in seven of Maryland's most rural counties. By seamlessly connecting urban providers at the University of Maryland, Department of Psychiatry to a network of rural clinics, 203 public mental health consumers were served and 623 sessions were delivered via telepsychiatry. The treatment modality proved successful in overcoming historical client access barriers in these isolated, underserved communities. Similarly, by expanding service capacity of the clinics, the model gained recognition for its effectiveness in delivering mental health services in rural counties across the state of Maryland. The discussion highlights challenges encountered in developing a multi partnership network operating structure while identifying best practice solutions as building blocks of a comprehensive, integrated rural healthcare network. The panel features a consumer, clinician, program provider and lead urban / rural entities who will share insights from their participation over the three year project lifecycle. Promising practices to maximize client utilization and operational efficiency include: (1) using SharePoint, a common records system shared by remote entities; (2) co-locating staffing structures to promote alignment across referral and service delivery continuums; (3) using a “clearinghouse” approach to identify specialty needs within clinics and contracting appropriate service providers; (4) enhancing clinical utilization through time sharing arrangements between clinical partners; (5) developing an originating site fee mechanism to reimburse clinics for administrative costs while incentivizing higher utilization and appointment ratios; and(6) expanding the scope of services by leveraging the existing network site structure.

Objectives

The panel will share insights on lessons learned from their participation in Maryland's Rural Health Care Network Development Grant Program.

Partners will discuss the building blocks of a blue print Rural Health Care Network Development Grant Program emphasizing integrated systems and operating architecture to promote alignment across referral and service delivery continuums.

Discussion Panel Session Number 27 Session Title: 64 MOBILE HEALTH IN THE DEVELOPING WORLD – GAPS AND OPPORTUNITIES

Track: Mobile Health   Room Number: Ballroom A

MODERATOR: Jean-Louis Belard, MD, PhD, Senior Clinical Advisor for Integrative Medicine, Telemedicine and Advanced Technology Research Center, Fort Detrick, MD, USA

Belard Jean-Louis MD, PhD 1

Senior Clinical Advisor for Integrative Medicine

Barrigan Cynthia RN, MPH 1

Portfolio Manager, International Health Programs

Augusterfer Eugene F. LCSW 2

President

Katzenstein James MBA, PhD 3

Executive Director

1 Telemedicine and Advanced Technology Research Center, Fort Detrick, MD, USA 2 Creative Strategies International, LLC, McLean, VA, USA 3 Healthspan International, Mission Viejo, CA, USA

The panel will focus on development and implementation of telemedicine, telemental health and technology as capacity building in the developing world with a focus on how mobile health, m-health, promises to play a significant role in the delivery of sustainable healthcare in rural areas of the developing world, specifically Sub-Saharan Africa. Following an overview and needs assessment as defined by the U.N. Development Programme and the World Health Organization, there will be an in-depth discussion of best practices using the case study method of each panelist's area of expertise, including the roles of humanitarian, military and academic institutions. Case studies will include both peer reviewed published material as well as data based on each panelist's experience.

Objectives

Gain valuable information regarding the health needs in Sub-Saharan Africa, including primary care, women and children's health and mental health.

Gain an understanding of the role of telemedicine in meeting the gaps of sustainable healthcare that exist in the developing world and the challenges of implementing telemedicine and telemental health.

Individual Oral Panel Session Number 28 Session Title: TELEHEALTH BEST PRACTICES FOR CHF, COPD & DIABETES

Track: Remote Monitoring   Room Number: 20/21

MODERATOR: James Mathers, MD, FCCP, Past President, American College of Chest Physicians, Richmond, VA, USA

Allegra Mary T. RN, MSN

Vice President

Masonicare Home Health & Hospice, Wallingford, CT, USA 239 Telemonitoring Supports Safe Transition from Hospital to Home for Patients with Heart Failure

Objective The 30-day hospital readmission rate for patients with congestive heart failure (CHF) in the U.S. is approximately 25%, at an estimated cost of $7,000 per readmission. This study tests the hypothesis that home care nurses, advanced practice nurses (APRNs) and cardiologists, using team management and daily telemonitoring of vital signs and symptoms, can reduce the 30-day readmission rate by 10%.

Method Patients discharged from hospital with a primary diagnosis of CHF during a 12-month period (n = 111) were trained to use home telemonitors (LifeLink Monitoring, Lake Katrine, NY) and to monitor and send weight, blood pressure, heart rate, O₂ saturation and symptoms daily. Home care nurses, including APRNs, were trained in post-discharge CHF management. A hospital-to-home coordinator attended daily CHF rounds to assess patients' needs prior to discharge. Home care nurses assisted in transition to home, educating patients and caregivers about diet, medication and signs and symptoms of CHF decompensation to report to clinicians. Nurses reviewed telemonitoring data on the Internet daily, calling patients to discuss causes of sudden weight gain, symptoms and other abnormalities. Telemonitoring data were reviewed at least weekly by cardiologists and APRNs, with medication reviews as needed.

Results The 30-day readmission rate was reduced to 13%, significantly exceeding the goal. Readmission rates for each quarter of the 12-month study period ranged from 9% to 17%.

Conclusion Case management guided by telemonitoring of weight, BP, SpO₂ and symptoms significantly reduced readmission for patients with CHF. Telemonitoring data enabled nurses to respond rapidly to adverse changes and to teach patients and caregivers better management of CHF. Further study is warranted to determine the contribution of each element of the intervention. A randomized controlled trial will enable a rigorous economic analysis.

Objectives

Describe a best practice intervention that can assist with transitioning patients safely from hospital to home.

Identify how telehealth can help to decrease hospital 30-day readmission rates.

Poole Laurie RN, BScN, MHSA

Vice President

Telemedicine Solutions, Ontario Telemedicine Network, Toronto, ON, Canada

342 Planning for an Expanded Telehomecare Program in Ontario, Canada

In 2007, the Ontario Telemedicine Network launched a Phase One Telehomecare Program (OTN) to support patients with Congestive Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD). Under the project leadership of OTN, eight Primary Care Teams in Ontario enrolled 813 patients in the Program, making it the largest telehomecare program in Canada. The project provided remote monitoring and patient self-management support to patients with CHF and COPD. Patients were equipped in their homes with a touch screen monitor and peripheral devices that captured vital sign data, provided education content and health status questionnaires. A nurse in each primary care team was responsible for patient recruitment, enrollment, monitoring and education. Following a four month monitoring period, the patients were formally discharged from the program but continued to receive support from the multidisciplinary team at the primary care team. The program was evaluated by an independent third party organization. Enrolled patients were almost universally satisfied with the program. They found the remote monitoring technology very easy to use and reported high levels of satisfaction with the information they received from telehomecare nurses and other providers. A key finding of the program was the reduction in health system utilization. Hospitalization was reduced by 66% for CHF patients and 64% for COPD patients. CHF and COPD patients reported significant reductions in emergency department by 72% and 74% respectively. Patients had fewer unplanned visits to their primary care physician, demonstrating that telehomecare patients are better at managing their chronic disease. OTN is currently working on an expansion plan to support the enrollment of 40,000 patients with complex chronic diseases over a three year period. OTN will develop a telehomecare utility to give providers a single point of access to telehomecare services and support. OTN will build the telehomecare architecture so that it aligns with the province's overall e-health blueprint and conforms to provincial standards and specifications. To support healthcare providers, OTN will also develop telehomecare best practices and change management and adoption strategies to support an expanded program.

Objectives

Outline the business and technical requirements to support an expanded telehomecare program.

Outline the change management and adoption strategies to support an expanded telehomecare program.

Gallagher Bridget GNP, MSN

Senior Vice President

Community Services, Jewish Home Lifecare, New York, NY, USA

444 Managing Chronic Illnesses with Telehealth in a Best Practice Framework

Jewish Home Lifecare's use of telehealth technologies, such as remote monitoring units, medication dispensers and telehealth kiosks, are enhanced by performance measurement and management, and a robust program of evidence-based best practices. JHL's telehealth program has achieved and sustained positive outcomes in a number of areas; including a decrease in overall long-term home healthcare patient hospitalizations by more than 15%. Clinical best practices allow our telehealth program to become much more than the sum of its technological parts. Our organization uses the FADES model (Focus, Analyze, Develop, Execute and Study) to improve clinical outcomes. While Focusing on hospitalization rates, an Analysis revealed that the most frequent cause of acute care hospitalization was Congestive Heart Failure (CHF). This evidence prompted an extensive literature review, which guided a committee of clinicians in Developing a clinical best practice for clients with CHF. Execution was preceded by intense in-service training for all clinical staff. Studying the impact of our best practice, we found that for CHF clients, the re-hospitalization rate decreased from 16% to below 5%, a level which has been sustained for over eight years. JHL received two grants from the NY Dept of Health to determine the effectiveness of telehealth. The studies compared the outcomes of clients with diabetes using the Health Buddy, compared to those with a Health Buddy and Medication Dispenser, compared to those who only used the JHL best practice. 54% of clients using the JHL best practice had a decrease in A1C which is quite impressive. However, when combining telehealth with our best practice, 67% of clients using the Health Buddy had a decrease in A1C, and 74% of those using the Health Buddy and Medication Dispenser experienced a decrease. JHL found that using telehealth in conjunction with our best practice had the greatest impact on clinical outcomes.

Objectives

To understand how to effectively use telehealth in a best practice framework.

To demonstrate the impact of using telehealth to improve clinical outcomes.

Presentation Panel Session Number 29 Session Title: 111 ROBOTICS AND TELEMEDICINE: TECHNOLOGY ADVANCEMENTS TO ENHANCE REMOTE DIAGNOSTICS AND PATIENT CARE

Track: Technology & Telecommunications   Room Number: 22/23

MODERATOR: Ronald Marchessault, Jr., Program Manager, Technology Transfer & Transition, TATRC, Fort Detrick, MD, USA

Marchessault Ronald Jr. 1

Program Manager, Technology Transfer & Transition

Hu John PhD 2

President & CEO

Wang Yulun PhD 3

Chairman & CEO

Matthews Judith Tabolt PhD, MPH, RN 4

Assistant Professor of Nursing

1 TATRC, Fort Detrick, MD, USA 2 Hstar Technologies Corp, Cambridge, MA, USA 3 InTouch Health, Santa Barbara, CA, USA 4 University of Pittsburgh, Pittsburgh, PA, USA

Robotics and telecommunications technologies are converging to deliver significant advancements in healthcare delivery, not to replace human abilities but to extend them. We will explore this evolving technology sector from three vantage points: technology that is available today, delivering remote presence telemedicine across a wide range of clinical applications; future applications for humanoid robotic systems; and the clinician's perspective on opportunities and critical constraints. Dr. Yulun Wang, Chairman and CEO of InTouch Health, will discuss current telemedicine solutions utilizing InTouch's remote presence endpoints, including the RP-7 mobile robotic platform, and how this is changing the way hospitals utilize scarce specialist resources to deliver essential care anywhere. Application areas include telestroke networks, critical care coverage, and multi-specialty outreach to underserved or remote hospitals that lack critical expertise. Dr. Wang will explore challenges hospitals need to overcome to implement remote presence solutions, and offer his view of future opportunities. Dr. John Hu, President and CEO of Hstar Technologies, will discuss the opportunity for humanoid robotics systems to serve as clinical assistants, integrating teleoperation and telecommunications with direct, physical assistance to complement the abilities of local and remote staff. Dr. Hu will present the Remote Nursing Assistant (‘RoNA’), a bi-manual system capable of lifting 300 pounds or more, to assist nurses with patient lifting and maneuvering, while offering additional manipulation and sensing capabilities to enhance telemedicine applications. Dr. Judith Matthews, Assistant Prof. of Nursing at the University of Pittsburgh, will outline key areas where robotics can enhance the physical abilities of nurses to care for patients, and discuss challenges from a safety and care delivery perspective. She will discuss critical enablers from the service delivery side, above all patient and worker safety, as well as the softer side of robotics – the human interface, its look and feel, and how to gain the confidence and support of caregivers.

Objectives

Learn how robotics and telecommunications capabilities are combining to deliver significant advances in medical care.

Consider the long-term opportunity to improve care and reduce costs by extending human capabilities through the combination of robotics and telehealth services, and begin to factor these into hospital 5 and 10-year plans.

Presentation Panel Session Number 30 Session Title: 83 PROMOTING LICENSURE PORTABILITY FOR PHYSICIANS: WHERE WE ARE AND WHERE DO WE NEED TO GO

Track: Public Policy   Room Number: Ballroom D

MODERATOR: Christine Martin, MBA, Executive Director, California Telemedicine and e-Health Center, Sacramento, CA, USA

Martin Christine MBA 1

Executive Director

Puskin Dena Saltzman ScD 2

Senior Advisor

Robin Lisa 3

Senior Vice President

Ranslow Betsy MS, OT/L 4

Director, Division of Stakeholder Engagement/Policy

1 California Telemedicine and e-Health Center, Sacramento, CA, USA 2 Health Resources and Services Administration, Rockville, MD, USA 3 Federation of State Medical Boards, Washington, DC, USA 4 Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, Washington, DC, USA

Promoting greater licensure portability is frequently cited as one of many strategies to overcome cross-state licensure barriers to more effective and efficient Telehealth practice. Streamlined and more uniform licensure application processes, including uniform licensure applications and other administrative simplifications, are key first steps in improving licensure portability. This session will review Federal and State efforts to streamline the physician licensure process, emphasizing the implications of these efforts for advancing Telehealth practice. The discussion will focus on activities of the Federation of State Medical Boards (FSMB), the National Governors Association's State Alliance for e-Health, as well as lessons learned from grant/contractual activities funded by the Federal government. Currently, 25 state medical boards are implementing the FSMB's uniform application to simplify the licensure application process. The FSMB is redesigning its Federation Credentials Verification Service (FCVS) to facilitate state medical boards efficiently obtaining verified, primary source record of a physician's core medical credentials, thereby expediting the licensure application process. All states, except Arkansas and Nebraska, accept the FCVS and 12 states require it. Finally, with a grant from the Health Resources and Services Administration, the FSMB is advancing adoption of expedited licensure policies under which application processing is expedited for applicants with active licenses in good standing from other states in which the applicants practice. Idaho, Iowa, Michigan, Nevada, New Mexico, North Carolina, Oregon, and Rhode Island currently have adopted the expedited endorsement process. The State Alliance has challenged state medical boards to work together to streamline the licensure process and has been working on developing practical implementation strategies to assist in this effort. Despite these efforts, licensure portability initiatives face strong political, cultural, and economic challenges. Panel members will review these challenges and suggest possible next steps for overcoming them in light of their implications for effective Telehealth practice.

Objectives

To understand the implications for Telehealth of ongoing Federal and State efforts to streamline the physician licensure process.

To understand the challenges to overcoming barriers to licensure portability initiatives and next steps for overcoming them in light of their implications for effective Telehealth practice.

Presentation Panel Session Number 31 Session Title: 133 INTEROPERABILITY OF HEALTH DEVICES AND HEALTH INFORMATION

Track: Operations, Business & Finance   Room Number: 13/14

MODERATOR: Dale Alverson, MD, Medical Director, Center for Telehealth, University of New Mexico Health Sciences, Albuquerque, NM, USA

Alverson Dale MD 1

Medical Director, Center for Telehealth

Parker Chuck 2

Executive Director

Hogge Nathan 3

Product Manager

1 University of New Mexico Health Sciences, Albuquerque, NM, USA 2 Continua Health Alliance, Beaverton, OR, USA 3 Alaska Native Tribal Health Consortium, Anchorage, AK, USA

Deciding how to move healthcare data leads one into a swarm of information on standards, frameworks, programs, policies and discussions on interoperability. This ever evolving target of ubiquitous health information exchange is riddled with acronyms, rulings and shifts in direction. This “how to” session will take a high level overview of the current state of interoperability of healthcare data leaving no acronym behind. Panelists will cover the basics on current key topics surrounding healthcare information exchange how they apply to you.

Individual Oral Panel Session Number 32 Session Title: EXPERIENCES WITH LARGE-SCALE TELEHEALTH INITIATIVES

Track: Operations, Business & Finance   Room Number: 15/16

MODERATOR: Ed Brown, MD, Chief Executive Officer, Ontario Telemedicine Network, Toronto, ON, Canada

Lowery Curtis MD 1

Department Chairperson, Tina Benton, RN, BSN¹

Abbiatti Michael EdS 2 Franklin Ed EdD 2 Manley Michael RNP 1 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA 2 ARE-ON, Fayetteville, AR, USA 512 Rural State-Robust Telemedicine: Strategies for Statewide Telemedical Saturation

Barriers to care, health disparities, limited transportation, high poverty, professional isolation, distrust of other physicians, and programmatic silos as far as the eye can see. When Arkansas began its telemedical efforts, the economic and political climate was far from perfect, and the steps to move from isolation to saturation were staged over seven years. As lessons were learned and successes achieved, a strategy to telemedical saturation formed:

Send outreach workers to travel into rural areas to educate providers about telemedicine, while assuring them telemedicine would support their consumers and practice, not “steal” them.

Make champions of the physicians who adopted the technology.

Welcome partnering agencies into your network; other healthcare and educational agencies make a difference in offering comprehensive telemedicine services.

Find a variety of programs and services to share and exchange with partners, so all consumers benefit from the greatest number of services.

Fortify and (re)build relationships with agencies who may perceive these efforts as unfriendly competition.

Search and apply for grants that build your broadband to a comprehensive status. Designate a leader, form advisory boards to steer the project, and make certain all partners and their interests are well represented.

Fold in non-traditional partners to expand your reach, such as community colleges, public libraries, and public schools.

Offer training and education on telemedicine, enabling those interested to visit your facilities to learn about the technology.

Continue outreach and education to rural areas.

Using these strategies, Arkansas's only academic medical center and its partners have built a network of 474 partners in 135 communities, including Arkansas's hospitals, all four-year and two-year colleges, all state human development centers, the state's trauma network, community health centers, mental health clinics, home health agencies, and many more.

Objectives

Attendees will learn how one rural state went from healthcare isolation to saturation through telemedicine.

Attendees will learn lessons that successfully transform a rural area into a telemedicine network that improves patients' access to healthcare.

Sossong Sarah MPH

Center for Healthcare Delivery

Crowley Eileen MD Kaiser Permanente, Oakland, CA, USA

251 Regional Telehealth Strategy, Planning, and Implementation at Kaiser Permanente

Kaiser Permanente (KP) is breaking new ground in telemedicine as it uses its integrated organizational structure to move into the telehealth space. Although a relatively new player in the telehealth space, KP used Teledermatology as it's first foray into telehealth, and KP's Teledermatology program now boasts full implementation in over 13 major medical centers and 25 satellite facilities providing a volume of over 3 K monthly teledermatology consultations and over 30 K consultations since the programs inception in January 2009. As an integrated healthcare delivery system, KP possesses many of the crucial elements needed for successful telehealth design and delivery. However, these advantages also presented significant challenges to effective telehealth system design, piloting, implementation, and ongoing monitoring for success as seen through the use case of Teledermatology. This presentation will provide an overview of the approach used for designing Northern California's telespecialty infrastructure through KP's first telespecialty program - Teledermatology. The presentation will provide an overview of KP telehealth strategy, use cases, and future directions. Specific to Teledermatology, the discussion will address the major challenges faced in KP's design and implemention. Focus will be in the solutions and best practices identified to address these challenges, including utilization of KP's National Garfield Innovation Center, building new tele-worklist functionality into the EMR, rapid cycle workflow improvement tactics with physicians and staff, and development of meaningful metrics and dashboards for continual quality & service improvement. Finally, the presentation will address future challenges to the Telederm program and telehealth generally, including the rapidly expanding use of KP's member web portal by patients to diagnose and treat medical conditions without an in-person doctor's visit.

Objectives

Share the innovative approaches taken to designing a large scale telehealth program at Kaiser Permanente.

Discuss the benefits and drawbacks of telehealth system design in a large scale integrated healthcare system.

McVeigh Francis L. OD, FAAO, MS

Senior Clinical Consultant, IPA, TATRC, Fort Detrick, MD, USA

573 Outcome Metrics and Effectiveness of the Army-wide Tele-Health Network Across 19 Time Zones

An Army-wide U.S. telemedicine network has been developed to meet the evolving clinical needs of a geographically dispersed military population. The network spans across five regional medical commands, 19 time zones and 50 countries - including the U.S., American Samoa, Germany, Iraq and Afghanistan. Outcome metrics and evidence, best practices, and clinical and administrative assessments were documented. Over ninety sites were actively engaged in telehealth encounters and involved 29 different specialty areas of emphasis. Greater than 40,000 telehealth encounters were conducted in the years 2009 and 2010 with a 70% increase in 2010. A greater than $2.1 million ROI in tele-neurosurgery in 2009 and greater than $2 Million in telehealth cost avoidance were realized in 2010. Tele-consultation clinical models such as behavioral health, neurosurgery, headache evaluation, neuropsychology, and speech and language pathology were established. Telemedicine increased access to care up to 28 days in some areas, reduced patient and specialist travel, decreased lost work times, returned money to the medical command by avoiding clinical referrals to the civilian sector, and was widely accepted among the patient population. Challenges such as physician and leadership buy-in, identifying outcome metrics, managing from afar, and measuring the return on the investment were addressed. Various tele-behavioral health initiatives were established to connect Soldiers far forward in the battlefield with providers. This presentation will highlight the metrics collected that were used to evaluate the tele-TBI and tele-behavioral health networks, highlight the diverse clinical applications in the network, and discuss emerging future initiatives into patients' homes.

Objectives

1 Participants will be able to describe the quantitative and qualitative benefits of using telemedicine for TBI patients.

2 Participants will be able to reference and build upon successful tele-TBI clinical models that were implemented such as: neurosurgery, behavioral health, headache clinics, speech and language pathology, and others.

4:15 pm–5:15 pm  Monday, May 2

Presentation Panel Session Number 33 Session Title: 105 OFFICIAL TELEHEALTH PRACTICE GUIDELINES FOR DIABETIC RETINOPATHY - OVERVIEW AND LATEST UPDATE

Track: Clinical Services   Room Number: 19

MODERATOR: Helen K. Li, MD, Adjunct Associate Professor, School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA

Li Helen K. MD 1

Adjunct Associate Professor, School of Biomedical Informatics

Cavallerano Jerry OD, PhD 2

Co-Director, Center of Ocular Telehealth, Beetham Eye Institute

Bursell Sven E. PhD 3

Director, Telehealth Programs

Horton Mark B. OD, MD 4

Chief, Eye&ENT; Director, IHS-JVN Teleophthalmology Program

1 University of Texas Health Science Center, Houston, TX, USA 2 Joslin Diabetes Center, Boston, MA, USA 3 University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA 4 Phoenix Indian Medical Center, Phoenix, AZ, USA

ATA Practice Guidelines for Ocular Telehealth for Diabetic Retinopathy (DR) were originally published in 2004. The purpose of these guidelines is to (a) promote informed and reasonable expectations by the patient, provider, healthcare facility, and third party payer, (b) address clinical, technical and administrative components of such programs, and (c) form the basis for evaluating and selecting diabetic retinopathy telehealth techniques and technologies for specific programmatic implementation. ATA sponsored writing committees reviewed and updated the original version of Telehealth Practice Recommendations for Diabetic Retinopathy. Revisions maintain the clinical, technical, and operational structure of the original document, and reflect changing trends in telehealth occurring since the first version of the guidelines. ATA Guideline Committee editorial input and public comment guided final changes to the document. This panel will provide an overview of the 2010 revision of the guidelines with an emphasis upon new content and public comment.

Objectives

The audience will understand the purpose and application of the ATA Practice Guidelines for Diabetic Retinopathy, and recognize important areas of update from the original version published in 2005.

The audience will understand the distinction between the four validation categories defined in the ATA Practice Guidelines for Diabetic Retinopathy.

Presentation Panel Session Number 34 Session Title: 104 SUCCESSFUL TELEMENTAL HEALTH APPLICATIONS IN DIVERSE INSTITUTIONAL SETTINGS

Track: Telemental Health   Room Number: 24/25

MODERATOR: Paula Guy, Executive Director, Georgia Partnership for TeleHealth, Waycross, GA, USA

Guy Paula 1

Executive Director

Kirson Joel MD 2

Medical Director

Goldstein Felissa MD 3 Hanna Mona MD 4

Medical Director

1 Georgia Partnership for TeleHealth, Waycross, GA, USA 2 Anchor Hospital, Atlanta, GA, USA 3 Child & Adolescent Psychiatrist, Marcus Autism Center, Atlanta, GA, USA 4 Ogeechee Behavioral Health Services, Swainsboro, GA, USA

The Georgia Partnership for TeleHealth (GPT) was recently awarded funding to operate the Southeast Telehealth Resource Center, as well as stimulus funding to expand an already robust network consisting of 172 sites to date. GPT's network offers over 40 medical specialties, and has seen much success in its telemental health programs, in particular, with approximately 3,700 telepsychiatry encounters conducted in 2009. Numerous psychiatrists throughout the state provide care to diverse populations in a variety of settings. This proposed panel presentation will highlight four such applications, including telepsychiatry for:

Emergency Departments • Nursing Homes.

Autistic Children and Adolescents.

Community Mental Health.

Attendees of this presentation will learn best practices for telepsychiatry in these areas, including:

Processes and protocols.

Patient outcomes/success stories.

Guidelines for handling emergencies that may arise during telepsychiatry consultations.

The panelists will include Dr. Joel Kirson, Medical Director of Anchor Hospital in Atlanta, who provides telepsychiatry to emergency departments and nursing homes in rural Georgia; Dr. Felissa Goldstein, a psychiatrist at Marcus Autism Center in Atlanta, whose telemedicine clinics increase access to care for rural Georgians with autism; and Dr. Mona Hanna of Ogeechee Behavioral Health Services, a community service board in rural Georgia that provides substance abuse and mental health services to residents of the counties it serves. The panel will be moderated by Paula Guy, Executive Director of the Georgia Partnership for TeleHealth.

Objectives

How to use telemedicine in a variety of mental health settings.

How to deal with emergencies during telemental health encounters.

Presentation Panel Session Number 35 Session Title: 110 USABILITY, ACCESSIBILITY AND INTEROPERABILITY STANDARDS FOR MULTIMODAL MOBILE HEALTHCARE & CLINICAL TRIALS APPLICATIONS

Track: Mobile Health   Room Number: Ballroom A

MODERATOR: Raj Tumuluri, President, Openstream Inc., Somerset, NJ, USA

Tumuluri Raj 1

President

Dahl Deborah 2

Principal

Wacinski Thomas A. 3

Chief Technology Officer and Director

1 Openstream Inc., Somerset, NJ, USA 2 Conversational Technologies, Somerset, NJ, USA 3 EasyMed Services Inc, Toronto, ON, Canada

Recent advances in mobile technologies are heralding new ways to provide quality patient-care, reducing time-to-bring life-saving drugs to the market and increasing the efficacy of Clinical Trials. Current mobile application trends are geared to reduce wastage and loss of life due to poor compliance. However, the lack of convenient and accessible user interfaces has been limiting the success and wide-scale adoption of these mobile applications. Several standards bodies have taken notice of this fact and the new W3C standards work on multimodal interaction will address the interactivity and accessibility needs of the young and old alike. Recent developments in context-aware user-interfaces and standards that combine touch-tap and speech have made the consumer-class of mobile devices interfaced with other measuring instruments, a viable option for high-quality medical services and are now available for remote patients and urgent cases. The Internet, World Wide Web (WWW), Mobile Devices as a global information infrastructure now offer a low cost environment for telemedicine applications. The new multimodal interfaces improve interaction with these healthcare applications make them ideal for effective collaboration in a natural way through mobile devices. In this session we will present the current standardization effort in this area, discuss the inter-operability of the multimodal healthcare applications and the new trends in healthcare and monitoring applications. We will also review the best practices for ensuring that these applications meet the usability and accessibility needs of patients and care-givers.

Objectives

To inform, educate and critique the relevant international standards.

To review the best practices for ensuring that applications meet the needs of patients and care-givers.

Presentation Panel Session Number 36 Session Title: 24 USING PERVASIVE INFORMATION CONVERGENCE FOR TELEHEALTH

Track: Remote Monitoring   Room Number: 20/21

MODERATOR: Nancy Green, Healthcare Managing Principal, Verizon, Ashburn, VA, USA

Green Nancy 1

Healthcare Managing Principal

Krishnan Ravi 2

Industry Partner

Grundler Gerard CPHIMS, PMP 3

Managing Principal, Healthcare Practice

1 Verizon Business, Ashburn, VA, USA 2 Verizon Business, San Francisco, CA, USA 3 Verizon Business – Global Services, Washington, DC, USA

The assimilation of information technology, telecommunications and the clinical domain is shifting the traditional definition of Telehealth and Home Health. Today, Telehealth is seen not just as remote video communication, but much more as a full-fledged virtual care continuum platform; one, where the entire provider ecosystem — physicians, care givers, patients, payers, and administrators — has an integral role. In the new era of Telehealth, the key thrust is not just on care delivery, but on wellness management. And, most importantly, the imperative in the modern paradigm of Telehealth is not as much on data transmission, as it is on information convergence. But how healthcare providers should deal with information convergence? This presentation will: Highlight trends on how clinicians can consult with patients and other specialists virtually on any device. Clinicians can access all relevant information concurrently, and, most importantly, they can move from one device/platform to another during the session without breaking the session up. At the backend, the ‘transacted’ session is saved and seamlessly communicated to data repositories and can be viewed, annotated, and edited as required. Educate the audience on how the synergy of IT and Telecommunications is making tangible a much more powerful concept — information convergence, or, ‘Always On’ Healthcare. In this new world, pertinent health information is available at the fingertips of all concerned parties in a healthcare process-chain seamlessly. We will share some best practices on how to maximize and guarantee access to clinical services regardless of platform, device and/or systems –while keeping secure identity, access, and authentication protocols. Provide best practices on how to enable and manage the entire platform from the cloud. Trends on how every day more, the technology infrastructure is far less likely to be physically housed at the provider's data center, and is more likely to be managed in a cloud by the solution provider, thus allowing for a substantially reduced capital investment.

Objectives

Define information convergence in a healthcare context and to delineate its relevance in Telehealth.

Reproduce a telehealth, home health and mobile health strategy within your organization.

Presentation Panel Session Number 37 Session Title: 71 JOINT MEDICAL DISTANCE SUPPORT AND EVACUATION – JOINT CAPABILITIES TECHNOLOGY DEMONSTRATION

Track: Technology & Telecommunications   Room Number: 22/23

MODERATOR: COL Ronald K. Poropatich, MD, Deputy Director, USAMRMC/TATRC, Fort Detrick, MD, USA

Poropatich COL Ronald K. MD 1

Deputy Director

Cook Greg W. PhD 2

Chief, Medical Concept Development

Manemeit Carl BS/MS 1

Joint Combat Casualty Care System Project Manager

Gilbert Gary R. PhD 3

Research Portfolio Manager

1 USAMRMC/TATRC, Frederick, MD, USA 2 US Joint Forces Command J02M, Norfolk, VA, USA 3 USAMRMC/TATRC & Georgetown University ISIS Center, Fort Detrick, MD, USA

The United States Joint Forces Command (USJFCOM) is conducting a Joint Capability Technology Demonstration (JCTD) called the Joint Medical Distance Support and Evacuation (JMDSE). The objective is to demonstrate on demand just-in-time delivery of comprehensive combat casualty care capabilities to medics or corpsmen in isolated environments via the Joint Precision Air Delivery System - Medical (JPADS-Med) in order to enhance battlefield medicine, support medical forces and act as a force multiplier for high-demand low-density assets. Dubbed, the Joint Combat Casualty Care System (JCCCS), these enhanced capabilities will augment and extend in-place combat casualty care within forward Army, Marine Corps and Special Operations ground forces, Air Force Para-rescue teams, and Navy ships that have limited organic medical support. Medics or corpsmen will have the capability to capture and transmit digital physiological monitoring data and other elements common to the Tactical Combat Casualty Care (TCCC) Card. Over the past two years, the JMDSE JCTD has funded upgrades and integration among commercial medical devices, like the Tempus-IC, a physiological monitoring and telemedicine system with the capability to transmit medical data via WiFi or Ethernet connection. A professional version has been developed for the military with the capability to enter patient medical data on an electronic TCCC card, a screen dimmer for night operations, a polarized screen to reduce sun glare, optional ultrasound and laryngoscope capabilities, and the capability to transmit medical data using military tactical radios. During 2010-11 the JMDSE JCTD completed three operational demonstrations and combat medic user assessments. We discuss the operational concept, the user generated requirements, the technologies employed, evaluation methodologies, and results.

Objectives

Provide overview of Joint Medical Distance Support and Evacuation (JMDSE) Joint Capabilities Technology Demonstration (JCTD) Joint Combat Casualty Care System (JCCCS).

Discuss results and lessons learned during development and user assessment of JMDSE JCTD technologies.

Presentation Panel Session Number 38 Session Title: ACHIEVING THE POTENTIAL OF THE FCC's TELEHEALTH AND BROADBAND PROGRAMS

Track: Public Policy   Room Number: Ballroom D

MODERATOR: William England, PhD, JD, Vice President, Rural Healthcare Division, Universal Service Administrative Company, Washington, DC, USA

England William PhD, JD 1

Vice President, Rural Healthcare Division

McDermott Kerry MPH 2

Director, Healthcare, Office of Strategic Planning and Policy Analysis, Expert Advisor, National Broadband Task force

Brown Eric MBA 3

President and CEO

1 Universal Service Administrative Company, Washington, DC, USA 2 Federal Communications Commission, Washington, DC, USA 3 California Telehealth Network, Sacramento, CA, USA

The prospect of a revamped FCC rural health program to actually spend most of the $400 million allocated annually and of the federal government's new initiative to expand broadband services are potentially powerful tools for the future of telehealth. This session will provide at early peek at that future.

Individual Oral Panel Session Number 39 Session Title: TOOLS TO IMPROVE EFFICIENCY AND EFFECTIVENESS OF TELEHEALTH

Track: Operations, Business & Finance   Room Number: 13/14

MODERATOR: Rashid Bashshur, PhD, Director of Telemedicine, Professor of Health Management Policy, Telemedicine Resource Center, University of Michigan Health System, Ann Arbor, MI, USA

Azarbayejani Ali PhD 1

Chief Scientist

Feast Joshua MBA 1 Zhang Chuan SM 1 Massey Anthony MD, MBA 2 1 Cogito Health, Inc., Charlestown, MA, USA 2 CIGNA, Medical Services, Eden Prairie, MN, USA 229 Computational Speech Behavior Analysis for Predicting Engagement in Telephone-Based Healthcare

Purpose: Telephonic health coaching of population members with modifiable risk-factors can result in positive behavior change and better health. However, the healthcare industry successfully engages less than 50% of members targeted for telephonic coaching. We examine how computational speech behavior analysis in telephone-based outreach can measure and help improve engagement levels.

Design: Existing recorded telephone calls from a coaching enrollment activity are associated with known enroll/attend outcomes NO, YES/SHOW, and YES/NOSHOW. Speech behavior during the calls is analyzed to infer engagement levels and predict outcomes.

Setting: Calls are taken from an existing Depression Disease Management Program enrollment activity.

Subjects: A random sample of 88 cases are divided evenly 29/30/29 amongst the three outcomes.

Analysis: Accuracy of predictive models is measured in-sample. Standard statistical tests including LOOCV, complexity, and error bound methods characterize generalizability.

Results: Findings include 78% successful enrollment when agents employ an effective speaking style (versus 35% otherwise) and 84% predictive accuracy among those predicted to miss their coaching appointment.

Conclusion: Speech behavior during enrollment call is predictive of engagement, specifically enrollment and attendance outcomes, and can be computationally measured automatically. Operationalized systems can be used to provide guidance for intervention, facilitating varying levels of outreach according to a member's needs, which can improve efficiency and effectiveness of these programs. Operationalized systems can also be used to train agents by providing feedback on speaking styles, helping them become more effective and persuasive.

Key Words: Health Coaching, Disease Management, Engagement, Telephonic Coaching, Speech Behavior Analysis

OPEN IN VIEWER

Results
	Outcome		PredictiveAccuracy	OverallAccuracy
Getting to Yes	No	Yes		0.75
Predicted No	15	8	0.65
Predicted Yes	14	51	0.78
Classification Accuracy	0.55	0.86
Getting to Show	NoShow	Show		0.78
Predicted NoShow	21	4	0.84
Predicted Show	9	25	0.73
Classification Accuracy	0.70	0.86

Objectives

Automated speech behavior analysis in telehealth settings can predict engagement outcomes.

Predicting engagement outcomes facilitates varying outreach efforts according to.

Martin Christine L. MT, MBA, PMP

Executive Director

California Telemedicine & eHealth Center, Sacramento, CA, USA

365 Developing a Standardized Data Set for Monitoring Telehealth Program Performance

Routine monitoring of program performance is a fundamental success factor for telehealth programs. Well run programs identify program performance indicators, collect and analyze data and make program adjustments based on performance data. In 2010 the California Telemedicine & eHealth Center, CTEC, brought together a national panel of experts to identify a set of recommended performance indicators and the minimum data set that supports the indicators. Over 80 indicators were identified in areas that include program operations, provider measures, home monitoring, teleICU, Emergency Department, patient measures and economic measures. This presentation will present the process used to identify the performance indicators and data elements and will present the indicators and data set recommended by the national panel of experts.

Objectives

Provide findings of national experts panel on data set for program performance monitoring.

Discuss need for standardized data collection for managing program performance.

Unruh Kenton T.

Program Administrator

University of Washington, Seattle, WA, USA

400 Rethinking the Role of Clinical Workflow in the Design of Videoconferencing Systems for Telehealth

Diffusion of scientific knowledge into best practices takes decades. The delay in disseminating evidence-based practice from academic medical centers to community-based clinicians threatens the quality of care available to most of the U.S. population who receive healthcare in local communities. To address this problem, the University of Washington deployed lightweight videoconferencing to community clinicians' existing desktop computers, providing them with videoconferencing access to psychiatry, addictions, hepatology, and infectious disease specialists. From 2009 to 2010 over 30 different clinicians, in 18 community and tribal clinics presented over 200 patient cases to clinical specialists at the University of Washington. Core to the success of this program was the deployment of lightweight PC-based telecommunication technologies directly to clinicians' desktop, bypassing traditional high-end endpoints that usually reside in conference rooms or dedicated offices. An internal clinical workflow evaluation within the clinics revealed that from the perspective of clinicians operating in community-based clinics, accessing videoconferencing services directly to their regular PC: maximized clinicians' clinical workflow and fit smoothly into their flow of tasks; provided a familiar, focused physical environment within which to engage in consultations with specialists at the academic medical center; facilitated rich, detailed discussions of complex patient cases because supplemental data was often available in the office during the consultation to answer relevant, but unexpected information needs that emerged during the course of the consultation; reduced technical difficulties, “I know how to run my PC but I can never remember all the steps to getting the big videoconferencing machine connected;” and empowered users “I can just go into my office, shut the door, and login to my computer⋯I don't need to call IT or anybody else!” Findings provide guidance for deployment of telemedicine systems that align, rather than disrupt, existing clinical workflows. Findings also inform how to conduct workflow assessment prior to implementation.

Objectives

To elucidate the importance of clinical workflow to the design of telehealth systems.

To provide guidance for deployment of telehealth systems that align, rather than disrupt, existing clinical workflows by conducting workflow assessment prior to implementation.

Individual Oral Panel Session Number 40 Session Title: UNIVERSITY-BASED TELEHEALTH SERVICES

Track: Operations, Business & Finance   Room Number: 15/16

MODERATOR: Alexander Vo, PhD, Executive Director, UTMB Center for Telehealth Research and Policy, University of Texas Medical Branch, Galveston, TX, USA

Spaulding Ryan PhD

Director, Center for Telemedicine and Telehealth

Warren Mary Beth RN, MS University of Kansas Medical Center, Kansas City, KS, USA

334 Comparison of In-person and Telehealth CE Delivery Methods for Rural Kansas Health Professionals

The University of Kansas Center for Telemedicine and Telehealth (KUCTT) maintains a robust interactive televideo (ITV) network in Kansas for both telemedicine and distance learning activities in rural, underserved areas of the state. The KUCTT collaborated with the University of Kansas Area Health Education Centers (AHECs) to gather evaluation data from continuing education (CE) programs delivered either in-person or by ITV in 2008 and 2009. A total of 1,852 physicians, nurses and other health professionals attended the in-person sessions, and 532 attended the ITV sessions. A standardized CE evaluation was used across both delivery conditions to gather participant perceptions of the events. Independent samples t-tests and descriptive statistics were used for the analysis. Overall, attendee perceptions of the speaker, quality of the presentation and audio/visual materials were higher when continuing education was delivered in-person. However, the perceived value of the session content was rated higher by participants when delivered by ITV. In addition, there was no difference between the two types of delivery on perceived achievement of the CE objectives, with objectives being met approximately 98% of the time in both settings. The results of this study indicate that while distance learning via ITV may not be as desirable as in-person events for speaker and presentation characteristics, it is equally effective as the in-person modality for achieving the learning objectives of the CE offerings. It also provided perceived value to the CE recipients, though the reasons for this finding are unclear. One explanation may be that attendees in rural areas viewed the convenience and reduced travel of ITV to be valuable components of the experience in addition to the informational value. In short, the telemedicine infrastructure can be an effective tool for providing CE and providing value to rural participants and organizations. This study will be presented and discussed in more detail.

Objectives

Understand distance learning methods and research.

Understand how distance learning compares to in-person education.

Seale Deborah E. PhD (ABD)

Student

Illinois State University, Normal, IL, USA

679 Telehealth: A Case of Entrepreneurialism in Higher Education?

Universities have created telehealth administrative units to develop and support the practice of telehealth. The study examined how experienced, university-based telehealth leaders perceived the nature of work (i.e., structure and content) undertaken in telehealth units and the core competencies (i.e., knowledge, skills, abilities, and dispositions) needed by staff to ensure effective organizational performance. Telephone interviews were conducted using semi-structured interview questions. In August and September, 20 leaders were interviewed from 16 programs across the US constituting 31 interview hours. Interviews ranged from 48 to 127 minutes in length with a mean interview length of 90 minutes. Data were analyzed using Atlas.ti qualitative data analysis software to identify patterns. Findings revealed that the telehealth units studied were characterized by five features including working on the periphery, boundary spanning, project teams, matrix structures, and new competencies. Specifically, the work of telehealth units is peripheral to the core work of the university – teaching, research and service. Telehealth units facilitate and support the use of telehealth by others that do the core work to address healthcare disparities in the community. Second, telehealth units cross boundaries inside and outside of the university to bring together needed expertise and perspectives. Third, project teams are formed as multiple organizations, disciplines, and perspectives come together around a problem. In managing telehealth projects, telehealth professionals function as equals alongside project members from the university and community. Fourth, matrix structures are used to handle the dual accountabilities that arise from being responsible to the project and each member's home department. Fifth, the telehealth units become the repository of new competencies as new modes of thinking and problem-solving evolve.

Objectives

Describe the work undertaken in university-based telehealth units.

Identify 5-7 competencies shared by university-based telehealth units.

Saptono Andi

Health Information Management Department

Parmanto Bambang PhD Brienza David PhD McCue Michael PhD Schein Rich PhD Pramana Gede MS Pulantara Wayan University of Pittsburgh, Pittsburgh, PA, USA

356 Improving the Efficiency of Telerehabilitation Service Delivery with Integrated System

The process of prescribing assistive technology (AT) in rehabilitation requires clinicians to assess their clients' conditions, needs, and life settings. This information needs to be matched with the proper AT to provide the best solution that enables the client to achieve their goals. In rural clinics with limited expertise in AT, telerehabilitation becomes an attractive solution which facilitates clinicians to tap into the knowledge of AT experts from AT centers and metropolitan clinics. Most telerehabilitation solutions currently depend on dedicated information technology (IT) system. With dedicated system, clinicians may need to use more than one system at a time to assist their service. These systems may range from a health record system to manage their client's information, a videoconferencing or communication system to talk with the expert, as well as tools used to present test protocol stimuli and capture client responses, etc. The efficiency of telerehabilitation service delivery may potentially be enhanced through the use of an integrated IT system, combining all of the tools used in the delivery of the service into one platform. This resulted in the development of VISYTER, a unique telerehabilitation platform that is both versatile (can be deployed anywhere with Internet connection) and flexible (can be customized easily to match with the telerehabilitation effort's needs). This presentation reports on a study that was conducted to evaluate changes in efficiency between the use of dedicated and integrated system. Twenty-six occupational and physical therapists participated in a counterbalanced experimental study to measure the difference in time for completing client assessment tasks using the dedicated and integrated system. The study revealed that the integrated system allows clinicians to deliver service more efficiently due to the reduction of ‘switching’ between systems. Clinicians also felt that integration of systems allowed them to work more efficiently by allowing them to maintain communication with remote clients while working with additional information resources, such as electronic health records. This improvement in efficiency increases the overall system's usability, which may lead to wider acceptance of telerehabilitation in everyday practice.

Objectives

Attendees will learn about the system currently used to deliver rehabilitation service remotely.

Attendees will be able to learn methods to improve the usability of system to deliver telerehabilitation by improving its efficiency.

11:00 am–12:00 pm  Tuesday, May 3

Individual Oral Panel Session Number 41 Session Title: TELEONCOLOGY: SUCCESSFUL COLLABORATIVE PARTNERSHIPS

Track: Clinical Services   Room Number: 19

MODERATOR: Gary Doolittle, MD, Medical Director, Midwest Cancer Alliance, University of Kansas Medical Center, Kansas City, KS, USA

Belard Arnaud MBA 1 Dolney Derek PhD 2 Tochner Zelig MD 2 McDonough James PhD 2

LTC

O'Connell John Joseph MD 3

Program Director, National Capital Consortium, Principal Investigator, Proton Beam Program

1 Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA 2 University of Pennsylvania, Philadelphia, PA, USA 3 Walter Reed Army Medical Center, Washington, DC, USA 87 Implementation of a Remote Proton Radiation Treatment Planning Solution for Department of Defense Cancer Patients

Purpose/Objective(s): Proton radiotherapy is a relatively new and scarce treatment modality in radiation oncology, with only seven centers currently operating in the United States. Funded by Public Law 107–248, the University of Pennsylvania (UPenn) and the Walter Reed Army Medical Center (WRAMC) have developed a remote proton radiation therapy solution with the goals of improving access to proton radiation therapy for Department of Defense (DoD) beneficiaries while minimizing treatment delays and time spent away from home/work (net time savings estimated at one to three weeks per patient).

Materials/Methods: To meet both HIPAA guidelines and the more stringent security restrictions imposed by the DoD, our program developed a hybrid remote proton radiation therapy solution merging a CITRIX server with a JITIC-certified (Joint Interoperability Test Command) desktop videoconferencing unit. This conduit, thoroughly tested over a period of six months, integrates both institutions' radiation oncology treatment planning infrastructures into a single entity for DoD patients' treatment planning and delivery.

Results: This telemedicine solution grants DoD radiation oncologists the ability to 1) remotely access a UPenn proton therapy calculation engine for proton treatment planning, 2) transfer patient plans securely to the UPenn patient database, and 3) initiate ad-hoc point-to-point and multi-point calls to dynamically optimize and validate treatment plans.

Conclusions: Our robust and secure remote treatment planning solution not only grants DoD patients access to a state-of-the-art treatment modality, it also ensures participation in the treatment planning process by WRAMC radiation oncologists. Our program believes this telemedicine system can potentially lead to a greater integration of military treatment facilities and satellite clinics into regional proton therapy centers. This work was supported by the US Army Medical Research and Material Command under Contract Agreement No. DAMD17-W81XWH-04-2-0022. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the US Army.

Objectives

To discuss conducting remote treatment planning for radiotherapy.

Review how to provide greater access to a scarce treatment modality.

Doolittle Gary MD

Medical Director, Midwest Cancer Alliance, Ryan Spaulding, PhD, Krissy Martin, BA, Hope Krebill, RN, MSW, David Cook, PhD

University of Kansas Medical Center, Kansas City, KS, USA

605 Midwest Cancer Alliance Clinical Trials, Education and Research Across the Kansas Telemedicine Network

In 2008, the University of Kansas Medical Center launched the Midwest Cancer Alliance (MCA), a membership based organization that includes 14 hospitals, cancer care providers, researchers and support professionals throughout Kansas and Western Missouri. The MCA works to: 1) keep patients close to their homes during treatment, 2) promote access to clinical trials, leading edge diagnostics, and prevention strategies, and 3) enhance cancer care across the region. A centerpiece of the Alliance is the development of a clinical trials network, with a centralized Internal Review Board (IRB), and an online clinical trials data management system. To achieve the goal of providing more options close to home, and to facilitate education and research across the Alliance, the MCA partners with the University of Kansas Center for Telemedicine and Telehealth. The MCA members are equipped with high definition (HD) interactive tele-video (ITV) and dedicated, high bandwidth connections that provides a very high quality experience. Activities broadcast over the network range from oncology-specific Continuing Education courses and weekly tumor board meetings, to second opinion consults and clinical research nurse collaboration meetings. ITV will also be utilized to remotely consent and enroll patients in cancer clinical trials. To date, over 3,096 CE credits have been awarded for ITV participants at community cancer centers, 17 members' patients have received second opinion services, and rural partners have presented 7 cases at tumor board. Using telemedicine as a medium for communication and capacity building has also resulted in 15 patients placed on trial over the past year, and one patient has been consented via the technology. As the MCA continues to expand, the number of patients benefiting from telehealth services in clinical research is expected to increase substantially. This collaborative has elevated the sharing of professional expertise and resources for cancer care across the region and has demonstrated the tremendous value that telemedicine technology can offer. It also highlights the importance of institutional commitment and organization to the success of ITV services and may be the most comprehensive array of telemedicine services for cancer in the United States. Details of the partnership will be presented.

Objectives

Understand role of telemedicine in Midwest Cancer Alliance.

Understand role of telemedicine in cancer clinical trials.

Murad Muhammad F. MBBS, MCPS, FCPS 1

Senior Registrar

Jehan Farhat MBBS 1 Ali Qasim MBBS, MCPS, FCPS 1 Khan Mussarat HA MBBS 2 Zafar Asif FCPS, FRCS 1

1 Rawalpindi Medical College, Rawalpindi, Pakistan 2 Ministry of Health, Punjab, Attock, Pakistan 483 Teleoncology to Support Cancer services in a Teaching Hospital

Introduction: There are very limited Specialized Oncology Centers in Pakistan. In Surgical oncology practice here Patients have to make frequent visits in various centers for initial workup by surgeons, Tissue diagnosis by histopathologists, Staging investigations by Radiologists and management plan by oncologist which may involve surgery, chemotherapy or radiotherapy followed by or prior to surgery. This is time consuming and may cause delay in management of the patients. Teleoncology was introduced for weekly tumor case meetings between Surgery department, Holy Family Hospital and NORI Hospital using videoconferencing setup. The team of Surgeons, Radiologists, and Histopathologists of Holy family hospital and Oncologists from NORI hospital are now conducting joint regular Multidisciplinary meetings weekly for the well being of patients of the area. The purpose of this study is to describe the infrastructure, consultative process, technical aspects and is the initial evaluation of these meetings.

Materials and Methods: The surgical oncology patients are being discussed on every Friday morning since November 2009. A Standardized format was adopted for case discussion in these multidisciplinary meetings. The post graduate trainee used to present the case from either side followed by management plan discussion.

Results: A total of 92 patients have been discussed. The mean age of the group was 51 yrs (SD 16.2). 82 % of these patients were presented by surgical department while remaining was presented from cancer center. The Breast and GIT malignancies were the most common cases followed by endocrine and Skin and soft tissue tumors. There is significant improvement in management strategy of post graduate trainees after regular participation in these sessions.

Conclusion: Teleoncology services can be extended easily with little addition to existing infrastructure but significantly reduces the stress for families as the deal with this challenging disease. Moreover they improve the clinical evaluation and management strategies.

Objectives

To describe the infrastructure and technical aspects of Teleoncology.

To evaluate the consultative process in multidisciplinary meetings through videoconferencing for Teleoncology.

Presentation Panel Session Number 42 Session Title: 51 DEPRESSION TELE-CARE FOR ELDERLY PATIENTS AT HOME: SUCCESSES AND CHALLENGES

Track: Telemental Health   Room Number: 24/25

MODERATOR: Lisa Roberts, PhD, Global Clinical & Innovations Manager, Viterion TeleHealthcare, A Business of Bayer Healthcare, Bellevue, WA, USA

Roberts Lisa PhD 1

Global Clinical & Innovations Manager

Sheeran Thomas PhD, ME 2

Assistant Professor & Research Psychologist

Turvey Carolyn PhD 3

Associate Professor

Rabinowitz Terry MD, DDS, MS 4

Professor of Psychiatry and Family Medicine

1 Viterion TeleHealthcare, A Business of Bayer Healthcare, Bellevue, WA, USA 2 Brown Medical School & Rhode Island Hospital, Providence, RI, USA 3 University of Iowa, Iowa City, IA, USA 4 University of Vermont & Fletcher Allen Health Care, Burlington, VT, USA

The objective of this panel presentation is to describe methods and outcomes related to different technological and methodological approaches in providing mental health services to community-dwelling older adults in their homes. Results of three different studies will be presented, each using different technologies and care delivery approaches, along with implications for future directions. Dr. Sheeran will present the results of a study evaluating the feasibility and effectiveness of a home telemonitor-supported depression care management protocol. This study was conducted in collaboration with three home care agencies in Vermont, New York, and Florida. Completed with 50 patients with research-verified need for depression care, results of this study suggest that this model of service delivery is feasible, accepted by telehealth nurses and patients, and improves depressive symptoms. Dr. Turvey will present results from a study of 130 patients in an illness management program for depression and chronic illness delivered by telephone that included home monitoring of both depressive and chronic illness symptoms. The relation between depressive symptoms on phone-based home monitoring to self report and research diagnosis will be presented. Results indicate that this approach is a valid and reliable method to assess change in depressive symptoms during an intervention. Results on the effectiveness of two interventions in reducing depressive symptoms, one with an enhanced mental health component, the other without, will also be presented. Dr. Rabinowitz will discuss the development and implementation of a pilot project to test the feasibility of a low-cost, Web-based approach to delivering telepsychiatry consultations for depressed homebound elders. Key topics covered will include: 1) making contact with the collaborating home care agency to obtain their support and buy-in for the project, 2) training of research assistants and others in use of the telemedicine equipment and in patient recruitment, and 3) findings of this study including costs, advantages, disadvantages, lessons learned, and ideas for improvement regarding this modality.

Objectives

Describe key components of depression identification and care using telehealth technology.

Identify facilitators and barriers to service delivery and program success.

Presentation Panel Session Number 43 Session Title: 87 THE RESULTS OF A SECURE, BI-DIRECTIONAL MOBILE PHONE MESSAGING SYSTEM FOR US ARMY WOUNDED WARRIORS

Track: Mobile Health   Room Number: Ballroom A

MODERATOR: COL Ronald Poropatich, MD, Deputy Director, USAMRMC/TATRC, Fort Detrick, MD, USA

Poropatich Ronald MD 1

Deputy Director

Pavliscsak Holly BS, MHSA 2

mCare Project Manager

Rasche Jeanette MS 2

mCare Technical Director

Tong James BS 2

mCare Project Officer

1 USAMRMC/TATRC, Fort Detrick, MD, USA 2 TATRC - South, Fort Gordon, GA, USA

The purpose of this panel presentation is to detail the progress to date of mCare, a cell phone based bi-directional messaging system that securely utilizes patients' personal cell phones and connects them to a Web–based dashboard where providers manage messages. The panel presentation will highlight the impact of the mCare program on mobile health in the areas of patient care, technological advancements and research initiatives. The goal of the initial pilot mCare program was to enroll 100 volunteers, but the actual enrollment has been four times that rate. From May 2009, over 32,000 secure messages have been sent to more than 425 voluntary patients, residing in 28 states within the eastern half of the United States. From 5 sites, more than 150 military care team providers are accessing the system via a secure web-based portal to manage patient message traffic and monitor responses via a graphical user interface that is dynamic and flexible. Additionally, the success thus far in implementing a nine month, prospective, randomized controlled study with recruitment of an additional 400 subjects in a two arm study will be presented. Specifically, the study evaluates how mobile applications can improve patient and provider communication, promote goal awareness, increase patient and provider satisfaction with case management services, and increase patient compliance with administrative, clinical, and goal-oriented responsibilities.

Objectives

Participants will have a full understanding of a mobile health application at multiple sites.

Participants will be able to identify implementation strategies for deployment and implementation of mobile health applications.

Individual Oral Panel Session Number 44 Session Title: TELEHEALTH IN SUPPORT OF DISASTERS AND MASS CASUALTY INCIDENTS

Track: Emergency & Disaster Response   Room Number: 20/21

MODERATOR: Ronald Merrell, MD, FACS, Professor of Surgery, Virginia Commonwealth University, Richmond, VA, USA

Simmons Scott C. MS 1

Director of TeleHealth

Marttos Antonio Jr. MD 1 Cruz Daniel A. 1 Perales Samuel 2 1 University of Miami Miller School of Medicine, Miami, FL, USA 2 University of Miami Field Hospital, Port Au Prince, Haiti 428 Telehealth in Support of Haitian Earthquake Relief - The University of Miami/Project Medishare Experience

Within 24 hours of the January 2010 Haiti earthquake the University of Miami (UM)/Project Medishare team set up a field medical facility within the UN-secured zone on the grounds of the Port Au Prince airport. Ten days later, a 220-bed, tent based field hospital was established within the airport's grounds. In June 2010, the field hospital was disassembled and its resources were relocated to an existing facility, Bernard Mevs Hospital. The facility is still supported by the University of Miami and Project Medishare and continues to be the primary trauma and critical care hospital in Port Au Prince, including neonatal and pediatric critical care. Patients are received from medical facilities throughout the region, and medical staff routinely travel to these other facilities to provide assistance. Telehealth has played a critical role in the University of Miami/Project Medishare response to the Haitian earthquake since the first few days after the earthquake. A combination of donated high-bandwidth satellite links and leased Haitian wireless Internet services provided the telecommunications backbone for telehealth. Specific telehealth capabilities include teleradiology, videonferencing-based interactive telehealth sessions, and store-and-forward (asynchronous) teleconsultation. Daily interactive sessions have been conducted with University of Miami trauma and critical care specialists for bedside rounds for adult and pediatric patients. Interactive telehealth consultations have also been conducted with UM pediatric cardiologists and oncologists. These telehealth capabilities continue to perform since their initial deployment and have transitioned into the new cooperative clinical facility at Bernard Mevs in Port Au Prince. This presentation will provide an overview of the set-up and long-term operation of the UM/Medishare telehealth capacity, lessons learned, and propose suggestions for organizations that want to use telehealth approaches in disaster and humanitarian response.

Objectives

Learn about implementation strategies for disaster telehealth.

Learn best practices for disaster telehealth operations.

Davis Theresa M. RN, MSN

Operations Director

Inova Health System, Falls Church, VA, USA

557 Technology: A Catalyst for Leveraging Critical Care Expertise During a Mass Casualty Incident

The Crisis Critical Care Capacity and Trauma (C4T) project focuses on the management of a surge of critically injured patients in the event of a mass casualty incident. The project is funded through Homeland Security. In the event of a large scale incident, the number of critically injured patients are predicted to surpass the capacity of area emergency rooms. The care received in the first twenty-four hours after an injury can mean the difference between life and death. The three most urgent priorities are: ethical healthcare delivery during an altered standards of care situation, allocation of scarce resources and the provision of training that will sustain skilled clinical teams. A regional disaster center and a health system partnered to develop a disaster response model that includes mobile tele-ICU. The tele-ICU portion of the project provides voice and video mobile technology to leverage skilled physicians and nurses to multiple hospital emergency rooms during a mass casualty incident. The IRB approved study explores the difference between evaluation scores pre and post mobile tele-ICU training. The intervention is the training program that included didactic education, trauma scenario practice and a full scale drill. The tool contained 39 questions in 5 categories. The categories consisted of perceived ease of use, perceived usefulness, intention to use, attitude toward using and understanding of the process of using mobile tele-ICU. The mean scores in the pre-evaluation were: 3.98 (usefulness); 3.62 (ease); 3.59 (process); 4.27 (attitude); 4.20 (intention to use). The mean scores in the post-evaluation scores were: 4.45 (usefulness); 4.34 (ease); 4.03 (process); 4.78 (attitude); 4.77 (intention). There were 43 subjects in the pre-group and 44 subjects in the post-group. The hypothesis is that the scores will be significantly different between the pre intervention scores and the post intervention scores. This was a pilot study done in 3 hospitals using 1-way video and voice technology. It will be duplicated in 8 additional hospitals using 2-way video and voice technology. The success of this project can change the way we manage disasters by providing the critical resource of remote clinical expertise during a mass casualty incident in community hospitals that may not have a dedicated trauma center.

Objectives

Describe the use of technology in surge capacity during a mass casualty incident.

Name three priority focuses during a mass casualty incident.

Individual Oral Panel Session Number 45 Session Title: BEST PRACTICES FOR USING TECHNOLOGY IN A RURAL AND AUSTERE ENVIRONMENT

Track: Technology & Telecommunications   Room Number: 22/23

MODERATOR: Thelma McClosky Armstrong, Director, Eastern Montana Telemedicine Network, Billings, MT, USA

Zafar Asif MD, FCPS, FRCS 1 2

Surgical Unit II

Qureshi Nausheen MD, FCPS 1 2 Ali Qasim MD, FCPS, MRCS 2 Murad Faisal MD, FCPS 2

1 Rawalpindi Medical College, Rawalpindi, Pakistan 2 Holy Family Hospital, Rawalpindi, Pakistan 254 Real-time Tele-ENT services for Rural Pakistan

Introduction: Attock is district in North West Punjab Province of Pakistan. It comprises of 6 tehsils with estimated population of 1.58 million. The Attock city is the districts headquarter and is 80 kms from Islamabad. The DHQ hospital does not cater for ENT patients as no Specialist is available. Patients with complex problems or requiring surgery were being referred to Rawalpindi - Islamabad hospitals. This practice has changed since establishment of Telemedicine center in Attock hospital.

Methodology: Telemedicine center Attock is one of the spokes connected to Holy family hospital hub. This is part of Pakistan Ministry of Information technology's rural support program. This center‘s capabilities have been further enhanced by US State department support. The ENT Clinics are conducted by IT support person and Nurse trained to use otoscope and general examination camera. The data of patients scheduled for clinics is uploaded on the servers and available to specialists. Bandwidth of 384 kbs is available for transmission of images and videoconferencing provided by PAKSAT Satellite and Wateen Telecom wimax services. ENT Consultants and Residents conduct 2 weekly clinics. Patients requiring admission and surgery are admitted in Holy family hospital. These patients attend Telemedicine center for regular follow ups.

Results: In 2 year s between July 2008 and June 2010, 1090 ENT Teleconsultations have been carried out. Two third of patients are females. 650 patients were treated on site and followed up on outpatient basis. Admission was arranged in Holy family hospital for 334 patients requiring surgery. 234 patients have since then returned for follow up at remote site. The operating procedures varied from tonsillectomy to mastoidectomies. Urgent admissions were arranged for foreign bodies, Peritonsillar and mastoid abscess.

Conclusion: Telemedicine has enabled us to extend Specialist ENT services to catchment areas of Rawalpindi teaching hospitals. This is an efficient and cost effective method to reach out to rural communities providing specialist services at their doorstep. These results should be enough to convince Health policy makers to incorporate Telemedicine in main stream healthcare.

Objectives

Extending specialist care to rural areas utilizing telemedicine.

How best to utilize existing resources.

Caputo Michael MS 1

Chief Information Officer

Gibson Robert OD 2 Pass Anastas OD, MS, JD 3 Mader Thomas MD 4

1 Washington University in St. Louis, St. Louis, MO, USA 2 NASA Johnson Space Center/Coastal Eye Associates, Houston, TX, USA 3 University of Houston University Eye Institute, Houston, TX, USA 4 Alaska Native Medical Center, Anchorage, AK, USA 606 Technical Challenges in Providing Ophthalmic Telemedicine for Ocular Monitoring During Long Duration Spaceflight

The use of telemedicine to support ocular health on the International Space Station was put into operational service in 2009. Since that time 12 ocular telemedicine sessions have been completed which linked astronauts on the International Space Station with ophthalmic experts on the ground for medical examinations and remote guidance. The challenging environment onboard a spacecraft imposes restrictions on all facets of hardware design and implementation. Existing commercial systems were reviewed as well as NASA's prior art for ocular telemedicine. An emerging commercial device was selected for use. The current capabilities of the ocular imaging system will be discussed as well as the technical challenges that remain barriers to providing optimal image quality for monitoring, detecting and diagnosing changes in ocular health during long duration space missions.

Objectives

Learn about state of the art of ocular telemedicine during spaceflight operations.

Understand the technical challenges of providing telemedicine during spaceflight operations.

Clarke Malcolm PhD 1

Reader

Mars Maurice 2

1 Brunel University, Uxbridge, United Kingdom 2 Nelson Mandela School of Medicine, Durban, South Africa 407 A Follow Up Investigation On Use Of 3G Mobile Communications For Telehealth Services In Rural Kwazulu-Natal

Introduction In 2008 we reported an investigation of using 3G mobile to support Telehealth services in rural KwaZulu-Natal (KZN). This paper reports a follow up to determine changes to coverage or service. In 2008 we found 3G could be a cost-effective alternative to terrestrial communications and confirmed that where 3G was available, video conferencing was practical.

Method We followed the same methods as the original study and repeated measurements at the original and/or representative sites using a laptop configured with a 3G/GPRS modem on the Vodacom mobile network in KZN. Wireshark was used to capture and analyse network traffic; Iperf was used to determine sustained throughput for TCP traffic; Polycom PVX was used as a software based videoconference application (H323); and Skype was used as an example of an Internet-based video/voice application. Typical Internet applications were also tested.

Results The results were consistent with the results for 2008 for 3G, up speed was around 300 Kbps for TCP traffic and down speed was determined to be around 400 Kbps. Video traffic (H323) was carried without noticeable problem. Video using a bandwidth of 256 Kbps were found to be consistently good and is capable of sustaining video as an application. Coverage of 3G is was still limited to urban or business areas or popular tourist destinations. There was no 3G coverage in rural areas. GPRS was improved from 2008, with up speed of 70 Kbps and down speed of 100 Kbps compared to 30 Kbps and 40 Kbps respectively in 2008. These speeds should support web applications; however in all sites we experienced unreliable communication and performance with applications. We found that round trip times (RTT) as were around 300 ms for 3G and over 750 ms for GPRS. This would compare with 20 ms for typical terrestrial networks.

Conclusion Our recent investigation confirms that 3G can support good throughput of and support good quality video conferencing. However 3G is still only available in urban areas; with no coverage in rural areas. GPRS was widely available and measured bandwidth should support eHealth applications. However experience of the KZN revealed excessive RTT that caused many eHealth applications to fail. We conclude that the mobile network is currently still not suitable to provide the infrastructure for a Telehealth network.

Objectives

Discuss the use of mobile communications for rural telehealth services.

To review findings of 3G research.

Presentation Panel Session Number 46 Session Title: MEDICARE & MEDICAID INNOVATION OPPORTUNITIES FOR TELEMEDICINE

Track: Public Policy   Room Number: Ballroom D

MODERATOR: Gary Capistrant, Senior Director of Public Policy, American Telemedicine Association, Washington, DC, USA

Mathers James Speaker TBD, MD, FCCP 1

Past President

Capistrant Gary 1

Senior Director of Public Policy

Yu Wil 2

Special Assistant of Innovations and Research, Office of the National Coordinator for Health IT

1 American College of Chest Physicians, Richmond, VA, USA 2 Department of Health and Human Services, Washington, DC, USA

The new Center for Medicare and Medicaid Innovation is targeted for funding at $10 billion over 10 years. The Center holds great promise as a tool to innovate Medicare and Medicaid payment mechanisms and services. This session will focus on specific ways that telehealth and other health technology can be used in the Center's initiatives to better serve patients and taxpayers.

Presentation Panel Session Number 47 Session Title: 142 INTEGRATING TELEMEDICINE IN PRIVATE PRACTICES

Track: Operations, Business & Finance   Room Number: 13/14

MODERATOR: Daniel Davis, MD, CEO, Interactive Care Technologies, LLC, Honolulu, HI, USA

Davis Daniel MD 1

CEO

Dappen Alan MD 2

Founder

Goldyne Marc MD, PhD 3

Clinical Professor of Dermatology

1 Interactive Care Technologies, LLC, Honolulu, HI, USA 2 DocTalker Family Medicine, Vienna, VA, USA 3 University of California, San Francisco, San Francisco, CA, USA

This “How To” session will cover integrating telemedicine into individual private practices and beyond the use in hospitals and clinics presents unique challenges and opportunities. Primary care physicians can take advantage of the cost savings, improved outcome quality and expanded revenue base that can be achieved through the use of telemedicine.

Presentation Panel Session Number 48 Session Title: 74 WHAT MATTERS TO PROVIDERS WHO ARE HEAVY USERS OF TELEHEALTH SERVICES

Track: Operations, Business & Finance   Room Number: 15/16

MODERATOR: Stewart Ferguson, PhD, Chief Information Officer, Alaska Native Tribal Health Consortium, Anchorage, AK, USA

Ferguson Stewart PhD 1

Chief Information Officer

Kokesh John MD 2

Medical Director, Department of Otolaryngology

Patricoski Chris MD 1

Telehealth Clinical Director

Syrydiuk Jeff BSc, MBA 3

Vice President, Adoption & Marketing

1 Alaska Native Tribal Health Consortium, Anchorage, AK, USA 2 Alaska Native Medical Center, Anchorage, AK, USA 3 Ontario Telemedicine Network, Toronto, ON, Canada

One hallmark of a successful telehealth program is consistent and growing usage by providers. Usage ultimately depends on a provider's decision to try telehealth, continue using it after the initial experience, and to expand its use by applying it to more situations. Many successful programs with a history of a large volume of cases have “heavy users” - providers who use telehealth much more frequently than their colleagues. These “heavy users” are critical to a telehealth program, as they become advocates for telehealth and often innovate new uses and improvements. To determine the factors that are important to heavy users, two large volume telehealth programs- one specializing in store and forward telehealth and the other in videoconferencing – identified providers who had created or consulted upon more than 1000 cases over the history of their respective programs. The AFHCAN Telehealth System in Alaska provides services to 250 sites throughout Alaska and will conduct an estimated 17,000 store-and-forward cases in 2010. AFHCAN currently has 15 providers that have each created more than 1,000 cases, and 29 physicians that have consulted on more than 1,000 cases each. The Ontario Telemedicine Network provides services to more than 1,000 sites throughout Ontario Canada and will conduct more than 100,000 videoconference-based telehealth consultations in 2010. OTN currently has more than 80 sites that have presented more than 1,000 patients, and more than 30 physicians that have consulted on more than 1,000 cases over the past two years. Indepth interviews using quantitative and qualitative measures were conducted with these users using a standardized set of questions focused on what aspects of a telehealth program or service where most important to them and most critical for their continued usage. The interviews covered a wide range of perspectives from technology, operations, performance, training and business relations. The goal of the panel is to look for areas of commonality between two distinct high volume programs and to educate the audience on which factors are characteristic of a program that develops heavy users and high usage.

Objectives

Learn about the critical issues that matter to clinicians involved in store-and-foward telehealth.

Learn about the critical issues that matter to clinicians involved in live-video based telehealth.

1:15 pm–2:15 pm  Tuesday, May 3

Individual Oral Panel Session Number 49 Session Title: SUCCESSFUL TELEONCOLOGY PROGRAMS SERVING RURAL POPULATIONS

Track: Clinical Services   Room Number: 19

MODERATOR: Ibrahim Qaddoumi, Pediatric Oncologist, St. Jude Oncology Department, Germantown, TN, USA

Nelson Eve-Lynn PhD 1

Assistant Director, Telemedicine and Telehealth

Mulhern Moira PhD 2 Pendleton Cathy LSCSW 2 Groneman Brooke PhD 3 Bush Carol RN 3 1 University of Kansas Medical Center, Kansas City, KS, USA 2 Turning Point, Shawnee Mission, KS, USA 3 Midwest Cancer Alliance, Kansas City, KS, USA 429 Televideo Support Services for Rural Cancer Patients and Their Families

Cancer impacts individuals and families across psychological, emotional, economic and social levels, yet access to holistic support services remains a significant gap from diagnosis to survivorship. To address these rural community-identified needs, the Midwest Cancer Alliance (MCA) piloted support services over real-time televideo. The presenters will describe leveraging the extensive telemedicine infrastructure and the long-standing relationships with the MCA teleoncology service (Doolittle, 2010) as well as building new partnerships. There is very little published information about professionally-lead support groups using videoconferencing and the project sought to approximate best practices from onsite support services. The MCA leaders sought out a leading metropolitan community organization, Turning Point, to adapt their programming for the rural telemedicine setting. Turning Point offers comprehensive educational and support services to help individuals and families better manage the illness process, reduce symptoms, and increase coping skills. The rural sites worked with Turning Point leaders to select from a menu of over 65 support programs for the initial televideo groups. The presenters will address key feasibility elements including: training rural coordinators about support group expectations, confidentiality, and process; preparing rural coordinators to handle participant emotional discomfort; and dialoguing between facilitators and rural coordinators about how to build rapport and promote participation over televideo. The presenters will give an overview of qualitative feedback concerning advantages and challenges and will summarize ongoing feasibility evaluation including satisfaction and program costs. Turning Point strives to be a community gathering space; the presenters will summarize future directions to continue to build a “virtual gathering place” over televideo to meet these same holistic care needs across rural settings. The initial success of the rural telemedicine support services at individual rural sites has lead to future plans to pilot multipoint technologies as well as broader community programming over televideo.

Objectives

To describe implementation steps for holistic cancer support services using videoconferencing.

To list advantages and challenges related to televideo support groups from patient, family, rural coordinator, and facilitator perspectives.

Low Gordon APN

Program Coordinator, W.C. Hitt, MD, Tesa Ivey, MSN, APN, Lisa Hammom, MSN, APN, Delia James, APN

University of Arkansas for Medical Sciences, Little Rock, AR, USA

495 Telecolposcopy: Improving Interventions for the Most Preventable Form of Cancer

Somewhere in a rural area without needed specialty healthcare services, a woman is dying from cervical cancer, the single most preventable form of cancer. When miles and money separate a rural woman from her nearest provider equipped to perform cervical cancer biopsy, that woman may never seek care. One HRSA OAT grant-funded initiative is implementing telemedical interventions that measure how telemedicine-aided colposcopy is affecting rural patients and the healthcare system. In its first year of funding, Arkansas START (System to Access Rural Telecolposcopy) has implemented and sustained three “telecolposcopy” sites that use telemedicine to connect county health unit nurses with specialists at the state's only academic medical center. Rural women with abnormal Pap smears receive specialty advice, assessment, and biopsy directed through telemedicine at the virtual clinics, which once lacked regional access to sliding scale colposcopy prior to program implementation. Interactive video units with cervical scopes allow distant specialists to see the cervix, dysplasia, and the patient in real-time. Further support and referral to treatment programs are provided to women in need. In its 8 months, this program has seen 499 rural women at three virtual clinics. Of these, 415 biopsies have been collected, 261 resulting in benign or mild dysplasia and 155 resulting in moderate or severe dysplasia, which could indicate or lead to invasive cervical cancer. Moreover, women with moderate or severe dysplasia overwhelmingly reported that had the rural telecolposcopy program not been available in their region, they would have likely never sought diagnosis. Had this program never been implemented, the cost to Medicaid to treat advanced stages of cervical cancer among the program participants with dysplasia could total over $5 Million in three years; whereas this telemedicine-based cancer detection program will be implemented for less than $1 M over the same timeline.

Objectives

ttendees will learn the strategies and outcomes of telemedicine-facilitated colposcopy.

Attendees will learn about one telecolposcopy program, START (System to Access Rural Telecolposcopy).

S Sudhamony BTech

Additional Director

R Ravindrakumar MTech Kartha Mohanachandra GD, MSc CDAC, Trivandrum, India

410 Effectiveness of Mobile Tele-Oncology Unit in Early Cancer Detection, Treatment and Follow-up

Early detection of cancer is one of the highest priorities of National Cancer Control Program undertaken by Government of India. In line with this objective, Mobile Tele Oncology project was undertaken in the State of Kerala in southwest India by Centre for Development of Advanced Computing Thiruvananthapuram (C-DAC), a scientific society under Department of Information Technology, Govt. of India. C-DAC designed and developed the Mobile Tele-Oncology System, Sanjeevani, and deployed it for Cancer Control Program with the support of Malabar Cancer Care Society, Kannur, an NGO and peripheral centre of Regional Cancer Centre, Thiruvananthapuram (RCC). Sanjeevani is equipped with Telemedicine and medical equipments like Digital XRay Unit, Ultrasound Scanner, VideoColposcope, CryoSurgery Unit. Electronic Medical Record of patients is generated and maintained using eDhanwanthari Telemedicine Software developed by C-DAC. Sanjeevani is aimed at detection of cancer among the rural population right at their doorstep; provide treatment for Cervical Intraepithelial Neoplasia (CIN) and build cancer awareness. Sanjeevani is operational from April 2010 and covers three districts of Kerala with total population of about 5 Million. Twenty medical camps were organized in selected rural areas. 1,897 persons were screened and 72 pre cancerous cases were detected. 16 ladies in whom cervical precancerous lesions were detected were given cryotherapy treatment. Patients were referred to specialist hospitals on detection of other suspected cancers like breast and oral cancers. Follow-up consultation for registered patients of RCC was provided through Telemedicine facility in Sanjeevani. For Tele- consultation, it uses satellite connectivity provided by ISRO, Govt. of India. The project has shown promising results in early detection to bring down morbidity and mortality in rural areas of India where incidence of Cervical Cancer is high and facilities are limited. Further steps for replication are under contemplation.

Objectives

Detection of cancer among the rural population right at their doorstep and provide treatment for pre cancerous cases of cervical cancer.

Provide follow up consultation and cancer screening using mobile telemedicine van.

Presentation Panel Session Number 50 Session Title: 39 USE OF EMERGING TECHNOLOGIES TO SUPPORT THE PSYCHOLOGICAL HEALTH OF SERVICE MEMBERS, VETERANS, AND THEIR FAMILIES

Track: Telemental Health   Room Number: 24/25

MODERATOR: Gregory Gahm, PhD, Director, National Center for Telehealth and Technology, Tacoma, WA, USA

Gahm Gregory PhD

Director

Bush Nigel PhD

Research Psychologist

Ciulla Robert PhD

Acting Chief, Population and Prevention Programs

Holloway Kevin PhD

Psychologist

National Center for Telehealth and Technology, Tacoma, WA, USA

Combat deployments to Iraq and Afghanistan are resulting in increased rates of behavioral health problems and an increased need for resources to support Service Members, Veterans and their families. However, many who need assistance are hesitant to access help due to concerns about peer or supervisor reactions or because they fear a negative impact on their career. Others are located in geographically remote locations that may be far from military or VA treatment facilities. Innovative technologies offer a potential solution to these challenges. This panel includes three presentations related to the use of innovative technologies to support America's military community. First, in order to deliver relevant solutions information is required about what technologies are likely to be the most ubiquitous or popular among those we aim to help. Preliminary results from surveys of active duty Soldiers' will be presented to describe self-reported access to and usage of a range of technologies in deployed and homefront contexts. This information helps present the context in which behavioral health technology solutions can be developed. A second presentation will discuss the potential of smart phone applications to deliver constant, hip pocket access to behavioral health resources. The presentation will include a description of recent efforts to develop military-relevant behavioral health smart phone apps. The third presentation will review efforts to leverage 3D shared virtual worlds to deliver psychological education and resources. These environments offer the capability to deliver interactive learning experiences to anyone with an Internet connection in a manner that is consistent with the gaming interests of many. The Psychological Health Island in Second Life will be reviewed as one example. Discussions will include technologies on the horizon that may have the potential to improve support to those in need.

Objectives

Attendees will be able to describe Soldier usage rates of a range of personal technologies.

Attendees will be able to describe the potential of smart phone applications and VW to provide psychological support to Service Members.

Individual Oral Panel Session Number 51 Session Title: INTERNATIONAL OUTCOMES STUDIES ON USE OF MOBILE HEALTH TECHNOLOGIES

Track: Mobile Health   Room Number: Ballroom A

MODERATOR: Pramod Gaur, PhD, Vice President – Telehealth, UnitedHealthGroup, White Plains, NY, USA

Alpsten Tobias MSc

CEO

iPLATO Healthcare, London, United Kingdom 145 Using Mobile Technology To Support People With Epilepsy

Healthcare systems around the world are increasingly required to do more with less. This best practice presentation describes a range of mHealth services provided by the National Hospital of Neurology and Neurosurgery in London to help patients with severe epilepsy adhere to recommended treatment, record seizures and empower them to effectively manage their condition. Following a long period of preparation, this service was launched in early January 2010. Evidence of cost effectiveness and clinical outcomes will become available in early 2011. In a short case study we exemplify how mobile health services can increase efficiencies and improve the health of people with long term conditions. Based on this real experience from the UK, this case study highlights the benefits but also discusses the challenges such as patient acceptance, data security, information governance and innovating with clinicians, hospitals and payers.

Objectives

To discuss patient centric mHealth service design.

2 To review the outcomes of low cost remote interventions.

Gupta Rajendra Pratap BA, BSc, MA 1 2 3 4

Member - Executive Council

1 Telemedicine Society of India, Navi Mumbai, India 2 DMAA - The Care Continuum Alliance, Washington DC., Washington DC, USA 3 HIMSS Asia Pacific India chapter, Bangalore, India 4 Disease Management Association of India, Bangalore, India 141 M-health Applications In: Epidemiology, Health Risk Assessment & Chronic Care Management

India is a land of a billion people with an Urban and Rural divide. Healthcare remains the priority for both the rural and urban populations. People have to travel over 10 kilometres to reach a primary healthcare centre. In such a setting, reaching out to the masses is a challenge that has to be cost effective and accurate. The challenge lies in reaching out to people both in urban and rural setting. In 2009, Disease Management Association of India (DMAI) embarked on a project to conduct the first ever Health Risk Assessment Index (HRAI) using the m-health network. HRAI was conducted in a small town amongst 2,043 people as a pilot project using remote monitoring devices networked with a cell phone to transmit the data. The devices used were glucose monitor, blood pressure monitor, spirometry, pulse oxymetry, and ECG. All the tests were conducted onsite and the health data form was filled in a mobile phone. It was a paperless screening for health risk assessment. The presentation covers the experience of deploying mHealth in conducting the Health Risk Assessment survey using mobile devices and running chronic disease management programs using blue tooth enabled cell phones. The presentation could be helpful to policy makers & industry alike to showcase the importance of using m-health to reach out to people and impact the positive outcomes in chronic disease management using blue tooth enabled devices along with a smart phone.

Objectives

How mHealth can be leveraged for epidemiology, health risk assessment & population health improvement.

How mHealth impacts the management of chronic diseases & population health improvement.

Individual Oral Panel Session Number 52 Session Title: SUCCESSFUL TELESTROKE PROGRAMS: RESULTS, LESSONS AND ISSUES

Track: Emergency & Disaster Response   Room Number: 20/21

MODERATOR: Joseph Tracy, MS, Vice President – Telehealth Services, Lehigh Valley Health Network, Bethlehem, PA, USA

Hall-Barrow Julie EdD

Assistant Professor and Education Director, Terri Imus, BSN, Loretta Williams, BSN, Tammy Northcutt, BSN, Debra Johnson, BSN

University of Arkansas for Medical Sciences, Little Rock, AR, USA

486 Door-to-Needle Times: Improving a Successful Tele-stroke Intervention

Established in 2008, AR SAVES (Stroke Assistance through Virtual Emergency Support) helps rural emergency rooms diagnose stroke patients and improve their outcomes through real-time, interactive video that unites remote neurologists with rural stroke patients on an around-the-clock basis, thus creating a virtual environment where rural patients can seek the level of care afforded to patients at urban medical centers. Through funding from the Arkansas Department of Human Services, Medical Division, AR SAVES has provided over 300 consults, increasing t-PA administration from less than 1% to 30% for eligible patients. AR SAVES currently operates with 3 hubs and 20 spokes and will grow to 4 hubs and 27 spokes by June 2011. To improve door-to-needle times, the AR SAVES team has instituted several quality initiatives both clinically and interactively. These newly developed strategies aim to increase the success of the AR SAVES program through enhanced facilitation of emergency-based telemedicine care:

Increasing mock telemedicine drills with staff of each participating site utilizing a competency based check-list.

Instituted an interactive video case conference review in the monthly all-sites meeting.

Additional training for participants including a more robust initial training program and a statewide stroke conference, inviting distant providers who could not attend through interactive video.

As a way of systematically coordinating these quality initiatives, the AR SAVES program oversees all data related to each tele-stroke consult and works collaboratively with each ER nursing facilitator to implement the stated strategies. When comparing door-to-needle times between Years 1 and 2, quality and performance reviews have led to a 10-minute reduction in the time necessary for patients to enter a rural ER to the time of t-PA administration. Lessening the time needed for treatment only improves a patient's likelihood of decreased stroke morbidity and mortality.

Objectives

Attendees will learn about the AR SAVES (Stroke Assistance through Virtual Emergency Support) program and its outcomes thus far.

Attendees will learn the telemedical strategies developed to make AR SAVES a successful telemedicine program.

Ickenstein Guntram W. MD, PhD

Chairman Neuromedicine HELIOS Hospital Group, Director Department of Neurology & Stroke Unit Dysphagia Center, HELIOS General Hospital Aue - Technical University Dresden, Gartenstr, Germany

748 An Empirical Analysis of the Current Need for Teleneuromedical Care in German Hospitals

Background: At present, modern telemedicine methods are being introduced, that may contribute to reducing lack of qualified stroke patient care, particularly in less populated regions. With the help of video conferencing systems, a so-called neuromedical teleconsultation is carried out.

Methods: The study included a multicentered, completely standardized survey of physicians in hospitals by means of a computerized on-line questionnaire. Descriptive statistical methods were used for data analysis.

Results: 119 acute hospitals without neurology departments were included in the study. The most important reasons for participating in a teleneuromedical network is seen as the improvement in the quality of treatment (82%), the ability to avoid unnecessary patient transport (76%), easier and faster access to stroke expertise (72%) as well as better competitiveness among medical services (67%). The most significant problem areas are the financing system of teleneuromedicine with regard to the acquisition costs of the technical equipment (43%) and the compensation for the stroke-unit center with the specialists' consultation service (31%) as well as legal aspects of teleneuromedicine (27%).

Conclusions: This investigation showed that there is a high acceptance for teleneuromedicine among co-operating hospitals in Germany. However these facilities have goals in addition to improved quality in stroke treatment. Therefore the use of teleneuromedicine must be also associated with long term incentives for the overall healthcare system, particularly since the implementation of a teleneuromedicine network system is time consuming and associated with high implementation costs.

Objectives

To discuss the current need for teleneuromedical care in German Hospitals without Neurology Departments.

To show acceptance rate of teleneuromedicine in hospitals in Germany.

Carroll Patricia RN, MS

Outreach Coordinator

Utah Telehealth Network, Salt Lake City, UT, USA

290 The University of Utah, Stroke Center Telestroke Program & Multiple Use Telemedicine Model

The University of Utah Health Care, Clinical Neurosciences and Spine Center, Stroke Center Telestroke Program, established in May 2004 in partnership with Utah Telehealth Network (UTN), provides stroke consultation to both rural and urban Utah. Certified as a primary stroke center by Joint Commissions on Accreditation of Healthcare Organizations (JCAHO), the Stroke Center provides comprehensive high-quality care to patients with cerebrovascular disease. Using real-time videoconferencing and teleradiology, the Telestroke Program provides 24-hour on-call board certified neurologists to community hospitals to aid in prompt diagnosis and treatment of stroke patients. Once the connection is established, the neurologist conducts a one-on-one evaluation with the stroke patient and reviews the patient's CT scans, which are uploaded to the University PACS system. Following the evaluation, the neurologist discusses the findings with the community ED physician to determine the best treatment plan and appropriate triage. In six years, five University of Utah Hospital vascular neurologists have conducted over 200 telestroke consultations with seven spoke hospitals (six rural and one urban), spanning 84,900 square miles. The most remote hospital is 289 miles away. The objective of this presentation is to discuss the U of U Telestroke Program within the context of a multi-use telemedicine model. The Telestroke Program & model will be discussed including membership, contracts, key implementation recommendations, interoperability, IT support and sustainability. The Physician Telestroke Connectivity Survey data for 2009-2010 will be summarized.

Objectives

To discuss the U of U Telestroke Program within the context of a multi-use telemedicine model.

Outline the multi-use telemedicine model, including: membership, contracts, key implementation recommendations, interoperability, IT support and sustainability.

Individual Oral Panel Session Number 53 Session Title: MEDICAL INFORMATION EXCHANGE, LINKING ELECTRONIC HEALTH RECORDS AND TELEMEDICINE

Track: Technology & Telecommunications   Room Number: 22/23

MODERATOR: Neal Neuberger, CISSP, President, Health Tech Strategies, LLC, McLean, VA, USA

Khurelbaatar Mungun-Ulzii

Cardiologist

Dagva Mungunchimeg Cardiovascular Center Project, Ulaanbaatar, Mongolia

482 Web-based Medical Record in Telemedicine in Mongolia

The Cardiovascular Center, the Grand Duchy of Luxembourg Government funded project, is a telemedicine project that covers rural hospitals and central hospitals in the capital city in Mongolia. As a telemedicine project, one of its major objectives is to make central expertise available to rural doctors thus decreasing unnecessary referrals. However, patient information sharing among doctors in different regions of the country was one of the major challenges of the project because doctors in the rural regions had limited knowledge on basic IT skills. The project initially used software to maintain an emailing system for tele-consultation among doctors. However, the software eventually failed due to its requirement of frequent re-installation and upgrading. Besides as the software only allowed second opinion, that is, information sharing between two doctors at a time, there was no strong incentive for all the doctors in project-involved provinces to use the system until they needed advice. To overcome these difficulties, the project has developed a web-based medical record which allows continues improvement and doesn't require individual installation. The major achievement in the system is a discussion forum which allows not only second opinion but many more. After its launch in May 2009, a total of 394 patient files have been created. 212 questions were asked, which generated 881 responses with an average of 4 responses per question. The web-based EMR also facilitates patient care management by making it possible to set appointments with central level doctors from rural regions so that patients will be transferred on scheduled date for surgical and/or interventional procedures. From this preliminary result we can see that the program is effectively used and its discussion forum motivates doctors to participate in order to share their experiences and learn from such an interaction. The web-based medical record is suitable for the emerging country like Mongolia.

Objectives

To share our experience on development of medical record for teleconsultation.

To share our experience on how EMR is assisting rural doctors practice.

Hogge Nathan

Product Manager

Ferguson Stewart PhD Macedo Ron Alaska Native Tribal Health Consortium, Anchorage, AK, USA

555 Connecting Telehealth and the New HIE in Town

“Meaningful Use” and associated incentives are driving not only EHR adoption and upgrades through the US, but also pushing many organizations to participate in Health Information Exchanges (HIE) and to offer Personal Health Records (PHRs) for their patients. HIE technology - by its very nature - provides much of the functionality of a basic telehealth system as it provides organizations with the ability to move healthcare data across large distances and across organizational boundaries. PHR systems similarly blur the boundary with telehealth as multiple PHR solutions are now available that integrate with more than 100 different home health monitoring devices. However, it is not a clear how or when a Telehealth System should connect with these solutions - and where this technology will drive the telehealth market. Many telehealth systems still remain disconnected from existing EHR systems. The AFHCAN Telehealth Program, connecting more than 40 different organizations with more than 250 sites in Alaska, has faced this challenge by developing a standards-based approach in partnership with the Indian Health Service (IHS). The current solution offers the ability to pull both patient demographics and patient health summaries from multiple EHRs, and to transport and render this information at other organizations similar to a mini-HIE. Ongoing development efforts include the development of a bi-directional model to track all telehealth activity within the EHR. These efforts, and the challenges they present, will be explained in the context of the larger picture of HIE technology and emerging NHIN Exchange solutions and HIE adoption.

Objectives

To discuss telehealth interaction with NHIN Exchange and HIEs.

To review the connection of EHR using standards-based approach.

Casscells S. Ward MD 1

Vice President for External Affairs and Public Policy, Parsa Mirhaji, MD, PhD², Assistant Professor of Informatics

1 University of Texas Health Science Center, Houston, TX, USA 2 University of Texas, Houston, TX, USA 756 The Obama Administration Charts a New Course for EHRs: A Semantic Web

The President's Advisory Council on Science and Technology has recommended - and ONC is poised to adopt - a new exchange language for electronic records which will tag all data elements with metadata (eg, who took the blood pressure, when, where, on what medicines, and who is allowed to see it) into the Internet (or a private cloud). This novel approach has the potential to improve data security and analysis, EHR interoperability, and costs. But metadata-tagging, and subsequent semantic technologies such as natural language processing, will require a major overhaul of EHR architectures and business strategies.

Objectives

To review new exchange language for electronic health records.

To discuss how metadata-tagging will change EHR architectures and business strategies.

Discussion Panel Session Number 54 Session Title: 60 INTERNET-BASED TELEMENTAL HEALTH: ARE WE FACING A NEW "WILD WEST?"

Track: Public Policy   Room Number: Ballroom D

MODERATOR: Joseph Ternullo, JD, MPH, Associate Director, Center for Connected Health, Partners Healthcare System, Boston, MA, USA

Ternullo Joseph JD, MPH 1

Associate Director

Maheu Marlene M. PhD 2

Executive Director

Puskin Dena S. ScD 3

Senior Advisor

McMenamin Joseph P. MD, JD 4

Partner

Drude Kenneth PhD 5

Psychologist

1 Center for Connected Health, Partners Healthcare System, Boston, MA, USA 2 TeleMental Health Institute, Inc., Carson City, NV, USA 3 Health Resources and Services Administration, Rockville, MD, USA 4 McGuireWoods, Richmond, VA, USA 5 University Psychological Associates Inc., Dayton, OH, USA

This discussion will review the current legal and regulatory environment in telemental health, and outline options for “next steps” to establish best practices leading to a framework for future legal and regulatory oversight. With over 200,000 monthly Google searches for on-line clinical mental health services, consumer demand is quickly outstripping the pace of our scientific reports of risks and benefits. Correspondingly, the number of on-line practitioners, products and services is growing exponentially. Between February and July 2010, the number of related search results grew from roughly 400,000 to 1.7 million. Appearances can be deceiving in mental health when on-line consumers seek solutions. What at first glance may seem to be an everyday problem might belie a far more serious condition that is inappropriate for an on-line intervention without in-office intake or assessment. Regulations and practice definitions are expanding rapidly, but haven't kept pace with potential malpractice related to email, messaging, social networking, video conferencing and expanding mobile applications. Our often vague legal and ethical standards have led to a “Wild West” environment, where practitioners deliver services on-line but sometimes without the training to comply with existing legal, regulatory, or ethical requirements related to informed consent, tested clinical research, emergency backup, authentication or patient training. Strong potential for defensive regulatory response exists if significant problems and abuses become apparent, particularly when instantaneous communication through the media can easily magnify problems that emerge. Unfortunately, although affording greater protections for the public, defensive regulatory action may also deny long-overdue services to people who need them and make well-meaning practitioners vulnerable to unwitting infractions of law. This presentation will thus focus on potential legal and regulatory "“next steps.”.

Objectives

Participants will be able to describe the current legal and regulatory environment in telemental health.

Participants will be able to discuss the “next steps” in legal, regulatory and ethical requirements in Internet-based telemental health.

Presentation Panel Session Number 55 Session Title:

Track: Operations, Business & Finance   Room Number: 13/14

MODERATOR: Sylvia Au, MS, State Genetics Coordinator, Hawaii Department of Health, Honolulu, HI, USA

Au Sylvia MS 1

State Genetics Coordinator

Andersson Hans MD 2

Director

Kubendran Shobana MS 3

Genetic Counselor, Assistant Professor

1 Hawai'i Department of Health, Honolulu, HI, USA 2 Hayward Genetics Center, Tulane University Medical Center, New Orleans, LA, USA 3 KUSM Wichita, Wichita, KS, USA 86 TELEGENETICS IN THE REGIONAL COLLABORATIVES: INCREASING ACCESS TO GENETIC SERVICES

Before the age of 25, 5.3% of the population has a disease with a significant genetic component. In the US, there is one genetic specialist per 100,000 population. In addition, there are approximately 4 million births each year in the US and even if only 1% of these births receive positive newborn screens, there are an additional 40,000 newborns per year requiring evaluation and treatment if they are confirmed to have a disease. This makes clinical services and education provided by genetic specialists a very scarce resource for the individuals, families, healthcare providers and public health programs that need their services. Funded through the Health Resources and Services Administration (HRSA), the seven Genetics and Newborn Screening Service Collaboratives (RCs) across the nation are in various stages of using telegenetics to increase access to genetic evaluation, counseling, treatment, and management; and to improve provider and family education opportunities, particularly in rural and underserved communities. This session will include in-depth discussions of the programs in the Heartland, Southeast, and Western States RCs. The Heartland holds regularly scheduled telegenetics clinics located in AR, KS, and MO that provide services within these states and across state lines. The Southeast provides clinical telegenetics services from the genetic specialists directly to an in-patient hospital floor and also to a community pediatric clinic. The Southeast also hosts monthly telegenetics regional grand rounds for continuing genetic specialist education. The Western States has telegenetics activities within states (OR and WA), between states (OR to ID), and across the waters of the Pacific (Honolulu and Hawai'i neighbor islands). The discussion will illustrate the successes and challenges faced by a small medical specialty in adapting to telehealth and possible partnerships with more established telehealth efforts to sustain and improve current activities.

Objectives

Increased knowledge about the telegenetics activities to improve public health and access to genetic services within the seven HRSA-funded Regional Collaboratives.

Increased linkages between ATA members and the regional collaborative, genetics subspecialists and public health with potential telemedicine sites and programs.

Individual Oral Panel Session Number 56 Session Title: TEAM-BASED, CARE COORDINATION AND PERSONAL TELEMEDICINE PRACTICES

Track: Operations, Business & Finance   Room Number: 15/16

MODERATOR: Seong Ki Mun, PhD, Director, Arlington Innovation Center, Virginia Tech – NCR, Alexandria, VA, USA

Antoniotti Nina M. RN, MBA, PhD

Director of Telehealth

Marshfield Clinic, Marshfield, WI, USA

677 “Moving into the Medical Home: TeleHealth Support for Primary Care”

The medical home, also known as patient-centered medical home, is a concept wherein a partnership exists between patients, caregivers, and primary care providers, where primary care facilitates and coordinates the care needed by patients. The medical home model is anticipated to improve access, reduce unnecessary care, improve outcomes, and lead to higher patient satisfaction. Healthcare reform is driving the move to the medical home model, which is also the foundation for an accountable care organization (ACO). Although there is much scientific evidence to support medical home, and payers have begun as early as last year, to structure payment under ACO models, no one has yet to identify how the increased burden on primary care will be handled. With requirements to support transition of care through all environments (hospital, office, skilled nursing facility, and the home), primary care providers are looking for innovative ways to meet the needs of a growing population of patients who will need primary care support in the hospital, the office, and the home. Telehealth is critical to the success of the medical home model. This presentation outlines a case study of a large multispecialty clinic that has structured primary care services into the medical home model. By using interactive video, remote monitoring, coordination of care processes, and actual home visits, three primary care centers have transitioned into the medical home model of care. Approximately 15 physicians and 750 patients are partnering in three rural areas to work within a primary care driven model. Organizational requirements, financial commitments, staffing, policies and procedures, and reimbursement and payment strategies for negotiating with payers will be covered. Clinical outcomes are reduced hospitalization, readmissions, costs, and increases in satisfaction and patient compliance. Participants will leave the course with a template for considering the partnerships that can exist between the medical home model and telehealth. As a key component of the medical home strategy, telehealth has truly been brought into the mainstream with the medical home concept. Primary care now can experience the benefits of early access, continued care, open communication, and happier patients, that specialty services have known for years.

Objectives

To understand the requirements for medical home.

To identify value and needs for use of TeleHealth in a primary care medical home model.

Vorhees Nancy L. MSN

Chief Operating Officer

Northwest Health Partners, Inland Northwest Health Services, Spokane, WA, USA

146 Telehealth as a Key Component of Technology-Based Care Coordination Programs in Rural Communities

In coming years health reform, whether driven by federal legislation or private payer policy changes, will significantly affect the healthcare system in the US. The goal is seamless delivery and coordination of care for patients across multiple healthcare organizations, moving away from fee-for-service systems to outcomes-focused/team-based healthcare. Health reform efforts seek to accomplish this goal through payment reform to change fundamental incentives around the delivery of care and health information technology and information exchange to provide a stronger foundation for clinical decision-making. Health information technology and information exchange by itself is not enough to transform the healthcare system as envisioned by policy makers. Telehealth programs will be a critical to health reform's success. Team-based care requires greatly improved communication as well as better access to health information. Telehealth facilitates communication, especially in rural communities where patients and members of their care teams may be spread over a large geography. Care coordination and planning will be most effective when patients, family members, and members of the care team can interact in real-time with each other and with critical health information available from wherever that patient has received health services. Are healthcare organizations ready for this change? Northwest Telehealth conducted a survey of rural healthcare organizations to assess their level of preparedness for care coordination and their understanding of the technology tools that are necessary for this new healthcare paradigm to succeed. The survey analyzed their willingness and ability to participate in care coordination teams, the technology tools they currently have available, the role of telehealth in care coordination, and the factors they believe are necessary for effective, efficient care coordination. The results of the survey provide guidance for telehealth programs on how to position their services to support care coordination in rural regions.

Objectives

To analyze the preparedness of rural healthcare providers for care coordination.

To discuss the role of telehealth in care coordination.

Riesenbach Ron BSc, MSc, MBA, PEng, CPHIMS-CA

Vice President of Emerging Business

Brown Ed MD Poole Laurie BScN, MHSA Ontario Telemedicine Network, Toronto, ON, Canada

284 Driving Adoption Through Personal Telemedicine

The Ontario Telemedicine Network (OTN) is one of the largest telemedicine networks in the world. With 2,000 videoconference endpoints in 1,100 sites across the province, OTN facilitated more than 100,000 clinical consults last year. Despite these accomplishments, telemedicine encounters account for less than 1% of all the encounters between patients and their care providers in Ontario. As such, OTN is working to find new ways to drive Telemedicine adoption. Among the strategies being pursued, OTN is adding to its real-time videoconference service new modalities such as store-forward and telehomecare. A major challenge with these new modalities will be ensuring that services are intuitive enough for busy healthcare practitioners to use and efficient enough as the service grows. OTN is developing an integrated portal which will bring telemedicine from an institution-to-institution system to a ‘personal telemedicine’ solution. With personal telemedicine, healthcare providers will be able to use their own computers and smart phones to get the information and applications they need to serve their patients at a distance. Telemedicine is a highly collaborative health service involving specialist consultants, primary care providers, service administrators and patients. Drawing from lessons from social networking, OTN is deploying tools in the portal to enable users to find, negotiate, schedule and connect with one another. As well, OTN is adapting its services so that they are available “in the cloud” which make applications accessible from wherever the provider may be. The solutions being developed by OTN draw heavily from recent advances in web-applications, consumer electronics, and public Internet networks. We are expecting these innovations to reduce expensive videoconference hardware and complex workflows bringing new efficiencies to the service. This presentation will outline OTN's recent innovations and show comparative end-user adoption and utilization results.

Objectives

Personal telemedicine holds great promise as an effective and scalable service delivery model.

Increasingly Web-savvy Providers and Patients are pressuring telemedicine networks to change their cumbersome and manual processes. Telemedicine service providers must change or be replaced by more nimble organizations.

3:00 pm–4:00 pm  Tuesday, May 3

Individual Oral Panel Session Number 57 Session Title: TELEREHABILITATION: ASSESSMENT AND TREATMENT STUDY RESULTS AND TOOLS FOR PAIN MANAGEMENT, LITERACY AND AUTISM

Track: Clinical Services   Room Number: 19

MODERATOR: Ellen Cohn, PhD, Associate Dean for Instructional Development, University of Pittsburgh – Rehabilitation Engineering Research Center (RERC) on Telerehabilitation, Pittsburgh, PA, USA

A Philip A.

Clinical Informatics Researcher

Carey Julie Kromelow Justin Brose William G. MD Health Education for Living with Pain, San Mateo, CA, USA

392 Interdisciplinary Pain Rehabilitation via Telemedicine

Aim of Investigation: To demonstrate the applicability of Telemedicine to Interdisciplinary Pain Rehabilitation. Interdisciplinary pain rehabilitation is recognized as one of the most effective forms of chronic pain treatment. Published benefits of telemedicine include high satisfaction by patients and providers, as well as time and cost savings. A curriculum designed to support learning via telemedicine was created; comprised of integrated video and audio contact with event based triggers. Progress was determined by individualized functional goal in 4 life categories: ADLs, vocational, social, and recreational goals.

Methods: Initial care plans were developed by structured comprehensive in office interdisciplinary evaluation. Initial self-management training was delivered in office. Telemedicine care included structured interviews, narrative, videos, activity prompts, pain management reminders, and motivational messages. Interdisciplinary clinical conferences reviewed patient contacts and adjusted care plan and interaction frequency. Goal analysis provided measurement of progress.

Results: Since 2006 interdisciplinary telemedicine pain rehabilitation was provided to 345 patients, via 24,500 telephone or videoconference contacts, 8,100 emails, and 39,000 automated activity and inspiration calls. Analysis revealed 72% of patients were successful in achieving goals set via the in-office program and 90% were able to achieve or maintain goals set via the telemedicine program (90% ADLs; 82% vocational; 100% social; 100% recreational).

Conclusions: Interdisciplinary pain rehabilitation treatment can be delivered using telemedicine with evidence of functional progress and goal attainment. Telemedicine provides an alternative to the delivery of in person care while maintaining a high level of clinician interaction and patient education while improving patient outcomes. The benefit of interdisciplinary telemedicine in chronic pain has immediate applicability in the care of patients, especially where logistic or geographic barriers prevent the use of conventional in-office program treatment.

Objectives

To develop evidence and methods to support best practices for telemedicine applications in chronic pain.

To develop evidence and methods for interdisciplinary treatment utilizing telemedicine in chronic pain.

Waite Monique BSpPath (Hons)

Lecturer

Theodoros Deborah BSpThy (Hons), PhD Russell Trevor The University of Queensland, Brisbane, Australia

367 The Online Treatment of Phonological Awareness for Literacy: A Phase I Trial

Phonological awareness treatment programs aiming to develop a child's sensitivity to sound in words, have been found to promote positive outcomes in children with literacy difficulties. Although a number of computerized phonological awareness programs are available, to date there have been no studies investigating interactive videoconferencing as a mode for delivering such intervention. Therefore the current Phase I trial aimed to provide a proof of concept of the telehealth treatment of literacy using the Phonological Awareness for Literacy (PAL) program. A portable PC multimedia videoconferencing system, the eHAB(TM), was operated between two rooms via a 128 Kbps university network or a Wi-Fi network. Eight children, aged 8 to 10 years with literacy difficulties participated. The system enabled the display of stimulus images and text onto the participant's computer, and incorporated several interactive tools to facilitate aspects of the PAL program. Each participant underwent treatment via the system twice weekly for a period of 10 weeks. The participant was evaluated on various phonological awareness, reading, and spelling measures, and the online treatment was evaluated in terms of participant and parent satisfaction. Clinical outcomes were measured using descriptive statistics and Wilcoxon paired signed ranks tests. Significant group effects were found for two outcomes: nonword spelling (p = < 0.01), and text reading accuracy (p = 0.01). However, there was also a trend towards improvements for most other outcome measures, with a high degree of inter-participant variability in response to intervention. A high level of participant and parent satisfaction was also found, with the mean rating for all questions falling above the mid-point on a negative-to-positive satisfaction scale. Collectively, these results support ongoing research into the use of the online PAL program.

Objectives

To understand the potential of an Internet-based videoconferencing system for treating children with literacy difficulties.

To understand the factors that may have contributed to the study's results.

Schutte Jamie L. MS

Instructor

McCue Michael PhD Parmanto Bambang PhD Pulantara Wayan I. University of Pittsburgh, Pittsburgh, PA, USA

480 Usability, Reliability, and Validity of Remote Autism Diagnostic Observation Schedule Module 4 Administration

Autism Spectrum Disorders are usually diagnosed in early childhood through a combination of observing behaviors, investigating developmental history, and conducting standardized diagnostic assessments. Few assessments are designed for use with adults, and it is difficult to diagnose individuals who were undiagnosed or misdiagnosed in childhood. The Autism Diagnostic Observation Schedule (ADOS) module 4 has recently become part of the gold standard in ASD diagnosis in adults. Unfortunately, few clinicians are trained in administering and scoring the ADOS module 4. Specialists are typically located in large cities, and can be inaccessible to individuals residing in rural areas. Teleassessment, the remote administration of assessment tools through use of interactive videoconferencing between a client and a remotely located assessment expert, has potential to improve access to services for underserved and rural clients. Specifically, an ADOS module 4 remote assessment system that integrates videoconferencing, presentation of stimuli, scoring, data storage, and report generation and sharing into an integrated and intuitive web portal environment has been developed. Clinical usability studies are underway (and will be completed by December, 2010) that use participatory development and cognitive walkthroughs to evaluate the functionality of the remote administration system. A reliability study will use a within-subjects (adults with ASD diagnoses) cross-over design to examine the correlation between face-to-face and remote administration ADOS scores, (preliminary results will be available by May, 2010). Finally, a validity study will estimate the diagnostic accuracy of a remotely administered ADOS module 4 with adult participants who are diagnostically representative of those who might seek services from an adult autism outpatient clinic. Researchers believe that results will demonstrate that an integrated Internet-based teleassessment system is as reliable and valid as face-to-face assessment, and has the added benefit for reducing service delivery costs associated with travel and time.

Objectives

Define teleassessment and understand the potential benefits of remote assessment services for individuals with ASD.

View and evaluate the strengths and drawbacks of the integrated Internet-based teleassessment system designed for administrating the gold standard adult autism assessment tool.

Individual Oral Panel Session Number 58 Session Title: TELEHEALTH-BASED CARE MODELS FOR AUTISM

Track: Telemental Health   Room Number: 24/25

MODERATOR: Michael Campbell, MS, MBA, CCC-SLP, Director of the Speech and Hearing Program, The University of North Carolina at Greensboro, Browns Summit, NC, USA

Lee John BA

Behavioral Consultant

Padilla Yaniz BA Kopelman Todd PhD Wacker David PhD Lindgren Scott PhD University of Iowa Hospitals and Clinics, Iowa City, IA, USA

161 Increasing Accessibility of Behavioral Treatment for Autism Through Telehealth

Autism is a neurodevelopmental disorder defined by impairments in the areas of social interaction, communication, and atypical behaviors that affects approximately 1 in 110 persons. Research has demonstrated that the delivery of early intervention services is critical for young children with an autism diagnosis. Providing evidence-based behavioral services for young children with autism can be challenging in rural areas due to limited accessibility of trained professionals. This presentation will describe a project aimed at evaluating the hypothesis of whether telehealth technology can be used to effectively and efficiently deliver Applied Behavior Analytic (ABA) services to young children with autism spectrum disorders who reside in rural locations in Iowa. At least 30 children with autism spectrum disorders will be included over the course of this two-year NIMH project. All children are between 1 and 6 years of age and display significant problem behaviors (e.g., tantrums, noncompliance, aggression, or self-injurious behaviors). Each child is comprehensively evaluated to confirm that they meet diagnostic criteria for an autism spectrum disorder. Following diagnostic confirmation, a behavioral evaluation is conducted using telehealth at a regional Child Health Specialty Clinic (CHSC) near the child's home. The child's parents are then trained to conduct an evidence-based behavioral treatment, functional communication training (FCT). Parents, assisted by CHSC staff, receive weekly consultation on assessment and treatment procedures via telehealth delivered by behavior specialists at the University of Iowa Children's Hospital. All sessions are recorded and data is collected and graphed to determine changes in the child's disruptive and appropriate communicative behaviors. In this presentation, a brief overview of autism and ABA will be provided. Following this overview, we will describe the procedures used in this study, including a description of the telehealth equipment. We will then review up-to-date outcome data on changes in disruptive behavior, parent ratings of treatment acceptability, and cost efficiency data for use of telehealth to deliver behavioral services.

Objectives

Increased understanding of how telehealth can be used to deliver behavioral interventions to children in rural areas.

Increased awareness of outcome data on reduction in problem behaviors and parent acceptability of treatment for children participating in the project.

Angjellari-Dajci Fjorentina PhD, MA 1

Assistant Professor of Economics

Stachura Max E. MD 2 Astapova Elena MD, PhD 2 Goldstein Felissa MD 3 Lawless William F. PhD 1

1 Paine College, Augusta, GA, USA 2 Medical College of Georgia, Augusta, GA, USA 3 Marcus Autism Center, Atlanta, GA, USA 301 Benefit-Cost Methodological Framework for Evaluating Telehealth Models for Autism Spectrum Disorders

Background/Significance: Economic evaluations of telehealth's use for diagnosis, treatment and management of Autism spectrum disorders (ASDs) are rare or non-existent. The increasing nationwide ASD prevalence is raising the gap between ASD service availability and demand, producing a critical need for economic evaluations of telethealth-based systems that enhance access to healthcare resources and lower treatment and management costs. Most systematic economic evaluations of telehealth interventions focus on cost or cost-effectiveness and either neglect economic benefits or evaluate benefits in terms of cost savings alone.

Objective: Our objective was to create a comprehensive methodological framework for measuring both realizable economic benefits and current costs faced by major stakeholder groups involved in ASD diagnosis, treatment and management.

Methods: Our benefit-cost analysis (BCA) employs a societal perspective to framework the economic evaluation: account for the net effect of resource transfers from one group to another in a comparative approach to two telehealth models (consultative telemedicine and home monitoring) and the in-person care model. We aimed at evaluating both benefits and costs for each stakeholder group (patient/family, provider, and payer/insurer, employer and taxpayer) separately, and then used societal aggregation. Our BCA methodology compares economic costs with monetized economic benefits of program outcomes for each model to determine whether telehealth programs are both economically justified and societally better than alternative uses of the same resources.

Results: Results using our BCA give a more compressive evaluation compared to cost-effectiveness analyses due to monetary conversions of outcomes and evaluation of interventions with multiple outcomes, as well as allow for better identification of threshold levels and sensitivity analysis.

Conclusion: Our methodological framework has value for ASD-specific and other medical applications to evaluate whether telehealth-based care systems can make early clinical intervention with long-term cost savings possible and document stakeholder group economic benefits that outweigh related costs.

Objectives

Create a comprehensive methodological framework for measuring both realizable economic benefits and current costs faced by major stakeholder groups involved in ASD diagnosis, treatment and management.

Employ a societal comparative approach to two telehealth models (consultative telemedicine and home monitoring) and the in-person care model.

Reischl Uwe PhD, MD 1

Professor, Ronald Oberleitner, BS

2 Lacy Timothy MD 2

1 Boise State University, Boise, ID, USA 2 Behavior Imaging Solutions, Boise, ID, USA 521 Store-and-Forward Telehealth for Remote Supervision of Behavior Therapy for Military Dependents with Autism

The U.S. Air Force funded an assessment of a novel telemedicine technology that has the potential to improve Applied Behavior Analysis (ABA) therapy for military dependents with autism. ABA is often conducted in the home between 10–40 hours per week over extended periods of time. Because of a shortage of behavior therapists, ABA is often conducted by non-certified “tutors” or increasingly, family members (caregivers). In this pilot study, remote supervision of caregivers providing home-based ABA was facilitated using Behavior Imaging®, a select store-and-forward telemedicine technology developed for behavior health applications. This system consists of a software video capture system (“Behavior Capture”) and remote controlled camera connected to a Health Information Portability and Accountability Act (HIPAA) compliant server that acts as a web-based tele-consultation portal (“Behavior Connect”) between supervisor and caregiver. Four ABA therapy service provider agencies were selected to treat 30 military beneficiaries. Supervision was provided to at least 9 tutors and 21 family members for up to 3 months in the delivery of therapy. Behavior Imaging technology was adopted to suit the workflow of each service agency. Questionnaires were administered to all participants before and after an evaluation period to assess the following: System utility, perceived system effectiveness, actual system usage, and user's perceived system strengths and limitations. Both provider and caregiver perspectives were noted before and after assessment. The findings revealed the following: Providers and caregivers perceived the technology to be used easily, the technology improves effectiveness for select aspects of therapy, and system applications varied during the assessment period. Both Supervisors and caregivers universally agreed that, while the technology cannot replace in-person behavior therapy, it can provide useful distance supervision for families or tutors when a behavior therapist is not available in person.

Objectives

Discuss the application of behavior imaging to the management of autism.

Examine the use of telehealth in Applied Behavior Assessment supervision.

Discussion Panel Session Number 59 Session Title: 67 A MODEL FOR CROSS AGENCY COLLABORATION TO DELIVER TELEHEALTH FOR SCHOOL-BASED AND RURAL COMMUNITIES

Track: Telemental Health   Room Number: Ballroom A

MODERATOR: Caroline Bonham, MBBS, MSc, Assistant Professor Psychiatry/Associate Training Director, University of New Mexico Center for Rural and Community Behavioral Health, Albuquerque, NM, USA

Bonham Caroline MBBS, MSc 1

Assistant Professor Psychiatry/Associate Training Director

Adelsheim Steven MD 2

Director/Professor of Psychiatry

Kelly Leslie G. MA 2

Statewide Telebehavioral Health Coordinator

Bonds Celeste MAOM 3

School Health Services Director Region IX

Fore Chris PhD 4

Behavioral Health Consultant

Rameriz-Moya Lorerky MD 5

Child & Adolescent Psychiatry, Second Year Fellow

1 University of New Mexico Center for Rural and Community Behavioral Health, Albuquerque, NM, USA 2 University of New Mexico, Albuquerque, NM, USA 3 Ruidoso High School Health Center/Region IX, Ruidoso, NM, USA 4 Indian Health Services, Albuquerque, NM, USA 5 University of New Mexico Department of Psychiatry, Albuquerque, NM, USA

Background: Mental health problems in youth can be associated with substantial impairment such as physical health co-morbidity, family disruption, and difficulties with educational achievement. In order to access care for these problems, youth and their families are expected to seek help from different providers at multiple agencies. In rural communities, families may need to travel as far as 90 miles to attend these appointments and receive care. Telemental health is a valuable way to offer training, supervision, consultation, and direct clinical care to families, providers, and agencies in a manner that is truly family centered and interdisciplinary.

Methods: We asked providers and families who participated in telehealth to complete satisfaction surveys in order to learn about their experiences using this method of mental healthcare delivery.

Results: Of 60 families surveyed, all were satisfied with their interactions with their clinician and indicated they would recommend telehealth to others. However, one individual disagreed that telehealth was as good as care provided in person and another individual experienced problems with video quality. Sixteen indicated they would NOT have attended the appointment if telehealth was not available. Of 65 providers who attended case conference discussions over telehealth, all were satisfied with the content of the presentations. However, 6 respondents indicated there were technological failures.

Discussion: In this panel of professionals from different health and educational disciplines, we will discuss our model for using telemental health in school based health centers to provide quality care, consultation, and continuing education and training to youth, families and providers. As suggested by our survey results, telehealth offers advantages through its capacity to increase access to care and to facilitate communication across agencies; however, connectivity continues to be problematic in rural areas.

Objectives

To provide an understanding of model development and collaboration and their importance when delivering telemental health services.

To understand the vital component of training and workforce development using telemedicine as a service delivery model.

Discussion Panel Session Number 60 Session Title: 106 THE USE OF EXPERIENTIAL LEARNING AND MENTORING IN NEW TELEMEDICINE PROGRAMS

Track: Emergency & Disaster Response   Room Number: 20/21

MODERATOR: Shawn Farrell, MBA, Director, Neurology Telemedicine Program, Massachusetts General Hospital, Boston, MA, USA

Farrell Shawn MBA 1

Director, Neurology Telemedicine Program

Nystrom Karin APRN 2

Associate Clinical Director

Forducey Pamela PhD 3

Director of Applications

Viswanathan Anand MD 1

Director of the MGH Neurology Telemedicine Program

Cress Tammy RN, MSN, FAHA 4

Director of Telehealth

Solenski Nina MD 5

Associate Professor, UVA Primary Stroke Center

1 Massachusetts General Hospital, Boston, MA, USA 2 Yale-New Haven Hospital, New Haven, CT, USA 3 Integris Health, Oklahoma City, OK, USA 4 Swedish Medical Center, Seattle, WA, USA 5 University of Virginia, Charlottesville, VA, USA

The Massachusetts General Hospital (MGH) Telestroke Program is the oldest continuously operating “hub and spoke” acute stroke telemedicine network in the United States, and provides remote care to patients in 26 community hospitals throughout New England. Through its Telestroke Alliance Program, MGH has provided mentoring services and its complete program architecture (i.e. its clinical and business processes, protocols, procedures, tools, technology architecture and software) to several new telestroke programs in development across the country. This panel will explore how four other hospital networks (Swedish Medical Center in Washington, Integris Health in Oklahoma, Yale-New Haven Hospital in Connecticut, and University of Virginia Health System in Virginia) have taken these basic structural elements and modified them to meet their specific clinical needs. Panelists will discuss how their successful programs - each a variant of the MGH program - have evolved in order to achieve success in their regional marketplace. They will also discuss what improvements in clinical outcomes have been achieved through the implementation of their programs, what challenges they have faced, and what their future plans are. The panel members will share important lessons learned throughout the implementation process, what key elements are essential for success, and what benefits were gained from utilizing the mentored approach. The panelists and moderator will engage in an interactive discussion regarding the future of telestroke, teleneurology, and specialty telemedicine using the "hub and spoke" approach. The vital role academic medical centers and other “hub” hospitals will play in the global dissemination of telemedicine best practices will be discussed.

Objectives

To discuss the importance of seeking guidance, and in learning from the cumulative experiences of others, in adapting a telemedicine program to meet the needs and available resources of a regional market.

To review the importance of using clinical outcomes data along with financial and other business metrics to evaluate and demonstrate telemedicine program success.

Individual Oral Panel Session Number 61 Session Title: EMERGING TECHNOLOGIES SUPPORTING ADVANCED TELEMEDICINE SERVICES FOR MILITARY AND CIVILIAN USE

Track: Technology & Telecommunications   Room Number: 22/23

MODERATOR: S. Ward Casscells, MD, Vice President for External Affairs and Public Policy, University of Texas Health Science Center, Houston, TX, USA

Cleary Daniel J. MBA, MS 1

Computer Scientist

Genc Sahika PhD 1 Astapova Elena V. MD, PhD 2 Stachura Max E. MD 2 Wood Joseph C. PhD, MD 3 1 GE Global Research, Niskayuna, NY, USA 2 Center for Telehealth, Medical College of Georgia, Augusta, GA, USA 3 Dwight D Eisenhower Army Medical Center, Fort Gordon, GA, USA 325 Health Sensor Informatics Offers Improved Understanding of TBI and PTSD in Returning Soldiers

Health informatics technology advances offer the potential to measure and observe disease with greater pervasiveness, objectivity and accuracy. The rich body of data offered by sensor informatics may identify currently unknown and unexplored disease relationships. Our research focuses on developing unobtrusive sensors and related health informatics to provide high-quality, objective information about activity and sleep quality in soldiers with TBI/PTSD. This innovative project seeks to establish direct correlations between physiological measurements and clinical assessment - self-reported and clinically observed. No comparable studies of sensor technologies in TBI/PTSD exist. Technical approach: (a) Identifying key PTSD/TBI symptoms and clinical pathways; (b) Mapping disease symptoms to standard clinical models; (c) Developing sensor-based health informatics system(s); (d) Deploying health informatics system in a Warrior Transition Battalion (WTB) barracks; and (e) Providing analytical and statistical outcomes that potentially establish correlation between observed measurements and assessments. Our health informatics sensor system includes unobtrusive vital signs measurement, room environment sensors and daily activity. The analytical model combines a finite state automaton (FSA) with elements of traditional control systems. Estimates of activity and sleep transitions (events) are combined producing a state model for direct measurement and comparison with regular clinical assessment. System development and testing is at GE Global Research laboratories, Niskayuna, NY with deployed testing at the WTB barracks, Fort Gordon, GA. Specific efforts are aimed at improving the wounded warrior transition process and the monitoring and treatment of PTSD/TBI illness. We present year 1 of our 2-year TBI/PTSD research, including the technical and human-subject challenges facing the research team: including sensor selection, deployment method, clinical assessment instrument selection, and testing/validating sensor-based health informatics systems. Emerging health sensor informatics technologies potentially offer advances in identifying, monitoring and objectively measuring physiological symptoms of illness and disease in many areas including homecare, eldercare, and hospice.

Objectives

To discuss emerging capabilities in health sensor informatics.

To review health informatics advances and their potential to improve Military and Civilian Telehealth.

Beebe Michael K. BGS, MA

R&D Project Manager

Gilbert Gary R. BS, MS, PhD USAMRMC/TATRC, Fort Detrick, MD, USA

432 ‘Game Changers' - Unmanned Systems (UMS) for Medical Resupply and Personnel Evacuation Research and Development

These R&D projects investigate, develop and demonstrate enabling technologies designed to autonomously deliver medical supplies, from medical treatment facilities in the rear to medical personnel on the ground for combat casualty care, stabilization, and subsequent evacuation. Platforms considered are unmanned air (UAV) and ground vehicle (UGV) technologies for: 1) Autonomous unmanned aerial vehicle UAV take-off, landing and navigation in urban and wooded terrain; 2) Collaboration and coordination between point of injury responders, platform controllers and receiving medical personnel. 3) UAV/UGV system integration for collaborative operations, including teleoperations and telerobotics; and (4) Telemedicine capability between the UMS system and the next higher echelon of medical care for enroute patient monitoring and the application of enroute teleoperated treatment protocols. The system is designed for Class VIII medical supply delivery, but the potential for casualty evacuation using a portable casualty sustainment module aboard the platforms is also discussed. This system is being developed to support military operations, but its applicability to disaster relief scenarios where normal lines of supply and evacuation have been disrupted and relief personnel are stretched thin is also discussed. These projects include the recently completed and very successful Combat Medic UAS project; the CBRN Contaminated Human Remains Recovery project; and the new ‘Black Knight’ Integrated UAS/UGV project.

Objectives

Understand what is technically feasible today regarding the employment of unmanned systems for various medical missions, both civilian and military.

Understand the technical, operational and policy issues associated with the employment of unmanned systems for medical missions.

Stevens Brenda L. PMP

Product Line Manager

DHIMS, Falls Church, VA, USA

49 Department of Defense: Imaging Technology and the Electronic Health Record

The Defense Health Information Management System, a program office under the Office of the Chief Information Officer, is charged with managing the development of the military's electronic health record. Deployed worldwide, the EHR is one of the most comprehensive electronic records in use at more than 60 military treatment facilities, 15 battlefield hospitals and on board 28 U.S. Navy ships that support 9.6 million service member and beneficiary records. The global nature of the military's EHR allows providers to view healthcare that was documented in a service member's record whether at the point of injury, on the battlefield, in a home-based treatment facility or at the Department of Veterans Affairs. One of the latest enhancements to the military's EHR is the ability to integrate medical digital artifacts and images including radiographs, photographs, audio files, video and scanned documents into the patient's existing record. The Healthcare Artifact and Image Management Solution will give the military's transient healthcare providers global awareness and access to the images at military treatment facilities anywhere, worldwide. HAIMS was created to address existing bandwidth problems associated with medical image sharing. For example, HAIMS will have a distributed database for regional documentation and image storage. From the database, HAIMS will identify each image and connect it to the appropriate patient allowing a consultant at National Naval Medical Center in Bethesda to view the x-ray of a service member in Iraq and provide a diagnosis due to a shortage of providers. The application will convert the images into a Web-based format, decreasing the file sizes often associated with x-rays and digital images. The HAIMS application is scheduled for deployment by the end of 2011. For the first time, attendees will see the military's solution to the challenges of information sharing for a 9.6 million transient patient population.

Objectives

Understand the complexity of the military's global electronic health record.

Examine one of the latest enhancements to the military's EHR that allows medical artifacts and images to be integrated into an electronic record.

Discussion Panel Session Number 62 Session Title: 53 SEVEN PILLARS OF WISDOM IN EMERGENCY MANAGEMENT FOR TELEMENTAL HEALTH IN REMOTE AND AUSTERE ENVIRONMENTS

Track: Public Policy   Room Number: Ballroom D

MODERATOR: Jay H. Shore, MD, MPH, Associate Professor, University of Colorado Denver, Aurora, CO, USA

Shore Jay H. MD, MPH 1

Associate Professor, COL

Poropatich Ronald MD 2

Deputy Director

Gahm Gregory PhD 3

Director

Mishkind Matt PhD 3

Acting Chief, Clinical Telehealth Division

Yellowlees Peter MD 4

Professor

1 University of Colorado Denver, Aurora, CO, USA 2 TATRC, Fort Detrick, MD, USA 3 National Center for Telehealth and Technology, Tacoma, WA, USA 4 University of California Davis, Sacramento, CA, USA

Clinical telemental health continues to grow beyond live interactive videoconferencing to include Internet/Web-based videoconferencing, mobile technologies, and asynchronous platforms (eg. video, email). These expanding platforms have increased the deployment of telemental health into unsupervised clinical settings and remote and austere environments. A critical area in this expansion is the use of these technologies in the management of psychiatric emergencies. This discussion panel will be comprised of four esteemed telemedicine experts with clinical and administrative experiences in delivery of remote telemental health treatments across a range of platforms (eg. video, mobile), and settings (military, civilian). Each panelist will briefly present a case or program description illustrating administrative procedures and clinical processes used to address psychiatric emergencies. This will be followed by a panel wide discussion with audience participation focusing on the following seven questions: 1) Are there conditions that should not be managed via telemental health? Is this determined by patient circumstances or specific inclusion/exclusion criteria? 2) What is the minimal level of patient site resources and clinical supervision required for remote emergency management? Does this vary by technology? 3) How should medical issues impacting patient safety (eg. alcohol, medication, medical illness) be assessed, triaged and addressed thru various telemental health modalities? 4) What are criteria for involving outside organizations (eg. community crisis teams, police) for emergency interventions? 5) What processes can be employed to assess and protect the safety of those in the patient's environment (eg. family, community, local staff)? 6) How does telemental health impact the patient-provider relationship during emergency management? 7) What is the optimal pairing of technology with patient, diagnosis and environment for emergency mental health management? The panel will conclude with a summary of consensus and divergence for the considered questions.

Objectives

To understand current and emerging best practices for management of mental health emergencies in a variety of telemental health settings and technologies.

Identify areas of consensus and divergence in the clinical and administrative aspects of telemental health emergency care.

Discussion Panel Session Number 63 Session Title: 62 GETTING PHYSICIAN BUY-IN: DESIGNING QUALITY METRICS THAT SUPPORT PHYSICIAN COMPLIANCE

Track: Operations, Business & Finance   Room Number: 13/14

MODERATOR: Richard B. Sanders, MPH, Director, Telemedicine Services, Eagle Hospital Physicians, Atlanta, GA, USA

Sanders Richard B. MPH 1

Director, Telemedicine Services

Rogove Herb DO, FCCM, FACP 2

CEO and President

MacCormick Mac MD 1

Chief Operating Officer

Giarrizzi Dana DO, FHM 1

Medical Director

Miller Chad MD 2

Neuro-Intensivist

1 Eagle Hospital Physicians, Atlanta, GA, USA 2 C3O Medical Group, Ojai, CA, USA

As healthcare continues to move forward and faces a changing landscape of national health policy, increasing patient needs and physician shortages in healthcare delivery, telemedicine will become mainstream. The design, integration and evaluation of quality metrics that support physician compliance have received little attention in the literature to date. In the future compliance with these metrics at the local and national level as well as their integration into the practice of inpatient telemedicine will be required nationally. Patients, care givers, family members and health professionals alike want to be assured that telemedicine medical evaluations are safe, effective, patient-centered, timely, efficient and equitable. To guarantee that inpatient telemedicine meets these requirements, inpatient telemedicine solutions must incorporate known best practices as well as develop their own critical processes and solutions to support quality care and physician compliance. High levels of compliance will also be important in ensuring continued acceptance and adoption of inpatient telemedicine services. During this panel discussion, industry experts will discuss their experience in creating telemedicine quality metrics and evaluation of compliance among physicians in practice as well as discuss what the future of telemedicine physician compliance will be. Participants will learn from the experts' experience and engage in a discussion of how best practices in quality and physician compliance may be translated into the process and practice of inpatient telemedicine.

Objectives

Understand the importance of creating and developing operational processes in telemedicine programs that support physician compliance with known quality metrics and encourage physician buy in.

Describe physician compliance methodologies and discuss how future developments may impact compliance and physician buy in to telemedicine programs.

Presentation Panel Session Number 64 Session Title: 56 ESTABLISHING A CORRECTIONAL TELEMEDICINE SERVICE: PRACTICES AND BENEFITS

Track: Operations, Business & Finance   Room Number: 15/16

MODERATOR: Rob Sprang, MBA, Director, Kentucky TeleCare, University of Kentucky, Lexington, KY, USA

Sprang Rob MBA 1

Director

Chula Michelle 2

Clinical Nurse

Vice-Pasch Dianna BSN 3

Clinical Coordinator

1 Kentucky TeleCare, University of Kentucky, Lexington, KY, USA 2 Federal Medical Center, Lexington, KY, USA 3 University of Kentucky, Lexington, KY, USA

Telehealth programs are challenged to develop financial models that offer long term sustainability. Medical centers try to keep inmates segregated from other patients and inmates in local, state and Federal correctional facilities have constitutionally protected rights to similar levels of care as citizens that are not imprisoned. The financial cost of transporting inmates is a growing burden to correctional facilities and the public safety risk of moving inmates is an ever-present concern. These converging problems, and the resulting solution provided by telehealth creates a replicable model to be considered by all telehealth programs. The Federal Medical Center (FMC) in Lexington, Kentucky is one of ten medical prisons in the federal system. With a census of nearly 2,000 patients, approximately 1,000 are housed in the facility due to their medical condition. The presentation will outline transportation and security cost savings and how telehealth helps FMC meet the federal guidelines of providing appropriate inmate care. Over 15 specialty clinics are delivered via the interactive videoconference technology. Benefits for FMC include: reduced costs for transportation/security, quick access to care, enhanced continuity of care and learning opportunities for the FMC providers who manage the care of the inmates with consultation notes written by the UK Medical Center (UKMC) faculty. UKMC receives the clinical revenue, while reducing the cost and public safety problems of transporting inmates outside the walls of the prison. This presentation will include: Prison nurse, UKMC Telehealth Director and the Telehealth Clinical Coordinator. Attendees will understand the challenges of healthcare delivery in a correctional institution, and the problems caused by transporting inmates. Attendees will learn how telehealth benefits both the medical center and prison and how such revenue-generating activities cross subsidize the rural mission outreach. Time will be devoted for practical guidance so attendees may develop their own correctional telehealth application.

Objectives

Understand healthcare challenges in correctional facilities and how to position telehealth.

How revenue from correctional telehealth can cross-subsidize the rural outreach mission of telehealth programs.

4:15 pm–5:15 pm  Tuesday, May 3

Individual Oral Panel Session Number 65 Session Title: TELENURSING TRIAGE AND DISTANCE LEARNING

Track: Clinical Services  Room Number: 19

MODERATOR: Jill Winters, PhD, RN, Dean, Professor & CEO, Columbia College of Nursing, Glendale, WI, USA

Pitsch Stacy BSN, RNC-NIC

Program Manager

Williams Donna RN, RN IV and Call Center Director Hall-Barrow Julie EdD University of Arkansas for Medical Sciences, Little Rock, AR, USA 491 Connecting Faces with Names: Telemedicine-Based Nurse-To-Nurse Report

The traditional patient transfer leaves much to be desired in the way nurses report to the receiving facility. Often rushed, impersonal, and in shorthand, these reports can deconstruct rather than foster relationships between transferring sites. In a novel approach to eradicate these concerns and improve nurse relationships, Arkansas's Center for Distance Health is using telemedicine to facilitate reporting through interactive video, offering a face-to-face discussion between nurses caring for the transferred patient. Now instituted at seven of Arkansas's rural healthcare facilities' Labor and Delivery Units and the state's academic medical center, which handles the state's high-risk deliveries, this new report system allows nurses to ask questions and give instructions regarding patient care, while also allowing the transferred patient the unique opportunity to “meet” the nurse at UAMS before leaving her rural hometown hospital. A few measures ensured the success and smooth operation of the interactive video-infused patient transfers. First, specialized telemedicine equipment and a secure, high speed Internet connection at participating sites establish the link necessary to exchange sensitive patient information through an interactive, face-to-face encounter. Next, rural sites received extensive training and support prior to implementation of the program to ensure maximum operability when conducting this new methodology in nurse communication during patient transfers. Also, a 24/7 nurse-staffed Call Center establishes the interactive video connection, troubleshoots any technical issues, and documents the interactive nurse report. While changes in pre- and post-program satisfaction are being calculated, there has been a witnessed increase in familiarity and respect between the participating sites, which reflects feelings that were once undetectable or non-existent in the past. It has also likely improved the circumstances for patients facing high-risk deliveries.

Objectives

Attendees will learn the benefits of using telemedicine-facilitated patient transfers.

Attendees will learn steps to ensure successful telemedicine-facilitated patient transfers.

Finkelstein Stanley M. PhD 1

Professor

Cady Rhonda G. RN, MS 1 Kelly Anne MD 1 Garwick Ann PhD 1 Looman Wendy PhD 1 McCord James MD 2 Erickson Catherine 1

Doctoral Candidate

1 University of Minnesota, Minneapolis, MN, USA 2 Children's Hospitals and Clinics of Minnesota, St. Paul, MN, USA 85 Home to Clinic Telehealth: Transforming Triage for Complex Pediatric Patients

Communication between provider and patient has expanded from the traditional in-clinic visit to encompass interactions between home and clinic using telehealth technologies. While home to clinic communication via telephone is common clinical practice, communication via home to clinic interactive video is an untested and emerging application. Such application of interactive video may improve triage and the resulting care coordination for children with complex healthcare needs (CCHCN), who have disproportionately higher rates of healthcare services utilization than the general pediatric population. Whether this technology can transform the home to clinic communication and triage process requires evidence-based research to determine this application's effectiveness. A new study compares the impact of increasing levels of telehealth technology and provider training on the home to clinic communication and triage process. A three-armed randomized controlled trial utilizes standard clinic telephone triage delivered by a registered nurse, telephone triage delivered by an advanced practice nurse (APN), and telephone plus interactive video triage delivered by an APN. Outcome measures of effectiveness include levels of healthcare service utilization, child and family quality of life, and consumer and triage nurse satisfaction. Initial results indicate that interactive video can provide important visual information not otherwise available to the triage process, and the resulting care coordination has the potential to reduce the need for some clinic or emergency department visits and the cost savings that result. Families and triage nurses find this process satisfactory and useful. Despite potential benefits, multiple barriers to translation from research to clinical practice exist. These include alignment of reimbursement payments, HIPAA-compliance issues, broadband availability, institutional firewall protection, and EMR documentation of the video session. Finally, policy changes are needed that will ensure the sustainability of such new telehealth nursing models for CCHCN and other populations with high healthcare service needs.

Objectives

Review how to improve care coordination for CCHCN.

Discuss how pediatric nurse practitioners use telehealth technology for triage.

Whitmore Tiffany MPA 1

Telemedicine Coordinator

Reddy Tatiana RN, MSN, CNOR 1 Seibert Pennie PhD 1 2 Schommer Julie BS, BA 1 Gagnon Samantha 1 2

1 Saint Alphonsus Regional Medical Center, Boise, ID, USA 2 Boise State University, Boise, ID, USA 478 Telehealth Successfully Delivers an Operating Room Orientation Program

Introduction: Nurses in small hospitals work in multiple units and often do not have formalized training specific to the operating room. Moreover, nurses at these hospitals have to travel to urban areas to receive training, which can be time intensive and costly. To address the needs of nurses working in these settings, we developed an operating room preceptor program that can be delivered in-person or via telehealth.

Methods: Working with the Association of periOperative Registered Nurses (AORN) we combined their online orientation course, Perioperative Nursing 101, with classroom activities via the InTouch Remote Presence System (comprised of Control Station and RP-7 Robot or RP-Lite) to provide evidence-based education for nurses working in the operating room. Participants completed weekly online modules followed by classroom learning sessions with preceptor observation and instruction offered either in-person or via telehealth.

Results: Participants consisted of 23 nurses (7 in person: 6 female, 1 male; 16 telehealth: 12 female and 4 male). We compared the in person with the telehealth group on numerous demographics, competency assessments, and AORN scores and found both groups to be statistically similar on the majority of measures. For example, T Tests revealed both groups were statistically similar with respect to AORN scores (final exam scores in person mean 87.2% and telehealth mean 88.7%). However, chi square analysis of competency assessments revealed some statistically significant differences, most of which indicated the telehealth group performed better than the in person group. Evaluations were positive, with 80% rating the program consistent with an in person program and 87% indicating they would recommend the telehealth approach.

Conclusions: Our analysis supports the idea that using the InTouch Remote Presence System to combine AORN's online modules with a clinical nurse preceptor program provides a successful approach for delivering standardized perioperative training for nurses in outlying hospitals.

Objectives

Evaluate whether a telehealth preceptorship can be equally effective as in-person for perioperative nursing.

Analyze whether a telehealth preceptor program assists nurses in outlying hospitals understand and utilize best practices.

Individual Oral Panel Session Number 66 Session Title: CASE STUDIES IN THE USE OF TELEMEDICINE FOR PSYCHOLOGICAL HEALTH AND POST TRAUMATIC STRESS DISORDERS (PTSD)

Track: Telemental Health   Room Number: 24/25

MODERATOR: Peter Yellowlees, MBBS, MD, Professor of Psychiatry, University of California, Davis, Sacramento, CA, USA

Agha Zia MD, MS 1

Director Health Services Research

Repp Andrea L. MA 2 Ross Bridgett PsyD 2 Moreno Lucy MPH 1 Fidler Janel MA 2 Zuest Danielle K. MA 1 Floto Elizabeth MA 2 Barsotti Ryan MA 2 Zamora Tania BS 1 Liu Lin PhD 1 Shah Nilesh MD 1 Thorp Steven PhD 1

1 VA San Diego Healthcare System and University of California San Diego, San Diego, CA, USA 2 Veterans Medical Research Foundation, San Diego, CA, USA 506 Cost Analysis of Delivering PTSD Psychotherapy via Telemedicine

Veterans with Post Traumatic Stress Disorder (PTSD), and institutions treating them, often incur geographic and financial obstacles pertaining to access to care. Telemedicine (TM) provides a means to provide quality PTSD care without traveling to major cities or hospitals. Preliminary data from two ongoing randomized clinical trials (RCTs) at VA San Diego will be presented. These large RCTs (N = 508 patients, 26 therapists) are designed to confirm the effectiveness of telemedicine versus in-person delivery of manualized therapies (Cognitive Processing Therapy and Prolonged Exposure Therapy).

Methods: Patients from 4 participating VA remote sites are recruited and randomly assigned to receive one-on-one psychotherapy (12 sessions) via telemedicine (TM) or in-person (IP) with a therapist located at hub site. Data on cost (direct and indirect) and effectiveness from the parent RCTs detailed was used. Travel distance and time was calculated using Google Maps and cost was calculated using VA reimbursement schedules for patient travel. A decision analytic model was built to simulate average cost and average cost-effectiveness for TM and IP modality and one-way sensitivity analyses were conducted.

Results: This analysis compared those currently enrolled (N = 102) assuming treatment via telemedicine versus in person care. Analysis shows significant savings per patient (12 sessions) in mean distance traveled (IP = 602 miles; TM = 334 miles; F(1, 202) = 12.8, p < 0.0001) and mean time for travel (IP = 12hours; TM = 7 hours; F(1, 202) = 10.4, p = 0.0010. Cost savings for travel were also significant with lower mean travel cost (IP = $250; TM = $193; p < 0.0001) for telemedicine. Summary Table Cost-effectiveness of TM versus IP Modality.

Conclusion: Our preliminary findings suggest TM is a means of providing improved access to specialized one-on-one psychotherapy for veterans suffering from PTSD. Telemedicine decreases geographic barriers to care and is cost-effective from a societal and healthcare provider perspective in this setting.

Objectives

Discuss the use of telemedicine for PTSD therapy.

Review factors associated with cost effectiveness.

Brooks Elizabeth PhD

Instructor

Shore Jay MD, MPH University of Colorado Denver, Aurora, CO, USA

319 In-Home Monitoring Modifications for Personalizing Care: Adapting to an American Indian Veteran Population

Objective: In-home monitoring has substantial potential for reducing disparities in the access of health services to underserved populations, particularly those in rural, remote areas. This is particularly true within the domain of mental healthcare, where such disparities are often substantial. However, a common complaint of standardized in-home monitoring devices is, by design, their generic content which may fail to “personalize” the experience for the patient. To address this concern, we modified both the process and content of an existing Posttraumatic Stress Disorder (PTSD) monitoring program to use specifically with a rural American Indian veteran population enrolled in the Veterans Administration.

Methods: Module adaptations were conducted in two phases then tested in a year-long pilot trial with patients currently undergoing mental health treatment. The first adaption phase focused on modifying the existing PTSD dialogue. Based on input from a community planning meeting, we developed an American Indian-specific program which could be integrated into patients' current mental health treatment. The second adaptation phase consisted of refining procedures for care coordination and clinician involvement. For example, the care coordinator assumed a more proactive relationship with patients than typically conducted. Additionally, the clinician reviewed the program content during therapy sessions; thus providing an opportunity to reinforce the educational material presented in the dialogues, discuss patient responses, and answer questions.

Results and Discussion: At the Annual Meeting, we will provide an overview of the process changes developed for this population as well as the initial results of our year-long pilot. Data analysis included examining feasibility, acceptability, and patient status using information collected though multiple data sources. The results, which will be presented at the Annual Meeting, provide evidence that in-home monitoring programs can be readily adapted to more specific audiences and allow for cultural modifications that enhance patient outcomes.

Objectives

Understand process modifications needed to adapt in-home monitoring to an American Indian population.

Understand content modifications needed to adapt in-home monitoring to an American.

Mishkind Matt PhD

Acting Chief, Clinical Telehealth Division

National Center for Telehealth and Technology, Joint Base Lewis-McChord, Tacoma, WA, USA

396 TRICARE Assistance Program: A Department of Defense Initiative to Expand Web-based Counseling

TRICARE Management Activity (TMA) and The National Center for Telehealth and Technology (T2), a component center of the Defense Centers of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury (PH/TBI), are leading Department of Defense (DoD) initiatives to develop telehealth and technology solutions for PH/TBI. Stigma and other barriers such as geography and mobility have long been considered deterrents to Service Members seeking in-person mental healthcare. Yet, current technologies (e.g., video IM; email; online chat) can improve mental healthcare access specifically in the form of outreach to rural and underserved locations. This presentation will focus on the web-based TRICARE Assistance Program (TRIAP), which was part of a response to the House Report 2638 DoD Appropriations Act for Fiscal Year (FY) 2009 Joint Explanatory Statement (p.405), directing the DoD to establish and use a web-based Clinical Mental Health Services Program as a way to deliver critical clinical mental health services to Service Members and their Families in rural areas. TRIAP was recognized as a way to augment the basic TRICARE mental health benefit to provide information resources and short-term non-medical counseling options to beneficiaries. As of August 2010, 1825 calls have been placed to TRIAP with the largest percentage coming from the Army (41%) followed by Navy (23%), Air Force (18%), Marine Corps (13%), Coast Guard (4%), and USPHS (.2%). Twenty-nine percent were from Junior Enlisted ranks, 48% were Non-Commissioned Officers, and 23% were Officers. The most common reasons for the calls include stress management, stress related to a deployment, and partner/other relational problems. During the presentation we will address development of the process, updated data, and highlight next steps including the possibility of integrating with other programs designed to provide support to Service Members and their Families.

Objectives

To understand current and emerging best practices for management of remote counseling for military beneficiaries.

Identify areas of consensus and divergence in best steps forward for possible policy modifications.

Discussion Panel Session Number 67 Session Title: 90 THERAPY ANYTIME, ANYWHERE: INTEGRATING TECHNOLOGY INTO BEHAVIORAL HEALTH TREATMENT

Track: Telemental Health   Room Number: Ballroom A

MODERATOR: Karen Tozzi, MEd, Senior Vice President of Development, Gateway Community Services, Inc., Jacksonville, FL, USA

Tozzi Karen MEd 1

Senior Vice President of Development

Powers Gary RN 1

President and Chief Executive Officer

Hamilton Nancy MPA 2

President and CEO

Shuler Erakal PhD 1

Senior Vice President of Clinical Services

Danicourt Wendy BS, CAP 2

Access, Managed Care & eServices Director

Hodgkins Candace PhD, 1

Senior Vice President of Research

1 Gateway Community Services, Inc., Jacksonville, FL, USA 2 Operation PAR, Pinellas Park, FL, USA

Behavioral Health systems of care are resistant to the roles emerging technologies can play in providing substance abuse treatment. Barriers are created by a system that clings to old models of care. In 2006/2007, Gateway Community Services launched project of a toll free number and e-therapy approach to addressing accessibility problems for substance abuse assessment and treatment in Northeast Florida. Gateway Community Services in Jacksonville, Florida began developing phone and Internet-based services called Gateway Connect which is accessible by toll-free telephone at (877) 389-9966 and on the Internet at www.gatewayconnect.org. Clients were given several options for immediate engagement including an on-line or phone assessment, regularly scheduled dial-in conference calls, sign-in with password protected and encrypted login and pin session for group and individual counseling, psycho-educational Webinars and staff monitored chat rooms. After four years of successful implementation, data collected shows this program reduces barriers to treatment and boasts better results than their traditional face to face services. The project followed 339 intakes in 2.5 years. Of the 254 reached at 6 months after intake for follow-up (rate at intake in parenthesis): 76.8% did not use any Alcohol or drugs in past 30 days (30.3%); 98.4% had no involvement in crime (88.6%); 75.6% were employed or in an Educational program (53.1%); 92.9% report no health/behavioral/social consequences for their substance use (79.1%); and 67.3% were in stable housing (48.4%). Joining Gateway is another Treatment Agency, Operation PAR, from St Petersburg. These agencies have addressed licensing issues, developed standards of care, established structured training and attacked barriers of a resistant system of care. They continually advocate that quality, evidence-based practices are being used but delivered in a different manner. Evidence-based manualized assessment and treatment protocols are adapted for web and phone use. Protections are carefully put in place to be HIPPA compliant. Data is collected on outcomes to continually improve the services and demonstrate the impact of eTherapy. This panel discussion will allow people who have been developing this field to discuss their challenges, successes and strategies for integrating technology into treatment.

Objectives

Participants will gain understanding of methods of integrating varied technologies into behavioral health treatment.

Participants will increase understanding of how to address barriers by traditional modes of thinking in creative, win/win manners.

Individual Oral Panel Session Number 68 Session Title: THE USE OF TELEMEDICINE IN TRAUMA TRIAGE

Track: Emergency & Disaster Response   Room Number: 20/21

MODERATOR: Scott Simmons, MS, Director of Telehealth, University of Miami Miller School of Medicine, Miami, FL, USA

Hu Peter 1

Assistant Professor of Program in Trauma and Department of Anesthesia

Woodford Matthew MD 1 Mackenzie Colin MD 1 2 Dutton Richard MD 1 2 Seebode Steeve 1 Liu Kenghao MS 1 Scalea Thomas MD 1 2 1 University of Maryland School of Medicine, Baltimore, MD, USA 2 R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA 327 Pre-hospital Hypoxemia and Tachycardia Trends Better Predict Patient Mortality than Trauma Registry Values

Introduction: Early prediction of mortality in the field is challenging for patients with traumatic injuries. Currently triage and treatment algorithms depend on single ‘snapshot’ pre-hospital vital signs (VS) during transport. Modern monitors have the capacity to provide VS trends over time. We hypothesized that continuously recorded heart rate (HR) and pulse oximetry (SpO2) “Dose” (duration clinically abnormal values x frequency) can identify which trends predict mortality best in comparison to single values from the trauma registry (TR).

Methods: 177 Trauma patient vital signs were automatically collected every second during the field transport via helicopter The first 5,10,15 min Dose of HR > 100, > 110, > 120 beats/minute (bpm) and SPO2 < 95%, < 90% were calculated. The Doses (Dose-HR, Dose-SpO2) and the signal value from trauma registry (TR-HR, TR-SpO2) were analyzed to compare their ability to predict mortality by Receiver Operator Characteristic method. P < 0.05 was considered statistically significant.

Results: The average trauma patient helicopter transport duration was 25 mins. Patient mortality was 8/117 = 7%. The prediction power measured by Area Under the Curve (AUC) for Dose-HR (0.733-0.824, p < 0.0002-0.018) and Dose-SpO2 (0.766-0.847, p < 0.0001-0.005) were consistently better than TR-HR (0.60, p < 0.19) and TR-SpO2 (0.591, p < 0.20). Dose-HR > 110 bpm and Dose-SpO2 < 90% at 15 min was a better predictor of mortality than Dose-HR > 120 bpm and Dose-SpO2 < 95% at 5,10.15 mins (Fig. 1).

OPEN IN VIEWER

Figure 1.

ACU curves from ROC analysis of Dose HR and SpO2 vs. TR HR and SpO2.

Conclusions: The dose of continuously recorded HR < 110 bpm and SpO2 < 90% recorded every second show a significantly higher mortality predictive power than dose HR > 120 bpm and SpO2 < 95% and single TR values during transport. Pre- hospital care and modern Registries would benefit from continuous trending by showing that SpO2 Dose < 90% and HR > 110/min is a cause for concern because it predicts patient instability, mortality and the need for early trauma center intervention. Support by W81XWH-05-0374, W81XWH-06-C-0034, and W81XWH-07-2-0118.

Objectives

Compare the methods for predicting patient outcome by using field (in flight) real-time patient vital signs.

Discuss the real-time telemedical application based on the prediction method.

Lozano Daniel D. MD, MBA

Director Burn Center

Tracy Joseph Pagella Patrick MSN, RN, FNP-BC Joho Brian RN Lehigh Valley Health Network, Allentown, PA, USA 256 The Use of Telemedicine in Burn Patient Triage

Introduction: The Lehigh Valley Health Network (LVHN) Regional Burn Center has a patient catchment area that extends to some 65 counties in Pennsylvania at the present time and also includes portions of New York and New Jersey. With burn patients often having to be transported over a long distance, two distinct phenomena became noticeable. Patients were either transported long distances to the burn center for very minor burns that did not require burn center treatment, or patients were not transported that had burns requiring treatment at a burn center, but and then presented later with complications.

Methods: Using a store and forward methodology, we developed a telemedicine program that allows referring hospitals to obtain real time feedback on potential patient transfers. Pictures Burn images are forwarded from each site to a HIPPA to LVHN, compliant server, where they pictures can then be accessed via a computer PC and/or a mobile hand- held device. This not only allows for a timely response and but also for the effective use of resources and insures the proper treatment of burn injuries.

Results: From the inception of the program in November 2008 until through June 30, 2010, 338 patients have been evaluated using the Tele Burn service at Lehigh Valley Health Network.LVHN. Of those patients 44% required immediate transfer and hospital admission, 38% were evaluated at least once in the burn outpatient clinic, and 13% remained local and received treatment in their community. ; and The remaining 5% were lost to all follow up.

Conclusion: The Tele Burn service which gives physicians and patients in outlying areas immediate access to the LVHN Regional Burn Center specialists. It has directly improved the quality of care of burn injuries in the region. Close to half of all of the smaller burn injuries that were evaluated using Tele Burn service ultimately required admission for burn injuries that were deeper than initially estimated. The patients with these injuries required surgery and were able to be treated in a timely fashion reducing the likelihood of complications.

Objectives

Learn the appropriate triage of burn patients.

Learn how telemedicine can be used to provide cost effective burn treatment.

Marttos Antonio MD

Assistant Professor of Surgery, Director of Trauma Telemedicine

Kuchkarian Fernanda M. MPH Rojas Daniel Alonso Gabriel Augenstein Jeffrey MD, PhD University of Miami Miller School of Medicine, Miami, FL, USA

603 Connecting from the Scene: Equipping First Responders with Emerging Telemedicine Applications in the Field

First responders and emergency personnel know that lifesaving decisions are time sensitive and require access to effective communication tools for the exchange of critical patient information. Telemedicine is transforming the delivery of trauma care through the use of rapidly deployable, lightweight mobile devices that allows first responders to connect immediately from the accident scene. In a pilot project between the Ryder Trauma Center in Miami, Florida and Key West Rescue, wireless, high-speed powerful tablet PCs and high definition cameras have been deployed to emergency responders. Key West is the southernmost city in the country and in a rural county with large travel distances and only one major road to enter and exit the Florida Keys. When patients need aerial transport, the travel time is one hour. Key West is one of the nation's first communities to use this technology inside ambulances and medical helicopters. Through the use of interactive, real-time videoconferencing equipment and mobile devices, pertinent patient information can be transmitted to a trauma specialist while the patient is being treated in the field, in ambulances or medical helicopters. Access to patient information through live video transmission facilitates triage decisions regarding the transfer of patients, thus avoiding unnecessary costly transfers as well improving patient management when transfers are needed. This is especially significant for specialized services otherwise unavailable in rural areas such as with stroke, burns and cardiac care. By seeing the patient, trauma surgeons can guide emergency personnel on potentially life-saving interventions during the “golden hour”. In return, emergency personnel feel supported and guided, thereby potentially increasing their skills. Telemedicine mobile systems in acute trauma environments have the potential to reduce the gap in care between rural and urban areas. This presentation will focus on implementation goals and outcomes, challenges, lessons learned, reproducibility and plans for the future.

Objectives

To describe the use of mobile devices to link emergency personnel in the field with trauma center, transmitting images and patient information.

To discuss implementation goals and challenges, reproducibility and sustainability.

Individual Oral Panel Session Number 69 Session Title: UNDERSTANDING TELEMEDICINE TECHNOLOGIES

Track: Technology & Telecommunications   Room Number: 22/23

MODERATOR: Michael Holcomb, BS, Associate Director, Information Technology, Arizona Telemedicine Program, Tucson, AZ, USA

Whalen Thomas H. PhD

Director of Research

Frontline Foundation, Atlanta, GA, USA

352 Making Remote Alerting Systems Trustworthy for Meaningful Use: A Decision Science Perspective

Beyond the technical aspects, an alerting system will not achieve meaningful use unless (a) caregivers actively respond to alerts, possibly transferring the patient to a more intensive level of care, and (b) patients normally are not transferred to a more intensive level of care while the system is not generating an alert. Detection of true positives, false positives, true negatives, and false negatives is presented, as false positives and false negatives are inevitable in any real system. Excessive false positives cause alarm fatigue, while excessive false negatives require caregivers to expend resources double-checking on patients, thus depleting resources that the alerting system should have freed. The rates of true positives and false positives depend on the critical level of deviation at which an alert is generated. The main body of the presentation will discuss the application of the "Receiver Operator Characteristic" (ROC) curve, which shows the likelihood of these events for all possible critical levels. The area under a ROC curve is often used to assess the overall power of an alerting system; the use of a budget line is sometimes more appropriate in medical applications. The main part of the presentation will cover the merits of these measures and a nontechnical exposition of how they work, in the context of various telehealth areas of application. The purpose is to increase awareness of an important tool for building telehealth systems that avoid two of the biggest reasons for abandonment of technically-promising systems: alarm fatigue from excessive false positives, and reliance on traditional methods to the exclusion of the alerting system due to excessive false negatives. A system that fails for one of these reasons might have succeeded if it had been tuned to a better balance of sensitivity versus precision.

Objectives

Avoid abandonment of alerting system due to alarm fatigue from excessive false positives.

Avoid abandonment of alerting system due to returning to traditional methods to the exclusion of the alerting system due to excessive false negatives.

Watzlaf Valerie

School of Health and Rehabilitation Sciences

Cohn Ellen Moeini Sohrab Firouzan Patti University of Pittsburgh, Pittsburgh, PA, USA

422 VoIP for Telerehabilitation: A Risk Assessment for HIPAA Compliance

Introduction: Voice over the Internet Protocol (VoIP) software systems are used by healthcare providers to provide telemedicine, tele-psychiatry, and telerehabilitation services to patients via voice and video teleconferencing. According to the National Institute of Standards and Technology (VoIP 800–58) the advantages of VoIP is its cost and integration with other services, such as video across the Internet, which then provides a teleconferencing system. The disadvantages of VoIP are the start-up costs and security. Since VOIP is connected to the data network and may share some of the same hardware and software, there are more ways for the data to be compromised. Privacy and security applications as well as HIPAA compliance within these protocols have been questioned by information technologists, providers of care and other healthcare entities. In order to determine if the VoIP technologies are private, secure and HIPAA compliant, a risk assessment should be performed.

Description: This project developed a privacy and security checklist that can be used to evaluate a VoIP software system to determine if it meets privacy and security regulations and whether it is HIPAA compliant. Based on this analysis, specific HIPAA criteria that therapists and healthcare facilities should follow, is outlined and discussed. The top 10 VoIP software systems used for video conferencing were then evaluated using the HIPAA checklist. The privacy and security policies available on the top 10 VoIP software websites were reviewed and evaluated based on the HIPAA checklist. Results demonstrate that some VoIP software systems comply with all privacy and security components while others do not. Specific privacy and security areas that did not meet the requirements will be discussed.

Conclusion: Before healthcare providers use VoIP software for teleconferencing with their patients they should weigh the risks and benefits in relation to privacy and security issues.

Objectives

Establish privacy and security policies related to HIPAA that are important when using Voice over the Internet Protocol (VoIP) software for telemedicine and telrehabilitation services with patients.

Conduct a risk assessment on Voice over the Internet Protocol (VoIP) software to determine if it is HIPAA compliant when used for telerehabilitation or telemedicine video conferencing with patients.

Unruh Kenton T. PhD

Operation Specialist for Telemedicine

Scott John D. MSc, MD University of Washington, Seattle, WA, USA

390 Tradeoffs and Unintended Consequences Inherent in Widespread Desktop Videoconferencing Deployments

From 2009 to 2010, the University of Washington deployed desktop videoconferencing systems (DVC) to over 30 clinicians in 18 community and tribal clinics across five states: Alaska, Washington, Montana, Idaho, and Oregon. These clinicians presented over 300 patient cases to psychiatry, addictions, infectious disease, and hepatology specialists at the University of Washington. The end-to-end infrastructure was monitored during 300 case presentations and clinicians, IT staff, and clinic administrators were questioned on performance. Findings from this internal study identified key tradeoffs present in desktop videoconferencing deployments. These tradeoffs embodied both concrete benefits and unintended consequences of utilizing DVC for telehealth. The benefits overwhelmingly aided community-based clinicians who benefited from the availability, convenience, and ‘workflow fit,’ of desktop videoconferencing for specialty consultations. Despite the presence of these benefits, clinic sites experienced unintended consequences associated with desktop videoconferencing deployments. The first unintended consequence was a shift in service scheduling and telehealth management. For example, DVC disrupted existing organizational protocols for telehealth within the clinic. Once installed, clinicians used DVC at will. They scheduled and managed their own videoconferencing connections to suit their clinical needs independent of previously established protocols for telehealth services within the clinic. The second unintended consequence was unpredictable impact on network services and clinic applications with which desktop videoconferencing shares bandwidth. The third unintended consequence was communication breakdowns between clinical staff, IT staff, and clinic administrators. DVC gave clinical staff the capacity to control their videoconferencing at will, with or without communicating their activities to IT staff or clinic administrators. These findings extend informatics research on the sociotechnical impact of IT in clinical settings by identifying key tradeoffs inherent in DVC deployments. These findings suggest actionable strategies to capitalize on the benefits and minimize the unintended consequences of desktop videoconferencing deployments.

Objectives

To elucidate key tradeoffs and unintended consequences experienced in desktop videoconferencing deployments.

To disseminate actionable strategies to capitalize on the benefits and minimize the unintended consequences of videoconferencing deployments.

Presentation Panel Session Number 70 Session Title: 154 EMERGING MARKETS IN FEDERAL TELEHEALTH

Track: Public Policy   Room Number: Ballroom D

MODERATOR: Molly Coye, MD, MPH, Chief Innovation Officer, UCLA Health System, Los Angeles, CA, USA

Coye Molly MD, MPH 1

Chief Innovation Officer

Bisio Jean 2

President

Manigante Lisa MPP, MPH 3

Marketing and Reimbursement

1 UCLA Health System, Los Angeles, CA USA Humana Cares, St. Petersburg, FL USA Robert Bosch Health Care, Inc., Palo Alto, CA, USA

Over 50 million Americans are enrolled in federal health insurance programs that have the full authority and funding to immediately provide health services via telemedicine - 33 million people in Medicaid Managed Care, 11 million in Medicare Advantage and 8 million veterans in the VHA's health system. Additional opportunities will arise in the next 12 months with Accountable Care Organizations and Independence at Home initiatives. Hear what you need to know about providing telehealth services and products for them.

Presentation Panel Session Number 71 Session Title: 28 USING TELEMEDICINE TO FOSTER COLLABORATION OF MENTAL HEALTH AND PRIMARY CARE

Track: Operations, Business & Finance   Room Number: 13/14

MODERATOR: Carl Keldie, MD, CCHP, Chief Medical Officer, PHS Correctional Healthcare, Inc., Brentwood, TN, USA

Keldie Carl MD, CCHP

Chief Medical Officer

Pastor Joseph MD

Associate Chief Mental Health Officer

Haggard Rebekah MD, CCHP

Patient Safety Officer

PHS Correctional Healthcare, Inc., Brentwood, TN, USA

PHS Correctional Healthcare has been utilizing telemedicine to deliver quality care in corrections for a number of years in several states. PHS recognizes that disease management for 2010 and beyond requires ingenuity and novel approaches, with an ongoing focus on safety, efficacy and cost combined with recognized principles of standardization, risk management and decision support. A number of disease management tools utilized with telemedicine, enhance the services provided. Tools that will be described include disease registries, pharmacy services reports, lab data and the use of EHR's. PHS has been able to demonstrate that telemedicine can be applied to deliver quality primary care in corrections; including management of chronic diseases and psychiatry. PHS has identified the utilization of telemedicine as a way to leverage "best practices" and make significant improvements in standardizing patient care. Telepsychiatry has long been an application of telemedicine and is increasingly utilized in corrections as well as the private sector. This technology provides rapid access to care, especially when coupled with an EHR and CPOE. This presentation will demonstrate that combining telepsychiatry with an EHR enhances clinical care, patient satisfaction and mitigates diagnostic errors. Learning objectives will focus on methods to collaborate with primary care, real time patient care and CPOE, and the doctor-patient relationship via telepsychiatry. Chronic care is another application that has proven useful for disease management, change management and promotion of safety, efficacy and cost. Chart reviews of over 600 chronic care telemedicine encounters were reviewed. Outcome data will be described showing that 70% of patient encounters had significant disease management actions taken. 120 ineffective or unnecessary medications were discontinued and 160 medication doses were adjusted. 96% of patients were managed effectively via telemedicine.

Objectives

Recognize that the delivery of chronic care telemedicine is an effective means of disease management as evidenced by outcome metrics for over 60 patients.

Define how disease management tools when applied to telemedicine improve the quality of primary care and mental healthcare via telepsychiatry.

Poster Presentations Abstract Index

American Telemedicine Association 2011 Poster Presentations Abstract Index

May 1–3, 2011 Tampa, FL

MONDAY, MAY 2, 2011

5:15 pm–6:30 pm   Monday, May 2

Exhibit Hall

P1 A SYSTEMATIC REVIEW OF TELEHOSPICE RESEARCH

PRESENTERS AND CONTRIBUTING AUTHORS Debra Parker Oliver, MSW, PhD¹, Associate Professor, George Demiris, PhD², Elaine Wittenberg-Lyles, PhD³, Karla Washington, MSW, PhD⁴, Tamara Day, BSN¹, Hannah Novak³

¹University of Missouri, Columbia, MO, USA, ²University of Washington, Seattle, WA, USA, ³University of North Texas, Denton, TX, USA, ⁴University of Louisville, Louisville, KY, USA

P2 USABILITY TESTING OF SMARTPHONE APPS FOR SPINA BIFIDA: CLINICAL PERSPECTIVE

PRESENTERS AND CONTRIBUTING AUTHORS Andrea D. Fairman, MOT, OTR/L, CPRP, PhD Candidate, Brad E. Dicianno, MD, I Gede Wira Yudha Eka Pramana, MS, Daihua Xie Yu, MS, Bambang Parmanto, PhD, Michael P. McCue, PhD

University of Pittsburgh, Pittsburgh, PA, USA

P3 SMARTPHONES IN OPHTHALMOLOGY PRACTICE: SCREENING FOR BLINDING DISEASES

PRESENTERS AND CONTRIBUTING AUTHORS Sajeesh Kumar, PhD, Assistant Professor, Robert J. Noecker, MD, MBA

University of Pittsburgh, Pittsburgh, PA, USA

P4 TELENURSING: AN EFFECTIVE HOME HEALTH PROVISION

PRESENTERS AND CONTRIBUTING AUTHORS Carol E. Smith, RN, PhD, FAAN, Professor

University of Kansas Medical Center-School of Nursing, Kansas City, KS, USA

P5 USING TELEHEALTH TO DELIVER SPECIALIZED SPEECH THERAPY TO CHILDREN WITH COCHLEAR IMPLANTS

PRESENTERS AND CONTRIBUTING AUTHORS Rex E. Gantenbein, PhD¹, Director, CRHRE, Barbara Robinson, PhD¹, Dale Alverson, MD², Gary Kahn, MD³, Arlene Stredler Brown, CCC-SLP, CED^4,5, Anu Sharma, PhD⁴, Joanna Stith, PhD, CCC-SLP, LSLS Cert AVT⁶

¹University of Wyoming, Laramie, WY, USA, ²University of New Mexico, Albuquerque, NM, USA, ³Healthbridge Systems, Boulder, CO, USA, ⁴University of Colorado Boulder, Boulder, CO, USA, ⁵The Keystone Project, Boulder, CO, USA, ⁶Listening for Life LLC, Denver, CO, USA

P6 REACHING OUT TO TELEPSYCHIATRY PROVIDERS WITH ONLINE ORIENTATION AND TRAINING

PRESENTERS AND CONTRIBUTING AUTHORS Nancy Rowe, BA, Telemedicine Manager

NARBHA, Flagstaff, AZ, USA

P7 TELEHEALTH: CREATING OFFICE EFFICIENCIES - MYTH OR REALITY

PRESENTERS AND CONTRIBUTING AUTHORS Susan Makela, BSN, MPA¹, Director Upper Peninsula Telehealth Network/Educational Services, Joann Manty, BSN, DNP¹, Lorraine Buis, PhD²

¹Marquette General Health System, Marquette, MI, USA, ²Wayne State University - College of Nursing, Detroit, MI, USA

P8 ENHANCEMENT VS. DISRUPTION: TELEHEALTH TECHNOLOGY CHANGES NURSING WORK PROCESSES

PRESENTERS AND CONTRIBUTING AUTHORS Rhonda G. Cady, MS, RN, Student, Stanley Finkelstein, PhD

University of Minnesota, Minneapolis, MN, USA

P9 IN-PERSON, VIDEO, AND TELEPHONIC MEDICAL INTERPRETATION

PRESENTERS AND CONTRIBUTING AUTHORS Craig Locatis, PhD¹, Project Officer, Michael Ackerman, PhD¹, Deborah Williamson, DHA²

¹National Library of Medicine, Bethesda, MD, USA, ²Medical University of South Carolina, Charleston, SC, USA

P10 THE USE OF MOBILE (CELLULAR) ORAL TELEMEDICINE IN BOTSWANA

PRESENTERS AND CONTRIBUTING AUTHORS Sankalpo Ghose, BS¹, Medical Student, Ryan Littman-Quinn, BA², Neo Mohutsiwa-Dibe, BDS³, Tsholo Molefi, BDS³, Motsholathebe Phuthego, BS, DDS, MS(OMFS)³, Carrie Kovarik, MD⁴

¹Medical College of Wisconsin / Botswana-UPenn Partnership, Milwaukee, WI, USA / Gaborone, Botswana, ²Botswana-UPenn Partnership, Gaborone, Botswana, ³Princess Marina Hospital, Department of Oral Medicine, Gaborone, Botswana, ⁴University of Pennsylvania Medical Center, Department of Dermatology, Philadelphia, PA, USA

P11 AN EXAMINATION OF THE PERCEPTIONS OF NURSES DURING AN EMR IMPLEMENTATION

PRESENTERS AND CONTRIBUTING AUTHORS Bree Holtz, MSc, PhD, Post-Doctoral Researcher

Veterans Affairs Ann Arbor Health System (HSR&D), Ann Arbor, MI, USA

P12 DEVELOP REGIONAL COLLABORATIVE MEDICAL SERVICE AND TELEMEDICINE TO IMPROVE NATIONAL HEALTH CARE IN CHINA

PRESENTERS AND CONTRIBUTING AUTHORS Junping Zhao, MD, PhD, Director, Huayuan Guo, Zhenjiang Zhang

Chinese PLA General Hospital, Beijing, China

P13 EMR-HIE TELEMEDICINE SERVICES FOR MEDICALLY COMPLEX CHILDREN ON THE NAVAJO NATION

PRESENTERS AND CONTRIBUTING AUTHORS Donald A. Graf, BS¹, Director Telemedicine, Judith Walker²

¹United Healthcare, Phoenix, AZ, USA, ²Arizona Department of Health Services, Phoenix, AZ, USA

P14 TELEMEDICINE AND DISTANCE EDUCATION APPLICATIONS FOR AT-RISK SUBSTANCE USE BEHAVIORS IN THE MILITARY

PRESENTERS AND CONTRIBUTING AUTHORS Kristine Anderson, DL Manager

Saint Francis University CERMUSA, Loretto, PA, USA

P15 USE OF A COMMUNITY-BASED TELEHEALTH PLATFORM FOR COGNITIVE ASSESSMENT OF OLDER ADULTS

PRESENTERS AND CONTRIBUTING AUTHORS George Demiris, PhD, Associate Professor, Hilaire J. Thompson, PhD, RN, FAAN

University of Washington, Seattle, WA, USA

P16 BARRIERS AND FACILITATORS TO THE USE OF TELEHEALTH FOR HEART FAILURE BY HOME HEALTHCARE NURSES AND PATIENTS WITH HF

PRESENTERS AND CONTRIBUTING AUTHORS Kavita Radhakrishnan, RN, BSN, MSEE¹, Research Assistant, Cynthia Jacelon, RN, PhD¹, Joan Roche, RN, PhD¹, Mary Thomas, RN, MSN²

¹University of Massachusetts, Amherst, MA, USA, ²Baystate Health, Springfield, MA, USA

P17 REMOTE DELIVERY OF A PHASE 2 CARDIAC REHABILITATION PROGRAM

PRESENTERS AND CONTRIBUTING AUTHORS Bonnie J. Wakefield, PhD, RN, Investigator, Veterans Administration (VA) Rural Health Resource Center – Central Region, Shannon Nelson, MS, Melody Scherubel, RN, Thomas Klobucar, PhD, Peter Kaboli, MD

Iowa City VA Medical Center, Iowa City, IA, USA

P18 FALL REDUCTION: AN UNEXPECTED BENEFIT OF TELEMONITORING IN THE HOME HEALTHCARE SETTING

PRESENTERS AND CONTRIBUTING AUTHORS Glen Cohen, Director of Sales and Marketing

Heritage Home Healthcare, Albuquerque, NM, USA

P19 PEDIATRIC AMBULANCE PROOF OF CONCEPT FOR DISASTERS: MOBILE VIDEO AND RADIO FREQUENCY (RFID) TRACKING

PRESENTERS AND CONTRIBUTING AUTHORS Stacey L. Cole, MBA^1,2, Medical Student, Madan Dharmar, MBBS, PhD³, Rikki Roehrich⁴, George Wu⁴, Aron Farbstein⁴, James P. Marcin, MD, MPH³

¹University of Utah, Salt Lake City, UT, USA, ²Center for Health and Technology, UC Davis, Sacramento, CA, USA, ³UC Davis, Department of Pediatrics, Sacramento, CA, USA, ⁴UC Davis, Center for Health and Technology, Sacramento, CA, USA

P20 BRIEF EPISODES OF ABNORMAL SHOCK INDEX PREDICTS MORTALITY IN SEVERE TRAUMATIC BRAIN INJURY

PRESENTERS AND CONTRIBUTING AUTHORS Peter F. Hu^1,2, Assistant Professor, Deborah M. Stein, MD^1,2, Lynn Stansbury, MD¹, Megan Brenner, MD^1,2, Wei Xiong, MS¹, Xiaoli Jiao, PhD¹, Thomas Scalea, MD¹

¹University of Maryland School of Medicine, Baltimore, MD, USA, ²R Adams Cowley Shock Trauma Center, Baltimore, MD, USA

P21 ASSESSMENT OF SWALLOWING DISORDERS VIA TELEREHABILITATION

PRESENTERS AND CONTRIBUTING AUTHORS Shobha Sharma ^1,2, PhD Candidate, Elizabeth C. Ward^1,2,3, Clare Burns⁴, Deborah Theodoros^1,2, Trevor Russell^2,5

¹Division of Speech Pathology, The University of Queensland, Brisbane, Australia, ²Telerehabilitation Unit, The University of Queensland, Brisbane, Australia, ³Center for Functioning and Health Research (CFAHR), Queensland Health, Brisbane, Australia, ⁴Speech Pathology Department, The Royal Brisbane & Women's Hospital, Brisbane, Australia, ⁵Division of Physiotherapy, The University of Queensland, Brisbane, Australia

P22 DESIGN AND EVALUATION OF MOBILE PORTABLE TELEMEDICINE SYSTEM DEVELOPED FOR THE EMS AND TRANSPORT ENVIRONMENT

PRESENTERS AND CONTRIBUTING AUTHORS Fuji Lai, Director

InTouch Health, Santa Barbara, CA, USA

P23 PSYCHOMETRIC COMPARISON OF REMOTE-TELEVIDEO AND FACE-TO-FACE ADMINISTRATION OF A COGNITIVE ASSESSMENT BATTERY

PRESENTERS AND CONTRIBUTING AUTHORS Aaron S. Kemp¹, Neurocognitive Research Coordinator, Kirstan N. Gooch², Joisabel L. Goldberg², Sitha Bun², Christopher Reist^1,3, Barton W. Palmer^4,5, Mark Bondi^4,5, James P. O'Halloran²

¹University of California, Irvine School of Medicine, Irvine, CA, USA, ²NeuroComp Systems, Inc., Irvine, CA, USA, ³Veterans Administration Healthcare System, Long Beach, CA, USA, ⁴University of California, San Diego, CA, USA, ⁵Veterans Medical Research Foundation, San Diego, CA, USA

P24 ACHIEVING MEANINGFUL USE THROUGH IMPROVED DOCUMENTATION OF TOBACCO STATUS

PRESENTERS AND CONTRIBUTING AUTHORS Deborah Greenwood, RN, MEd, CNS, BC-ADM, CDE, ADA/AADE¹, Program Coordinator, Diabetes Clinical Nurse Specialist, Kimberly Buss, MD, MPH¹, Leslie Pratt, RN, MPA¹, Andrea I. Hankins, MS², Carol A. Parise, PhD², Tami MacAller, MPH³, Kristin Harms⁴, Joan Olveda, RN¹

¹Sutter Health, Roseville, CA, USA, ²Sutter Institute for Medical Research, Sacramento, CA, USA, ³California Diabetes Program, University of California San Francisco, California Department of Public Health, Sacramento, CA, USA, ⁴California Smokers' Helpline, University of California San Diego, San Diego, CA, USA

P25 TELEHEALTH STROKE PREVENTION EDUCATION IN ELDERLY APPALACHIAN VIRGINIANS

PRESENTERS AND CONTRIBUTING AUTHORS Patty A. Schweickert, MSN, FNP¹, Nurse Practitioner Neuroradiology, Carolyn M. Rutledge, PhD², David C. Cattell-Gordon, MDiv, MSW¹, Nina J. Solenski, MD¹, Mary E. Jensen, MD¹, Sheila Branson, MSN, FNP³, John R. Gaughen, MD¹

¹University of Virginia, Charlottesville, VA, USA, ²Old Dominion University, Norfolk, VA, USA, ³MEOC PACE, Big Stone Gap, VA, USA

P26 DEVELOPING THE CAPACITY TO DEVELOP CAPACITY: A NEW MODEL FOR AFRICA

PRESENTERS AND CONTRIBUTING AUTHORS Maurice Mars, MBChB, MD, University of KwaZulu-Natal

Nelson R Mandela School of Medicine, Durban, South Africa

P27 TELE-AUDIOLOGY PRACTICE IN A VARIETY OF SETTINGS

PRESENTERS AND CONTRIBUTING AUTHORS Gregg D. Givens, PhD¹, Professor and Chair, Department of Communication Sciences and Disorders, Ellen Crowell, BS¹, Gloria Jones, BS¹, Bradley Brechtelsbauer, MD², Jianchu Yao, PhD¹

¹East Carolina University, Greenville, NC, USA, ²Eastern Carolina ENT Head & Neck Surgery, Greenville, NC, USA

P28 NORTHERN CALIFORNIA KAISER PERMANENTE'S TELEDERMATOLOGY PROGRAM IMPROVES TIME TO BIOPSY FOR SKIN CANCER

PRESENTERS AND CONTRIBUTING AUTHORS Sarah Sossong, MPH¹, Estelle Kahn, MD²

¹Center for Healthcare Delivery, Kaiser Permanente, Oakland, CA, USA, ²Emory University, Atlanta, GA, USA

P29 M-HEALTH PLATFORM ARCHITECTURE OPTIMIZATION FOR DEPLOYED AND DISASTER RELIEF OPERATIONS

PRESENTERS AND CONTRIBUTING AUTHORS Seong K. Mun, PhD¹, Director, Sang-Goo Lee, PhD², Dong-Hoon Shin, PhD²

¹Arlington Innovation Center, Virginia Tech, Alexandria, VA, USA, ²Seoul National University, Seoul, Republic of Korea

P30 EXPANDING PEDIATRIC CARE TO RURAL WEST TEXAS

PRESENTERS AND CONTRIBUTING AUTHORS Debbie Voyles, BS, MBA, Director of Telemedicine, Laura Lappe, BS, David Lefforge, MS, MBA

TTUHSC, Lubbock, TX, USA

P31 INVESTIGATING AN UNIFORM DATA SYSTEM FOR TELEREHABILITATION

PRESENTERS AND CONTRIBUTING AUTHORS Sajeesh Kumar, PhD, Assistant Professor, Mike McCue, PhD, Bambang Parmanto, PhD, Richard Schein, PhD, Linda Hartman, Andi Saptono

University of Pittsburgh, Pittsburgh, PA, USA

P32 HESITATION OF RURAL AMERICANS TO PARTICIPATE IN RESEARCH AND DISEASE MANAGEMENT PROGRAMS AND WHAT WE CAN DO ABOUT IT

PRESENTERS AND CONTRIBUTING AUTHORS Karen Cober, RN, MSN, Vice President, Mountain States HomeCare & Hospice

Mountain States Health Alliance, Johnson City, TN, USA

P33 YEAR 1 EXPERIENCE OF A NEW TELEHEALTH RESOURCE CENTER

PRESENTERS AND CONTRIBUTING AUTHORS Elizabeth A. Krupinski, PhD, Professor, Ronald S. Weinstein, MD, Kristine A. Erps, Mike Holcomb, Ana Maria Lopez, MD

University of Arizona, Tucson, AZ, USA

P34 A ROLE FOR TELEMEDICINE IN THE REDUCTION OF CONTROLLED SUBSTANCE MISUSE AND DIVERSION

PRESENTERS AND CONTRIBUTING AUTHORS Robert L. Caudill, MD, BA, BS, School of Medicine

University of Louisville, Louisville, KY, USA

P35 IMPROVING TELECONSULTATION USE: A SUCCESSFUL EXPERIENCE

PRESENTERS AND CONTRIBUTING AUTHORS Maria Beatriz M. Alkmim, Telehealth Center, Monica Pena Abreu, Junia Xavier Maia, Renato Minelli Figueira, Antonio Luiz Ribeiro

Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

P36 CHALLENGES OF A COMPREHENSIVE PERSONAL HEALTH RECORD

PRESENTERS AND CONTRIBUTING AUTHORS Mark Jeffrey, BS, Senior Program Analyst

TATRC, Fort Detrick, MD, USA

P37 THE TELE-ICU DURING A “DISASTER”: SEAMLESS TRANSITION FROM ROUTINE OPERATIONS TO DISASTER MODE

PRESENTERS AND CONTRIBUTING AUTHORS Howard N. Reynolds, MD¹, Associate Professor of Medicine, University of Maryland School of Medicine, Geoffrey Sheinfeld, MD¹, James Chang²

¹University of Maryland Shock Trauma Center, Baltimore, MD, USA, ²University of Maryland Medical Center, Baltimore, MD, USA

P38 EMERGENCY TELE-MEDICINE RESPONSE: PAKISTAN FLOODS 2010

PRESENTERS AND CONTRIBUTING AUTHORS Asif Zafar, MD, FCPS, FRCS¹, Head of Department of Surgery, Qasim Ali, MD, FCPS, MRCS², Faisal Murad, MD, FCPS², Abdul Qadir Mirza³, Muhammad Khurram⁴

¹Rawalpindi Medical College, Rawalpindi, Pakistan, ²Surgical Unit II, Holy Family Hospital, Rawalpindi, Pakistan, ³Mayo Hospital, Lahore, Pakistan, ⁴Telemedicine & e-Health Training Center, Holy Family Hospital, Rawalpindi, Pakistan

P39 VISUALIZING THE TELEREHABILITATION LITERATURE

PRESENTERS AND CONTRIBUTING AUTHORS Linda M. Hartman, MLS, Reference Librarian, Sajeesh Kumar, PhD, Michael McCue, PhD, Bambang Parmanto, PhD, Richard M. Schein, PhD, Andi Saptono

University of Pittsburgh, Pittsburgh, PA, USA

P40 ANALYSIS OF USER GENERATED IMAGES AS DIAGNOSTIC AID IN ACUTE CARE

PRESENTERS AND CONTRIBUTING AUTHORS Neal Sikka, MD, Peter Dowiatt, DO, Department of Emergency Medicine

George Washington University, Washington, DC, USA

P41 REGIONAL CARDIAC TELECARE PROGRAM: INNOVATIVE ACCESS TO SPECIALIZED CARE!

PRESENTERS AND CONTRIBUTING AUTHORS Christine Struthers, APN, Cardiac Telehealth, Kathryn Eastwood, Cynthia Jennings, Lisa Mielniczuk, Heather Sherrard, Sharon Ann Kearns

University of Ottawa Heart Institute, Ottawa, ON, Canada

P42 TELEMEDICINE TO ENHANCE COMMUNICATION BETWEEN AT-HOME ATTENDINGS AND BEDSIDE PERSONNEL IN A PICU

PRESENTERS AND CONTRIBUTING AUTHORS Phoebe H. Yager, MD, Director, PICU Telemedicine Program; Associate Program Director, PCCM Fellowship, Michael Whalen, MD, Brian Cummings, MD, Natan Noviski, MD

Massachusetts General Hospital, Boston, MA, USA

P43 SCHOOL NURSE PERCEPTIONS OF EVOLVING SCHOOL-BASED TELEMEDICINE IN KANSAS

PRESENTERS AND CONTRIBUTING AUTHORS Ryan Spaulding, PhD, Director, Center for Telemedicine and Telehealth, Ashley Spaulding, MA, Karen Pestano

University of Kansas Medical Center, Kansas City, KS, USA

P44 GAMBLING WITH CARE COORDINATION: THE CHALLENGE OF FREQUENT ALERTS (Abstract Withdrawn)

PRESENTERS AND CONTRIBUTING AUTHORS Vladimir Ortiz, RN, MSN, Telehealth Care Coordinator, Michelle Ruby, RN, Shirley Denardo, RN, Eric Marshall

NF/SG VA Medical Center, Gainesville, FL, USA

P45 QUALITY OF LIFE IN DECOMPENSATED HEART FAILURE HOME TELEHEALTH PATIENTS (Abstract Withdrawn)

PRESENTERS AND CONTRIBUTING AUTHORS Michelle Ruby, Telehealth Care Coordinator, Carsten Schmalfuss, MD, Eric Marshall, Richard Schofield, MD, Shirley Denardo

NF/SG VA Medical Center, Gainesville, FL, USA

P46 SYSTEM REDESIGN OF TELEHEALTH TO REDUCE READMISSIONS FOR DECOMPENSATED HEART FAILURE (TDHF): A BEST PRACTICE MODEL (Abstract Withdrawn)

PRESENTERS AND CONTRIBUTING AUTHORS Eric Marshall, Program Specialist, Amy Mullikin, ARNP-BC, Michelle Ruby, RN, Shirley Denardo, RN, Vladimir Ortiz, RN, MSN, Richard Schofield, MD

NF/SG VA Medical Center, Gainesville, FL, USA

P47 IMPROVING HEALTH SERVICES IN GILGIT-BALTISTAN THROUGH TELEHEALTH

PRESENTERS AND CONTRIBUTING AUTHORS Shariq Khoja, PhD, Assistant Professor, Hammad Durrani, MBBS, MPH, Abdul Muqeet

Aga Khan University, Karachi, Pakistan

P48 ECUADORIAN SOCIAL SECURITY'S TELEPHONE APPOINTMENTS AND MEDICAL TRIAGE 24 X 7 PROGRAM

PRESENTERS AND CONTRIBUTING AUTHORS Anibal Carrera, MBA, MSc, CEO, Milton Jijon, MD, Mario Paredes, MD

Cronix, Quito, Ecuador

P49 GENERAL PEDIATRICIANS AS ECHOCARDIOGRAPHERS: TELE-ECHOCARDIOGRAPHY IMPROVES ACCESS AT REMOTE LOCATIONS

PRESENTERS AND CONTRIBUTING AUTHORS Allegra K. Frank, MHA, CCRP¹, Health System Specialist - Telehealth Advisor, Ryan Flanagan, MD¹, Ryan J. McDonald, MD¹, James B. Kinney, MD¹, Robert A. Puntel, MD²

¹Madigan Army Medical Center, Tacoma, WA, USA, ²St Joseph Hospital & Medical Center, Phoenix, AZ, USA

P50 CRAFTING FLORIDA'S HEALTH INFORMATION EXCHANGE AND TELEMEDICINE POLICIES BASED ON HEALTH IT SURVEY DATA

PRESENTERS AND CONTRIBUTING AUTHORS Christopher B. Sullivan, PhD, Executive Director

Telehealth Florida, Tallahassee, FL, USA

P51 INTERNATIONAL TRAUMA TELECONFERENCE: EVALUATING TRAUMA CARE AND FACILITATING QUALITY IMPROVEMENT

PRESENTERS AND CONTRIBUTING AUTHORS Edgar B. Rodas, MD¹, Michael W. Parra, MD¹, Roberto C. Castillo, MHS, MS-III², Student, Jose Mauricio Suarez, MD³, Fabian Puentes, MD⁴, Ruben Camacho, MD⁵

¹Broward General Medical Center, Fort Lauderdale, FL, USA, ²Nova Southeastern University - College of Osteopathic Medicine, Fort Lauderdale, FL, USA, ³Clinica Los Rosales, Pereira, Colombia, ⁴Hospital San Felix, La Dorada, Colombia, ⁵Instituto Ecuatoriano del Seguro Social, Manta, Ecuador

P52 TELEHEALTH FOR ADULT FAMILY HOMES: AN UNEXPLORED TERRITORY

PRESENTERS AND CONTRIBUTING AUTHORS Anne P. Poppe, MN, RN, Research Scientist, George Demiris, PhD

University of Washington, Seattle, WA, USA

P53 WHAT IS THE FINANCIAL IMPACT OF NOT HAVING A TELESTROKE PROGRAM?

PRESENTERS AND CONTRIBUTING AUTHORS Nirav Desai, MS, MBA, VP - Marketing and Product Strategy

REACH Call, Augusta, GA, USA

P54 INTERDISCIPLINARY TELEMEDICINE AND ANALGESIC COMPLIANCE

PRESENTERS AND CONTRIBUTING AUTHORS Philip A. Spiegel¹, Clinical Informatics Researcher, Shannon Fish, PA-C¹, Julie Carey¹, Justin Kromelow¹, Carl Noe, MD², William G. Brose, MD¹

¹Health Education for Living with Pain, San Mateo, CA, USA, ²Department of Anesthesia - Division of Pain Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

P55 MOBILE NURSE - TELENURSE BASED ON WIMAX

PRESENTERS AND CONTRIBUTING AUTHORS Tepei Tang¹, Medical Director, Chienting Lee², Pinan Wu³, Edward Chen⁴, Cheneng Su¹, Shuling Hsu², Wenpei Tsai²

¹Mingjong Hospital, Pingtung, Taiwan, ²National Pingtung Hospital, Pingtung, Taiwan, ³Hengchun Tourism Hospital, Pingtung, Taiwan, ⁴Chyun Huei Health Technologies Inc., Taipei, Taiwan

P56 THE USE OF MOBILE TELEDERMATOLOGY TO IMPROVE ACCESS TO CARE IN PHILADELPHIA

PRESENTERS AND CONTRIBUTING AUTHORS Katie A. Armstrong, HBSc¹, Senior Medical Student, Camille E. Introcaso, MD², Rudolf R. Roth, MD², William D. James, MD², Carrie L. Kovarik, MD²

¹University of Toronto, Toronto, ON, Canada, ²University of Pennsylvania, Philadelphia, PA, USA

P57 HEALTH INFORMATICS RESEARCH ACTIVITIES IN ASIAN COUNTRIES: PRELIMINARY EVIDENCE FROM SYSTEMATIC REVIEW

PRESENTERS AND CONTRIBUTING AUTHORS Shariq Khoja, MBBS, PhD, Assistant Professor-CHS and Coordinator eHealth Program, Hammad Durrani, MBBS, MSc

The Aga Khan University, Karachi, Pakistan

P58 THE HYDRA PROJECT - PERFORMING TELEHEALTH OVER THE SMART METER INFRASTRUCTURE

PRESENTERS AND CONTRIBUTING AUTHORS Malcolm Clarke, PhD, Reader, Joost de Folter, BSc, Vivek Verma, BSc

Brunel University, Uxbridge, United Kingdom

P59 IMPLEMENTATION OF TELEHEALTH IN AN URBAN PUBLIC SCHOOL SYSTEM -- LESSONS LEARNED FROM THE FIRST YEAR OF OPERATION

PRESENTERS AND CONTRIBUTING AUTHORS Sonia M. Batista, RN, MS, RD, LD/N, Clinical TeleHealth Coordinator, Joycelyn Lawrence, MD, Scott C. Simmons, MS, Anne E. Burdick, MD, MPH

University of Miami Miller School of Medicine, Miami, FL, USA

P60 WALK WITH VETERANS PILOT STUDY: USING AN AUTOMATED ONLINE PEDOMETER-BASED WALKING PROGRAM FOR VETERANS WITH COPD

PRESENTERS AND CONTRIBUTING AUTHORS Bree Holtz, MSc, PhD, Post-Doctorate Researcher, Caroline Richardson, MD, David Goodrich, PhD

Ann Arbor VA HSR&D Center of Excellence, Ann Arbor, MI, USA

P61 THE USE OF SOCIAL MEDIA IN TELEMEDICINE: WHERE WE HAVE BEEN, AND WHERE WE CAN GO

PRESENTERS AND CONTRIBUTING AUTHORS Carolyn LaPlante, BA, PhD student, Pamela Whitten, PhD, Jennifer Cornacchione, MA

Michigan State University, East Lansing, MI, USA

P62 THE APPLICATION OF TELEDERMATOLOGY TO DETERMINE TREATMENT DECISION FOR RECEIVING CHEMOTHERAPY

PRESENTERS AND CONTRIBUTING AUTHORS Erdeta Bani, BA, MPA, Project Coordinator

Memorial Sloan-Kettering Cancer Center, New York, NY, USA

P63 TELEHEALTH IS BETTER THAN TRADITIONAL FACE-TO-FACE ENCOUNTERS

PRESENTERS AND CONTRIBUTING AUTHORS Rob Sprang, MBA, Director, Neelkamal Soares, MD, FAAP, Developmental-Behavioral Pediatrician

University of Kentucky, Lexington, KY, USA

P64 TELEHEALTH AND TELECOMMUNICATIONS AS SOCIAL SUPPORT INTERVENTIONS FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS

PRESENTERS AND CONTRIBUTING AUTHORS Shannon M. Hudson, RN, BSN, Nursing Student

Medical University of South Carolina, Charleston, SC, USA

P65 GUIDELINES FOR DEVELOPMENT AND REIMBURSEMENT OF ORIGINATING SITE FEES FOR MARYLAND'S TELEPSYCHIATRY PROGRAM

PRESENTERS AND CONTRIBUTING AUTHORS Jean N. Honey, BA, MBA, Telepsychiatry Project Coordinator

Mid Shore Mental Health Systems, Inc, Easton, MD, USA

P66 MISSOURI TELEHEALTH NETWORK - A SUSTAINABLE TELEHEALTH PROGRAM: STRATEGY TO E-HEALTH

PRESENTERS AND CONTRIBUTING AUTHORS Rachel Mutrux, BA, Director, Missouri Telehealth Network

University of Missouri, Columbia, MO, USA

P67 MOBILE (CELLULAR) TELEMENTORING IN BOTSWANA

PRESENTERS AND CONTRIBUTING AUTHORS Aileen Y. Chang, BA^1,2, Medical Student, Sankalpo Ghose, BS^2,3, Ryan Littman-Quinn, BA², Rachel B. Anolik, BS^1,2, Andrea Kyer, BFA⁴, Loeto Mazhani, MD⁵, Anne K. Seymour, MS^2,4, Carrie L. Kovarik, MD^2,6

¹University of Pennsylvania Medical Center, Philadelphia, PA, USA, ²Botswana-UPenn Partnership, Gaborone, Botswana, ³Medical College of Wisconsin, Milwaukee, WI, USA, ⁴University of Pennsylvania Biomedical Library, Philadelphia, PA, USA, ⁵University of Botswana, Gaborone, Botswana, ⁶University of Pennsylvania Medical Center, Department of Dermatology, Philadelphia, PA, USA

P68 TELESPIRITUAL CARE: INTEGRATING TECHNOLOGY IN THE APPLICATION OF SPIRITUAL CARE

PRESENTERS AND CONTRIBUTING AUTHORS Janet Webb, MBA, Master of Divinity, CPE (Chaplain), Executive Director

Spiritual Care Services, LLC, Mooresboro, NC, USA

P69 TELEHEALTH TRENDS EMERGING FROM TELE-EDUCATION

PRESENTERS AND CONTRIBUTING AUTHORS Araz Hamian, Project Manager, Katya Wilson, MBA, PMP

AMBiT Consulting Inc, Vancouver, BC, Canada

P70 TELE-REHABILITATION SUPPORTING COMMUNITY-BASED REHABILITATION PROGRAM FOR INDIGENOUS COMMUNITIES IN AMAZONAS

PRESENTERS AND CONTRIBUTING AUTHORS Jorge A. Velez, MD/HSM¹, Director, Edward Lemaire, PhD², Marie-Pierre Gagnon, PhD³, Rodolfo Millán, TS/MSc⁴, María Inés Largo, FTT³, Lorena Nieto, PhT, MBA¹, Luz Marina Sarmiento, RN⁵, Milton Perdomo, PhT⁵, Alejandro Ecahavarría, Eng¹

¹Colombian Telemedicine Centre, Cali, Colombia, ²Ottawa Hospital, University, The Ottawa Hospital Rehabilitation Centre, Institute for Rehabilitation Research and Development, Ottawa, ON, Canada, ³Centre Hospitalier Universitaire de Québec-CHUQ, Quebec, QC, Canada, ⁴IDEAL Foundation for the Integral Rehabilitation, Cali, Colombia, ⁵Disability Assistance Program, Secretary of Health, Amazonas, Leticia, Colombia

P71 NO LONGER AN ISLAND: RURAL NURSE PRACTITIONERS GAIN SUPPORT THROUGH TELEHEALTH

PRESENTERS AND CONTRIBUTING AUTHORS Sarah Rhoads, DNP, APN, Assistant Professor, Gordon Low, MSN, APN, Delia James, MNSc, APN, Tesa Ivey, MNSc, APN

University of Arkansas for Medical Sciences, Little Rock, AR, USA

P72 FINDING THE RIGHT KEYS TO SUCCESS (Abstract Withdrawn)

PRESENTERS AND CONTRIBUTING AUTHORS Joann Jerry, MN, Lead Care Coordinator, James Maudlin, M.Div

NF/SG VHS, Lake City, FL, USA

P73 HEALTH CARE REFORM AND EVOLUTION OF A TELEMEDICINE SYSTEM

PRESENTERS AND CONTRIBUTING AUTHORS Doug Romer, RN¹, Executive Director Patient Care Services, Tiffany Whitmore, MPA², Allison Gilbreath, MHA², Tatiana Reddy, RN, MSN, CNOR², Pennie S. Seibert^2,3

¹Grande Ronde Hospital, La Grande, OR, USA, ²Saint Alphonsus Regional Medical Center, Boise, ID, USA, ³Boise State University, Boise, ID, USA

P74 SEEING IS BELIEVING: TELEMEDICINE IMPROVES ACCESS TO GENETICS CONSULTS IN A RURAL STATE

PRESENTERS AND CONTRIBUTING AUTHORS Terri J. Teague-Ross, MS, Center for Distance Health: ANGELS/TOUCH, Shannon Lewis, BSN, RN, Whit Hall, MD, G. Bradley Schaefer, MD

University of Arkansas for Medical Sciences, Little Rock, AR, USA

P75 USING TELEMEDICINE TO FACILITATE RESPONSIBLE NEONATAL TRANSPORTS SAVES MONEY AND TIME

PRESENTERS AND CONTRIBUTING AUTHORS Terri J. Teague-Ross, MS, Center for Distance Health: ANGELS/TOUCH, Anne Marie Morse, EMT, CFC, CMTE, OCS, Whit Hall, MD

University of Arkansas for Medical Sciences, Little Rock, AR, USA

P76 PATIENT ACCEPTANCE OF A HOME-BASED CANCER SYMPTOM REPORT AND TRACKING SYSTEM

PRESENTERS AND CONTRIBUTING AUTHORS DerShung Yang, PhD, Ana Maria Lopez, MD, MPH, FACP², Nina M. Haas, MA¹, Lindsay N. Kreykes, MPH¹, Research Specialist Senior

¹BrightOutcome, Buffalo Grove, IL, USA, ²University of Arizona, Tucson, AZ, USA

P77 DISCERNING SUCCESSFUL TELEMEDICINE APPLICATIONS FOR OBSTETRICS AND NEONATOLOGY

PRESENTERS AND CONTRIBUTING AUTHORS William Greenfield, MD, Assistant Professor and Assistant Residency Program Director, Terri Teague-Ross, MS, Shannon Lewis, BSN, RN, Stacy Pitsch, BSN, RNC-NIC, Elizabeth Kim, MD, Julie Hall-Barrow, EdD, Whit Hall, MD

University of Arkansas for Medical Sciences, Little Rock, AR, USA

P78 REMOTE PRESENCE GENERAL SURGERY PROGRAM: BUILDING SURGERY CAPACITY IN RURAL COMMUNITIES

PRESENTERS AND CONTRIBUTING AUTHORS Kent Kreuder, MD¹, Medical Director for Telemedicine, Tiffany Whitmore, MPA¹, Allison Gilbreath, MHA¹, Pennie Seibert, PhD^1,2, Samantha Gagnon^1,2, Julie Schommer, BS, BA¹

¹Saint Alphonsus Regional Medical Center, Boise, ID, USA, ²Boise State University, Boise, ID, USA

P79 STOPPING TOBACCO, STARTING CHANGES IN PREGNANCY CARE: TELEMEDICINE-BASED PROVIDER EDUCATION

PRESENTERS AND CONTRIBUTING AUTHORS Stephanie Wyatt, MNSc, WH-APN(c), Program Assistant Director, Sarah Rhoads, APN, DNP

University of Arkansas for Medical Sciences, Little Rock, AR, USA

P80 ECHOES OF INNOVATION: PRELIMINARY OUTCOMES OF PERINATAL TELEMEDICINE ECHO PROGRAMS

PRESENTERS AND CONTRIBUTING AUTHORS Curtis Lowery, MD, Department Chairperson, Tina Benton, RN, BSN, Renee Bornemeier, MD, Lori Heil, RDCS, Rosalyn Perkins, MNSc, APN, Mandi Dixon, RDMS, Terri Teague-Ross, MS

University of Arkansas for Medical Sciences, Little Rock, AR, USA

P81 TATRC WEST FACILITATES PARTNERSHIPS IN SUPPORT OF NOVEL MEDICAL SIMULATION TECHNOLOGIES (Abstract Withdrawn)

PRESENTERS AND CONTRIBUTING AUTHORS Marko N. Kostic¹, Scientific Advisor, Elias Wilson¹, Scott Morris¹, Manja Lenkin¹, Jessica Kenyon¹, Warren S. Grundfest, MD^1,2

¹TATRC, Marina del Rey, CA, USA, ²University of California Los Angeles, Los Angeles, CA, USA

P82 ELECTRONIC PATIENT PORTAL DEVELOPMENT FOR OVARIAN CANCER SURVIVORS

PRESENTERS AND CONTRIBUTING AUTHORS Ana Maria Lopez, MD, MPH, FACP^1,2, Medical Director, DerShung Yang, PhD³, Evelia Kory, MPH^1,2

¹Arizona Telemedicine Program, Tucson, AZ, USA, ²University of Arizona, Tucson, AZ, USA, ³Caracal, Inc, Buffalo Grove, IL, USA

P83 MUJER A MUJER: STORIES OF BREAST CANCER SURVIVORS

PRESENTERS AND CONTRIBUTING AUTHORS Ana Maria Lopez, MD, MPH, FACP¹, Medical Director, Angela Valencia, MPH², Evelia Kory, MPH¹, Bettina Hofacre, BS²

¹Arizona Telemedicine Program, Tucson, AZ, USA, ²Arizona Cancer Center, Tucson, AZ, USA

P84 ¡VIDA! BREAST CANCER TELE-EDUCATION FOR BREAST CANCER SURVIVORS AND HEALTH CARE PROVIDERS

PRESENTERS AND CONTRIBUTING AUTHORS Ana Maria López, MD, MPH, Medical Director

Arizona Telemedicine Program, Tucson, AZ, USA

P85 DEVELOPMENT OF AN ELECTRONIC COLORECTAL CANCER SCREENING AND DIAGNOSIS DECISION MAKING TOOL

PRESENTERS AND CONTRIBUTING AUTHORS Ana Maria Lopez, MD, MPH, FACP^1,2, Medical Director, DerShung Yang, PhD³, Linda Larkey, PhD², Emily Shipsey, MPH^1,2, Evelia Kory, MPH^1,2

¹Arizona Telemedicine Program, Tucson, AZ, USA, ²University of Arizona, Tucson, AZ, USA, ³Caracal Inc, Buffalo Grove, IL, USA

P86 TREATMENT AVOIDANCE IN PTSD PATIENTS: FACE-TO-FACE VERSUS TELEMEDICINE

PRESENTERS AND CONTRIBUTING AUTHORS Danielle Zuest, MA¹, Research Project Coordinator, Zia Agha, MD¹, Elizabeth Floto, MA², Janel Fidler, MA², Lucy Moreno, MPH¹, Ryan Barsotti, MA², Andrea Repp, MA², Bridgett Ross, PsyD², Tania Zamora, BS¹, Nilesh Shah, MD¹, Steven Thorp, PhD¹

¹VA San Diego, San Diego, CA, USA, ²Veterans Medical Research Foundation, San Diego, CA, USA

P87 DEVELOPMENT OF SUSTAINABLE AND REPLICABLE MODEL OF TELEMEDICINE, EXPERIENCE SHARING

PRESENTERS AND CONTRIBUTING AUTHORS Mungunchimeg Dagva, Cardiologist, Mungun-Ulzii Khurelbaatar

Cardiovascular Center Project, Ulaanbaatar, Mongolia

P88 E-HEALTH AND EDUCATIONAL SOCIAL NETWORK - DRAMATURGY AS A MOTIVATING RESOURCE TO APPROACH DIFFICULT THEMES

PRESENTERS AND CONTRIBUTING AUTHORS Diogo J. Miranda, MFA, Interactive Media Coordinator, Wen L. Chao

University of Sao Paulo - Medical School, Sao Paulo, Brazil

P89 A ONE-YEAR OUTCOMES ASSESSMENT OF REMOTE DIABETIC RETINOPATHY MANAGEMENT USING THE TRIAD OCULAR TELEHEALTH NETWORK

PRESENTERS AND CONTRIBUTING AUTHORS Joshua D. Spiegel¹, Student Intern, Yaqin Li, PhD¹, Thomas P. Karnowski², Scott Morris, MD³, Elizabeth Sparrow, OD³, Edward Chaum, MD, PhD¹

¹University of Tennessee Health Science Center, Hamilton Eye Institute, Memphis, TN, USA, ²Oak Ridge National Laboratory, Oak Ridge, TN, USA, ³Church Health Center, Memphis, TN, USA

P90 LEGAL AND POLICY ISSUES FOR HOME TELEHEALTH EVOLVING IN 2011 (Abstract Withdrawn)

PRESENTERS AND CONTRIBUTING AUTHORS Deborah A. Randall, JD, Health Attorney and Telehealth Consultant

Law Office of Deborah Randall, Chevy Chase, MD, USA

P91 TELEHEALTH PRACTICE GUIDELINES FOR DIABETIC RETINOPATHY

PRESENTERS AND CONTRIBUTING AUTHORS Jerry Cavallerano, OD, PhD^1,2, Staff Optometrist

¹Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA, ²Harvard Medical School, Boston, MA, USA

P92 TELEMEDICINE IN THE ICU: REAL-TIME FEEDBACK IMPROVES VENTILATOR ASSOCIATED PNEUMONIA BUNDLE PROGRAM

PRESENTERS AND CONTRIBUTING AUTHORS Steven Trottier, MD, Critical Care Physician, Wendy Deibert, RN, Christopher Veremakis, MD, Brian Diffenderfer

St. John's Mercy, St. Louis, MO, USA

P93 EMERGING ROBOTICS APPLICATIONS FOR TELEMEDICINE AND PATIENT CARE: THE ROBOTIC NURSING ASSISTANT

PRESENTERS AND CONTRIBUTING AUTHORS John Hu, PhD, President, CEO and Co-founder, Aaron Edsinger, PhD, Yi-Je Lim, PhD, Nick Donaldson, Aaron Solochek

Hstar Technologies Corp., Cambridge, MA, USA

P94 MEASURABLY REDUCING BLOOD PRESSURE: REMOTE HEALTH MONITORING WITH MHEALTH

PRESENTERS AND CONTRIBUTING AUTHORS Michelle Violette, RN, BScN, MSc, Senior Telehealth Business Analyst

Healthanywhere, MIssissauga, ON, Canada

P95 FEASIBILITY OF IN-HOME TELEHEALTH LACTATION CONSULTATION

PRESENTERS AND CONTRIBUTING AUTHORS Eve-Lynn Nelson, PhD¹, Associate Director, Wilaiporn Rojjanasrirat, PhD, RNC, RN², Karen Wambach, PhD, RN¹, Terry Busch, RN, MSN, IBCLC¹, Debbie Borgdstadt, BSN, LPN, IBCLC¹, Tzu-Yu Kung, RN, MSN, ARNP¹, Melanie Neely, RN, BSN¹

¹University of Kansas Medical Center, Kansas City, KS, USA, ²Graceland University, Independence, MO, USA

P96 PROVIDING A SUSTAINABLE MODEL OF PATIENT EDUCATION THROUGH INFORMATION TECHNOLOGY

PRESENTERS AND CONTRIBUTING AUTHORS Carol V. McIlhenny, RN, BSN¹, Telehealth Research Specialist, Leigh Montecalvo, RN, MSN¹, Brenda L. Guzic, BSW, RN, MA¹, Dawna R. Knee, BS¹, James Hayden, MD², Ashok Bapat, PhD, MBA¹, Barbara R. Demuth, RN, MSN¹, Jay B. Roberts, MA¹

¹Saint Francis University, Loretto, PA, USA, ²Broad Top Area Medical Center, Broad Top City, PA, USA

P97 DISTANCE LEARNING AND HIGH-FIDELITY MEDICAL SIMULATION IN A BACCALAUREATE NURSING PROGRAM

PRESENTERS AND CONTRIBUTING AUTHORS Brenda L. Guzic, ADN, BSW, MA, RN, Telehealth Research Specialist

Saint Francis University, Loretto, PA, USA

P98 USER-CENTERED DESIGN FOR EVALUATING TELEREHABILITATION USER NEEDS AND CLINICIAN-PATIENT INTERACTION

PRESENTERS AND CONTRIBUTING AUTHORS David Brennan, MBE, Senior Research Engineer

National Rehabilitation Hospital, Washington, DC, USA

P99 AN MHEALTH BASED PERSONALIZED DRUG TAKING ADVISOR SYSTEM FOR A LARGE POPULATION

PRESENTERS AND CONTRIBUTING AUTHORS Mingyu Wang, PhD¹, Research Institute of Information Technology, Jijiang Yang, PhD¹, Q. Gao, PhD²

¹Tsinghua University, Beijing, China, ²IVT, Beijing, China

P100 REUSING GENOME WIDE ASSOCIATION DATA IN EMR FOR CLINICAL DECISION SUPPORT IMPROVEMENT

PRESENTERS AND CONTRIBUTING AUTHORS Hong Huang, Assistant Professor

University of South Florida, Tampa, FL, USA

P101 OPHTHALMOLOGY CLINICAL GRAND ROUNDS ACROSS THE BORDERS

PRESENTERS AND CONTRIBUTING AUTHORS Alexandre C. Taleb, MD, PhD, Medical School, Consuelo B D Adán, MD, PhD², Giselle Ricur, MD³

¹Federal University of Goias, Goiania, GO, Brazil, ²Federal University of Sao Paulo, Sao Paulo, SP, Brazil, ³Instituto Zaldivar, Mendoza, Argentina

P102 BEHAVIORAL ASSESSMENTS FOR CHILDREN WITH AUTISM THROUGH TELEHEALTH

PRESENTERS AND CONTRIBUTING AUTHORS Jennifer L. Kuhle, Research Assistant, Yaniz C. Padilla Dalmau, David P. Wacker, Scott D. Lindgren, Todd Kopelman, John F. Lee

University of Iowa, Iowa City, IA, USA

P103 REMOTE ASSESSMENT OF MEMORY IN RURAL AMERICAN INDIANS VIA VIDEOCONFERENCE

PRESENTERS AND CONTRIBUTING AUTHORS Munro Cullum, PhD¹, Professor of Psychiatry and Neurology, Maria C. Grosch¹, Linda S. Hynan, PhD¹, Lara L. Graham¹, Mili R. Parikh¹, Jay Shore, MD², Myron F. Weiner, MD¹

¹University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, ²University of Colorado Denver, Denver, CO, USA

P104 TELESSAUDE GOIAS (GO TELEHEALTH)

PRESENTERS AND CONTRIBUTING AUTHORS Alexandre C. Taleb, MD, PhD, Medical School, Gustavo Queiroz, MD, Marcos P. Avila, MD, PhD

Federal University of Goias, Goiania, GO, Brazil

P105 EFFECTIVENESS OF TELEMEDICINE SYSTEM TO MEDICAL EXPENDITURES OF HEART DISEASE PATIENTS

PRESENTERS AND CONTRIBUTING AUTHORS Yuji Akematsu, Research Fellow, Kazunori Minetaki, Masatsugu Tsuji

University of Hyogo, Kobe, Hyogo, Japan

P106 EMPIRICAL STUDY OF EMERGENCY MEDICAL SERVICES FOR ACS PATIENTS AND IMPLICATIONS FOR TELEMEDICINE

PRESENTERS AND CONTRIBUTING AUTHORS Masatsugu Tsuji, PhD, Professor, Kazunori Minetaki, MA, Yuji -Akematsu, PhD

University of Hyogo, Kobe, Japan

P107 AN ASSESSMENT OF VIDEOCONFERENCING UNITS’ ENERGY CONSUMPTION AND RESTART PROPERTIES

PRESENTERS AND CONTRIBUTING AUTHORS Brendan P. Purdy, BN MN(C), Telehealth Coordinator, Adam Smith

University Health Network, Toronto, ON, Canada

P108 PERSONALIZED HOLISTIC MOBILE DIABETES MANAGEMENT SYSTEM

PRESENTERS AND CONTRIBUTING AUTHORS Dylan R. Marin, BSc, Research Student, Permanand Mohan, BSc, MSc, PhD

University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago

P109 THE APPLICATION OF TELEMEDICINE IN GERIATRIC EMERGENCY MEDICAL SERVICES

PRESENTERS AND CONTRIBUTING AUTHORS Kang Hyun Lee, Director, Yun Kwon Kim, Hyun Kim, Sung Oh Hwang

Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea

P110 PEDIATRIC MEDICAL SIMULATION TRAINING FOR COMMUNITY HOSPITALS VIA TELEMEDICINE

PRESENTERS AND CONTRIBUTING AUTHORS Phoebe H. Yager, MD, Director, PICU Telemedicine Program; Associate Program Director, PCCM Fellowship, Brian Cummings, MD, Michael Whalen, MD, Natan Noviski, MD

Massachusetts General Hospital, Boston, MA, USA

P111 THE DEVELOPMENT OF A RURAL TELECRISIS PROGRAM

PRESENTERS AND CONTRIBUTING AUTHORS Melody King-Smillie, RN, BScN¹, Regional Manager, Connie Widmeyer, RN, BScN, CPMHN(C)², Leah Hood, RN, BScN²

¹Ontario Telemedicine Network, London, ON, Canada, ²Grey Bruce Health Services, Owen Sound, ON, Canada

P112 ON DEVELOPING SUCCESSFUL BUSINESS MODELS TO DEPLOY TELEMEDICINE SOLUTIONS FOR DIVERSE DEMOGRAPHICS

PRESENTERS AND CONTRIBUTING AUTHORS Raj Devasigamani, MS, MBA, Doctorate Student, Lakshman S. Tamil, PhD

University of Texas at Dallas, Dallas, TX, USA

P113 CONTRACTUAL VERSUS FEE FOR SERVICE TELEPSYCHIATRY REIMBURSEMENT IN MARYLAND

PRESENTERS AND CONTRIBUTING AUTHORS Brian Grady, MD, Director TeleMental Health

University of Maryland, Baltimore, MD, USA

P114 TELEMEDICINE IN THE MEDIA: ATTRIBUTE AGENDA SETTING IN CALIFORNIA'S PRINT NEWS

PRESENTERS AND CONTRIBUTING AUTHORS Rikki Roehrich, MS, Center for Health and Technology

UC Davis Health System, Sacramento, CA, USA

P115 THE NEW CENTERS FOR MEDICARE & MEDICAID INNOVATION: HOW IT WILL CHANGE TELEHEALTH (Abstract Withdrawn)

PRESENTERS AND CONTRIBUTING AUTHORS Rene Quashie, JD, Associate

Center for Telehealth and E-Law (CTel) and Drinker Biddle & Reath, L.L.P., Washington, DC, USA

P116 REVIEW OF ROBOTIC TELEMEDICINE IN INTENSIVE CARE UNITS (ICU)

PRESENTERS AND CONTRIBUTING AUTHORS Eliza Reynolds¹, Student, Andre Grujovski², Tim Wright², Michael Foster²

¹University of Maryland, College Park, College Park, MD, USA, ²InTouch Health, Santa Barbara, CA, USA

P117 DEVELOPING TELEHEALTH IMPLEMENTATION STRATEGIES BASED ON ECONOMIC ASPECTS

PRESENTERS AND CONTRIBUTING AUTHORS Renato Minelli Figueira, Professor, Maria Beatriz M. Alkmim

Universidade Federal de Minas Gerais, Belo Horizonte - MG, Brazil

Poster Presentations AbstractsAmerican Telemedicine Association 2011 Poster Presentations Abstracts

May 1–3, 2011 Tampa, FL

MONDAY, MAY 2, 2011

5:15 pm–6:30 pm Monday, May 2

Exhibit Hall

Oliver Debra Parker MSW, PhD 1

Associate Professor

Demiris George PhD 2 Wittenberg-Lyles Elaine PhD 3 Washington Karla MSW, PhD 4 Day Tamara BSN 1 Novak Hannah 3 1 University of Missouri, Columbia, MO, USA 2 University of Washington, Seattle, WA, USA 3 University of North Texas, Denton, TX, USA 4 University of Louisville, Louisville, KY, USA P1 A Systematic Review of Telehospice Research

Scope: The purpose of this systematic review was to focus on available research and answer the question, What is the state of the evidence related to telehospice services?

Methods: The review was limited to studies that were published in the English language and indexed between January 1, 2000 and March 23, 2010. Indexed databases included PubMed and PsycINFO and contained specified key words. Only research published in peer review journals and reporting empirical data, rather than opinion or editorials, were included. A two part scoring framework was modified and applied to assess the methodological rigor and pertinence of each study. Scoring criteria allowed the evaluation of both quantitative and qualitative methodologies.

Findings: Twenty six studies were identified with the search strategy. While limited in number and in strength, studies have evaluated the use of a variety of technologies, attitudes toward use by providers and consumers, clinical outcomes, barriers, and readiness, and cost. No randomized clinical trials were identified.

Conclusions: A small evidence base for telehospice has emerged over the last ten years. Although the evidence is of medium strength, its pertinence is strong. The evidence base could be strengthened with randomized trials and additional clinical outcome-focused research in larger randomized samples and in qualitative studies with better described samples. Wide acceptance of telehospice as a solution will be dependent on strong evidence of beneficial clinical outcomes and cost effectiveness before widespread adoption will occur.

Objectives

Participants will identify the publish research related to telehospice.

Participants will understand the methodological rigor and pertinence of the evidence in telehospice research.

Fairman Andrea D. MOT, OTR/L, CPRP, PhD Candidate Dicianno Brad E. MD Pramana I Gede Wira Yudha Eka MS Yu Daihua Xie MS Parmanto Bambang PhD McCue Michael P. PhD University of Pittsburgh, Pittsburgh, PA, USA

P2 Usability Testing of Smartphone Apps for Spina Bifida: Clinical Perspective

Smartphones can conveniently and inexpensively serve as vehicles to promote completion and monitoring of self-management tasks to maintain health and wellness of persons with chronic conditions. However, even with the rapid growth of smartphone hardware and software technologies, there are still significant limitations in the accessibility of these small, mobile devices. Their high degree of portability results in a trade off including limited size of the visual display, keyboard or touch screen capabilities. For many persons with disabilities, these limitations can become barriers to effectively and efficiently utilizing smartphone devices. Likewise, cognitive accessibility of current commercially available devices can be a challenge for some potential users with disabilities who may best benefit from in-vivo supports. Smartphone applications (“apps”) can be uniquely tailored to the needs of a population or specific user. The clinical considerations (i.e. cognitive, sensory and physical needs) that must be taken into account when designing apps for complex conditions, such as spina bifida, are discussed and generalized to other disability populations. Usability testing methods which follow design principles of human-computer interaction, with an emphasis on involving real users in the design process are described. Outcomes are reported with regard to the following aspects of accessibility:

- Visual, auditory and tactile interfaces and application structure for enhancing ease of operation, effective and motivating interaction.

- Automatic tailoring, context awareness and self-configuration of the user interface as determined by cognitive and physical motor abilities and preferences.

Funding Disclosure Information:

The Verizon Foundation, National Institute on Disability and Rehabilitation Research, Rehabilitation Engineering and Research Center on Telerehabilitation, Grant #: H133E090002.

Objectives

Identify clinical considerations for smart phone application design as exemplified by the sensory, physical and cognitive needs of persons with spina bifida.

Learn about usability testing methods of smart phone apps to support performance of self-management tasks to maintain health and wellness for persons with chronic conditions.

Kumar Sajeesh PhD

Assistant Professor

Noecker Robert J. MD, MBA University of Pittsburgh, Pittsburgh, PA, USA

P3 Smartphones in Ophthalmology Practice: Screening for Blinding Diseases

Background: Diabetic retinopathy is the most common cause of blindness in Americans under the age of 65 years. It has been estimated that blindness from diabetic retinopathy is preventable in at least 65% of cases, if early detection and laser therapy would have been applied in a timely manner. Meanwhile, mobile phones have recently been shown to be suitable for medical applications. The unique aspect of mobile phone based ophthalmology is that it represents a filtering or triage system, allowing a sensitive approach for the management of patients with emergent ocular lesions.

Methodology: In this study, we investigated the clinical feasibility of teleconsultation using smartphones in diabetic retinopathy related ocular lesions. Forty (40) patients were randomly selected at a remote care center of University of Pittsburgh Medical Center. Patient information and ophthalmic images were acquired using retinal camera. Teleconsultants reviewed the images on Smartphone as well as through a specific web application. These two consultations were compared for potential agreement towards diagnoses.

Results: Significant agreement was observed between both the methods employed.

Significance: This work represents the first mHealth study for diabetic retinopathy using Smartphones. Despite current limitations, Smartphones could potentially improve the practice of ophthalmology.

Objectives

Clinical feasibility of teleconsultation using smartphones.

Use of mobile phone in diabetic retinopathy related ocular lesions.

Smith Carol E. RN, PhD, FAAN

Professor

University of Kansas Medical Center-School of Nursing, Kansas City, KS, USA

P4 Telenursing: An Effective Home Health Provision

Telehealth is defined as the use of audio visual to deliver healthcare services and information, in real time, over distance. Telenursing, utilizes current telecommunication technology, that allows nurses to work with tools which support and advance current nursing practices. Nurses, in their office or at home, using the existing two way audio/visual technologies over regular phone lines can see patients in their own homes, regardless if the patient lives in a different city, county, state or country. Likewise, patients can see and hear ‘their’ nurse live while having direct communications. Telenursing allowed our nurses to employ a variety of technologies to support long-distance clinical health and home care assessments, required self administer daily Home Parental Nutrition 12 hour infusions. These patients' range in age from 25 to 64 (M = 50.6), were 50% female and were on HPN for life-long malignant therapy. With telehealth, these patients with complex treatment regimes were confidentially monitored and the families' questions answered. Data from 42-telehealth visits has resulted in positive evaluation from patients and caregivers. Patients are able to see and hear their nurse for immediate intervention, as nurses rated they could clearly observe the patients self aseptic and intravenous infusion techniques. Also nurses addressed their current health issues or questions. This delivery system of care to increased numbers of patients, has allowed a more consistent contact, at reduced costs. Positive patient outcomes and satisfaction are noted at a time when human and material resources are diminishing. Telehealth combined with Telenursing are effective strategies in the vision of global healthcare for the world population.

Objectives

Will see how telehealth can be used to deliver healthcare services and information, in real time, over distance.

Understand how telehealth can enable nurses to work with tools which support and advance current nursing practices.

Gantenbein Rex E. PhD 1

Director, CRHRE

Robinson Barbara PhD 1 Alverson Dale MD 2 Kahn Gary MD 3 Brown Arlene Stredler CCC-SLP, CED 4 5 Sharma Anu PhD 4 Stith Joanna PhD, CCC-SLP, LSLS Cert AVT 6

1 University of Wyoming, Laramie, WY, USA 2 University of New Mexico, Albuquerque, NM, USA 3 Healthbridge Systems, Boulder, CO, USA 4 University of Colorado Boulder, Boulder, CO, USA 5 The Keystone Project, Boulder, CO, USA 6 Listening for Life LLC, Denver, CO, USA P5 Using Telehealth to Deliver Specialized Speech Therapy to Children with Cochlear Implants

Background and Objectives: For a deaf child to maximize benefits of a cochlear implant, he/she must learn a specific hierarchy of skills. Auditory Verbal Therapy (AVT) is an effective therapy for such children; however, the availability of certified AVT practitioners is extremely limited, especially in rural areas; for example, while there are six certified practitioners in Colorado and two in New Mexico, none practices in rural areas. There are no certified practitioners in Wyoming.

We have developed a partnership in these three states to study the use of telehealth to improve access to speech/language therapy for children with cochlear implants. Our objective is to evaluate delivery of high-quality therapy to children who might otherwise not have access to it, with the long-term goal of carrying out clinical trials comparing the effectiveness of telehealth therapy in distance with face-to-face environments.

Method: We are currently carrying out a study in which a child with cochlear implants and his parents in Wyoming participate in weekly AVT sessions with a certified therapist in Colorado via telehealth. The study includes qualitative evaluation and measurement of the child's cortical auditory-evoked potentials (P1) as a clinical biomarker to track development of his central auditory system.

Findings: Discussions with participants indicate high satisfaction with the therapy sessions, despite technical issues that must be resolved. Baseline qualitative and qualitative data on the child's auditory development will be compared to measures taken at regular intervals throughout the therapy period to observe the maturation of his auditory system.

Conclusions: Early delivery of AVT to hearing-impaired children with cochlear implants is critical to speech and hearing development. In rural communities where AVT is unavailable, telehealth is a viable delivery mechanism to increase access to therapy.

Objectives

How telehealth can be used to deliver speech and hearing therapy in rural areas.

What obstacles exist in delivering telehealth services to children.

Rowe Nancy BA

Telemedicine Manager

NARBHA, Flagstaff, AZ, USA

P6 Reaching Out to Telepsychiatry Providers with Online Orientation and Training

How does a rapidly growing telemedicine network, with providers joining from all over the country, ensure that quality of patient care remains consistent? NARBHA established a telepsychiatry program in 1996 with only Sara Gibson, MD, providing patient services. Since then, Dr. Gibson, now NARBHA's telemedicine medical director, has oriented each new telepsychiatry practitioner before they were allowed to see patients via video. The orientation aims to ensure that practitioners competently and appropriately use their video equipment; understand clinical telemedicine policies and procedures; and can orient new patients to telemedicine. Topics include camera angle, room setup, informed consent, confidentiality and privacy, record-keeping, prescribing, coding, and connection quality and security. As the network grew, Dr. Gibson could no longer individually orient practitioners in person or via video. Mailing an orientation recording solved the time problem but the DVD was not interactive and could not verify that practitioners watched the orientation. In May 2010, Dr. Gibson audio-recorded her slide presentation; this was posted online with all related documents. This provides easy, instant access for any practitioner, anywhere in the country; allows quick updates to any part of the orientation and accompanying policies, procedures, and forms; includes an online quiz to ensure that users view and understand the orientation; and lets users email Dr. Gibson with questions. To date, five new practitioners have completed the orientation. NARBHA also offers several online, interactive Telepsychiatry Basics presentations, which cover clinical and administrative/technical aspects of telepsychiatry. In addition, NARBHA's telemedicine website contains procedures and guidelines, tips and techniques, policies, resource links, and contact information so that telepsychiatry practitioners can access information and resources and stay up to date on network policies and changes.

Objectives

Effective ways to reach remote practitioners with a telemedicine orientation.

Items to cover in a telemedicine orientation for telemental health practitioners.

Makela Susan BSN, MPA 1

Director Upper Peninsula Telehealth Network/Educational Services

Manty Joann BSN, DNP 1 Buis Lorraine PhD 2

1 Marquette General Health System, Marquette, MI, USA 2 Wayne State University - College of Nursing, Detroit, MI, USA P7 Telehealth: Creating Office Efficiencies - Myth or Reality

Healthcare delivered via telemedicine (TM) is comparable to face-to-face (FTF) encounters on quality and satisfaction, but little is known about how TM encounters differ from FTF in patient wait times. This study seeks to document the effect of TM on patient wait times, and to understand patient perceptions of efficiencies created by TM. We are collecting patient wait time data during clinical encounters for TM and FTF visits for practitioners in the Upper Peninsula Telehealth Network, a large clinical TM network of 46 sites in Michigan's northernmost region. Wait times for clinical encounter milestones (time taken to exam room and provider entry) are being documented for providers who see patients via TM and FTF during May, Aug., Nov. 2010, and Feb. 2011. Included in this sample are all TM encounters and all FTF visits during two consecutive, randomly selected days, during the identified months. Additionally, TM patients are being surveyed on perceptions of efficiencies created by TM. Preliminary data analyses indicate TM patients (n = 47) wait on average 7.76 minutes less than FTF patients (n = 245) to enter an exam room (M = 7.53 and M = 15.29 minutes, respectively, Welch t-test = −3.12, p < .01) and there are no significant differences between groups in the time spent waiting for providers in the exam room. Survey data indicate the majority of TM patients are white (85%) females (73%), with a mean age 46+/−16.97 years. TM saves patients time as FTF encounters would necessitate 4+ hours of travel time for 46% of respondents. Respondents agree TM saves time (87%), the care received via TM is as good as FTF (76%), and without TM, they would have to wait longer between visits (29%) or would have not have seen their provider (45%). Reasons why TM patients wait less than FTF patients are unclear. Future research should seek to understand these reasons as they may streamline FTF processes. Furthermore, preliminary data from this study may help to build the business case for TM.

Objectives

Understand the impact of telemedicine on patient wait times and clinical encounters.

Understand patient perceptions of efficiencies created by telemedicine.

Cady Rhonda G. MS, RN

Student

Finkelstein Stanley PhD University of Minnesota, Minneapolis, MN, USA

P8 Enhancement Vs. Disruption: Telehealth Technology Changes Nursing Work Processes

Ambulatory care clinics rely on triage nurses to provide safe and effective nursing advice using the telephone. This low-tech telehealth modality is an integral component of triage nurse work processes. The purpose of this qualitative research is to understand the transformation of these processes when the delivery mode of triage changes from telephone to interactive video. Assessment of work processes before and after interactive video implementation provides a basis for evaluating this technologies impact on productivity. Cognitive ethnography uses short observations of representative activities to identify interactions and artifacts of task performance. Artifacts are physical components added to work processes to maintain, display or operate upon information. This research conducted a cognitive ethnography of telephone and interactive video triage episodes, collected during 32 hours of direct observation of triage nurses at a large, urban pediatric clinic. Semi-structured interviews and field notes supplemented data collection. Directed content analysis identified the tasks, interactions and artifacts used by the triage nurses. The final categories that emerged from the data were coordination of care, information hand-off, problem solving, workarounds and interruptions. Coordination of care is the central theme of triage nurse workflow. Interactive video triage changes nursing work processes. All triage is initiated by telephone. Interactive video triage adds additional tasks and artifacts; the nurse must open the software and initiate an interactive video call. Telephone triage supports verbal-only communication between nurse and parent. Interactive video triage supports verbal and visual communication between nurse, parent and child, supplementing triage interactions. The additional tasks, interactions and artifacts of interactive video triage change nurse work processes while providing additional information that could reduce the overall time needed to coordinate an episode of care. The next step is a time-motion study of telephone and interactive video triage to quantify nurse productivity using the different delivery modes.

Objectives

Discuss the role of human factors research in evaluating the work impact of telehealth technology.

Describe the disruption and enhancement of ambulatory care nursing triage when interactive video replaces telephone interactions.

Locatis Craig PhD 1

Project Officer

Ackerman Michael PhD 1 Williamson Deborah DHA 2

1 National Library of Medicine, Bethesda, MD, USA 2 Medical University of South Carolina, Charleston, SC, USA P9 In-Person, Video, and Telephonic Medical Interpretation

Using trained interpreters to provide medical interpretation services is superior to services provided on an ad hoc basis, but little is known about the effectiveness of providing their services remotely, especially using video. Remote medical interpretation services by trained interpreters via telephone and videoconference were compared to those provided in-person. Two hundred and forty one encounters with Spanish speaking patient volunteers involving twenty four health providers and seven interpreters were assessed. Patients, providers and interpreters each independently completed scales evaluating the quality of clinical encounters and, optionally, made free text comments. Interviews were conducted with twenty three of the providers, the seven interpreters, and a subset of thirty patients. Time data were collected. Encounters with in-person interpretation were rated significantly higher by providers and interpreters, while patients rated all methods the same. There were no significant differences in provider and interpreter ratings of remote methods. Provider and interpreter comments on scales and interview data support the higher in-person ratings, but they also showed a distinct preference for video over the phone. Phone interviews were significantly shorter than in-person. Patients rated interpretation services highly no matter how they were provided but experienced only the method employed at the time of the encounter. Providers and interpreters were exposed to all three methods, were more critical of remote methods, and preferred videoconferencing to the telephone as a remote method. The significantly shorter phone interviews raise questions about the prospects of miscommunication in telephonic interpretation, given the absence of a visual channel, but other factors might have affected time results. Since the patient population studied was Hispanic and predominantly female care must be taken in generalizing these results to other populations.

Objectives

How three methods of medical interpretation compare.

User preferences for in-person and remote methods.

Ghose Sankalpo BS 1

Medical Student

Littman-Quinn Ryan BA 2 Mohutsiwa-Dibe Neo BDS 3 Molefi Tsholo BDS 3 Phuthego Motsholathebe BS, DDS, MS(OMFS) 3 Kovarik Carrie MD 4

1 Medical College of Wisconsin / Botswana-UPenn Partnership, Milwaukee, WI, USA / Gaborone, Botswana 2 Botswana-UPenn Partnership, Gaborone, Botswana 3 Princess Marina Hospital, Department of Oral Medicine, Gaborone, Botswana 4 University of Pennsylvania Medical Center, Department of Dermatology, Philadelphia, PA, USA P10 The use of Mobile (Cellular) Oral Telemedicine in Botswana

Background: Telemedicine is becoming a more relevant and realistic means of providing for the delivery of health information and services to resource-poor populations. In Botswana, there is at present only one oral and maxillofacial surgeon in public service. As a result, all complex oral medicine and oral surgery cases in the country - numbering about 300 per year - are referred to him at Princess Marina Hospital in the capital city of Gaborone in a process limited by cost, transportation, time, and lack of reliable means for follow-up. We present preliminary results of a pilot study evaluating the use of mobile telemedicine for the diagnosis and triage of oral medicine and oral surgery in Botswana.

Objectives: (1) To prove that telemedical mobile technology is a reliable method for diagnosing, triaging, and treating complex cases in oral medicine and surgery. (2) To prove that mobile technology can connect resource-poor areas with oral medicine surgery specialists.

Research Design & Methodology: Clinicians in district hospitals use a Sony Ericsson C905 mobile phone, equipped with customized software and a built-in camera, to prepare and send digital referrals for complex oral medicine and oral surgery cases to the sole specialist in Gaborone. The cases are sent from the phones over a data-enabled mobile phone network and are subsequently viewable for remote consultation by the specialist on a customized secure website on the Internet.

Original Data & Results: A total of 54 cases have been sent and successfully consulted on from cases in four satellite hospitals - Tshabong Primary Hospital, Tshabong; Nyangabgwe Referral Hospital, Francistown; Maun General Hospital, Maun; and Sekgoma Memorial Hospital, Serowe - since August 2009.

Implications: Remote consultation for complex cases in oral medicine and surgery will be feasible, accurate, and cost-effective.

Relevance & Impact: We aim to show that telemedical mobile technology is a reliable and effective method for the diagnosis, triage, and treatment of complex cases in oral medicine and surgery. Connecting clinicians in resource-poor hospitals to remotely-located oral medicine specialists will help to provide for a more robust response, both at the level of the individual patient and for the healthcare system in general.

Objectives

Discuss the use of mHealth software/technology.

Demonstrate the practice of mHealth in international settings.

Holtz Bree MSc, PhD

Post-Doctoral Researcher

Veterans Affairs Ann Arbor Health System (HSR&D), Ann Arbor, MI, USA

P11 An Examination of the Perceptions of Nurses During an EMR Implementation

Electronic medical records (EMR), the computerized storage and retrieval of patients' health data, have the potential to improve the quality of healthcare services, reduce medical errors and lower medical costs. Despite these benefits, healthcare providers have traditionally been slow in the adoption of these systems. Past research of EMRs tends to focus on physician perceptions and their adoption tendencies, even though nurses are the front-line of patient care and have a great deal of patient charting responsibilities. This study sought to better understand the intended adoption behaviors of nurses during an EMR implementation. A mixed methods approach was used to better document the adoption perceptions of nurses during an EMR implementation. The first phase was conducted via an online survey with nurses (n = 113) from a regional hospital in Michigan at their last EMR training session. The second phase used an interview guide with nurses (n = 31) from the hospital's intensive care unit/critical care unit (ICU/CCU) to further explore the findings from the survey. The results indicated that social influence was the strongest predictor of intended adoption behaviors (β = 0.32, p = 0.01), however, performance expectancy was still a significant indicator of adoption behavior (β = 0.17, p = 0.05). Additionally, a social network was sketched to display the interactions of the ICU/CCU nurses in regards to the EMR, in order to provide a more in-depth view of social influence during the EMR deployment. The implications of this study indicate the need to better understand the role of social influence and organizational parameters such as shift and unit in order to advance theory and prescribe solutions to enhance diffusion and adoption of EMRs. Practical implications derived from this study include strategies for management and department communications, resource allocation, and training recommendations.

Objectives

Review practical implications of EMR.

Discuss adoption theory of EMR.

Zhao Junping MD, PhD

Director

Guo Huayuan Zhang Zhenjiang Chinese PLA General Hospital, Beijing, China

P12 Develop Regional Collaborative Medical Service and Telemedicine to Improve National Healthcare in China

Since reform and opening up to the outside world, Chinese health and social security level has been steadily improved due to the rapid development of economy and social affairs. However, there still exists a big difference between “to see doctor is difficult and expensive,” with the people increasingly demand. It's not been well dealt with yet. In order to solve the problem, CPC Central Committee and State Council announced a new healthcare reform plan in 2009, It's the first time describe the information system in such plan in China. Based on our experience concerning the regional collaborative medical service demonstration projects in Beijing, Dalian, Xiamen, the paper analyzed the conditions of our country's health and social security status, and got the conclusion that the priority development of regional collaborative medical service and telemedicine is an effective way to improve our health and social security service level.

Objectives

Discuss telemedicine projects in China.

Review regional collaboration projects.

Graf Donald A. BS 1

Director Telemedicine

Walker Judith 2

1 United Healthcare, Phoenix, AZ, USA 2 Arizona Department of Health Services, Phoenix, AZ, USA P13 EMR-HIE Telemedicine Services for Medically Complex Children on the Navajo Nation

Background: Children's Rehabilitative Services (CRS) provides family-centered medical care to approximately 24,000 children with chronic and disabling health conditions through four regional clinics throughout the state. Members often require multiple specialists and a high level of care coordination. These specialty services are carved out from members' regular Medicaid health plans, which provide services that are unrelated to the CRS condition. The relative scarcity of some providers poses a challenge to meeting the special healthcare needs of some children. Telemedicine provides specialty services to children living in remote areas of the state. Electronic medical records facilitate care coordination across multiple points of service. By January 2011, CRS telemedicine services will expand to include the Navajo Nation.

Objective: Link Web-based HIE-EMR system with expanding telemedicine programs will maximize access to scarce pediatric neurologists and improves care coordination for patients living in remote areas in the Navajo Nation.

Critical Components Partnerships

▪ Creating HIE-EMR system on an expanding telemedicine program involves coordinating relationships between Hub/Spoke sites on and off the Navajo Nation, specialty physicians, Medicaid regulators, technical service providers, program administration and regional hospitals.

Operational Considerations

▪ Funding (startup capital, coordination, connectivity, maintenance)

▪ Contracting (PHI, Tribal protocols, Medicaid/CMS rules, Grant constraints)

▪ Credentialing providers Inter and intra State (Tribal considerations)

▪ Sustain administrative, regulatory and medical management support

Physical Environment

▪ Supports adaptive assistance directed to medically complex children

▪ Cultural considerations for ethnically diverse and underserved population

Physician Support

▪ Credentials on the line

▪ Must support diagnosis and treatment process

▪ Complex Electronic Infrastructure

▪ Web-based HIE/EMR system

▪ Transactional and Interface standards for information exchanged between telemedicine, HIE-EMR systems using HL7 and CCR transactions

▪ Business associate, data sharing and equipment use agreements

Objectives

Linking Web-based HIE-EMR to Telemedicine Program.

Improve care coordination for complex pediatric neurology patients living on the Navajo Nation.

Anderson Kristine

DL Manager

Saint Francis University CERMUSA, Loretto, PA, USA

P14 Telemedicine and Distance Education Applications for At-Risk Substance use Behaviors in the Military

Substance use disorders are an immediate concern in all branches of the military. Almost 2 million veterans, or 6% of veterans in the United States, reported using illicit drugs in the past year according to the NSHDA report (2002). An annual average of 7% of veterans experienced serious psychological distress (SAMHSA, 2007) and approximately, 21% of service members admit drinking heavily, a statistic that has remained steady for the past twenty years. The Screening, Brief Intervention, and Referral to Treatment (SBIRT) program is a Substance Abuse and Mental Health Services Administration (SAMHSA) sponsored behavioral intervention for at-risk drinkers and drug users; it has been found to be successful in encouraging people to alter or modify their risky behaviors. Currently, the program is offered as in-person training to serve the needs of civilians. The innovative approach of this research is to implement telemedicine and distance education applications to evaluate and serve the needs of the military. This method of interaction is cost effective and overcomes barriers often encountered with remote areas (large rural areas, lack of heath access, and inadequate services) that military may be located. The research concluded a quantitative study during in the winter of 2010–2011 with active members of the military (n = 100). The presentation will share the data outcomes, with special attention to the critical findings in the field of providing preventive medicine. The results include actual data with results of statistical tests presented. The benefit of the research is that it provided insight into the knowledge, experiences, and understanding of substance abuse among active military. The outcomes are valuable whilst designing a telemedicine application that benefits their peers. The goal of the program is to have intermediate leaders of the military use the SBIRT technique to help reduce excessive levels of alcohol consumption among service members.

Objectives

Recognize the reported at-risk substance use behaviors prevalent in military populations.

Identification of the problem and services with nondependent substance use disorders in the military that can be addressed by implementing a SBIRT online program.

Demiris George PhD

Associate Professor

Thompson Hilaire J. PhD, RN, FAAN University of Washington, Seattle, WA, USA

P15 Use of a Community-Based Telehealth Platform for Cognitive Assessment of Older Adults

Older adults vary in the development and progression of chronic disease and decline at differing rates in areas of well-being. The cognitive faculties that prompt and guide human activities are essential in preserving independence. As cognitive impairment increases over time, as in dementia, dependence in activities of daily living and inability to be left alone safely may lead to institutionalization. The aim of this study is to demonstrate the feasibility of an innovative community based telehealth application that integrates physiological monitoring and cognitive assessment of older adults with the goal to monitor overall well-being and potentially prevent or predict adverse events. Our approach utilized multi-user hardware in a community room within an independent retirement community. Physiological monitoring was introduced with a health management platform that provided users secure access to their patient profile with the ability to capture relevant vital sign data into their personal health record. The cognitive assessment software included interactive steps that enable the assessment and over improvement of cognitive abilities including divided attention, planning, speed of processing and working memory. Participants were invited to assess vital signs weekly and conduct cognitive training three times a week. Data were made accessible to participants and the community health nurse. We recruited 27 subjects (average age of 88.2 years). The mean number of chronic health conditions was 4.2. An increased number of chronic diseases negatively correlated with planning (r = −0.52, p = 0.016). Increased age was negatively correlated with cognitive tasks associated with divided attention (r = −0.48, p = 0.029), planning (r = −0.53, p = 0.013), and spatial perception (r = −0.718, p < 0.0005). The amount of assistance needed for subjects to operate the technology decreased over time. During exit focus groups, subjects were very accepting of the telehealth technology pointing out its ease of use and the opportunity to engage meaningfully in cognitive performance activities and monitoring of vital signs.

Objectives

To showcase innovative use of telehealth for cognitive assessment and improvement of older adults.

To demonstrate the integration of diverse technologies into one system that promotes personal health record keeping for multiple stakeholders.

Radhakrishnan Kavita RN, BSN, MSEE 1

Research Assistant

Jacelon Cynthia RN, PhD 1 Roche Joan RN, PhD 1 Thomas Mary RN, MSN 2

1 University of Massachusetts, Amherst, MA, USA 2 Baystate Health, Springfield, MA, USA P16 Barriers and Facilitators to the use of Telehealth for Heart Failure by Home Healthcare Nurses and Patients with HF

Background: Individuals discharged from the hospital after heart failure (HF) are often readmitted within 30 days. Telehealth technology can help individuals and the home health agency manage the disease during this critical period. However, despite high levels of acceptance of telehealth during initial phase of use, home healthcare providers' and patients' use of telehealth diminish over time.

Purpose: The Purpose of this study was to identify facilitators and barriers to successful long-term application of telehealth for managing heart failure by home health nurses and their clients. The Unified Theory of Acceptance and Uses of Technology (UTAUT) framework guided this study.

Methods: This descriptive, mixed methods study used a combination of focus groups and questionnaires to explore perceptions about telehealth for management of HF at a homecare agency. A telehealth acceptance survey was used to obtain the perceptions of telehealth for HF management from 31 homecare nurses. The responses from the survey guided the questions for 3 focus groups (n = 9 nurses), an interview with the telehealth nurse, and interviews with 4 clients.

Results: Survey respondents (67.7%) responded the belief that telehealth helps improve HF. Perceived benefits reported by nurses about telehealth include providing a means for objective assessments, timely information regarding client status, a sense of security, and client accountability. However, barriers included inadequate staff training, lack of guidelines for client referrals, poor integration of telehealth into nurse's workflow, lack of trust in equipment's accuracy, increased nursing workload related to false alarms, client anxiety, and client over-dependency on telehealth.

Conclusion: The study identified facilitators and exposed barriers to effective application of telehealth for managing HF in a home health agency. Next steps include identifying individuals with heart failure who benefit most using telehealth, and implementing system changes to maximize the effectiveness of telehealth technology at the home care agency.

Objectives

Home care nurses' and their clients' perceptions of telehealth for HF will be presented.

Facilitators and barriers to successful long-term application of telehealth for managing heart failure by home health nurses and their clients.

Wakefield Bonnie J. PhD, RN

Investigator, Veterans Administration (VA) Rural Health Resource Center – Central Region

Nelson Shannon MS Scherubel Melody RN Klobucar Thomas PhD Kaboli Peter MD Iowa City VA Medical Center, Iowa City, IA, USA

P17 Remote Delivery of a Phase 2 Cardiac Rehabilitation Program

The purpose of this project, funded by the Veterans Administration (VA) Rural Health Resource Center - Central Region, is to: 1) test feasibility and safety of a Phase 2 cardiac rehabilitation (CR) program delivered to the patient's home using telehealth; and 2) compare outcomes of patients enrolled in the remote program to patients who attend a local face-to-face Phase 2 program. Baseline and 12-week outcome data will be collected including: tobacco use; blood pressure; lipid control; weight ; depression; medication adherence; hospital admissions; quality of life; heart disease knowledge; satisfaction; adverse events; mortality; and costs. We will also assess program uptake (i.e., number of eligible patients referred; percent of eligible patients enrolled; percent of patients who complete the program; and reasons patients do not complete the program). Approximately 100 subjects will be recruited for the remote program. Each subject enrolled in the remote program will receive an American Heart Association workbook, blood pressure cuff, heart rate monitor, pedometer, and exercise pedal. Participants will receive an individualized exercise prescription at baseline and be contacted weekly for 12 weeks for education and assessment. Patients who attend a local face-to-face program will only be assessed at baseline and 12-weeks for outcome measures. Results will be presented comparing patients in the remote and face-to-face delivery programs. There are only a few reports in the literature describing home-based CR programs. This will be the first to test a remote CR program in a large population of older medically complex patients. It has significant implications since few VA medical centers provide comprehensive CR services on-site. If feasible and effective, this service will not only fill an important gap in VA services, but will bring services closer to the patient and their home, a fundamental principal in the improvement of care for rural veterans.

Objectives

Describe the design of a remote cardiac rehabilitation program.

Describe outcomes evaluation in a remote cardiac rehabilitation program.

Cohen Glen

Director of Sales and Marketing

Heritage Home Healthcare, Albuquerque, NM, USA

P18 Fall Reduction: An Unexpected Benefit of Telemonitoring in the Home Healthcare Setting

Falls in the population served by home healthcare companies is a serious issue both in terms of clinical prognosis and costs. This population is vulnerable for falls due to their diagnosis and symptoms, as well as increased fall risks associated with medications used to treat these problems. Falls are so significant so that the Center for Medicare and Medicaid Services (CMS) has included questions about a multi-factor fall risk assessment and fall prevention interventions in the mandated assessment tool used by CMS (the OASIS). Additionally, home health agencies are compared to competitors on several different outcome and processes measures, including emergent care for injury caused by fall or accident at home. Heritage Home Healthcare of AZ officially launched the telehealth program in 2008, with a primary emphasis on CHF and COPD. Consistent with previously published literature, Heritage also found reductions of re-hospitalizations, exacerbations of CHF and COPD and the actual number of days spent in the hospital for those who were re-admitted for CHF and COPD. Due to these positive findings, the program was expanded to increase diabetes and other coronary disease processes in 2009. While reviewing two year follow up data, we observed an unexpected finding. The fall rate for patients on telehealth was 2%. In an informational document, Falls Among Older Adults: An Overview, the Centers for Disease Control and Prevention (CDC) reported that more than one third of adults 65 and older fall each year in the United States (Hornbrook et al. 1994; Hausdorff et al. 2001). This finding has a tremendous clinical and cost impact. Knowing that these patients are at a high-risk for falls and that remote monitoring significantly improved this outcome, provided added return on investment for using telehealth monitoring within home healthcare service provision.

Objectives

Cardiovascular patients in home care setting are at a high risk for falls.

Remote monitoring reduces the fall risk in this population.

Cole Stacey L. MBA 1 2

Medical Student

Dharmar Madan MBBS, PhD 3 Roehrich Rikki 4 Wu George 4 Farbstein Aron 4 Marcin James P. MD, MPH 3

1 University of Utah, Salt Lake City, UT, USA 2 Center for Health and Technology, UC Davis, Sacramento, CA, USA 3 UC Davis, Department of Pediatrics, Sacramento, CA, USA 4 UC Davis, Center for Health and Technology, Sacramento, CA, USA P19 Pediatric Ambulance Proof of Concept for Disasters: Mobile Video and Radio Frequency (RFID) Tracking

Background: Disasters challenge the design of day-to-day healthcare, putting stress and strain on the medical care system. Pediatric patients often face even more challenges, including additional needs for unique resources and needs for better tracking so parents can be reunited with their children. During a statewide disaster drill we tested a mobile telemedicine system and a real-time RFID tracking system setup between two hospitals and a pediatric ambulance. Our goals were to evaluate the use of a mobile video system for remote consultation to specialists, and the effectiveness of RFID to track a simulated pediatric patient and resources being transported by pediatric ambulance between the two hospitals.

Methods: A mobile video system was setup and configured to a high-bandwidth cellular connection linked to a Virtual Private Network. WiFi RFID was setup at both the rural hospital and the tertiary medical center. The pediatric ambulance was equipped with a cellular router, an access point registered to the RFID system and a combination WiFi RFID/GPS tag. The system was configured to send GPS coordinates to Google Maps' web application, which allowed the ambulance and pediatric patient to be tracked in transit, as well as within either hospital.

Results: The video system was able to transmit video, but given the available bandwidth the frame rates were low and at times significantly delayed, particularly in areas where high-bandwidth cellular was not available. The RFID system effectively tracked the simulated transport of a pediatric patient from the rural hospital, throughout the transport, and the arrival of the patient to the tertiary center. During the demonstration asset tags simulating resources were accurately located within the pediatric ambulance.

Conclusion: This RFID system uniquely creates seamless tracking that uses both outdoor mobile tracking and indoor WiFi tracking, allowing pediatric patients to be located using a single Web-based system. This proof of concept demonstrates novel ways to potentially locate and provide pediatric patient care in a disaster.

Objectives

Participants will gain an understanding of Mobile RFID and telehealth applications.

Participants will learn about a mobile RFID and video system tested during a disaster drill.

Hu Peter F. 1 2

Assistant Professor

Stein Deborah M. MD 1 2 Stansbury Lynn MD 1 Brenner Megan MD 1 2 Xiong Wei MS 1 Jiao Xiaoli PhD 1 Scalea Thomas MD 1

1 University of Maryland School of Medicine, Baltimore, MD, USA 2 R Adams Cowley Shock Trauma Center, Baltimore, MD, USA P20 Brief Episodes of Abnormal Shock Index Predicts Mortality in Severe Traumatic Brain Injury

Introduction: Shock index (SI = heat rate [HR]/systolic blood pressure [SBP]) has been used to predict pre-hospital mortality in trauma patients. We examined brief episodes of abnormal Shock Index (SI > 0.7) as an early predictor of mortality and length of stay in intensive care (ICU) of severe traumatic brain injury (TBI) patients.

Methods: Continuous, automated, digital vital signs (VS) data were recorded every 6 seconds on ICU patients with severe, isolated TBI. We then calculated five-minute means of SI (HR/SBP) and the number of episodes (5 to 60 minutes in increments of 5 minutes) above-normal SI (SI 0.7 to 1.0 in increments of 0.05) at intervals over the ICU stay. We then used Receiver Operator Characteristic (ROC) methods to determine the predictive power of these episodes for 30-day mortality and length of ICU stay over 14 days (LOS).

Results: Twenty-one patients provided 6,200 hours of VS data (3,720,000 data points). Area Under the Curve (AUC) for the predictive power of episodes of above-normal SI for mortality ranged from 0.52 to 0.87 and for LOS, 0.58 to 0.95. SI > 0.7 lasting > 10 minutes best predicted mortality (AUC 0.84, p < 0.001) in the first 12 hours of ICU admission. SI > 0.7 lasting > 25 minutes best predicted LOS (AUC 0.87, p < 0.001) at 48 hours. With all ICU VS included, SI > 0.7 lasting > 15 min provide the best prediction of mortality (AUC 0.85, p < 0.001) and LOS (AUC 0.95, p < 0.0001).

Conclusions: SI calculated from continuous automated VS recordings predicts morality and LOS as early as the first 12 hours of ICU stay. We are now deploying and validating a real-time telemetric VS viewer that includes SI with other continuous VS displays from our tertiary care trauma center NeuroTrauma ICU. Supported in part by W81-XWH-07-2-0118.

Objectives

Describe the methods for predicting patient outcome by using real-time patient vital signs in ICU.

Discuss the real-time deployed telemedical application based on the prediction method.

Ward Elizabeth C. 1 2 3 Burns Clare 4 Theodoros Deborah 1 2 Russell Trevor 5 2 Waite Monique BSpPath (Hons) 6

Lecturer

1 Division of Speech Pathology, The University of Queensland, Brisbane, Australia 2 Telerehabilitation Unit, The University of Queensland, Brisbane, Australia 3 Center for Functioning and Health Research (CFAHR), Queensland Health, Brisbane, Australia 4 Speech Pathology Department, The Royal Brisbane & Women's Hospital, Brisbane, Australia 5 Division of Physiotherapy, The University of Queensland, Brisbane, Australia 6 The University of Queensland, Brisbane, Australia P21 Assessment of Swallowing Disorders VIA Telerehabilitation

Aim: The aim of this study was to determine the non-inferiority and clinical safety of conducting dysphagia assessments online.

Method: Patients with varying levels of swallowing abilities participated in this study. (Recruitment to date 21 participants, total cohort will be 40 participants.) Each patient was assessed using a Clinical Swallowing Examination (CSE) protocol that was modified to suit a telerehabilitation environment. To optimise the CSE in the online environment, 2 assessment personnel were required: (1) the on-line clinician who led the assessment (remote location) and (2) an allied health assistant who was in the room with the patient. The role of the assistant was to facilitate the food and fluid trials under direction by the online clinician. For research purposes, a face-to-face clinician also assessed the patient simultaneously with the online clinician to determine reliability of online decision making in comparison to the clinical standard. The telerehabilitation system was hosted on a portable notebook computer with specific modifications (freestanding web-cameras, an additional lapel microphone, split screen display at the patient end, store and forward capabilities) designed to optimise the visual and auditory information provided to the online clinician.

Results: Preliminary analysis on first 21 participants using Percent Exact Agreement (PEA) and Percent Close Agreement (PCA; agreement within 1 rating scale point) revealed high to excellent levels of agreement between the online and the face-to-face clinicians across the majority of the parameters of the CSE. The system allowed for clinical agreement for aspiration risk. Data regarding patient management planning was also consistent between environments. When the final cohort is completed, Kappa and ICC statistics will be conducted.

Conclusion: The pilot data supports that the current model of administering a CSE via telerehabilitation has the potential to be a viable and valuable method for the remote assessment of swallowing disorders.

Objectives

Clinical safety of telerehabilitation for dysphagia assessment.

Non-inferiority of online assessments.

Lai Fuji

Director

InTouch Health, Santa Barbara, CA, USA

P22 Design and Evaluation of Mobile Portable Telemedicine System Developed for the Ems and Transport Environment

Introduction: Urgent and emergent transport environments require patient care decisions to be made immediately in dynamic situations. Transport/EMS teams welcome the ability to consult, on demand during transport, with a remote clinician who would be able to offer their expertise at critical decision junctures. A mobile portable telemedicine system has the potential to address this need. Use cases include Emergency and Critical Care Transport, 911, disaster response, and selected home care applications.

Method: Design of this new system utilized human factors methodologies to analyze workflow and define user requirements via interviews, ethnographic studies (e.g. ridealongs), and assess concepts iteratively via prototype-based user feedback elicitation. Several healthcare institutions were selected to participate in system evaluation. Systems were brought to these clinical sites and assessed in tightly-coordinated situations to test and refine both the system and the clinical processes within targeted applications.

Results/Discussion: The resulting system designed and developed is portable, adaptable, lightweight -able to be used anywhere, inside or outside the ambulance. Transport team initiates a consult and remote clinicians are able to connect to the system to visualize the patient, interact via two-way video and audio, and access the relevant information needed to make clinical assessments. The system leverages tailored state-of-the-art technology innovations including cellular connectivity management and visualization control. Feedback was extremely positive across all stakeholders - from clinicians to transport teams/EMS to hospital administration to patients. The system was found to be useful and usable. There was great value to having the clinical expertise available to enable difficult patient care decisions to be made with confidence. The form factor was also found to fit seamlessly into the clinical workflow and design found to be user friendly. The findings indicate that this kind of mobile telemedicine system has the potential to have far-reaching impact on patient care in the transport/EMS environment.

Objectives

To present a new mobile portable telemedicine system designed and developed for the EMS and transport environment.

To present key clinical applications and findings from system evaluation in targeted environments.

Kemp Aaron S. 1

Neurocognitive Research Coordinator

Gooch Kirstan N. 2 Goldberg Joisabel L. 2 Bun Sitha 2 Reist Christopher 1 3 Palmer Barton W. 4 5 Bondi Mark 4 5 O'Halloran James P. 2

1 University of California, Irvine School of Medicine, Irvine, CA, USA 2 NeuroComp Systems, Inc., Irvine, CA, USA 3 Veterans Administration Healthcare System, Long Beach, CA, USA 4 University of California, San Diego, CA, USA 5 Veterans Medical Research Foundation, San Diego, CA, USA P23 Psychometric Comparison of Remote-Televideo and Face-to-Face Administration of a Cognitive Assessment Battery

Neurocognitive assessment is an essential component in clinical trials of candidate “cognitive-enhancing” treatments for a range of disorders. However, manual administration of large, paper-based, neurocognitive batteries is often inefficient, error-prone, and inconsistent across multiple sites. Existing computerized testing systems are also limited in both the assessment instruments available and the range of impairments that can be accommodated with the subject sitting alone at a single display. Therefore, a unique, dual-display, computerized testing system was developed, with funding from the National Institutes of Health (NIH), that integrates (rather than replaces) the examiner for computerized administration of standard neurocognitive assessment batteries. This dual-display configuration has now been extended to support two-way, wireless televideo communications for remote administration by an examiner at a distal location. The purpose of the current study was to evaluate the psychometric feasibility of this novel configuration by comparing the concurrent validity and test-retest reliability of computerized, remote-televideo (RT) administration of a representative battery of common neurocognitive assessment instruments with traditional, face-to-face (FF) administration of the same battery on paper. This battery was administered to 25 subjects with no history of psychiatric diagnoses, 5 patients with schizophrenia, and 10 patients with Mild Cognitive Impairment (MCI) via both methods ∼14 days apart with the order of administration counterbalanced across participants. Intraclass Correlation Coefficient (ICC) comparisons between RT and FF yielded highly significant measures of agreement for all tests and only one significant mean difference was found between the methods using paired-samples t-test comparisons. The ICCs for test-retest reliability were also highly significant for all tests compared. While further validation within the specific patient populations for which application is intended is still on-going, the current, preliminary results support the psychometric feasibility of administering a computerized battery of commonly applied neurocognitive assessment instruments via remote, televideo interactions with an expert examiner at a distal location.

Objectives

To appreciate the importance of remote-televideo administration of neurocognitive assessments.

To learn that remote-televideo administration of neurocognitive assessments is both feasible and psychometrically valid.

Greenwood Deborah RN, MEd, CNS, BC-ADM, CDE, ADA/AADE 1

Program Coordinator, Diabetes Clinical Nurse Specialist

Buss Kimberly MD, MPH 1 Pratt Leslie RN, MPA 1 Hankins Andrea I. MS 2 Parise Carol A. PhD 2 MacAller Tami MPH 3 Harms Kristin 4 Olveda Joan RN 1

1 Sutter Health, Roseville, CA, USA 2 Sutter Institute for Medical Research, Sacramento, CA, USA 3 California Diabetes Program, University of California San Francisco, California Department of Public Health, Sacramento, CA, USA 4 California Smokers' Helpline, University of California San Diego, San Diego, CA, USA P24 Achieving Meaningful use through Improved Documentation of Tobacco Status

Purpose: To improve tobacco documentation in the EMR by developing a system that simplifies the documentation and referral process.

Background: To achieve meaningful use of electronic medical records (EMR) and qualify for incentives through the Medicare and Medicaid Programs Electronic Health Record Incentive Program, healthcare providers must report on quality measures that include the following: More than 50 percent of patients 13 years of age or older have smoking status recorded as structured data. Sutter Medical Foundation collaborated with the California Smokers' Helpline (Helpline) to educate medical assistants (MA) about the importance of documentation of tobacco status. The purpose of this pilot study was to determine if this education improved documentation of tobacco status and increased referrals for tobacco cessation.

Methods: In January 2010, MAs at three care centers in the Sacramento Sierra Region were trained to identify and document tobacco status in the EMR (EPIC). If patients were ready to quit, the MA generated an electronic referral to the Helpline for tobacco cessation education and counseling. Tobacco status data were collected via retrospective EPIC query to include patient visits for the months of April, June, and August in 2009, as well as the same months in 2010. Documentation included initial status of tobacco use, verification at each visit, and documentation of an education intervention (Helpline referral).

Results: A total of 21,227 visits were recorded during three months in 2009 and 18,990 in 2010. Initial documentation increased from 88.1% to 91.3%. Verification increased from 22.1% to 44.5%. Documentation of an education intervention (Helpline referral) increased from 0.8% to 1.3%. All values were statistically significant (χ², p < 0.05).

Conclusion: Engaging MAs to systematically document tobacco status in the EMR improves documentation, especially with EMR verification on a visit to visit basis. Partnership with the state helpline generated increased referrals via the EMR. Follow up research to identify how to leverage the EMR further to improve tobacco cessation is needed.

Objectives

Describe meaningful use requirements for tobacco use documentation.

Identify one method to improve tobacco documentation rates in the EMR.

Schweickert Patty A. MSN, FNP 1

Nurse Practitioner Neuroradiology

Rutledge Carolyn M. PhD 2 Cattell-Gordon David C. MDiv, MSW 1 Solenski Nina J. MD 1 Jensen Mary E. MD 1 Branson Sheila MSN, FNP 3 Gaughen John R. MD 1

1 University of Virginia, Charlottesville, VA, USA 2 Old Dominion University, Norfolk, VA, USA 3 MEOC PACE, Big Stone Gap, VA, USA P25 Telehealth Stroke Prevention Education in Elderly Appalachian Virginians

Synopsis: Rural populations have limited access to stroke prevention education. Stroke education via telehealth may reduce risk of stroke thereby reducing incidence of stroke.

Purpose: To evaluate whether telehealth delivered stroke prevention education is as effective as in-person delivered stroke prevention education.

Research question: Is there a significant difference between adults that receive stroke prevention education via telehealth versus in-person related to: satisfaction, knowledge, and likelihood of taking actions to reduce vascular risk factors?

Hypothesis: There is expected to be no difference between telehealth and in-person delivery in satisfaction, knowledge, and likelihood of taking actions to reduce vascular risk factors.

Method: A quasi-experimental nonequivalent control group design using a convenience sample of eleven elderly adults (36% male, 64% female) with mean age of 71 was selected from an Appalachian PACE facility. Subjects received a 20 minute group in-person or telehealth delivered education session.

Outcomes: Satisfaction with delivery method was equivalent between groups (p = > 0.05). Pre/posttest knowledge was equivalent between groups (p > 0.05) with knowledge significantly increasing in both groups after the educational programs (p = < 0.05). Between groups likelihood to reduce risk factors showed no differences pre/posttest as well (p > 0.05). There were significant differences (p = < 0.5) in the pre/post-likelihood scores of the telehealth group but not the in-person group (p = > 0.05).

Conclusion: Equal effectiveness of telehealth and in-person delivery of stroke education in regards to satisfaction, knowledge, and likelihood of making changes to decrease vascular risk factors was ascertained. This project provided a rural, high-risk population access to telehealth stroke education. Feasibility in design and acceptance of telehealth education by rural elderly adults was also demonstrated. Further exploration of telehealth delivered stroke education in rural and underserved areas is indicated, with the goal of decreasing stroke risk and health disparities in vulnerable populations.

Objectives

Provide evidence that there is equal effectiveness of telehealth and face to face delivery of stroke prevention education, allowing opportunity for further research and implementation of stroke education via telehealth.

Provide evidence on the feasibility of study design and acceptance of telehealth education by rural elderly adults.

Mars Maurice MBChB, MD

University of KwaZulu-Natal

Nelson R Mandela School of Medicine, Durban, South Africa

P26 Developing the Capacity to Develop Capacity: A New Model for Africa

Sub-Saharan Africa (SSA) faces a disproportionate burden of disease, a shortage of healthcare professionals and limited funds for healthcare provision. eHealth can address aspects of the problem but integration of ICT in healthcare in SSA has been slow because of poor infrastructure, high connectivity costs, and lack of human capacity in eHealth. There is limited training in Telemedicine or Medical Informatics available in Africa. Sending people from Africa to the developed world for training is expensive and leads to a brain drain. We describe a new approach to building eHealth capacity in Africa.

Background: The University of KwaZulu-Natal (UKZ-N) has eleven years' experience in eHealth training in Africa using various models: bringing people to South Africa for workshops, sending students to the USA for postgraduate education, and bringing students to South Africa for postgraduate programmes. Each has its deficiencies. A new model is being implemented, based on our experience of interactive distance learning, using high and low bandwidth videoconferencing, in conjunction with a learning management system.

Model: The model of “developing capacity to develop capacity”, shares the existing Medical Informatics graduate programmes at UKZ-N with four other Universities in Uganda, Mozambique, Zimbabwe and South Africa. Students take their courses interactively from UKZ-N by videoconferencing, with staff at the receiving institutions acting as mentors and also taking the courses to develop their own capacity to take over teaching in time. The curriculum is shared with each of the universities and may be adapted over time to meet local needs. It is envisaged that teaching will ultimately be shared between participating institutions. A similar graduate training project in telemedicine is planned.

Conclusions: This model of collaborative teaching and curriculum development aims to develop capacity in eHealth in Africa and fast track the development of sustainable academic departments offering eHealth programmes in Africa.

Objectives

Describe eLearning models.

Understand cooperative capacity development.

Givens Gregg D. PhD 1

Professor and Chair, Department of Communication Sciences and Disorders

Crowell Ellen BS 1 Jones Gloria BS 1 Brechtelsbauer Bradley MD 2 Yao Jianchu PhD 1

1 East Carolina University, Greenville, NC, USA 2 Eastern Carolina ENT Head & Neck Surgery, Greenville, NC, USA P27 Tele-Audiology Practice in a Variety of Settings

This presentation details the application of a distributed web-based system with wireless audiometers and videoconferencing software to administer remote audiological assessments in a variety of settings including an active medical (otology) practice. This tele-audiology system consists of a central server, patient stations, and personal computers used by audiologists. These devices all interconnect through the Internet. The patient stations use off-the-shelf wireless audiometers that can exchange information between the patients and audiologists with the flexibility of using standard PCs or wireless network gateways. The system uses browser-server architecture and provides secure logon for users (patients, audiologists, nurses, financial workers, etc) and supports real time interaction using established diagnostic protocols. The telehearing system supports simultaneous multi-user encounters and diagnosis and requires only a reliable low bandwidth Internet connection at both ends. Due to the distributed nature of the system, the software residing at the server site, the management and support of the system is isolated from the users (both the audiologists and patients). Utilizing this system, participants were tested with a double-blind procedural design with IRB approval. Each participant received a traditional face-to-face assessment of pure tone hearing thresholds by an audiologist through both traditional and remote methods. Remote assessment results were compared to those collected from a traditional face-to-face assessment. Data demonstrate that assessment results from the two sources were comparable. Test administration completion time for the telepractice portion as well as patient satisfaction will also be reported. The presentation will also focus on issues in the system regarding, video communication, Internet infrastructure, Bluetooth technology and remote site facilitators. This presentation will describe the clinical protocols, and system evaluation. Data will be presented describing outcomes of remote audiological testing using this system in a variety of settings.

Objectives

Attendees will learn the basics of remote audiology procedures.

Attendees will become familiar with a web-based distributed model of hearing assessment.

Sossong Sarah MPH 1 Kahn Estelle MD 2

1 Center for Healthcare Delivery, Kaiser Permanente, Oakland, CA, USA 2 Emory University, Atlanta, GA, USA P28 Northern California Kaiser Permanente's Teledermatology Program Improves Time to Biopsy for Skin Cancer

Remote areas, such as California's Central Valley, are at an increased need for improved access to dermatological care. To address this problem, Kaiser Permanente has created a teledermatology program that attempts to provide primary care physicians (PCP) same day dermatologic consultations using “store and forward” (S/F) technology. S/F teledermatology is a tool that allows a PCP to consult a remote dermatologist by transmitting digital images and a short description of a patient's skin lesion through Kaiser Permanente's electronic medical record system, Health-Connect. The virtual roving dermatologist is then able to download these images and provide the PCP with a timely consult reply, usually the same day. The access and efficiency benefits were readily apparent with dramatic improvements in patients' access to dermatology services. However, quality outcomes have not been studied and this was perceived as a gap. Specifically, we chose to look at the efficacy of teledermatology in reducing the time to biopsy in skin cancer in remote areas as this has not been extensively studied outside of KP. The objective was to measure the time intervals between the initial PCP visit dates of a patient presenting with a suspicious skin lesion to the time of initial evaluation by a dermatologist to the time to biopsy of this lesion. Our methods included a retrospective chart review of KP patients seen in the Central Valley whose dermatology consults yielded a positive skin cancer biopsy. Our results showed that 293 patient cases met our study criteria (58% conventional referrals and 42% teledermatology referrals). The mean time to biopsy of skin cancer was 13.9 days for conventional referrals vs 9.7 days for teledermatology referrals (p < 0.0001). Although, the study was limited by the fact that it was a retrospective analysis of Kaiser Permanente patients within a particular geographical area, the results clearly indicate that the use of of teledermatology in remote areas to expedite the biopsy of skin cancer is promising. In summary, the Teledermatology (Virtual Roving Dermatology) Program at Central Valley Kaiser Permanente centers reduces the time to biopsy of a suspicious lesion that is later diagnosed as skin cancer (SCC, BCC, MM) as compared to traditional e-consults.

Objectives

Fill gaps in existing literature about teledermatology's effectiveness in potentially improving clinical quality outcomes.

Share study results on improved time to biopsy of skin cancer patients in remote areas as compared to traditional referral consults.

Mun Seong K. PhD 1

Director

Lee Sang-Goo PhD 2 Shin Dong-Hoon PhD 2

1 Arlington Innovation Center, Virginia Tech, Alexandria, VA, USA 2 Seoul National University, Seoul, Republic of Korea P29 M-Health Platform Architecture Optimization for Deployed and Disaster Relief Operations

Mobile health (m-Health) technologies in one form or another have been essential element in deployed situations and disaster assistance operations. But lack of an integrated common platform that can connect to multiple communication networks and multimedia medical data and decision support made the work of medic and field healthcare professionals difficult. We report the progress in designing such an integrated platform. For the medical informatics side, this mobile platform is designed to support wireless interfaces with (a) physiological data monitors for blood pressure, blood oxygen saturation, pulse rate, end tidal CO2, tympanic temperature, and blood sugar; (b) real-time four and twelve lead electrocardiogram (ECG) wave form data; (c) digital stethoscope, (d) diagnostic video images; (e) still color photo images; (f) recorded audio; (g) real-time voice-over-IP exchange for tele-mentoring & tele-consulting. Users will be able to install/download new software applications with the convenience comparable to commercial smart phone application environments, and also, connect new medical sensors and peripherals in ‘plug-and-play’ mode. For the communication side, the platform is designed to allow communication with commercial wireless services and military and police channels following pre-authorized secure protocol. The level of ruggedness; water, sand, mud, and heat beyond normal commercial grade has not been determined. Once such devices are deployed we expect the new operational scenario would be different from the traditional one and efforts are underway to make the design flexible enough to support various concepts of operations with potential users.

Objectives

New Platform in m-Health.

Modular Systems Integration.

Voyles Debbie BS, MBA

Director of Telemedicine

Lappe Laura BS Lefforge David MS, MBA TTUHSC, Lubbock, TX, USA

P30 Expanding Pediatric Care to Rural West Texas

The Texas Health and Human Services Commission (HHSC) recently highlighted a series of barriers to obtaining healthcare services for all children living in rural and underserved areas of Texas. One of those barriers is a shortage of healthcare providers, particularly pediatric subspecialists serving children living in rural and underserved areas. From the Texas Tech University Health Sciences Center (TTUSHC) institutional view point, the causes of the shortage of care in West Texas are not the important issue to our project. Acknowledgement of, and response to the shortage however are critically important, from which we have developed a program to increase access to pediatric care for children living in rural West Texas. Although there are many telemedicine programs in the US, Project Children's Healthcare Access for Rural Texas (CHART) is a newly created, unique community-based telemedicine program providing pediatric healthcare services to Medicaid-enrolled children in 20 West Texas rural and frontier communities where access to pediatric care is severely limited. Project CHART is a two year program funded by HHSC. The project, which started in 2009 and runs through August 2011, is in its second year of operation. The program has been designed to achieve the goal of increasing access to specialty care, including general pediatric care, to children in rural and underserved communities resulting in improved quality care and quality of life and decreasing health disparities.

TTUHSC's program will:

Expand current telemedicine services to children enrolled in Medicaid in West Texas to include up to 20 new patient site locations.

Increase Access to general pediatrics and pediatric subspecialty healthcare.

Assist each patient site to become independently sustainable once HHSC financial grants for the project end.

Operate within the rules for Telemedicine and Medicaid reimbursement.

Attendees will learn about strategies used and lessons learned, in the creation and evaluation of the service and research platform. In addition, results from the first year operations will be discussed.

Objectives

Driving factors in the success and failure of a community based telemedicine site.

Dynamics of working with specialty physicians for patient coverage.

Kumar Sajeesh PhD

Assistant Professor

McCue Mike PhD Parmanto Bambang PhD Schein Richard PhD Hartman Linda Saptono Andi University of Pittsburgh, Pittsburgh, PA, USA

P31 Investigating an Uniform Data System for Telerehabilitation

Background: The development of outcome measures and a Uniform Data System (UDS) is an important step toward solving the methodology and policy barriers in widespread use of Telerehabilitation. The goal of the UDS is to provide researchers a standard set of assessment procedures, collected longitudinally.

Method: The UDS development task is being conducted in three phases: (1) systematic review of Telerehabilitation; (2) Development of data collection strategies for telerehabilitation based on the consensus developed through an ‘UDS - International Consensus Group’ activities; (3) Development of a UDS by collaborating with national and international experts and in conjunction with professional telehealth organizations.

Results: The project, supported by the National Institute on Disability and Rehabilitation Research (NIDRR), is in progress and the expected deliverables of this initiative includes: 1) a validated Telerehabilitation outcome set; and 2) a Telerehabilitation Uniform Data System that provides high-quality and comparative information on the impact of Telerehabilitation solutions. This data set is expected to support decision and policy makers in guiding the application of Telerehabilitation solutions to improve and maintain the health of individuals, communities, and populations, as well as improve the operation of the healthcare system.

Objectives

Need of a Uniform Data System in telerehabilitation.

Process towards Development of an UDS.

Cober Karen RN, MSN

Vice President, Mountain States HomeCare & Hospice

Mountain States Health Alliance, Johnson City, TN, USA

P32 Hesitation of Rural Americans to Participate in Research and Disease Management Programs and What we can do about it

Objectives: To identify specific roadblocks to patient's participation in research studies and suggest actions to ameliorate this resistance. To share experiences of the SATH (Southern Appalachian Telehealth Project) with attendees, including successful approaches to recruiting, identifying key referral sources, marketing the program, and maintaining participants.

Process and Experience: Appalachia has many characteristics challenging the population. 57% drop out rate. 20% of homes have no telephone. In three (3) counties in SW Virginia > 20% live below the poverty level. The population is fiercely independent. In six (6) counties of SW Virginia there were 932 CHF discharges from area hospitals in 2005. Despite the need, in the first nine (9) months of our research less than 10 individuals joined the project. The need for disease management has been well documented and yet numerous projects, including government funded demonstration projects, have identified ‘lack of participation’ as a cause of project failure and/or cancellation. Our team regrouped and tried new approaches resulting in more than 30 additional participants in two (2) months and the momentum is expected to provide continued participant growth.

Conclusions: Recruiting patients to join research studies will continue to be a challenge. There are no easy answers but there are steps effective in improving participation. Patient's perception of their illness, fear of the ‘establishment,’ investigator's relationship building with referral sources, dealing with illiteracy, and other approaches can improve participation. These are lessons we can apply to future non-research disease management and preventive medicine initiatives.

Objectives

Attendees will learn effective approaches to overcoming resistance from potential participation.

Participants will share with the group their personal experience and effective methods for encouraging research participation.

Krupinski Elizabeth A. PhD

Professor

Weinstein Ronald S. MD Erps Kristine A. Holcomb Mike Lopez Ana Maria MD University of Arizona, Tucson, AZ, USA

P33 Year 1 Experience of a New Telehealth Resource Center

Rationale: Measure impact of a new Telehealth Resource center on attendees/programs after attending on-site training in basics of telemedicine (TM) and/or clinical applications.

Methods: During first 3 quarters since creation of the Telehealth Resource Center, 4 day-long courses were conducted with 103 attendees. Attendees were surveyed at end of course regarding characteristics of their programs, and what they expected to learn from course. After 6 months, were sent email requesting participation in follow-up survey to assess impact of training on their program.

Results: Majority (27%) were from non-profit or university (20%) hospitals and were mostly clinicians (16%), site coordinators (15%), program directors (13%), or IT (13%). Majority reported using telemedicine (66%) with most (34%) for 1-3 years and mostly for consults (42%), referrals (28%) or CE (19%). Five most common areas of interest were clinical (16%), education (14%), technology (9%), equipment (9%) and funding (7%). In terms of what they hoped to learn, top responses were how to manage TM program (15%), technology requirements (14%), how to establish clinical services (13%), how to run TM business (12%), how to evaluate TM (12%), and personnel requirements/skills (12%). At 6-month follow-up, 100% of those responding had started planning a new telemedicine program with 100% for clinical services. None have added new network sites or added personnel. Main reasons for not initiating a program or expanding an existing one were lack of/inadequate funding (100%), inconsistent/uncertain reimbursement (75%), inadequate time (50%) and lack of interest in consulting healthcare providers (50%).

Conclusion: Telehealth Resource Centers can provide valuable information and training on a wide variety of topics to those starting or wanting to expand TM programs. The impact of the training, however, is likely to be more long than short-term as attendees still need to overcome the well-known barriers to implementing TM.

Objectives

Understand potential impact of telehealth resource centers.

Appreciate long-term need to assess impact of telemedicine education & training.

Caudill Robert L. MD, BA, BS

School of Medicine

University of Louisville, Louisville, KY, USA

P34 A Role for Telemedicine in the Reduction of Controlled Substance Misuse and Diversion

Misuse and diversion of controlled substances are significant problems for individuals and society. Rural communities face distinct challenges in addressing this problem. Community Mental Health Centers in such sites must address both the isolation and scarcity of medical staff. Problems with recruitment and retention of medical personnel add to the difficulty of addressing staff members involved in questionable practices regarding the prescribing of these agents. Telemedicine has been a partial solution for staffing shortages at some rural CMHC's. RiverValley Behavioral Health, located in the western coal fields area of Kentucky, took an aggressive position toward addressing the problem of controlled substance misuse and diversion. Through implementation of policy changes, the agency removed all controlled substances other than clonazepam and long acting psychostimulants from their approved formulary. Protocols were established for cross-titration and discontinuation of these agents. RiverValley was an early adopter of telepsychiatry offerings from the University of Louisville. Psychiatrists from the University Telemedicine program took part in the successful execution of this policy. This report looks at the results after one year of implementation. A random sampling of patients is to be selected for retrospective review. Medication regimens will be compared before and after the new guidelines took effect. Comparisons will also be made between patients seen via telemedicine and those seen by locally based clinicians with regard to successful application of the new guidelines. Final data collection is to be completed over the closing months of 2010. We expect to demonstrate that the telemedicine prescribers played an important supporting role in bringing about this change in prescribing practice. A discussion will look at which aspects specific to the telemedicine practice may have enhanced or hindered the achievement of this goal.

Objectives

The outcomes from a community mental health center utilizing a significant amount of psychiatric services delivered via videoteleconferencing implementation of a restrictive policy to reduce the amount of controlled substances misused and diverted.

The challenges faced and addressed by both on-site and off-site (via telemedicine) prescribers during the implementation of such a policy.

Alkmim Maria Beatriz M.

Telehealth Center

Abreu Monica Pena Maia Junia Xavier Figueira Renato Minelli Ribeiro Antonio Luiz Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

P35 Improving Teleconsultation use: A Successful Experience

The Telehealth Center at the University Hospital of Federal University of Minas Gerais (THC/UFMG) coordinates the Teleassistance Network of Minas Gerais, a partnership between six public university hospitals, providing telehealth services to the primary care of 609 municipalities in the state of Minas Gerais, Brazil. Until August 2010, 12,000 offline teleconsultations (for 557 sites) and 412,000 electrocardiograms (for 709 sites) have been done. Teleconsultations were done until Feb.2009 directly between local doctors and specialists at the hospital. Although this service was in operation since April 2007, the number of solicitations was low: average of 0.4 per site per month. One of the causes was the high response time (average of 6 days). To improve the use of the service several modifications were done on the structure of the process. The most important one was the introduction of gatekeepers, defining which specialties each gatekeeper would be responsible. As consequence the teleconsultations were all addressed to a few numbers of teleconsultants. If the gatekeeper is not able to answer the solicitation he addresses it to the specialist. This modification reduced drastically the average response time to less than 24 hours since the gatekeeper answer about 85% of the solicitations. Another two modifications were the reduction on the number of specialists, since now they answer only 15% of the solicitations, and the possibility for the solicitant to identify the urgencies in the system. The final result was a gradual increase on the utilization of teleconsultations. In March/2009 it was 0.6 teleconsultation/site/month with 19% of site utilization, increasing to 2.0 and 51% in August/2010. Consequently it can be concluded that teleconsultation system has to answer properly the demands of its clients and response time is one of the most important.

Objectives

Review best practices in teleconsultation.

Discuss how to improve the use of teleconsultations.

Jeffrey Mark BS

Senior Program Analyst

TATRC, Fort Detrick, MD, USA

P36 Challenges of a Comprehensive Personal Health Record

Patient centric care and management of a Personal Health Record has been a key national focus for over 10 years. With the advancements of mobile electronics and increased communications this dream is fast becoming a reality. The Telemedicine and Advanced Technology Research Center manages several initiatives for the U.S. Army to address the challenges of a comprehensive PHR. This presentation will describe some of the challenges faced by the DoD during the research and development of a true longitudinal PHR as well as the supporting patient record device. We will discuss the benefits of a patient centric paradigm and how patient centric care promotes comprehensive medical documentation for all levels of care.

Objectives

Describe challenges in development of R&D comprehensive PHR.

Discuss benefits of patient centric approach to healthcare management.

Reynolds Howard N. MD 1

Associate Professor of Medicine, University of Maryland School of Medicine

Sheinfeld Geoffrey MD 1 Chang James 2

1 University of Maryland Shock Trauma Center, Baltimore, MD, USA 2 University of Maryland Medical Center, Baltimore, MD, USA P37 The TELE-ICU During a “Disaster”: Seamless Transition from Routine Operations to Disaster Mode

Introduction: An InTouch Health robot (Santa Barbara, Calif) was acquired, 2004, via HRSA disaster preparedness grant. The robot was incorporated into daily work in an Intensive Care Unit (ICU). During the winter of 2009-2010, 3 major winter storms paralyzed Baltimore. The Intensivists were unable to drive to the hospital. The following is a report of seamless transition to disaster mode.

Background: A de-centralized network had been established to physician's homes including PACs and Clinical Information System (CIS). Intensivists are onsite in the ICU daytime and home at night. Evening coverage is by Hospitalists supplemented by ROUTINE Intensivist's virtual robotic rounds at 10:00 pm. Between 2004 - 2009, Intensivist's made > 3,000 robotic visits to the ICU.

Event: On 12/09/ 2009, ± 33”, 02/05/ 2010, ± 25”, 02/10/2010, ± 33” of snow fell in Baltimore. In anticipation of snowfalls, Surgical Hospitalists and nursing remained in the hospital overnight. When travel was determined impossible on 12/10/09 & 2/11/2010, the Intensivist notified key hospital personnel of plans to activate disaster care mode. Intensivist remained home, accessed all patients via robot, PACs and CIS through the Internet. A physician care plan was developed, sent to the ICU electronically and incorporated into the medical record. Virtual follow-up was performed twice more during the 24 hours. There were no untoward events. Nursing, administrative and patient acceptance was high. The technology worked seamlessly during “disaster mode”.

Discussion: Prepared-but-unused disaster plans may not work when needed due to failed equipment, forgotten instructions, unfamiliarity or staff changes. During this event, function was flawless.

Conclusion: Familiarity and routine use can increase chances of technical success during “disasters” suggesting Disaster Preparedness be built upon actively used programs.

Objectives

Review perspectives on alternative care models in an environment of severe shortage of Intensivists.

Discuss the success of the application of a technology during a disaster when the technology is in daily usage.

Zafar Asif MD, FCPS, FRCS 1

Head of Department of Surgery

Ali Qasim MD, FCPS, MRCS 2 Murad Faisal MD, FCPS 2 Mirza Abdul Qadir 3 Khurram Muhammad 4

1 Rawalpindi Medical College, Rawalpindi, Pakistan 2 Surgical Unit II, Holy Family Hospital, Rawalpindi, Pakistan 3 Mayo Hospital, Lahore, Pakistan 4 Telemedicine & e-Health Training Center, Holy Family Hospital, Rawalpindi, Pakistan P38 Emergency Tele-Medicine Response: Pakistan Floods 2010

Background: Pakistan was devastated by floods in August 2010. Currently over 20 million people are suffering and homeless with over 160,000 square kilometers area affected as a result of the flooding. The colossal damage caused far exceeds the combined total of the 2004 Indian Ocean tsunami, the 2005 Kashmir and the 2010 Haiti earthquake. It is estimated that 2000 people lost their lives. Health infrastructure in food areas has also been destroyed with risk of serious outbreaks of diseases such as gastroenteritis, diarrhea, and skin diseases due to lack of clean drinking water and sanitation.

Methodology: As Pakistan struggles to provide relief and succor to people affected by worst floods in living memory, Telemedicine and eHealth Training Centre Holy Family Hospital is supporting ongoing efforts in the health sector utilizing existing satellite network provided by the Ministry of Information Technology. Rajanpur and D G Khan are located in the heart of the worst-affected areas of lower Punjab. Mayo Hospital Lahore and Holy family hubs have been running virtual clinics, providing tele-consultations to patients in remote sites. The methodology is simple, utilizing video link, specialists are available daily according to schedule provided to remote sites. The IT resource person and paramedics at the remote sites facilitate these consultations while the local hospital staff is busy providing care at camp sites.

Results: Since 3rd August 1,203 patients (826 in Rajanpur and 377 in D G Khan) have received treatment, predominantly for skin conditions, gastroenteritis and Malaria.

Conclusion: This is good example of use of information technology during times of disaster. Prior experience during the 2005 earthquake and internally displaced persons due to terrorist clean up operations in Swat, Pakistan was extremely helpful. There are lessons to be learnt, a comprehensive strategy for collaborative International response to deal with these challenges is required.

Objectives

Discuss emergency telemedicine response.

Review emergency telemedicine response in a special situation: floods.

Hartman Linda M. MLS

Reference Librarian

Kumar Sajeesh PhD McCue Michael PhD Parmanto Bambang PhD Schein Richard M. PhD Saptono Andi University of Pittsburgh, Pittsburgh, PA, USA

P39 Visualizing the Telerehabilitation Literature

Background: A multidisciplinary research approach provides many benefits, bringing various minds together to create solutions and improve the quality of life for many. This approach also creates challenges for those working in various areas and for those investigating new endeavors. Telerehabilitation (TR) blends itself nicely with multidisciplinary teams (researchers, practitioners, consumers, and suppliers) and within various disciplines (clinical, technical, psychosocial). New information is constantly discovered whether it be in the lab, clinical setting, or through professional reading. Because so many fields are involved it is difficult to know where the most pertinent literature lies. Data visualization allows the “untidiness” of TR literature to be arranged so questions, such as, “Where is the research taking place and where is it being published?”can be answered. Other examples include “What terms are used most often in the publications? What topics are referenced most by researchers?”

Method: Using the sources found in an ongoing systematic review, citations are being analyzed using a variety of data visualization tools. Various databases and resources covering several different disciplines are being utilized This allows for citations related to the many TR projects to be taken into consideration and analyzed.

Result: Patterns and trends found during this analysis will inform future researchers, clinicians, and consumers where to quickly and easily find pertinent information. It will also inform those creating knowledge through research and practice where to distribute new information so it benefits the most people.

Objectives

Evaluate telerehabilitation research and literature using an expanded approach.

Recognize trends in telerehabilitation research and literature using data visualization tools.

Sikka Neal MD Dowiatt Peter DO

Department of Emergency Medicine

George Washington University, Washington, DC, USA

P40 Analysis of user Generated Images as Diagnostic AID in Acute Care

Background: Consumers now possess high quality cameras on mobile phones that are able to capture an image and transmit the image to a provider to make real-time decisions without having to physically see the patient, which may reduce provider visits and healthcare costs. The objective of this study is to define minimally acceptable quality standards for user generated medical images taken on mobile phone cameras by correlating a clinician's ability to make management decisions based solely on an image and objective image characteristics.

Methods: Four physicians will evaluate user generated images captured on mobile phones, rate the quality of the image by assigning a numeric score, and assess if the image is sufficient to decide on an intervention with a yes/no response. Images will be processed with ExifTool v.8.27 to garner metadata variables such as megapixels, white balance, date, location, etc. Image quality ratings will be correlated to the metadata data set to determine objective measures needed for physicians to rate an image as high quality.

Results: A review of self report data taken from images generated in a mobile wound care study reveals that few patients (<30%) know the number of megapixels of their cell phone camera. The association between reported megapixels and physician image quality rating of a group of images was poor. Over the next 60 days, the entire available image set (about 300 images) will be analyzed and correlated with physician image quality ratings.

Conclusion: We tend to believe that the more megapixels, the better, but it is important to determine the minimum requirements for user generated images. Understanding these requirements allows for more consistency in the utilization of user generated images as a diagnostic tool and has implications for the transfer, storage, and integration of the images in to the medical record.

Objectives

To define minimally acceptable quality standards for user generated medical images taken on mobile phone cameras.

To correlate a clinician's ability to make management decisions based solely on an image and objective image characteristics.

Struthers Christine APN

Cardiac Telehealth

Eastwood Kathryn Jennings Cynthia Mielniczuk Lisa Sherrard Heather Kearns Sharon Ann University of Ottawa Heart Institute, Ottawa, ON, Canada

P41 Regional Cardiac Telecare Program: Innovative Access to Specialized Care!

Cardiac TLC started in 2008 as an expansion of the existing Telehome Monitoring (THM) program to create a regional hub and spoke model of care serviced by a cardiac quaternary center. The purpose was to improve care delivery to patients with chronic diseases such as heart failure (HF) to improve symptoms, quality of life and decrease emergency room visits and readmissions. THM and Interactive Voice Response (IVR) technologies were used to transmit clinical information from the patient's home to a central station at the hospital. HF patients transmitted daily weights and vital signs to an expert nurse who applied best practice guidelines to their care. Patients received automated calls every 2 weeks for 3 month to detect potential issues requiring intervention and to offer information on self-care management as well as common HF medications. Communication was maintained with local primary care physicians and specialists. Implementation strategies to ensure collaboration will be discussed along with inclusion & exclusion criteria. Timely interventions related to medication regimen, maintaining a dry target weight and self-care education will be described. To date 13 community hospitals and 2 family health teams are operational. Each site is responsible for patient identification, training and deployment of equipment. A total of 103 referrals were received and 66 patients completed their 6 month follow-up consisting of 3 months of THM followed by 3 months of IVR. Patient outcomes such as HF self-care improved after follow-up. Preliminary results on readmission and ER visits are promising to date. Lessons learned as they relate to program implementation, technology and patient care will be shared. Using home telehealth technologies deployed to community hospitals has improved patient outcomes and contributed to a decrease in healthcare resource utilization by improving access to specialized care.

Objectives

To describe the development of a regional home telehealth program.

To describe the outcomes related to the program.

Yager Phoebe H. MD

Director, PICU Telemedicine Program; Associate Program Director, PCCM Fellowship

Whalen Michael MD Cummings Brian MD Noviski Natan MD Massachusetts General Hospital, Boston, MA, USA

P42 Telemedicine to Enhance Communication between At-Home Attendings and Bedside Personnel in a PICU

Introduction: In a pediatric intensive care unit (PICU), where fellows provide in-house coverage with an attending on home-call during nights and weekends, the lack of face-to-face interaction among the attending, medical staff, patient and family may compromise communication. A mobile telemedicine cart in our PICU and a home-based unit for each staff attending are used to enable HIPPA-safe Internet connectivity at any time of day or night. The PICU cart includes a video camera and accessories for close-up patient examination. The at-home attending controls the camera in the PICU to examine the patient, view the bedside monitors and communicate with the team and parents in real time. Consent is obtained from the family at the time of PICU admission. Following each teleconference the attending completes an intake form to record the quality and duration of the connection, participants and comments about its utility. In order to assess the quality and impact of this novel use of telemedicine, data were collected retrospectively from the intake forms.

Results: Twenty-seven consecutive intake forms completed between July 2009 and August 2010 were analyzed. Connectivity was established in 92% of attempts. Audio and video quality were rated as ‘excellent’ 98% of the time. Calls lasted 5-40 minutes (median 15 min). The fellow was present for 100% of the conferences, nurse 88%, resident 32%, respiratory therapy 8% and parents 68%. Attendings noted an impact on medical management in 78% of encounters, e.g. two decisions to intubate, one to extubate, one to refrain from intubation, one to not perform a head CT scan and two to treat signs of abstinence syndrome. The attending reinforced the existing care plan in 48% of encounters. A parental update was provided in 68% of encounters.

Conclusions: Telemedicine offered an additional tool to help attending physicians manage critically ill patients, communicate with bedside care teams, and provide reassurance to families.

Objectives

To introduce an innovative use of telemedicine to enhance care of critically ill children by linking a remote attending to the bedside staff in a tertiary center pediatric ICU covered by in-house fellows during nights and weekends.

To report the early experience of a tertiary center pediatric ICU using telemedicine to enhance overnight and weekend communication between a remote attending and family members present at their child's bedside.

Spaulding Ryan PhD

Director, Center for Telemedicine and Telehealth

Spaulding Ashley MA Pestano Karen University of Kansas Medical Center, Kansas City, KS, USA

P43 School Nurse Perceptions of Evolving School-Based Telemedicine in Kansas

In 1998, the nation's first known school-based telemedicine project began in urban Kansas City, Kansas. Later known as TeleKidcare, the initiative was developed by the University of Kansas Center for Telemedicine and Telehealth (KUCTT) and the local school district. TeleKidcare began with four schools that utilized school nurses' offices as telemedicine referrals centers to the pediatric department at the University of Kansas Medical Center (KUMC). At its peak, TeleKidcare consisted of 12 inner city schools and provided nearly 1,000 consultations per year for underserved elementary students with ambulatory, psychiatric or mental health needs. In recent years, however, referrals to the program have declined, and ambulatory and most child psychiatry services have ended. Though the reasons for the gradual reduction in services are complex, the school nurses provided valuable insight into the TeleKidcare life cycle. School nurses were interviewed about the program, several of whom were involved at the outset of TeleKidcare and for its entire 12-year span. A standardized interview guide that consisted of 12, open-ended questions was used for the study. The interviewer also asked numerous probing questions to follow-up on important or unclear responses. The interviews were transcribed and qualitatively analyzed. In general, the findings suggested that operational, financial and cultural issues all affected the long-term sustainability of the program. Nurses reported that TeleKidcare had many benefits during the peak of its success, but the transition from a heavily subsidized project to a fee-for-service program was a major factor in its contraction. Results of this study have important implications for the sustainability of other telehealth services, particularly those that are for underserved populations in economically challenged areas. Details of the study and findings will be presented.

Objectives

Understand school-based telemedicine model.

Understand nurse perceptions of program changes.

Ortiz Vladimir RN, MSN

Telehealthcare Coordinator

Ruby Michelle RN Denardo Shirley RN Marshall Eric NF/SG VA Medical Center, Gainesville, FL, USA

P44 Gambling with Care Coordination: The Challenge of Frequent Alerts

Abstract Withdrawn

Ruby Michelle

Telehealthcare Coordinator

Schmalfuss Carsten MD Marshall Eric Schofield Richard MD Denardo Shirley NF/SG VA Medical Center, Gainesville, FL, USA

P45 Quality of Life in Decompensated Heart Failure Home Telehealth Patients

Abstract Withdrawn

Marshall Eric

Program Specialist

Mullikin Amy ARNP-BC Ruby Michelle RN Denardo Shirley RN Ortiz Vladimir RN, MSN Schofield Richard MD NF/SG VA Medical Center, Gainesville, FL, USA

P46 System Redesign of Telehealth to Reduce Readmissions for Decompensated Heart Failure (TDHF): A Best Practice Model

Abstract Withdrawn

Khoja Shariq PhD

Assistant Professor

Durrani Hammad MBBS, MPH Muqeet Abdul Aga Khan University, Karachi, Pakistan

P47 Improving Health Services in Gilgit-Baltistan through Telehealth

Objective: To develop a Telehealth link between different levels of health centers for patient management, triage and referral of MCH using telehealth. To decrease the number of referrals and avoid travel from primary health centers.

Introduction: Gilgit Baltistan of Pakistan face greatest barriers due to distance and geographical conditions, along with other challenges such as bad governance, affects of civil war, and landlocked conditions restricting access to required health services and referral of patients between the centers. To overcome these problems telehealth can be introduced to support diagnosis, enhance capacity and manage information in Gilgit Baltistan. Use of mobile technologies, such as GPRS and Edge, can provide reliable last-mile connectivity in remote mountainous areas where fiber-optic connectivity is not widely available, and satellite connectivity is either expensive or blocked due to border restrictions.

Methodology: This project have utilized iPath software and mobile connectivity for most peripheral health facilities, in conjunction with higher bandwidth services, such as DSL, to connect secondary care facilities to improve access and quality of health services in Gilgit Baltistan of Pakistan. The study is a facility-based intervention study, where one laptop computer is supplied at each site with available connectivity. Community Based Health Centers of Aga Khan Health Services, Pakistan in Gilgit Baltistan are connected with next level facilities and field Offices for Tele-consultation and Tele-monitoring.

Result and Conclusion: The short period of implementation has showed the feasibility and importance of telehealth in these areas. In nearly six months of duration 150 cases were reported from four Spoke sides, two sub-hubs and one hub based on reporting structure. This study also showed that nearly 68% of patient avoided traveling through this system. We have also observed that utilizing telecommunication technology have solved complex healthcare problems in remote areas with a very low bandwidth i.e. 32kbps in most remote areas. With this research study we have not only reduce complication but also have train healthcare provider by experience.

Objectives

To develop a Telehealth link between different levels of health centers for patient management using eHealth.

To decrease the number of referrals and avoid travel from primary health centers.

Carrera Anibal MBA, MSc

CEO

Jijon Milton MD Paredes Mario MD Cronix, Quito, Ecuador

P48 Ecuadorian Social Security's Telephone Appointments and Medical Triage 24 X 7 Program

This paper tries to establish the impact of implementing a Ecuadorian Social Security's Telephone Medical Appointment and Medical Triage Program available 24 hours. In the short time, the main objective were: Allow better access to medical specialty; reduce unmet demand, increase prescription drug and decrease costs and through this way to improve the quality of attention and increase standards of living and health status of the affiliate population. In the middle and large term, the main objectives are universal access to health for every Ecuadorians living outsie of Ecuador. The results show:

The data show and important increase in assignments of medical appointments, then, for the 2008 year was 1'427.701 and the end of 2009, 2'811.064, percentage increment of 97%.

The coverage increase and the extension of the services relates to the number of telephone calls from users (since 251,753 in April 2009 until 631,797 in June 2010) and the physicians (from 159 in April 2009 to 358 in June 2010) was progressively increased during 2009 to July 2010. Likewise has received 631,603 telephone calls from September 2009 to June 2010, to the Medical Triage Services.

These data show clearly an expansion of service coverage.

Concomitantly, the number of prescriptions issued was proportional to the increase in demand.

It was observe than the most consultations requested are in the beneficiaries between 31 and 65 years old.

The results allowed us to identify the specialties of higher demand, which is related to the epidemiological profile of the population served;

It also allowed us to identify the type and number of medical specialists needed to attend fully the consulting services and coverage needs of the affiliate population.

A survey of criteria of the community in front of the service offer has been demonstrated the acceptability on positive of this application system.

This study confirms our working hypothesis raised by the criteria that the introduce of this innovative information systems to apply in health benefit in several ways, improving services, reducing unmet coverage, reducing costs and serving to proper organization and planning of health systems. This novel program system could be applied in other countries with similar conditions in health systems.

Objectives

Improve quality of Service in Social Security.

Show Telehealth (Medical Triage) as a way to improve health access.

Frank Allegra K. MHA, CCRP 1

Health System Specialist - Telehealth Advisor

Flanagan Ryan MD 1 McDonald Ryan J. MD 1 Kinney James B. MD 1 Untel Robert A. MD 2

1 Madigan Army Medical Center, Tacoma, WA, USA 2 St Joseph Hospital & Medical Center, Phoenix, AZ, USA P49 General Pediatricians as Echocardiographers: Tele-Echocardiography Improves Access at Remote Locations

Published rates of congenital heart disease (CHD) range from 3 to 7 cases per 1,000 live births, and the average DOD birth rate is over 90,000 live births per year. Military pediatricians provide care in unique and often isolated locations, and while the military health system has consultants, their expertise is geographically limited to major military medical centers. Fortunately, advances in telemedicine technology make real-time echocardiography evaluation and expert consultation a reality for general pediatricians in remote locations. Thirty seven providers from six community hospitals underwent two days of intensive TeleEcho training at Madigan Army Medical Center (MAMC); including basic orientation to the equipment, human use review, cardiac anatomy, and extensive two-dimensional echocardiography practice. Afterwards, pediatric cardiologists at MAMC could guide general pediatricians through real-time TeleEcho exams using video conferencing equipment and ultrasound machines at their remote sites. Pediatricians identified 38 infants at remote hospitals for evaluation of possible CHD. Fifty-two anatomic cardiac diagnoses were made using TeleEcho; the majority of these diagnoses were hemodynamically insignificant lesions such as small PFOs, VSDs and PDAs. Five infants were found to have significant cardiac lesions including: Tetralogy of Fallot (TOF), critical coarctation of the aorta, double outlet right ventricle, TOF with pulmonary atresia, and significant pulmonary valve stenosis. Follow-up echos by pediatric cardiologists have demonstrated 100% accuracy in the TeleEcho diagnoses. TeleEcho is an accurate and reliable method of assessing potential CHD in neonates at remote locations: it prevents unnecessary medical evacuations from these facilities and expedites the evacuation of affected neonates to a higher level of care. This method widens the reach of medical subspecialists to provide the best care and gives our soldiers and family's confidence in our ability to deliver care - even at the most isolated facilities.

Objectives

The accuracy and reliability of TeleEcho performed by pediatricians can provide isolated general pediatricians with a definitive tool for neonatal assessment while enabling pediatric cardiologists to extend their referral network.

TeleEcho can also save DOD funds lost to network referrals and spare limited evacuation resources.

Sullivan Christopher B. PhD

Executive Director

Telehealth Florida, Tallahassee, FL, USA

P50 Crafting Florida's Health Information Exchange and Telemedicine Policies Based on Health it Survey Data

The proposed presentation, “Crafting Florida's Health Information Exchange and Telemedicine Policies Based on Health IT Survey Data,” will report on the results of health information technology surveys that assess the technical readiness of healthcare providers in Florida to engage in health information exchange (HIE) and telemedicine initiatives. It will then present the policy and legal issues that both inform and form strategic planning for their successful implementation. The presentation will present the data from health information technology surveys conducted among hospitals, federally qualified health centers, rural health clinics and Medicaid providers as part of the State Medicaid Health IT Plan. The health information technology surveys evaluated the state of technical capability for each healthcare provider surveyed, asking about the provider's use of electronic health records systems, the integration of health IT systems within the facility and the type of broadband connection available to each provider. The information from these surveys was fed directly into the strategic planning for the Medicaid Electronic Health Record (EHR) Incentive Program funded by CMS and into the Health Information Exchange Cooperative Agreement Program funded by the Office of the National Coordinator for Health Information Technology. This presentation will discuss the impact the results of the surveys had on plans for developing statewide HIE and for the Medicaid EHR Incentive Program.

The development of HIE and telemedicine networks among providers requires strategic planning that weaves together federal and state level policies and regulations, technical capacity and organizational readiness that impacts the ability of healthcare providers to exchange health information electronically. The presentation will address the findings of the health information technology surveys from a policy perspective, looking at how the current technical infrastructure of healthcare providers enables or hinders the strategic planning for implementing a statewide health information network in which all providers can be connected.

Objectives

The readiness of Florida's healthcare providers to engage in health information exchange.

How technology surveys can impact state policy-making for strategic planning of health information exchange and telemedicine initiatives.

Rodas Edgar B. MD 1 Parra Michael W. MD 1 Castillo Roberto C. MHS, MS-III 2

Student

Suarez Jose Mauricio MD 3 Puentes Fabian MD 4 Camacho Ruben MD 5

1 Broward General Medical Center, Fort Lauderdale, FL, USA 2 Nova Southeastern University - College of Osteopathic Medicine, Fort Lauderdale, FL, USA 3 Clinica Los Rosales, Pereira, Colombia 4 Hospital San Felix, La Dorada, Colombia 5 Instituto Ecuatoriano del Seguro Social, Manta, Ecuador P51 International Trauma Teleconference: Evaluating Trauma Care and Facilitating Quality Improvement

Background: Teleconferencing is currently ubiquitous as a means of academic discussion of medical care across borders. We describe the use of international videoconferencing in the field of trauma and critical care to evaluate care differences between the United States (U.S.) and Latin America (L.A.) based on local resources.

Methods: Between February 2009 and July 2010 a forum for monthly international teleconferences was created between a Level I Trauma Center in the U.S. and several hospitals in L.A. In-depth discussion and prospective evaluation of each case presented was conducted considering treatment provided in the pre-hospital setting, emergency/trauma room, operating room and subsequent post-operative care.

Results: Fifteen cases were presented from 1 U.S. hospital (N = 3) and 6 L.A. hospitals (n = 12). Clinical data presentation followed ATLS evaluation sequence in all U.S. cases, versus 3 of 12 L.A. cases. Compared to the U.S., no pre-hospital communication was present in L.A. cases, and pre-hospital services were only present in 40% of L.A. cases. In the Emergency Department, no formal trauma team structure was appreciated in L.A. cases; 1 case utilized ATLS protocol during initial evaluation and resuscitation, 2 utilized the European CRASH 2 protocol. Imaging resources were used properly in 6 of 12 cases. Operating room, surgeon and ICU were not readily available in 10 of 12 L.A. cases. A structured system for trauma care, multidisciplinary resources, protocols, and guidelines were absent.

Conclusions: This educational exchange centered on patient care highlights the disparities in evaluation of injured patients and the treatment modalities selected based on resource capability. Additionally, teleconferencing can also be utilized for quality improvement and ultimately may raise awareness concerning the need for a comprehensive, well-organized trauma structure, and provide the motivation for the development of local trauma systems in Latin America.

Objectives

The use of international videoconferencing in the field of trauma and critical care to evaluate care differences between the United States and Latin America based on local resources.

The use of international videoconferencing for quality improvement in the field of trauma and critical care.

Poppe Anne P. MN, RN

Research Scientist

Demiris George PhD University of Washington, Seattle, WA, USA

P52 Telehealth for Adult Family Homes: An Unexplored Territory

Adult family homes (AFH) are community residences that are meeting long-term care needs of frail older adults. AFHs are actual residences in the community licensed to provide congregate housing and domiciliary care for older adults. These homes offer personal care services and some even deliver varying levels of delegated nursing care for up to six older adults. Direct caregivers not only help with activities of daily living and protective supervision, they may also engage residents in physical and mental activities. The goal of AFH is to provide residents with holistic support for their well-being and promote their ability to function independently despite any physical or cognitive limitations from their medical conditions. Optimal operations of AFH enable older adults to remain “at home” when they experience functional or cognitive decline rather than being placed in a nursing home. In many cases, AFHs especially in rural areas struggle with limited resources and large geographic distances to available specialized healthcare resources. Telehealth introduces new opportunities for delivery of educational interventions to direct caregivers as well as tools to clinically assess and monitor residents, engage remote family members and improve overall quality of care within the AFH setting. This paper provides a theoretical framework of AFH as a mediator for healthy aging and introduces ways that telehealth can address the needs of residents, direct caregivers and family members. More specifically, we present an example of the use of videophones as a platform to deliver pain assessment training to AFH direct caregivers and discuss practical, ethical and technical challenges and implications.

Objectives

To introduce the potential of telehealth in the adult family homes, an emerging alternative to promote healthy aging.

To showcase a pilot demonstration of telehealth within an adult family home.

Desai Nirav MS, MBA

VP - Marketing and Product Strategy

REACH Call, Augusta, GA, USA

P53 What is the Financial Impact of Not Having a Telestroke Program?

This presentation makes a financial case that can motivate facilities to establish telestroke programs sooner than later. Using real customer data, the case projects the potential financial impact of a telestroke solution on a healthcare facility that has stroke experts (hub), and that can leverage their expertise to serve rural or underserved facilities that don't have neurological expertise (spokes). The analysis methodology is technology-agnostic and can be used by any facility to evaluate the volumes, case mix, revenues, and expenses associated with a telestroke initiative. Furthermore, the methodology shows attendees how to work through the different business models in a telestroke solution (e.g. hub pays for everything, with or without paying for physician call coverage, etc.).

Ultimately, attendees will:

Understand the elements of a practical economic analysis for a telestroke program

Understand how to develop a pro-forma and ROI (Return on Investment) analysis to justify the program

Learn how to customize the economic analysis to their facility's particular situation (preferred business models, physician call pay, etc.)

Identify the key success drivers for their telestroke program

Understand, by example, how much profit they could be losing for each day they delay their telestroke program

Objectives

Understand the elements of a practical economic analysis for a telestroke program.

Understand how to develop a pro-forma and Return on Investment (ROI) analysis to justify the program.

Spiegel Philip A. 1

Clinical Informatics Researcher, Shannon Fish, PA-C

1 Carey Julie 1 Kromelow Justin 1 Noe Carl MD 2 Brose William G. MD

1 Health Education for Living with Pain, San Mateo, CA, USA 2 Department of Anesthesia - Division of Pain Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA P54 Interdisciplinary Telemedicine and Analgesic Compliance

Aim of Investigation: To demonstrate the applicability of telemedicine to an interdisciplinary function oriented analgesic compliance program. Telemedicine's positive outcomes have been increasingly documented, since 2006 our practice has successfully treated patients using a functional restoration curriculum delivered via telemedicine. A complementary telemedicine analgesic compliance program was developed to address the increasing recognition of analgesic abuse, misuse, addiction, and diversion.

Methods: An analgesic risk assessment process identifying patients as low, moderate, or high risk was integrated into pain management consultations, including chart review, questionnaires, Calif. DOJ CURES program, and structured medical interview. 28 low risk patients were selected for telemedicine treatment and subsequently provided with standardized education on medication use, risks, benefits, and monitoring metrics (urine drug testing, medication lists, pill counts). Medication safety agreements and maintenance of an accurate medication list were required for participation. Functional goal monitoring was used to establish optimal safe medication dose. Risk was reviewed during bi-weekly video telemedicine contact. Function and maintenance of compliance requirements were analyzed.

Results: 100% of patients maintained compliance requirements; 90% achieved functional goals. Patients identified as at-risk for aberrant behaviors started treatment in-person and as risk level decreased, were successfully able to transition to telemedicine treatment with no aberrant behavior detected during telemedicine treatment. Average enrollment is 1.7 years.

Conclusions: Frequent telemedicine contact, objective compliance and functional measures, and structured curriculum allowed the maintenance of analgesic compliance. With the lack of geographically distributed pain medicine specialists and the increased recognition of risk associated with prescribing and use of opioids, analgesic compliance via telemedicine has applicability as a means of access to safe and high quality chronic pain treatment. Future research and treatment opportunities includes continued evolution of monitoring metrics and treatments, and a comparative study of in-person and telemedicine compliance.

Objectives

To develop evidence and methods for interdisciplinary treatment utilizing telemedicine in chronic pain.

To develop evidence and methods for monitoring medication adherence via telemedicine.

Tang Tepei 1

Medical Director

Lee Chienting 2 Wu Pinan 3 Chen Edward 4 Su Cheneng 1 Hsu Shuling 2 Tsai Wenpei

1 Mingjong Hospital, Pingtung, Taiwan 2 National Pingtung Hospital, Pingtung, Taiwan 3 Hengchun Tourism Hospital, Pingtung, Taiwan 4 Chyun Huei Health Technologies Inc., Taipei, Taiwan P55 Mobile Nurse - Telenurse Based on Wimax

Background: Despite recent advances in mobile telecommunication, many telemedicine services remain accessible only at fixed location. We report an ongoing project “mobile nurse” in southern Taiwan with the coverage of Worldwide Interoperability for Microwave Access (WiMAX) from January 1, 2010 to July 31, 2010. The target population was patients with advanced chronic obstructive pulmonary disease (COPD).

Methods: The mobile nurses were equipped with a portable and WiMAX enabled physical monitors, weighting less than a kilogram while easily fitting in a purse, as a roaming spoke-site to visit patients at any place periodically. The severity of patient's clinical conditions would be analyzed and categorized intelligently from uploaded data by mobile nurse and remote specialists via video visit. Remote specialists simply equipped with a smart phone as a roaming hub-site for responding to mobile nurses' video call anytime.

Results: The score of St. George respiratory questionnaire for quality of life and the frequency of exacerbated COPD with referring emergency room were measured. The scalability was measured with the maximum number of patients using “mobile nurse”, the average doctor's intervention time, and the capability to deal with complications of advanced COPD patients locally at every month-end.

Conclusions: With the pervasive deployment of WiMAX, the service model of telemedicine has changed from topology (refers to one-to-one or one-to-many) to mesh networks (refers to many-to-many). “Mobile nurses” are anticipated to resolve the limitations and to significantly improve the performance of conventional telemedicine and finally reach the seamless care anywhere.

Objectives

Discuss the use of mobile telemedicine.

Review the role of the telenurse in mobile telemedicine.

Armstrong Katie A. HBSc 1

Senior Medical Student

Introcaso Camille E. MD 2 Roth Rudolf R. MD 2 James William D. MD 2 Kovarik Carrie L. MD 2

1 University of Toronto, Toronto, ON, Canada 2 University of Pennsylvania, Philadelphia, PA, USA P56 The use of Mobile Teledermatology to Improve Access to Care in Philadelphia

Mobile teledermatology allows a practitioner to request dermatology consults without Internet access and has become a viable method of S&F teledermatology, as cellular networks have expanded and cellular phones have become equipped with high-quality cameras. Teledermatology provides outcomes similar to face-to-face consultation, is deemed acceptable by patients and primary care providers, and reduces patient wait times. With input from our group, the telehealth organization ClickDiagnostics developed a teledermatology application called ClickDoc, designed for ease of use and privacy in primary care settings where charitable care is provided. In 2009, five primary care clinics in underserved areas of Philadelphia were each provided with a Samsung cellular phone equipped with a 5.0 megapixel camera and a ClickDoc software platform application over which teledermatology consults could be transmitted to the http://click.telederm.org website. The teledermatology consults were answered by three volunteer attending dermatologists at the Hospital of the University of Pennsylvania, and the answers were sent from the website to the phones. In order to examine the adaptability of this service, we reviewed the frequency and types of skin diseases submitted for consultation between July 2009 and May 2010. In those ten months, 46 consults were submitted from three clinics. The daily clinics that could provide complete privacy and continuity for patients were the ones that utilized the consultation service. The primary care provider, with the consulting dermatologist's suggestions, successfully managed all 46 consults. This mobile teledermatology application has proven to be easy to use and provides a needed service. The manageable number of consults and the fact that all of the consults could be given a working diagnosis indicates that many patients with skin disease in the primary care setting can be effectively triaged and initially managed using a short time commitment on the part of volunteer dermatologists, and that a teledermatology consult service can be developed and instituted for patients lacking access to dermatology care. Based on our initial success, the American Academy of Dermatology has recreated this model at 15 other large health centers across the United States and Canada.

Objectives

To inform users of a growing application of m-health in dermatology.

To encourage other subspecialties to reach out to under-privileged communities using m-health.

Khoja Shariq MBBS, PhD

Assistant Professor-CHS and Coordinator eHealth Program

Durrani Hammad MBBS, MSc The Aga Khan University, Karachi, Pakistan

P57 Health Informatics Research Activities in Asian Countries: Preliminary Evidence from Systematic Review

Introduction: Sufficient studies have been reported on success and failures of Health-related Information Management (Health Informatics) initiatives, but their generalizability to developing countries is questionable. This study reviews publications from Asian countries.

Objective: The main objective of the study was to conduct a thorough and current state of the science review of health informatics applications in Asia.

Methodology: The systematic review followed Cochrane style methodology and included peer-reviewed articles published from 1998–2008, related to health informatics research done in Asian countries. Inclusion criteria was peer reviewed papers in English language, involving at least one Asian country. Some of the key words used were health informatics, health information systems, electronic medical/health records, and health management information systems.

Results: The search strategy resulted in 4,556 references. The exclusion of duplicates, articles without s, and not meeting the inclusion criteria resulted in 211 articles for final review. The preliminary results show descriptive results such as number of publications over the past ten years, list of countries involved; methodological characteristics of studies. The descriptive results show increasing trends of health informatics studies over the past ten years in Asia, with Japan, Taiwan, and Israel leading. The scoping exercise identified nine major themes around Health Informatics research studies: Hospital Information Management Systems (32%); Health Information Systems (12%); Health Technology Assessment and Evaluation (7%); Policy Issues in Health Informatics (4 %); Electronic Health Record (19%); Electronic Health Education material and Health Education Informatics (12%); Health Informatics and Telehealth (8%); Knowledge Management (4%); GIS in health informatics (2%).

Conclusion: The role of health informatics is to generate, analyze and disseminate sound data for decision making purposes. The systematic review gives us a broader understanding on the level of activity in Asia in the field of Health Informatics and helped in identifying its scope. Country specific and thematic reviews should be carried out to identify gaps and develop culturally sensitive projects and programs in health.

Objectives

To gives a broader understanding on the level of activity in Asia in the field of Health Informatics.

Show advancement of Health Informatics in Asia.

Clarke Malcolm PhD

Reader

de Folter Joost BSc Verma Vivek BSc Brunel University, Uxbridge, United Kingdom

P58 The Hydra Project - Performing Telehealth Over the Smart Meter Infrastructure

Introduction: The UK is mandating that smart metering is introduced in order to affect consumer behavior. This infrastructure requires ubiquitous communication to the home that is reliable and secure, but at low bandwidth. It could support third party applications. The Hydra project demonstrates telehealth as one such application. It also demonstrates the use of the Continua standards for communication in the home through Zigbee, IEEE 11073 for device communication and IHE-PCD01 for communication to the enterprise.

Approach: The Hydra project is an exemplar for the forthcoming smart metering being introduced to the UK. It is designed to demonstrate the benefit of an open architecture that can support secure and reliable third party applications. In Hydra we use Zigbee as wireless communication between medical device and the meter, as this is currently the technology of choice in the energy industry. Zigbee is also a certified technology of Continua. Zigbee has the further advantage of being a mesh network, and thus range can be extended anywhere in the home. IEEE 11073 is used for data communication from devices (BP and scales) to the meter. A simple manager in the meter transforms the IEEE 11073 to IHE-PCD01 message and sends it through the meter infrastructure. A bespoke application then forwards the data from the utility enterprise and forwards to the healthcare enterprise using a slight modification to the Continua architecture.

Results: The Hydra project is now transmitting data from patients' homes to be reviewed by the physician. Our project is a demonstrator of technology and we are not evaluating clinical outcomes, these would be similar to other home based monitoring systems. However use of the devices is transparent to the patient, there is no screen, buttons or terminal, and devices can be placed anywhere in the home for convenience. We are currently evaluating the user perception of such an approach.

Conclusion: Hydra is the first demonstrator of using the smart metering infrastructure to support telehealth applications. It clearly demonstrates that value added services can be included in smart metering. It is also the first where use of monitoring devices as part of a home monitoring system is transparent to the user. We will move on to integrating telecare (chair, bed, PIR sensors) to create a common platform.

Objectives

Discuss home monitoring in the UK.

Review emerging technologies in home monitoring, including the Hydra project.

Batista Sonia M. RN, MS, RD, LD/N

Clinical TeleHealth Coordinator

Lawrence Joycelyn MD Simmons Scott C. MS Burdick Anne E. MD, MPH University of Miami Miller School of Medicine, Miami, FL, USA

P59 Implementation of Telehealth in an Urban Public School System -- Lessons Learned from the First Year of Operation

The University of Miami (UM) Family Medicine and TeleHealth Departments have undertaken an initiative to use telehealth to improve the access and quality of health services available to school children in Miami-Dade County public schools in the underserved communities in North Miami Beach. The telehealth initiative builds on an existing school-based health program that has been in operation for nearly a decade. In an effort to minimize physician, parent, and student travel; increase time spent in the classroom; and enable onsite provision of pediatric subspecialty care, a telehealth initiative was begun in late 2009. Telehealth equipment was installed in six North Miami Beach schools (two high schools, one middle school, and three elementary schools). The family medicine physician and program's medical director is located at the middle school and provides pediatric primary care via telehealth for the other five schools, which are staffed by nurses and social workers. In addition to primary care evaluations, the specialties that are available to this patient population are: Endocrinology, Dermatology, Psychiatry, and Nutrition Counseling. Delivery of clinical telehealth services was started on June 1, 2010. Since then, children with various skin conditions have been able to receive the services of a dermatologist. In most cases, the appointment is made within one week of the date of referral by the primary care physician. Surveys conducted with the parents of the children seen so far have indicated 100% satisfaction with the technology; parents have also indicated that, without this technology, the child would likely not have received the care needed in a timely manner. This presentation will review the outcomes and lessons learned from the first year of the initiative's operation.

Objectives

Learn about implementation of a school telehealth program.

Learn best practices for school-based telehealth.

Holtz Bree MSc, PhD

Post-Doctorate Researcher

Richardson Caroline MD Goodrich David PhD Ann Arbor VA HSR&D Center of Excellence, Ann Arbor, MI, USA

P60 Walk with Veterans Pilot Study: Using an Automated Online Pedometer-Based Walking Program for Veterans with COPD

Approximately five percent of American adults have Chronic Obstructive Pulmonary Disease (COPD), a complex chronic condition. The prevalence of COPD is higher in Veterans than the general population, with Veterans in rural locations reporting higher rates than their urban counterparts (22.5% vs. 17% respectively). Physical activity incorporated into pulmonary rehabilitation programs is effective for improving COPD-related health outcomes. However, many Veterans with COPD do not have access to hospital-based pulmonary rehabilitation programs. The primary objective of this feasibility study was to test remote recruitment and intervention delivery using an automated online pedometer-based walking program for Veterans with COPD. However, this presentation focuses on subjects' perceptions of using the walking intervention website. Sixteen Veterans (94% male) with COPD responded to a mailed invitation letter, enrolled in the walking program and completed a 3-month online follow-up survey (35% response rate). Preliminary results indicate that a majority of the subjects reported being more active (69%), feeling healthier (58%), and losing weight (56%) since enrolling in the program. Three-quarters of the participants stated that viewing their steps online motivated them, especially by setting and having personal goals. The Activity Tracker, a web feature that allowed users to see how many steps they were taking, was the rated as being either an important or very important section of the website by 81% of the participants, followed by the Home/Portal page (69%) and the Profile Page (56%). Almost 70% of the participants felt that using a pedometer and walking has become a permanent lifestyle change. This study demonstrates that it is possible to positively impact the walking activities of individuals with COPD through a web-based interactive program. The results of this study can inform future projects that aim to improve health outcomes in a larger sample of persons with COPD using remote recruitment strategies.

Objectives

Understand the impact of a website walking program.

Provide data foundation for future studies.

LaPlante Carolyn BA

PhD student

Whitten Pamela PhD Cornacchione Jennifer MA Michigan State University, East Lansing, MI, USA

P61 The use of Social Media in Telemedicine: Where we have been, and Where we can go

In recent years, the use of social media has become increasingly widespread, with entities such as The World Health Organization (WHO) recognizing its potential because it allows for instant, dialogic information and “elevates communication to near face-to-face” (McNab, 2009). Social media is a form of interactive mediated communication that is developed, edited, and utilized by individuals on the Internet and represents an emerging platform for use in telemedicine. Currently, the interest in using social media to disseminate and find health information is growing; recent research has demonstrated that 37% of all American adults have used social media for a health purpose (Fox & Jones, 2009), a number which will surely grow over time and as more applications are developed. Example applications of social media use in telemedicine include dietitians using Twitter to provide nutrition advice using 140 characters or less, individuals watching YouTube videos to learn how to check their skin for signs of cancer, and patients with similar illnesses sharing experiences on Facebook. Additionally, social media has potential to form the backbone of telemedicine interventions or be integrated into physicians' practices as a communication aid. This presentation will discuss the current state of the research that addresses the use of social media in health. This is a rapidly growing area of literature but is still in its beginning stages; the majority of studies discuss ongoing activities of social media in health, with few focused on developing telemedicine interventions. The authors will also discuss future applications of social media, highlighting current projects and discussing its usefulness for the telemedicine field.

Objectives

Review of research on social media & health.

Implications for use of social media in telemedicine.

Bani Erdeta BA, MPA

Project Coordinator

Memorial Sloan-Kettering Cancer Center, New York, NY, USA

P62 The Application of Teledermatology to Determine Treatment Decision for Receiving Chemotherapy

The objective of this study was to evaluate the impact of teledermatology on provider satisfaction and treatment decision for patients receiving chemotherapy as part of their cancer care at Memorial Sloan-Kettering Cancer Center (MSKCC) Brooklyn Infusion Center. The project design was a pragmatic evaluation of the technology in a real-world setting at an operational scale rather than a controlled clinical trial. Patients presenting at MSKCC Brooklyn Infusion Center with a dermatological condition resulting from chemotherapy, were evaluated via teledermatology before a decision was made to proceed with treatment for the day. The MSKCC Brooklyn Infusion Center provides chemotherapy treatment to existing patients in a convenient location in Brooklyn. The new location allows Memorial Hospital to explore a new model for cancer treatment, in which patients receive their chemotherapy at the Brooklyn site and the remainder of their cancer care at locations in Manhattan. Services at the Brooklyn Infusion Center are focused primarily on the delivery of chemotherapy infusion. There is no pharmacy or laboratory located on-site, however laboratory drawing is available for delivery and processing at the Manhattan location. The staffing model is nurse practitioner/registered nurse driven, with an Urgent Care physician on-site. The delivery model allows for the use of technology to streamline the chemotherapy administration process by reducing wait times. Qualitative data suggest that the provider was satisfied with the teledermatology consultation and was able to make a clinical decision whether to proceed or not with the chemotherapy treatment. This ongoing preliminary study in the application of teledermatology for chemotherapy treatment decision making provides evidence as to the value of telemedicine in increasing access to sub-specialized providers during cancer care.

Objectives

To evaluate the impact of teledermatology on provider satisfaction and treatment decision for patients receiving chemotherapy as part of their cancer care.

To provide evidence as to the value of telemedicine in increasing access to sub-specialized providers during cancer care.

Sprang Rob MBA

Director

Soares Neelkamal MD, FAAP

Developmental-Behavioral Pediatrician

University of Kentucky, Lexington, KY, USA

P63 Telehealth is Better than Traditional Face-to-Face Encounters

Most telehealth research concentrates on the value of telehealth, how the technology is accepted by provider and patient, can extend clinical resources to the medically underserved, reduce the cost of delivery and how telehealth approaches the diagnostic value of a traditional in-person clinical encounter. The assumption is that traditional face-to-face encounters are the gold standard for provision of care. Recent experience in the Kentucky TeleCare Network has uncovered a new consideration regarding the provision of certain medical specialties and unique clinical situations that could prove telehealth to be a more effective diagnostic tool than traditional in-person encounters. Anecdotal evidence will be presented that will lead to a more rigorous, quantitative study to prove the hypothesis that, under certain circumstances, a telehealth encounter can result in a more accurate diagnosis than a traditional in-person encounter. The following are some early responses to this hypothesis: “When interviewing violent offenders, psychotic and unpredictable offenders or simply a large menacing inmate⋯don't have to focus on your own safety⋯give full attention to where it is warranted - the patient” “some of the more sociopathic/psychopathic inmates I see cannot exert pressure on me using their usual maladaptive skill set because I am not in the room. What can the predator do when he cannot pounce?” “paranoid individuals do not like to be around people and the slightly disembodied aspect of the consultation suits them”. “Male clinicians who saw female patients with abuse histories generally felt the women were more able to open up due to the emotional safety provided by the telemedicine system” “children are more open and honest during an interview when connected via the technology”. If a rigorous quantitative study affirms this early qualitative data, healthcare providers, regulatory agencies and other skeptics may be forced to reconsider the value of telehealth.

Objectives

Understand how telehealth may be more effective than traditional face-to-face encounters.

Use these "gold standard" telehealth applications to convince skeptics to use the technology and to support telehealth.

Hudson Shannon M. RN, BSN

Nursing Student

Medical University of South Carolina, Charleston, SC, USA

P64 Telehealth and Telecommunications as Social Support Interventions for Children with Special Healthcare Needs

Children with Special Healthcare Needs (CSHCN) are those with chronic conditions who require health services beyond that which is usually required by children. According to recent estimates, 13.9% of children in the US have special needs. CSHCN and their families are at risk for increased financial burden, social exclusion, social withdrawal, marginalization, depression, and anxiety; increased levels of perceived social support have been found to predict psychological adjustment in CSHCN. Telehealth interventions have been implemented in this population to enhance clinical care, home care, education, and discharge planning. The purpose of this work was to review the current empirical literature for an understanding of the impact of telehealth and telecommunications interventions on social support in CSHCN and their families. The modified framework for integrative review developed by Whittemore and Knafl (2005) provided the structure for the current review and social ecological theory provided the theoretical underpinning for the review. A computer database search was conducted using OVID/Medline, CINAHL, and PsychINFO; ancestry searching and journal hand searching were also employed. The final sample for analysis included 11 studies. The majority of studies investigated telehealth or telecommunications interventions directed at support for the caregivers of CSCHN; the focus of fewer studies was the child with special needs or siblings of CSHCN. Most interventions were telecommunication or Internet-based support groups. Almost all studies were exploratory in nature, identifying the types of support received or exchanged by participants. Emotional, informational and affective support were the most commonly identified types of support. Further research is necessary to link telehealth or telecommunications interventions, social support exchanged, and health outcomes.

Objectives

Participants will be able to describe the methods used to conduct an integrative review of the literature.

Participants will be able to discuss the status of the current empirical literature on telehealth and telecommunications as social support interventions for children with special healthcare needs and their families.

Honey Jean N. BA, MBA

Telepsychiatry Project Coordinator

Mid Shore Mental Health Systems, Inc, Easton, MD, USA

P65 Guidelines for Development and Reimbursement of Originating Site Fees for Maryland's Telepsychiatry Program

An originating site fee is an effective approach to building a comprehensive telepsychiatry infrastructure, recognizing contributions of all parties and aligning networks to common goals. Partners to Maryland's Telepsychiatry Network conducted a study to determine: 1. A reasonable rate of reimbursement for rural clinical sites participating in the initiative, and 2. A reimbursement mechanism to align clinical sites to overarching goals. The study used an Activities Based Costing approach to quantify incremental administrative costs borne by remote clinics, and based on those findings, determine a rate for reimbursement across sites. Reimbursement was applied on a per client seen basis. The methodology used in this study is recommended for similar networks in states where reimbursement regulations are not in effect, or in cases where the network or project is not covered by a fees for service payor source. The study examined and recommended the following:

Proposed reimbursement rate: The study examined the extent to which proposed CMS rate ($24 billable under code Q3014) is reflective of underlying site costs/ activities; and recommended a formula based on findings.

Proposed reimbursement mechanism: Once a viable rate was established, careful consideration was given to a reimbursement mechanism to incentivize desired project outcomes.

The reimbursement mechanism embraced the following key goals:

Incentivize clinics toward increased utilization and appointment ratios;

Promote sustainability of telepsychiatry recognizing the instrumental role of rural clinics in championing the growth and presence of telepsychiatry in their region; Promote alignment across multiple sites, integrating client referral and healthcare delivery systems, and linking all partners to shared goals and outcomes;

Prepare clinics for the passage of regulations, with a rate and reimbursement similar to a third party payer system within the Public Mental Health System.

Objectives

Describe the methodology for developing an originating site fee rate.

Describe the method of reimbursement for originating sites based on alignment to network goals.

Mutrux Rachel BA

Director, Missouri Telehealth Network

University of Missouri, Columbia, MO, USA

P66 Missouri Telehealth Network - A Sustainable Telehealth Program: Strategy to E-Health

Rational: Since 1994, The Missouri Telehealth Network (MTN) has increased access to healthcare by reducing barriers to telehealth that include cost of broadband, lack of reimbursement, and provider/ patient resistance. In an effort to expand the scope of services and achieve financial sustainability, efforts were launched to implement e-Health collaborations with Missouri health information technology and health information exchange stakeholders. state's backbone for HIE.

Topic Outline: Describe MTN's work with the Missouri Office of Health Information Technology (MO HITECH) in its efforts to plan, design, and implement an HIE encouraging the adoption and use of an EHR that allows for the exchange of health information across providers. Describe MTNs subcontractor relationship with the Missouri HIT Assistance Center, a funded Regional Extension Center of the Office of the National Coordinator for HIT. Services include: educating and training primary care providers in choosing an EHR vendor, explaining group purchasing advantages, re-engineering office workflow, implementing and managing an EHR, illustrating practice workflow analysis, redesign, functional interoperability and HIE, and ultimately achieving Meaningful Use. Illustrate how MTN will assist in the efforts to help 1,167 priority primary care providers reach Meaningful Use by March 2012.

Methods/Session Format: This presentation will outline the status of these efforts and show how MTNs expansion from telehealth to e-Health, including EHRs and HIE, will aid in the overall goal of producing a sustainable telehealth program.

Objectives

Understand MTNs subcontractor role for the Missouri Health Information Technology Assistance Center in the adoption and expansion of EHRs with the goal of achieving Meaningful Use.

Understand MTNs role in the state's effort to implement HIE and the strategies and collaborations MTN established to become the state's backbone for HIE.

Chang Aileen Y. BA 1 2

Medical Student

Ghose Sankalpo BS 2 3 Littman-Quinn Ryan BA 2 Anolik Rachel B. BS 1 2 Kyer Andrea BFA 4 Mazhani Loeto MD 5 Seymour Anne K. MS 2 4 Kovarik Carrie L. MD 2 6

1 University of Pennsylvania Medical Center, Philadelphia, PA, USA 2 Botswana-UPenn Partnership, Gaborone, Botswana 3 Medical College of Wisconsin, Milwaukee, WI, USA 4 University of Pennsylvania Biomedical Library, Philadelphia, PA, USA 5 University of Botswana, Gaborone, Botswana 6 University of Pennsylvania Medical Center, Department of Dermatology, Philadelphia, PA, USA P67 Mobile (Cellular) Telementoring in Botswana

Telemedicine is playing an increasingly greater role in the delivery of health information and services in resource-limited settings. Telementoring, which is a subset of telemedicine, allows for remote mentoring of students and residents. In partnership with the University of Botswana (UB) School of Medicine (SOM), we explored the role of mobile telementoring in resident (physicians in specialty training) education. The SOM, which admitted its first class of medical students and residents in 2009, is committed to providing high-level on-site educational resources for trainees, even when practicing in remote locations. The concept of mobile telementoring was introduced as a tool to help achieve this goal. During their training, students/residents rotate in district clinics in resource-poor and remote locations, where Internet-based educational resources may be inaccessible and specialty mentors may not be readily available. We felt that a point-of-care tool would be of great value in helping students/residents train and care for patients. We also believed that these tools would encourage them to continue practicing in Botswana and in remotely located clinics. We present preliminary results of a pilot study evaluating the use of mobile telementoring by UB residents. Seven residents (Medicine, Pediatrics) were trained to use a Google myTouch phone, equipped with Android-based applications, built-in camera, and data-enabled SIM cards. Point-of-care applications loaded locally on the phones included Dynamed, Archimedes, ePocrates, and 5-Minute Clinical Consult, in addition to email, web access, and a telemedicine application that allows for the submission of cases to local mentors. Residents were encouraged to use these phones as much as possible, in and out of the medical setting, over several months. Surveys were administered before, during, and after the study. Results that will be presented demonstrate that mobile telementoring is an effective tool for training students/residents, both at the bedside and at home. Mobile telementoring enables trainees access to point-of-care tools that facilitate patient care and education.

Acknowledgements: This work was made possible by support from the Orange Foundation in Botswana, Unbound Medicine, Inc., and the University of Botswana School of Medicine.

Objectives

To understand the role of mobile telementoring in resident and medical student education in resource-limited settings.

To understand how mobile telementoring facilitates patient care in resource-limited settings.

Webb Janet MBA, Master of Divinity, CPE (Chaplain)

Executive Director

Spiritual Care Services, LLC, Mooresboro, NC, USA

P68 Telespiritual Care: Integrating Technology in the Application of Spiritual Care

Telespiritual care includes chaplaincy services delivered through interactive video, phone (VoIP - Voice over Internet Protocol), IM/chat or email. Typically, a patient does not have access to a chaplain after being discharged from a hospital or other healthcare facility. This study investigates developing an Internet based tele-communications portal (website) that is used to connect the chaplain with the patient in a remote environment. Minimum requirements: high speed Internet access, computer with microphone and speaker (webcam optional); no advanced technical skills; free or low cost Internet based website development tools; VoIP provider; email; e-commerce. The results identified quality, affordable, user friendly Internet based tools that require no advanced technical skills from end-users. Tools include: domain registrar/host, website creator-editor, free VoIP provider, and free e-commerce partner. Total annual cost of tele-communications portal is $65.00. Besides being low cost and requiring no advanced technical skills, additional advantages of Telespiritual care include: website provides a visual showcase of chaplain services and is used to inform/educate; patients have access to a chaplain while they are recovering at home. Potential advantages (after additional study) may indicate that because of the online method of delivery, the stigma associated with seeking spiritual care is removed. Because of its convenience, cost, accessibility, confidentiality and the ability to remotely express/explore deep emotional/spiritual issues, more people may seek care. Using the Internet to provide remote spiritual care can cost-effectively connect a chaplain and patient with no advanced technical skills required of either. (Chaplains are not licensed through state boards or any other governing body which means that providing care within or across state lines is not regulated or monitored.)

Objectives

Define TeleSpiritual Care.

List Advantages of Online Spiritual Care.

Hamian Araz

Project Manager

Wilson Katya MBA, PMP AMBiT Consulting Inc, Vancouver, BC, Canada

P69 Telehealth Trends Emerging from Tele-Education

Medical education institutions are a staging ground for healthcare innovations, initiating trends that often propagate throughout the healthcare community. Using case studies from distributed medical education programs at three Canadian universities (UBC, Memorial, and Dalhousie), this presentation examines innovative uses of technology in medical education as emerging trends for telehealth practice:

Mixed-mode videoconferencing further reduces geographic barriers to participation: Software-based videoconferencing has progressed such that mixed-mode participation in videoconferencing sessions is now feasible. Participants may join a session either from a traditional videoconference facility or from their personal computers. This has resulted in greater collaboration and knowledge sharing as participants' ability to join a session, interact with other participants, and follow presentation materials, is no longer limited by location. This mode has been in use for over one year within BC, and demand is growing.

Shared use of videoconferencing facilities demonstrates cross-organizational cooperation: The UBC Faculty of Medicine and the Vancouver Island Health Authority (VIHA) have laid a framework for sharing each other's videoconference facilities. This required high levels of cooperation and coordination between the two organizations. Key issues that were resolved include: scheduling policies and procedures, operational support agreements, and network access. With this framework, the potential exists for increasing efficiency of facility utilization while providing telehealth users with access to high-quality technology.

Patient simulator implementation increases multi-disciplinary interaction: One of the objectives of patient simulation strategies in BC and Newfoundland is to provide multi-disciplinary training on high-fidelity simulators. Creating this opportunity requires cooperation among healthcare disciplines, consultation with stakeholders, and a cross-disciplinary project approach to the planning, design, and implementation of facilities.

As medical trainees experience these trends in tele-education and simulation, they become stewards for these same trends to emerge in telehealth.

Objectives

Using technology effectively for education.

New medical education trends applicable to healthcare.

Velez Jorge A. MD/HSM 1

Director

Lemaire Edward PhD 2 Gagnon Marie-Pierre PhD 3 Millán Rodolfo TS/MSc 4 Largo María Inés FTT 3 Nieto Lorena PhT, MBA 1 Sarmiento Luz Marina RN 5 Perdomo Milton PhT 5 Ecahavarría Alejandro Eng 1

1 Colombian Telemedicine Centre, Cali, Colombia 2 Ottawa Hospital, University, The Ottawa Hospital Rehabilitation Centre, Institute for Rehabilitation Research and Development, Ottawa, ON, Canada 3 Centre Hospitalier Universitaire de Québec-CHUQ, Quebec, QC, Canada 4 IDEAL Foundation for the Integral Rehabilitation, Cali, Colombia 5 Disability Assistance Program, Secretary of Health, Amazonas, Leticia, Colombia P70 Tele-Rehabilitation Supporting Community-Based Rehabilitation Program for Indigenous Communities in Amazonas

Objective: This project aims to incorporate information and communication technology in support of program activities in community-based rehabilitation programs in the indigenous communities of Amazonas.

Methodology: The project establishes a participatory methodology, involving the different stakeholders, in an evidence-based tele-rehabilitation network (systematic review process) and shared media. Establishment of a standard platform for sharing knowledge and support; including rehabilitation, management of social projects, health promotion and health prevention, and deployment of ICT applications, are depicted. An integrated approach to formative assessment will be implemented in order to inform decision-making during the development and implementation of the project. A survey using a questionnaire was conducted to evaluate the perceptions.

Results: The results show that it was possible to support the community-based rehabilitation program activities through telemedicine applications put in place since 2009. The realizations include: a diagnostic phase with user and technological assessment; with core tasks in October 2009, May 2010, September 2010 and November 2010.A set of ICT tools, Web based, evidence medicine applied to rehabilitation process, and mobile technology platform to support the interaction. A distance learning model for indigenous people, using telehealth strategies is supported.

Conclusions: Tele-rehabilitation has become a viable approach for providing interdisciplinary physical rehabilitation services to improve the lives of people with disabilities. Recent advances have provided a basis for implementing tele-rehabilitation services in rural and other underserved areas throughout the world. Dissemination activities such as the Amazonian Tele-Rehabilitation Symposium provide a forum for to advance physical rehabilitation. Future Work ICT to support assistance in the rehabilitation process and practice and training of personnel involved in the rehabilitation of indigenous people in remote and vulnerable areas. The project includes an outreach tele-rehabilitation task for indigenous communities in Canada, and an Action Plan to provide a tele-rehabilitation network in the region, involving the Amazonian countries.

Objectives

Discuss telerehabilitation experiences in indigenous communities.

To demonstrate the community-based approach to telerehabilitation.

Rhoads Sarah DNP, APN

Assistant Professor

Low Gordon MSN, APN James Delia MNSc, APN Ivey Tesa MNSc, APN University of Arkansas for Medical Sciences, Little Rock, AR, USA

P71 No Longer an Island: Rural Nurse Practitioners Gain Support through Telehealth

Rural nurse practitioners (NP) fill a desperate need for obstetrical and gynecologic healthcare in remote areas of Arkansas, often providing care for many counties and traveling from clinic-to-clinic daily. Further, the rural nurse practitioner is often professionally isolated, without the option to call a colleague into a patient's room for mutual insight and consultation. In 2009, the Arkansas Department of Health and the University of Arkansas for Medical Sciences collaborated to improve resources and support for the rural nurse practitioner, implementing a multi-component, telemedicine-driven program to help dissolve these issues. The first program component supports both the rural patent and NP through interactive video consultations. Through interactive video telemedicine connecting rural facilities with the state's only academic medical center, rural NPs, their patients, and tertiary center physicians and NPs use telemedicine as the means to provide co-management and consultation for at-risk pregnancies. The second component focuses on the educational enrichment of NPs through a monthly teleconference, which provides a venue for continuing education, a dialogue of various clinical topics, and the opportunity to earn continuing education units. The final program component offers a toll-free consultation hotline for rural NPs, through which a tertiary care NP provides coverage for the phone consultation. In essence, the rural NP is now supported through a variety of telemedicine-based technology, connecting them to a continual stream of specialty support that was once unavailable in their rural settings. As the demand for high risk services increases, it is essential for healthcare providers in women's health and obstetrics to partner in new and innovative ways, and telemedicine is the tool by which these collaborations should be based for any rural-to-urban settings.

Objectives

Attendees will learn about one program's three support mechanisms that enable rural nurse practitioners to provide better care for rural patients.

Attendees will learn how rural nurse practitioners can provide specialty services through telemedicine.

Jerry Joann MN

Lead Care Coordinator

Maudlin James M.Div NF/SG VHS, Lake City, FL, USA

P72 Finding the Right Keys to Success

Abstract Withdrawn

Romer Doug RN 1

Executive Director Patient Care Services

Whitmore Tiffany MPA 2 Gilbreath Allison MHA 2 Reddy Tatiana RN, MSN, CNOR 2 Seibert Pennie S. 2 3

1 Grande Ronde Hospital, La Grande, OR, USA 2 Saint Alphonsus Regional Medical Center, Boise, ID, USA 3 Boise State University, Boise, ID, USA P73 Healthcare Reform and Evolution of a Telemedicine System

Introduction: Telemedicine is expected to be a critical component of the successful implementation of healthcare reform. Approximately half the medical cases in the U.S. could be managed utilizing technology based systems, potentially reducing healthcare costs by 40%. As a result of the American Recovery and Reinvestment Act, approximately five billion dollars will be spent on telemedicine programs.

Methods: We developed a telemedicine network comprised of eleven hospitals. Each hospital receives telemedicine services from a variety of sources, both within and outside the established network. Multiple clinical and educational services are offered via the InTouch Health Remote Presence System on both an emergent and pre-scheduled basis.

Results: Since January 2009, 2,355 telemedicine sessions have been completed. Program examples include outpatient teleoncology, telepsychiatry, virtual ICU, interpretative services, emergency consultations, teledermatology, telecardiology, and numerous educational programs. Additionally, 24 emergent transports were prevented following successful telemedicine consultations resulting in $371,487 in cost savings to the healthcare system. This resulted in over $337,120 dollars remaining in the local healthcare community. Additional data will be presented regarding dollars maintained in the community to invest in outpatient care, process improvements, and patient travel.

Conclusion: Telemedicine provides an opportunity to improve access to high quality, specialty care in rural areas ensuring that patients receive care in a timely manner and remain in their local communities whenever possible. Through the use of telemedicine technologies, scarce physician resources can be leveraged across diverse geographic regions without the time and expense of travel. In emergent cases, the use of telemedicine facilitates the reservation of tertiary resources for high acuity cases and assists rural hospitals in maintaining as many patients as possible. In the event that transport is necessary, telemedicine ensures that accepting providers are engaged early to improve clinical decision making and healthcare efficiencies.

Objectives

Advance healthcare reform measures by capitalizing on telemedicine efficiencies to streamline resources and increase partnership.

Describe the value of utilizing telemedicine to develop a hospital network into one cohesive health system.

Teague-Ross Terri J. MS

Center for Distance Health: ANGELS/TOUCH

Lewis Shannon BSN, RN Hall Whit MD Schaefer G. Bradley MD University of Arkansas for Medical Sciences, Little Rock, AR, USA

P74 Seeing is Believing: Telemedicine Improves Access to Genetics Consults in a Rural State

Only one Level IV nursery serves Arkansas, and the majority of the state's rural hospitals are separated from the specialty resources fragile infants require. Using a statewide telemedicine network, healthcare leaders developed a Community-Based Research and Education Core Facility establishing telemedicine interactivity with several of the state's outlying nurseries, the majority of which serve a rural Medicaid population. Funding was also provided by the National Center for Research Resources and the Centers for Medicare and Medicaid Services. T1 lines and codec-and-camera carts allow videoconferencing using a high-definition resolution camera. A novel concept in how to obtain specialty genetics consults for neonates matched outlying hospitals with the state's only academic medical center. Families at participating sites are now able to connect to one of only three pediatric geneticists in the state at Arkansas Children's Hospital or the University of Arkansas for Medical Sciences to obtain information on their infant's diagnosis, prognosis, and treatment. Parents are able to ask questions, and physicians are able to see physical features clearly through telemedicine video, rather than trying to decipher verbal descriptions of malformations. A similar but unassociated telemedicine clinic is offered in Wichita, Kansas. Use of the Arkansas and Kansas clinics indicate the effectiveness and increasing popularity of this groundbreaking strategy. In 2008 when the service was in its infancy in Arkansas, one consult was obtained. The following year, two consults were facilitated, and in 2010, five consults took place during the first eight months of the year. In the Wichita clinic, 48 patients have been seen to date. The success of this new program can also be attributed to the hiring of a geneticist with previous experience in telemedicine-based patient care programs.

Objectives

Attendees will learn how telemedicine with a genetics application can be used to improve case management of fragile neonates.

Attendees will learn how to decrease appointment waiting time for patients in need of a genetics consult.

Teague-Ross Terri J. MS

Center for Distance Health: ANGELS/TOUCH

Morse Anne Marie EMT, CFC, CMTE, OCS Hall Whit MD University of Arkansas for Medical Sciences, Little Rock, AR, USA

P75 Using Telemedicine to Facilitate Responsible Neonatal Transports Saves Money and Time

Community hospitals in rural states such as Arkansas rely on academic medical centers for advice on preterm deliveries. If a neonatologist at an academic center uses interactive video (IAV) to examine an infant, the infant's condition can be assessed more accurately than over the telephone, as several parameters can be visually assessed in the neonate. From July 2009 through March 2010, nine hospitals primarily serving a Medicaid population partnered with the University of Arkansas for Medical Sciences (UAMS), and Arkansas Children's Hospital (ACH) to participate in virtual census rounds via a previously implemented telemedicine network. The network was created by healthcare leaders who developed a Community-Based Research and Education Core Facility, establishing telemedicine interactivity with several of the state's outlying hospitals. Funding was also provided by the National Center for Research Resources and the Centers for Medicare and Medicaid Services via a Transformation Grant. T1 lines and codec-and-camera carts allowed videoconferencing using a high-definition resolution camera, producing a 720p (progressive scan) image. During virtual census rounds at UAMS, ten consults on neonates possibly in need of transport were facilitated using IAV. Upon evaluation, eight of the ten were deemed able to remain in their community hospital, and unnecessary, costly transports were avoided. With an average cost of $10,000 - $12,000 for each air transport, this resulted in savings of almost $100,000. Angel One, a transport system for ACH, facilitated the use of IAV in almost a third of transport calls. Chi-square analysis revealed a significant difference in the number of transports avoided when telemedicine was used versus when it was not used (p = < 0.001). We conclude that using interactive video to evaluate neonates for transport prevents unnecessary expenditures and saves a great deal of time and inconvenience for healthcare providers and families.

Objectives

Attendees will learn which how to use telemedicine to make more responsible transport decisions.

Attendees will learn how to save money by avoiding costly and unnecessary patient transports.

Yang DerShung PhD Lopez Ana Maria MD, MPH, FACP 2 Haas Nina M. MA 1 Kreykes Lindsay N. MPH 1

Research Specialist Senior

1 BrightOutcome, Buffalo Grove, IL, USA 2 University of Arizona, Tucson, AZ, USA P76 Patient Acceptance of a Home-Based Cancer Symptom Report and Tracking System

Objective: A computer system was developed to allow cancer patients to report nine common chemotherapy-related symptoms at home via Web and/or automated phone system. The oncology care team received email/pager notifications when moderate-to-server symptoms were reported, typically triggering phone calls to patients. The system tracked if the issue had been resolved in a timely manner and if not, notified the care team again. A primary project goal was to evaluate patient acceptance of this solution.

Methods: Eighteen participants were recruited (9 breast cancer patients under adjuvant treatment; 9 metastatic patients) and randomly assigned to either intervention or control group. After one treatment cycle, the patient was crossed over to the other arm. In the intervention arm the developed system was used by both patients and providers. In the control arm patients received usual care without the system, but maintained symptom logs on paper. Four subjects stopped participation for various reasons.

Results: Despite the small sample, results showed a clear trend of improvement in patient acceptance as the patient experiences more frequent and more severe symptoms. Out of all the participating patients (n = 14), 64% reported that they would use the system in the future while 71% said they would recommend it to others. Of the patients with at least one nurse alert (n = 8), 75% said they would use the system and 88% would recommend it. Finally, patients with persistent symptoms (n = 3) 100% said they would use and recommend the system.

Conclusion/Discussion: This analysis demonstrated that patient acceptance of this solution was proportional to the extent of nurse alerts being generated. These results were obtained from only one treatment cycle. Patient acceptance could further improve when more treatment cycles are involved because more symptoms would likely occur over multiple cycles, which were confirmed from the paper symptom logs from the control.

Objectives

Home-based cancer symptom reporting/tracking via Web/phone is feasible.

Patient acceptance of home-based symptom reporting/tracking via Web/phone increases when they experience more frequent and more severe symptoms.

Greenfield William MD

Assistant Professor and Assistant Residency Program Director

Teague-Ross Terri MS Lewis Shannon BSN, RN Pitsch Stacy BSN, RNC-NIC Kim Elizabeth MD Hall-Barrow Julie EdD Hall Whit MD University of Arkansas for Medical Sciences, Little Rock, AR, USA

P77 Discerning Successful Telemedicine Applications for Obstetrics and Neonatology

With a goal of facilitating high-risk obstetric referrals to tertiary care centers, a new concept in obstetrics and neonatology collaboration partnered nine hospitals primarily serving a Medicaid population with the state's only academic medical center to participate in virtual census rounds via a previously implemented telemedicine network. The network was created by healthcare leaders who developed a Community-Based Research and Education Core Facility establishing telemedicine interactivity with several of the state's outlying hospitals. Funding was also provided by the National Center for Research Resources and the Centers for Medicare and Medicaid Services via a transformation grant. T1 lines and codec-and-camera carts allowed videoconferencing using a high-definition camera. During the nine months of the project, outside sites attended virtual census rounds a total of 121 times for obstetrics and 543 times for neonatology. Virtual census rounds were routinely used by neonatologists and pediatricians as a forum for follow-up (122), questions (43), and transport coordination (22), while obstetrician utilization of these services remained low (follow-up, 5; questions, 4; transport coordination, 5). Medical staff at participating hospitals evaluated this telemedicine initiative by completing surveys on a Likert five-point agreement scale. Despite high levels of satisfaction with telemedicine in general (average agreement 68%, N = 18), in a “comments” section of the survey, professionals expressed concerns over connection time and found little perceived value in using telemedicine in obstetrics, particularly in emergent scenarios. Attendance patterns during virtual census rounds, 17% for obstetrics and 57% for neonatology, also reflected this trend. While this application was not well-suited to obstetrics, “lessons learned” lead to the development of other innovative programs such as interactive nurse to nurse report.

Objectives

Attendees will learn which telemedicine applications are most successful in obstetrics and neonatology.

Attendees will learn how to tailor their program(s) to result in the highest possible level of participation.

Kreuder Kent MD 1

Medical Director for Telemedicine

Whitmore Tiffany MPA 1 Gilbreath Allison MHA 1 Seibert Pennie PhD 1 2 Gagnon Samantha 1 2 Schommer Julie BS, BA 1

1 Saint Alphonsus Regional Medical Center, Boise, ID, USA 2 Boise State University, Boise, ID, USA P78 Remote Presence General Surgery Program: Building Surgery Capacity in Rural Communities

Introduction: While 25% of the U.S. population resides in rural areas, only 10% of general surgeons practice there. Barriers exist for these rural surgeons to implement new techniques and best practice standards due to limitations in case volumes, proctoring, and inadequate rural surgical residency training. Although surgery is critical to rural hospitals' financial viability, insufficient support staff and equipment further complicate these limitations often leading to difficulties in retaining surgical patients. Telemedicine offers mechanisms to share knowledge and training despite geographical barriers.

Methods: We developed a Remote Presence General Surgery Program to provide support to general surgeons in rural Critical Access Hospitals (CAHs). An Operating Room Assessment was developed to understand which cases were performed at each CAH and identify barriers to maintaining patients in the community. While multiple factors contribute to procedures not being performed, surgeon comfort and staff training were the primary factors affecting patient retention for standard general surgery procedures.

Results: We detail two cases utilizing telemedicine and development of a surgical program using the InTouch Health Remote Presence System. In one case, a surgeon required assessment to resume practice following a medical emergency, and via telemedicine a second surgeon located distantly provided this assessment and clearance. The second case details a surgeon practicing in a rural community who received mentoring via the Remote Presence System. Using these cases we developed a surgical telemedicine network providing consultation, proctoring, support and training for surgeons and staff, with four hospitals currently participating. Strategies for regional collaboration, surgeon engagement, staff involvement and lessons learned from year one will be presented.

Conclusion: Utilizing telemedicine to provide surgeons and staff with collegial support allows CAHs to improve retention of surgeons and their patients, and also presents opportunities for hospitals to increase revenues by approximately $300,000 while ensuring patients receive increased access to care in their communities.

Objectives

Describe methods developed and lessons learned from implementing the surgical network via Remote Presence.

Identify general surgery case types that may be able to remain in CAH's with the proper telemedicine proctoring, equipment, and/or staff support.

Wyatt Stephanie MNSc, WH-APN(c)

Program Assistant Director

Rhoads Sarah APN, DNP University of Arkansas for Medical Sciences, Little Rock, AR, USA

P79 Stopping Tobacco, Starting Changes in Pregnancy Care: Telemedicine-Based Provider Education

In Arkansas, the prevalence of childbearing age smokers exceeds the national average, with 22.3% of women affected compared to the national rate of 21.2% (March of Dimes). Arkansas's only academic medical center took a proactive, technologically-forward approach to educating providers on the dangers of maternal smoking. Utilizing interactive video teleconferencing, providers were educated on March of Dimes-approved smoking cessation strategies specifically designed to encourage increased pregnant smoking cessation interventions in Arkansas. Leveraging an existing distance learning network populated by rural and urban providers, FAAST accommodated the busy, distant provider serving Arkansas's pregnant patients by offering interactive video sessions focusing on prenatal smoking intervention. According to the U.S. Department of Health and Human Services, this brief (2-4 minute) interaction can increase quit rates for pregnant women by 2-3 times of those who receive no intervention. FAAST instructed providers about the “5 A's” approach by promoting open discussion between rural and urban providers, each discussing the unique barriers and health disparities patients face in quitting smoking. Over 400 physicians and advanced practice nurses provide obstetric care in Arkansas, and123 providers attended these educational interactive video sessions, even extending outside the U.S. to India, Ecuador, and Russia. Attendees rated an average of 4.69 out of 5.00 on how well the program met their needs. Pre-session survey data reported an average score of 2.03 out of 5.00 on how well versed providers and nurses felt on the 5 A's approach, with 1.96 reporting they routinely employed the strategy to counsel pregnant patients who smoke. Interactive video enabled this March of Dimes-sponsored educational session to reach 25% of the state's providers in two educational sessions, a feat impossible without telemedicine in a rural state.

Objectives

Attendees will learn how teleconference training can improve pregnant women's chance of quitting smoking.

Attendees will learn how FAAST teaches providers techniques to approach pregnant, smoking patients.

Lowery Curtis MD

Department Chairperson

Benton Tina RN, BSN Bornemeier Renee MD Heil Lori RDCS Perkins Rosalyn MNSc, APN Dixon Mandi RDMS Teague-Ross Terri MS University of Arkansas for Medical Sciences, Little Rock, AR, USA

P80 Echoes of Innovation: Preliminary Outcomes of Perinatal Telemedicine ECHO Programs

In January 2009, Arkansas's only academic medical center began developing a telemedicine-based fetal echocardiography clinic, while dually planning for statewide training and education of sonographers in fetal echocardiography and congenital heart disease. The goal of the program is to utilize telemedicine in the provision of Fetal Echocardiograms to patients in rural areas of Arkansas, thereby reaching more high-risk maternity patients, diagnosing congenital heart disease earlier, decreasing medical costs, reducing patients' travel, and providing education to obstetricians and sonographers throughout the state. In planning the initiative, technical evaluations and testing of fetal patients were performed with potential sites, and telemedicine equipment was installed in the echocardiographic lab at the state's only children's hospital. A nurse coordinator and pediatric cardiologist offer patient education and consultation over telemedicine to further aid understanding of high-risk conditions. This system has the capacity to view images in real time or store to an ultrasound digital imaging system, and fetal echo reports and consults will be documented and provided to referring obstetricians. Telemedicine-aided education and training supplement face-to-face training. Since training has been initiated over the past 9 months, sonographers in the rural communities have improved their identification of congenital heart defects thus offering their patients new skills and technology in the identification of cardiologic conditions. Sonographers trained by the telemedicine sonography specialist scored a mean of 83% compared to the 78% mean score of those not trained by the specialist. The first fetal echocardiographic clinic was successfully performed in August 2009. Since then, approximately 50 patients have been evaluated for congenital heart defects via telemedicine. Three Telemedicine Fetal Echocardiographic Clinics have been established since the beginning of the year.

Objectives

Attendees will learn the steps necessary to plan and implement a pilot fetal echo program that unites pediatric cardiologists at a children's hospital with outlying and rural hospitals.

Attendees will learn the preliminary results of a fetal echo program and what milestones to expect in the first year of planning and implementation.

Kostic Marko N. 1

Scientific Advisor

Wilson Elias 1 Morris Scott 1 Lenkin Manja 1 Kenyon Jessica 1 Grundfest Warren S. MD 1 2

1 TATRC, Marina del Rey, CA, USA 2 University of California Los Angeles, Los Angeles, CA, USA P81 Tatrc West Facilitates Partnerships in Support of Novel Medical Simulation Technologies

Abstract Withdrawn

Lopez Ana Maria MD, MPH, FACP 1 2

Medical Director

Yang DerShung PhD 3 Kory Evelia MPH 1 2

1 Arizona Telemedicine Program, Tucson, AZ, USA 2 University of Arizona, Tucson, AZ, USA 3 Caracal, Inc, Buffalo Grove, IL, USA P82 Electronic Patient Portal Development for Ovarian Cancer Survivors

Internet-based communication between patients, their clinic and physician, also known as patient portals, have advanced beyond traditional physician-patient email, as they have included electronic medical record integration, health system navigation tools, forum discussions, and recorded patient experiences. Their recent introduction requires constant evaluation for improvement and effectiveness. Our purpose is to promote patient-centered communication by creating a patient portal that serves as a virtual medical home, by giving the patient the ability to connect to their social network, manage their medical records, learn about the latest in research, and actively handle their health maintenance. Our first prototype focused on serving ovarian cancer survivors, since there are limited resources for this population. The prototype was also designed for this specific group of women, since ovarian cancer cases are often not detected until the patient has reached an advanced stage, a time when information availability is most critical. The pre-development and development stages of the website required input of patients and non-patients – those in direct contact with patients, including clinicians, caregivers, community health workers, and support group leaders. Focus group discussions and structured interviews were conducted to determine the preferred content and design for the prototype. A patient portal prototype was developed and evaluated in terms of its usability by patients and non-patients. An interdisciplinary expert panel reviewed and assessed prototype development. The pilot was evaluated highly by patients and non-patients, though clinicians voiced concerns about foreseeing an administrative burden with its implementation. The following phase of this project, aims to test the pilot in a real clinical setting in order to explore and refine the integration of electronic medical records. Barriers and facilitators revealed by further testing will be more indicative of our patient portal's feasibility and usability.

Objectives

To learn about the development of an ovarian cancer, patient-centered portal that serves as a virtual medical home.

To learn about the outcomes of our Phase I evaluation of an ovarian cancer patient portal.

Lopez Ana Maria MD, MPH, FACP 1

Medical Director

Valencia Angela MPH 2 Kory Evelia MPH 1 Hofacre Bettina BS 2

1 Arizona Telemedicine Program, Tucson, AZ, USA 2 Arizona Cancer Center, Tucson, AZ, USA P83 Mujer a Mujer: Stories of Breast Cancer Survivors

Background: In our previous work, Latinas with breast cancer (BC) have identified the use of video decision aids as a potentially useful tool for informed medical decision making. However, there is a lack of culturally and linguistically competent video materials to address the needs of Latinas facing breast cancer. The main goal of this program was to improve access to culturally and linguistically appropriate BC information by producing video clips where Latina BC survivors share their stories to help newly diagnosed patients in their medical decision making. These video clips would be available thru telemedicine technology and the Internet. The primary objectives were to: 1) identify the educational needs of BC survivors at diagnosis, treatment and survivorship; 2) address the identified educational needs and 3) evaluate the utility of the video clips by online evaluations and video clip blogs.

Methods: The first phase of the study included focus groups discussions to identify the educational needs at the time of diagnosis. These data served as the foundation for the interview guide for the video production. Video clips were produced, edited and classified into different categories according to stage of treatment.

Results: A total of 59 participants were consented to be in this project. All participants were Latina BC survivors between the ages of 39 and 76 with a mean of 55 years. Fifteen percent of participants reported no health insurance and 45% reported Arizona's Medicaid insurance (AHCCCS). The educational video clips, Mujer a Mujer, are available in Spanish and English and are presented in a conversational format with BC survivors discussing what they wish they had known at the time of their BC diagnosis. The program is currently being evaluated and program results will be presented. Conclusions: This program will provide critical information that will assist Latinas with BC treatment decisions.

Objectives

Assess video decision aid tools for breast cancer survivors.

Improve access to culturally and linguistically appropriate breast cancer information.

López Ana Maria MD, MPH

Medical Director

Arizona Telemedicine Program, Tucson, AZ, USA

P84 ¡VIDA! Breast Cancer Tele-Education for Breast Cancer Survivors and Healthcare Providers

Background: ¡Vida! built on our completed work (Southern Arizona, Susan G Komen Foundation) in rural, urban, Latino and White, non-Latino communities which revealed the persistent need for breast cancer (BC) education among patients/family members and providers (HCP) especially in rural communities and among primarily Spanishspeaking Latinas. Our primary hypothesis was that increased access to culturally and linguistically competent BC survivorship education to patients, families and health workers would improve their knowledge and facilitate communication.

Methods: Access to educational content was primarily facilitated by telecommunications technology via the Arizona Telemedicine Program (ATP) and delivered in both English and Spanish. A “Community Partnership Group” (CPG) was established to guide curricular development and evaluation, initially including Payson, Yuma, Douglas, Nogales, and Tucson. Each educational session was conducted as a virtual roundtable with clinical experts, presenting in Spanish and English.

Results: Over 550 participants attended the sessions; of these almost 90% could not have attended without the telemedicine component, due to actual and opportunity costs of attending: each attendee at a remote site saved an estimated $53 to $403. The average attendee age was 56, 62% were Latina/os, 93% were women, and 67% attended a Spanish language session. Participants were generally satisfied with the content of the sessions, reporting an average score of 4.5 on a 5 point satisfaction scale. Satisfaction with the telemedicine format was divided linguistically: those attending Spanish-language sessions were more likely (p < 0.05) than those attending English-language sessions to report being satisfied with the telemedicine delivery relative to in-person, averaging a score of 4.4 as compared to a 3.6 on a 5 point scale.

Conclusions: The positive feedback from both participants and the CPG and measured improvements in knowledge dissemination have shown the program to be an effective means of BC knowledge outreach to underserved communities, and has been institutionalized.

Objectives

Methods for improving the quality of culturally and linguistically competent breast cancer education.

Implementation of cost-effective education in underserved communities through telemedicine.

Lopez Ana Maria MD, MPH, FACP 1 2

Medical Director

Yang DerShung PhD 3 Larkey Linda PhD 2 Shipsey Emily MPH 1 2 Kory Evelia MPH 1 2

1 Arizona Telemedicine Program, Tucson, AZ, USA 2 University of Arizona, Tucson, AZ, USA 3 Caracal Inc, Buffalo Grove, IL, USA P85 Development of an Electronic Colorectal Cancer Screening and Diagnosis Decision Making Tool

Colorectal cancer (CRC) is the third most frequently diagnosed cancer in men and women in the United States. CRC screening can significantly reduce mortality, however adherence remains low. Patient demand and physician delivery are factors that affect low adherence. Our electronic solution to promote adherence to CRC screening guidelines was to develop and test a decision support tool. Our decision support tool is a guideline-based system that assesses patient data to produce tailored screening and diagnostic recommendations. The prototype development was guided by a comprehensive literature review (organizational and communication-based barriers to screening), retrospective medical chart review, patient key informant interviews. Provider interviews indicated that a computerized system could help alleviate CRC screening barriers by tracking results, providing alerts and reminders, and providing a means for standardized reports. The prototype was created by following an object-oriented, software development methodology. A total of 27 participants (18 patients and 9 providers) evaluated this prototype to assess the system usability and usefulness. The response was overwhelmingly positive. We intend to expand the prototype to include: (1) screening guidelines for breast, cervical, and prostate cancer; (2) EMR integration; (3) and a matched case-control evaluation. Recommendations, generated by our algorithm, include the procedure, due date, frequency, and referenced justification or guideline and would be available for review on the patient and provider interface. The patient interface summarizes recommendations in a low health literacy level. The provider interface allows clinicians to track patients' screening status with alerts and reminders for procedures which are past due, and to modify the recommendations based on clinical judgment.

Objectives

To learn about the development of our decision support tool for CRC screening recommendations.

To learn about the evaluation of our decision support tool.

Zuest Danielle MA 1

Research Project Coordinator

Agha Zia MD 1 Floto Elizabeth MA 2 Fidler Janel MA 2 Moreno Lucy MPH 1 Barsotti Ryan MA 2 Repp Andrea MA 2 Ross Bridgett PsyD 2 Zamora Tania BS 1 Shah Nilesh MD 1 Thorp Steven PhD 1

1 VA San Diego, San Diego, CA, USA 2 Veterans Medical Research Foundation, San Diego, CA, USA P86 Treatment Avoidance in PTSD Patients: Face-to-Face Versus Telemedicine

Missed appointments are a common phenomenon and may be an indication of treatment avoidance. Post-traumatic stress disorder (PTSD) patients, as well as substance abuse patients, are more likely to miss psychiatric appointments than patients of other diagnoses. Telemedicine (TM) is being studied as a possible method of delivering treatment for PTSD. TM offers access to care for patients who do not live close to healthcare facilities that provide PTSD therapy. An ongoing PTSD study is providing 12 sessions of manualized prolonged exposure (PE) psychotherapy to San Diego Veterans via TM or in-person (IP) modality. Half of the participants are randomly assigned to see a therapist IP at the La Jolla VA Medical Center and the other half may choose one of three community-based outpatient clinics in which to receive therapy. The number of cancellations (patient called to cancel prior to start of session) and no shows from preliminary data (N = 62) of this study were analyzed to see if there is a difference between the number of cancellations and/or no shows for patients who received therapy through TM versus IP. Patients who received PE therapy via TM had fewer cancellations (24% vs. 34%) and no shows (5% vs. 19%) than patients who received PE therapy IP. These results include several cases where patients missed a session multiple times. The number of patients that dropped out of treatment was higher for IP (29%) than TM (6%). A qualitative comparison of reasons for PE therapy appointment cancellations/no shows for TM and IP treatment modalities will be discussed. Knowledge on the reasons why PTSD patients miss PE therapy appointments will help in understanding treatment success. The best predictor of PTSD treatment success is consistent therapy attendance. TM may not only be physically convenient, but may be emotionally convenient for avoidant patients. Tele-mediated communication between the patient and provider allows for self-expression and disclosure of emotionally difficult information since the patient may perceive the TM modality as an anonymity mask, removing the fear of social rejection. TM seems to empower the patient to seek more information from the provider since they feel less intimidated than during IP interactions. The physical and emotional convenience factors of TM may decrease the number of missed appointments.

Objectives

Exhibit the use of telemedicine for PTSD therapy.

Review telemedicine treatment adherence for PTSD.

Dagva Mungunchimeg

Cardiologist

Khurelbaatar Mungun-Ulzii Cardiovascular Center Project, Ulaanbaatar, Mongolia

P87 Development of Sustainable and Replicable Model of Telemedicine, Experience Sharing

Mongolia is a landlocked country located between Russia and China. It has harsh climate, weak infrastructure and big land with scattered population (1.5 person per sq.km). In terms of availability and accessibility to quality care, lack of equipment and isolated practice in the rural areas had created big gap between rural and central hospitals, which cause high number of undue referrals from rural regions. Cardiovascular disease is the primary cause of mortality in the country. Cardiovascular Center, the Grand Duchy of Luxembourg Government supported project, was launched in 2001 with the purpose of lowering the cardiovascular disease burden in the country. Objectives were to make specialized expertise available to rural physicians, to improve local case management and prevention capability and to build sustainable model in the field. The project has established telemedicine network that consists of following activities:

Tele-consultation - Network covers cardiovascular center (urban hospital) and 8 rural hospitals equipped with simple means of equipments including echocardiography, digital ECG and computer. Doctors seek advice by sharing patient information through specially designed web-based medical record that is simple to use.

Distance learning - A specially designed website that is mostly restricted to professional access and partly for public education is developed. The web site is constantly updated with distant-learning materials and algorithms based on end-users needs. It is used for self-education and CME credit earning.

Teamwork spirit building - The project organizes regular trainings, local seminars, annual conferences to bring doctors together and to help build the spirit of teamwork among doctors.

Equal development of above-mentioned activities is key to the successful establishment of the telemedicine in Mongolia. This presentation discusses the development of such a sustainable, replicable and cost-effective model of telemedicine.

Objectives

To share development of sustainable and replicable model of telemedicine.

To share the lessons learned from the project.

Miranda Diogo J. MFA

Interactive Media Coordinator

Chao Wen L. University of Sao Paulo - Medical School, Sao Paulo, Brazil

P88 E-Health and Educational Social Network - Dramaturgy as a Motivating Resource to Approach Difficult Themes

Introduction: Teenagers are accustomed to interactive technologies, but are also usually defenseless against many sensitive situations because of the difficult access to proper orientation. This is a recurrent fact, once the huge geographic distances and the difficulties met by school teachers to talk about sensitive themes increase the ignorance and decrease the interaction in themes such as sexuality, contraceptive methods, teenage pregnancy, STD, being a HIV + , obesity, anorexia, among others. To reach different circles with the same quality and result, it is necessary to identify cultural archetypes to adequate the communication of scientific evidences.

Results: We have selected 13 themes of interest to the Brazilian government to be disseminated through a TV show, broadcast on Ministry of Education Channel. We developed scientific content for each theme, and a screenwriter journalist of the Communication Educational Design inserted this content into the screenplays, indicating the course of the plot. This work was certified by a responsible M.D.. A workshop with the cast took place to deepen the themes understanding, and to analyze the compatibility of the actors' profiles. Each episode consists of dramaturgy, Virtual Man Project with narration (human body in 3D), specialists' comments and a debate with real life characters and actors themselves to address doubts and discuss with specialist professionals. A structured network was created, with complementary texts, games, evaluations, 3D CG sequences and interactive infographics. The main objective was to encourage a behavior change in teenagers by the experimental learning process through the episodes.

Conclusions: It is possible to build a TV show interconnecting fictional episodes with scientific knowledge to instruct students about themes of difficult approach. The use of CG and interactive documentaries creates a reflection moment immediately after the audience's emotional awareness of the anguish experienced by the characters. The use of social networks to promote a continuous debate about different themes seems to be the most comprehensive way to share knowledge. All this material is interactive resources that can be widely used in smartphones, iPad and others, which enables an enforcement of m-health structure to consolidate the learning process.

Objectives

Discuss dramaturgy as a motivating resource to learn health themes.

Review E-health and the use of educational social networks.

Spiegel Joshua D. 1

Student Intern

Li Yaqin PhD 1 Karnowski Thomas P. 2 Morris Scott MD 3 Sparrow Elizabeth OD 3 Chaum Edward MD, PhD 1

1 University of Tennessee Health Science Center, Hamilton Eye Institute, Memphis, TN, USA 2 Oak Ridge National Laboratory, Oak Ridge, TN, USA 3 Church Health Center, Memphis, TN, USA P89 A One-Year Outcomes Assessment of Remote Diabetic Retinopathy Management using the Triad Ocular Telehealth Network

In this study we evaluated the efficacy of a remote, ocular telehealth network (TRIAD), which assists in the diagnosis and referral management of patients at risk for diabetic retinopathy (DR) at the Church Health Center (CHC), a primary care practice for the working uninsured in Memphis, Tennessee. A cohort of 526 patients receiving care for diabetes participated in the study. Retinal images were obtained at the CHC, but evaluated remotely at the Hamilton Eye Institute. We present the one-year outcomes assessment of the management and treatment of patients identified with retinal findings warranting further evaluation or referral. Of the 526 patients screened, 409 patients (77.8%) were diagnosed with minimal or no DR and continue to be followed remotely at the CHC. 117 patients (22.2%) were recommended for referral based upon retinal findings including macular edema and proliferative DR; however, more than half of patients (62) had non-diabetic retinal findings. Of 117 patients recommended for further evaluation, 26.5% were referred to a retina specialist, 38.5% were followed by an optometrist at the CHC, and 35% were initially lost to follow up. 27 of 31 patients scheduled to see a retina specialist, were examined. 13 patients (48.2%) had a procedure performed, 9 (33.3%) had their diagnosis confirmed (or lessened in severity) with no procedure, 2 (7.4%) had a confirmed diagnosis requiring treatment but no procedure documented, and 3 patients (11.1%) did not present for their appointment.

This study showed that most diabetic patients can be managed for DR remotely, within a primary care practice using telemedical reporting methods. However, even with “real time” assessment, patient compliance and referral efficacy are highly dependent upon the timeliness of the referral after imaging. To improve referral outcomes, we have implemented an automated reminder method at the clinic to track and confirm recommended patient referrals.

Objectives

Compare efficiency of remote DR management vs. “real time” management.

Discuss outcomes assessment of telemedical management.

Randall Deborah A. JD

Health Attorney and Telehealth Consultant

Law Office of Deborah Randall, Chevy Chase, MD, USA

P90 Legal and Policy Issues for Home Telehealth Evolving in 2011

Abstract Withdrawn

Cavallerano Jerry OD, PhD 1 2

Staff Optometrist

1 Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA 2 Harvard Medical School, Boston, MA, USA P91 Telehealth Practice Guidelines for Diabetic Retinopathy

Background: A multidisciplinary team revised the Guidelines for Ocular Telehealth for Diabetic Retinopathy (DR), originally published in 2004. The guideline aims are to (a) promote informed and reasonable patient, provider, healthcare facility, and payer expectations (b) address clinical, technical and administrative components of such programs, and (c) form the basis for evaluating DR telehealth programs.

Methods: Primary authors revised sections on clinical, technical, and operational components of the Guidelines. Revisions were reviewed by the full editorial committee in a series of teleconferences.

Discussion: Relatively minor changes were necessary for clinical recommendations but substantial updates were necessary for technical and administrative recommendations. Clinical Recommendations: Seven standard field, Early Treatment Diabetic Retinopathy Study (ETDRS) 35-millimeter stereoscopic images (standard photos) remain the accepted standard for validation. Four categories of validation are maintained. Validation is driven by outcome as measured against accepted standards rather than by a specific technology or configuration. Technical Recommendations: Technology considerations address image acquisition, compression, image analysis, data communication/transfer, display capabilities, archiving and retrieval, security, reliability and redundancy, and documentation. The requirements concerning national mandates for interoperability and health information exchange are also addressed. Operational/Business Recommendations : This section addresses program safety and effectiveness, ethics of doctor-patient relationship, jurisdictional and community standards, qualifications of imagers, readers, and supervisory personnel, system maintenance, data security, disaster recovery, licensure, privileging, credentialing, and quality assurance.

Conclusions: These revised recommendations aim to improve clinical outcomes, promote informed and reasonable patient expectations, address clinical and administrative issues, and form the basis for evaluating and selecting DR telehealth techniques and technologies.

Objectives

Present revised ATA guidelines for the clinical, technical and administrative components of telemedicine program form diabetic retinopathy.

Present the role of telemedicine in caring for diabetic retinopathy.

Trottier Steven MD

Critical Care Physician

Deibert Wendy RN Veremakis Christopher MD Diffenderfer Brian St. John's Mercy, St. Louis, MO, USA

P92 Telemedicine in the ICU: Real-Time Feedback Improves Ventilator Associated Pneumonia Bundle Program

Introduction: Ventilator associated pneumonia (VAP) is the second most common nosocomial infection sustained by critically ill or injured patients. A constellation of practices collectively called the VAP Bundle decreases the risk of VAP. Achieving clinical compliance with the VAP bundle has been suboptimal.

Hypothesis: To assess a healthcare system telemedicine process improvement program with real-time feedback on VAP bundle compliance and risk of VAP.

Methods: The study was performed in the setting of an established intensive care unit telemedicine program in a 10 hospital healthcare system. A VAP bundle initiative was developed to assess compliance with the five components of the VAP bundle: head of bed elevated ≥30 degrees, active sedation vacation, active ventilator weaning protocol, deep vein thrombosis prophylaxis, and gastrointestinal prophylaxis. The telemedicine evaluation of mechanically ventilated patients occurred every four hours followed by immediate feedback to the specific bedside care providers. The VAP bundle compliance was performed one month prior to and fifteen months following the initiation of the program. Compliance was defined as having all five components active in 90% of the observations. The VAP cases were diagnosed according to the Center of Disease Control and Prevention guidelines and were reported monthly.

Results: Over a sixteen month period month period, 112,240 clinical observations were recorded. The VAP bundle compliance prior to the program was 40.8% and following the program was 94.8% (p value < 0.01). Ninety percent compliance was reached at the tenth month. The incidence of collective VAP cases across the ten hospitals fell from 6.5 per month to 3.4 per month (p value 0.08).

Conclusion: Establishment of a VAP bundle process improvement telemedicine program with real-time feedback significantly improved the clinical compliance with the VAP bundle and trended towards lower rates of clinical VAP cases.

Objectives

Discuss establishment of a telemedicine quality improvement program.

Exhibit that VAP Bundle compliance improves outcome.

Hu John PhD

President, CEO and Co-founder

Edsinger Aaron PhD Lim Yi-Je PhD Donaldson Nick Solochek Aaron Hstar Technologies Corp., Cambridge, MA, USA

P93 Emerging Robotics Applications for Telemedicine and Patient Care: The Robotic Nursing Assistant

The day-to-day work of moving and lifting patients with impaired mobility strains the abilities of hospital and extended care staff. It is generally acknowledged that there is no safe method for manually lifting patients - and unsafe lifting accounts for widespread musculoskeletal injury among nurses and patient attendants. A robotic nursing assistant that can assume the burden of heavy lifting and patient manipulation, combined with the ability to enable telehealth service delivery anywhere in the hospital, would substantially improve the quality of care, patient safety, and reduce costs. Hstar Technologies, with SBIR grant support from TATRC, is developing a revolutionary robotic nursing assistant (RoNA) system that provides physical assistance to nurses in a hospital ward. The design of RoNA is a safe and robust system that works effectively in a hospital environment under direct and telepresence control by a nurse or physician. RoNA has a humanoid design featuring bimanual dexterous manipulators that employ a series-elastic-actuation (SEA) system. These electric actuators provide manipulator compliance, safety, flexibility and the strength to lift patients weighing up to 300lbs. RoNA also features an innovative humanoid upper torso, a unique mobile platform with holonomic drive and posture stability enhancement, intelligent navigation control with 3D sensing and perception capability, an intuitive and innovative human-robot interaction control interface, and a highly integrated plan for healthcare system assembly. A mobile telemedicine system, RoNA provides real-time audio and video communications with providers anywhere, combined with the ability to gently manipulate and interact with the patient. We anticipate that robotic nursing assistants will increase job satisfaction, reduce lifting-related injuries, and dramatically extend the ability of remote medical specialists to effectively examine and treat patients.

Objectives

Learn how emerging robotics technologies are being applied to practical nursing and telehealth challenges.

Learn how intelligent robotic functions - teleoperation, patient lifting and maneuvering, and mobile telecommunications - can extend the reach and impact of clinical experts to improve patient care.

Violette Michelle RN, BScN, MSc

Senior Telehealth Business Analyst

Healthanywhere, MIssissauga, ON, Canada

P94 Measurably Reducing Blood Pressure: Remote Health Monitoring with Mhealth

This oral presentation will focus on how Remote Health Monitoring technology measurably reduced the employee blood pressure. Remote Health Monitoring concentrates on self-monitoring and remote review of a single, or set of, health related indicators, such as blood pressure readings, insulin levels, weight, medication adherence and diet and exercise plans of individuals that want to maintain their independence regardless if they are at home, at work or on-the-go. An innovative employer aware of the effect of unhealthy lifestyle on employee health and productivity and ultimately, their business's bottom line, decided to pilot a research project focused on corporate wellness. This program has been shown to improve employee health, increase productivity, and decrease overall absenteeism. This ongoing research project of 50 participants used a Remote Health Monitoring technology to monitor their hypertension. The goals of this project were to show the positive effects of disease self-management on employee health and productivity resulting in lower employee healthcare costs, reduced absenteeism and reduced turn-over of employees. The participants regularly took their own blood pressure (2-4 times daily) with a device using Bluetooth technology and the results were sent to a web portal where the participants could self-manage their health. Through the web portal the participants were able to create alerts that were triggered when their blood pressure was out of a set range sending a message back to their smartphone and suggesting follow up care and advice. The proven benefits of self-management of their blood pressure were reduced absenteeism, lower healthcare costs and of course improved employee health. Remote Health Monitoring technology measurably reduced the employee blood pressure and increased their awareness of their disease resulting in greater accountability of their overall health. The primary goal of this corporate wellness program was improved employee health and productivity (not just to save money).

Objectives

Review the use of Remote Health Monitoring in Corporate Wellness.

Demonstrate how mHealth technology measurably reduced employee blood pressure.

Nelson Eve-Lynn PhD 1

Associate Director

Rojjanasrirat Wilaiporn PhD, RNC, RN 2 Wambach Karen PhD, RN 1 Busch Terry RN, MSN, IBCLC 1 Borgdstadt Debbie BSN, LPN, IBCLC 1 Kung Tzu-Yu RN, MSN, ARNP 1 Neely Melanie RN, BSN 1

1 University of Kansas Medical Center, Kansas City, KS, USA 2 Graceland University, Independence, MO, USA P95 Feasibility of In-Home Telehealth Lactation Consultation

Background: Increasing breastfeeding initiation and duration rates is recognized as a national health priority (Healthy People 2010). Despite extensive evidence supporting the health benefits of breastfeeding, there are gaps in access to lactation consultants as well as challenges for new mothers to travel with infants. This is the first U.S. study to our knowledge to assess reliability and feasibility of in-home videoconferencing for lactation consultation.

Method: The descriptive study design included a convenient sample of 10 mother-baby dyads. Mothers were a diverse group, with mean age of 28.8 years, approximately 85% were married, 54% were Caucasian, 85% delivered vaginally, and the majority had household income below $40,000. The presentation will focus on findings from the Interactive Home Telehealth Satisfaction questionnaire, adapted from the American Telemedicine Association Care Toolkit. Data collections also included reliability evaluation using the LATCH (Jensen et al., 1994).

Results: All mothers rated “strongly agree” that they were comfortable talking about breastfeeding concerns and all reported that it was helpful to get answers to their health questions via the telehealth equipment. Most (7/10) reported that talking to the lactation consultant over the telehealth equipment was just like talking to them in person, and most (6/10) reported that the telehealth equipment was easy to use. The presenters will also summarize ongoing qualitative evaluation from both the mothers and the lactation consultants, particularly concerning confidence in the confidentiality with the point-to-point videoconferencing set-up. Reliability results will be summarized.

Conclusion: The study demonstrated that in-home telehealth support for lactation was acceptable and feasible. The telehealth approach allows lactation consultants not only identify breastfeeding problems, but also to evaluate breastfeeding information needs. The lessons learned can be applied as newer technologies expand lactation consultation reach across urban and rural underserved communities.

Objectives

To describe feasibility and implementation steps for in-home telehealth lactation consultation.

To describe mother and lactation consultant satisfaction with breastfeeding support using in-home videoconferencing technology.

McIlhenny Carol V. RN, BSN 1

Telehealth Research Specialist

Montecalvo Leigh RN, MSN 1 Guzic Brenda L. BSW, RN, MA 1 Knee Dawna R. BS 1 Hayden James MD 2 Bapat Ashok PhD, MBA 1 Demuth Barbara R. RN, MSN 1 Roberts Jay B. MA 1

1 Saint Francis University, Loretto, PA, USA 2 Broad Top Area Medical Center, Broad Top City, PA, USA P96 Providing a Sustainable Model of Patient Education through Information Technology

The delivery of quality, specialty healthcare services to rural populations can be a challenging process. Rural health clinics lack the financial resources to provide commercially available patient education materials. These clinics rely on pamphlets from pharmaceutical companies to give their patients health information. The information contained in these handouts may be biased or become outdated before the last pamphlet is used. A wealth of current, evidence-based information is available through Internet sources but this is often difficult for individuals to locate. Using the latest technologies, information availability can be improved for healthcare providers and the general public, thus assisting them to lead a healthier lifestyle. CERMUSA designed a telehealth wellness education model for the residents of Central Pennsylvania to address the ongoing challenge of providing all patients with access to high quality, current, evidence-based health education. Telehealth and telemedicine applications, when used to improve access to health education and healthcare providers in rural and medically underserved areas, can promote improved patient health and wellness. Two rural health clinics recruited 100 patients and used an Internet portal to deliver health information to their patients. The intervention group, who also received face-to-face wellness education, was utilized to determine the impact of telehealth wellness education interventions compared to conventional patient education methods. The research focused on patients with Type II Diabetes and Congestive Heart Failure and measured perceived quality of life indicators, health literacy, disease knowledge, behavior modification and satisfaction scores. The researchers also recorded clinical markers such as Blood Pressure, Body Mass Index and Hemoglobin A1C. Data analysis will determine whether there are statistically significant changes from baseline scores as a result of the education model as well as between the intervention and control groups.

Objectives

Identify changes in clinical outcomes based on educational activities.

Identify changes in patient self-management behavior as a result of educational activities.

Guzic Brenda L. ADN, BSW, MA, RN

Telehealth Research Specialist

Saint Francis University, Loretto, PA, USA

P97 Distance Learning and High-Fidelity Medical Simulation in a Baccalaureate Nursing Program

Introduction: It is critical for medical professionals to have access to quality training to meet patient needs and avoid adverse events. High-fidelity medical simulators allow trainees to practice medical interventions and prepare them to deliver high quality healthcare. Healthcare trainees in remote locations only benefit from this technology if they are connected to a simulator operator. There are few simulator operators in remote locations, preventing simulators from being optimally utilized. The current study evaluates using distance education and medical simulation via point-to-point video teleconferencing (P2PVTC) to connect simulator operators with distant trainees.

Methods: Participants (n = 7) were senior-level university nursing students. Didactic material on cardiovascular disease and diabetes mellitus was delivered to participants via an online course management system (CMS). Medical simulation at-a-distance was carried out using a Laerdal SimMan® via P2PVTC and remote desktop control (RDC). Data were collected via CMS and included healthcare knowledge gained (via pre- and post-test scores) and measures of participant satisfaction (via Likert scale).

Results: No significant (P > 0.05) increase in test scores was observed for the cardiac learning module. A test score increase of 5.83% (P = 0.084) was observed for the diabetes mellitus learning module. [1] Participants evaluated the course favorably (P < 0.05) with the exception of their satisfaction with precourse materials (P = 0.086). On a Likert scale of one (very low) to 10 (very high), six of the seven students (87%) rated their workshop experience as “very high”.

Conclusions: It is feasible to combine distance learning with high-fidelity medical simulation at-a-distance. Clinical skills of participants improved and participants acknowledged the value of simulation. Low sample size prevented generalizability of results.

Key Words: medical simulation, distance learning, nursing education [1] Intuitive Biostatistics: Interpreting Nonsignificant P values. Retrieved June 21, 2010 from http://graphpad.com/www/book/Interpret.htm

Objectives

Discuss the feasibility of combining distance learning with high-fidelity medical simulation at-a-distance.

How to integrate medical simulation into populations who have limited or no access to this form of instruction.

Brennan David MBE

Senior Research Engineer

National Rehabilitation Hospital, Washington, DC, USA

P98 User-Centered Design for Evaluating Telerehabilitation user Needs and Clinician-Patient Interaction

Telehealth refers to the utilization of information and communication technologies for providing and facilitating medical diagnosis, treatment, and patient care. A key indicator of success of a telehealth application is user acceptance of the underlying technologies that support it. If patients and/or clinicians are not comfortable with a technology or it does not meet their needs, satisfaction and rates of utilization will fall. In the area of medical rehabilitation, where treatment interventions are typically delivered at a high frequency and over a long duration, telehealth has potential to greatly improve access to care, address a shortage of clinicians, and address decreases in the length of stay for patients with disabling conditions. However, in order for interactive systems such as those used in telerehabilitation to be successful, it is imperative that designers have a keen understanding of telerehabilitation users, the activities they perform, and the environment in which they work. This poster will present results from a study designed to gain insight into the needs and preferences of rehabilitation clinicians and the ways in which they interact with patients. A series of working group discussion sessions were held with a cross-section of inpatient and outpatient staff from Occupational Therapy, Physical Therapy, Speech Language Pathology, Neuropsychology, Social Work, and Vocational Rehab services at the National Rehabilitation Hospital (Washington, DC). Participants received an introductory presentation on telerehabilitation followed by an open question-and -answer forum, to orient them to the topic and describe basic concepts. A questionnaire was administered to collect information on patient caseload, clinician-patient interaction, prior telerehab or videoconferencing experience, and reactions to examples of the use of different technologies during remote telerehabilitation patient encounters. Results from this study provide a valuable snapshot of clinicians' perspective on telerehabilitation and offer recommendations for future telerehabilitation research and design projects.

Objectives

Learn how user-centered design techniques can be applied to gain greater insight into the eventual end-users of a telehealth system.

Learn how clinicians viewed different aspects videoconferencing and remote patient interaction in terms of their perceived usefulness and viability as methods of delivering remote rehabilitation interventions.

Wang Mingyu PhD 1

Research Institute of Information Technology

Yang Jijiang PhD 1 Gao Q. PhD 2

1 Tsinghua University, Beijing, China 2 IVT, Beijing, China P99 An Mhealth Based Personalized Drug Taking Advisor System for a Large Population

With advance of mobile health (mhealth) technology, we now can collect ECG, blood pressure, blood glucose for a large population. We developed a system based on IVT's mHealth system which can track the historical data of each person's blood pressure and blood glucose, analyze the pharmacological property of the drugs each person is taking, then give each person an advice when it is the best time to take the drugs, and send the reminder via short messages.

Objectives

Discuss a personalized drug taking advisor system.

Review how telemedicine can help on drug usages.

Huang Hong

Assistant Professor

University of South Florida, Tampa, FL, USA

P100 Reusing Genome Wide Association Data in EMR For Clinical Decision Support Improvement

The development of Electronic Medical Record (EMR) system has made a dramatic change in data entry and office workflow for clinical practice. It also keeps on aggregating new patient related data that benefits clinical research and healthcare improvement. With the availability of the rapid and cheap genetic testing techniques, the massive genomic information as well as their extensive usage by researchers, patients, and clinical doctors is opening up a wide variety of medical applications. Over six hundred genome wide association studies have been reported in the literature. These data provided a comprehensive collection for analyzing different individuals' genetic variations and associations. Public available “de-identified” individual genetic data from genome wide association study can be reused and aggregated into an EMR system. Utilization and integration of these data in EMR eventually could trigger various electronic clinical applications on the fly. Genome wide association study data including type 2 diabetes and coronary heart disease were collected for this study. Hundreds of clinical measures related to diagnoses, lab values, and medications were identified via extracting or mapping the imported genome wide association data within the EMR system. The analysis of statistical associations between these clinical measures and disease genotypes prioritize the best clinical practice protocols for helping patients. Recent findings from genome wide association study indicated that different diseases might share with a consensus list of genetic markers or loci referring to multiple interactive molecular pathways for certain diseases. Twenty drug related biomarkers, interfering with the disease molecular pathways in several diseases, provide clinical decision support in clinical response and differentiation, risk identification, as well as dose selection guidance. These drug-related markers could link EMR medication with individual's genotypes. These are computationally important tasks in EMR that identify clinical reclassified risk, possible drug-drug interactions, and dosage recommendations.

Objectives

Describe the benefits of GWA data in clinical decision support.

Demonstrate the utility of GWA capabilities in EMR.

Taleb Alexandre C. MD, PhD

Medical School

Adán Consuelo B D MD, PhD 2 Ricur Giselle MD 3

1 Federal University of Goias, Goiania, GO, Brazil 2 Federal University of Sao Paulo, Sao Paulo, SP, Brazil 3 Instituto Zaldivar, Mendoza, Argentina P101 Ophthalmology Clinical Grand Rounds Across the Borders

This presentation reports the experience of the Ophthalmology Special Interest Group (SIG) from RUTE (Rede Universitária de Telemedicina - Brazilian Telemedicine Universities Network). RUTE is a countrywide network that connects 54 University Hospitals and Regional Hospitals in all 27 States of Brazil to provide through videoconference. There are 36 SIGs on RUTE network, two of them are internationals (ophthalmology and dermatology). The RUTE's Ophthalmology SIG connects 13 Hospitals, 12 in Brazil, comprising all geographical regions and 1 hospital in Argentina. A central multicast unit that can hold up to 64 participants at once hosts all meetings. There are monthly meetings, each month sponsored by one of the participating institutions, which is responsible for presenting 2 or 3 clinical cases that are broadly discussed on line. The Ophthalmology SIG started in January 2009 with 5 University Hospitals, growing constantly ever since. A pre-programmed schedule comprises all subspecialties in ophthalmology (cornea, cataract, retina and vitreous, uveitis, neurophthalmology, strabismus, pediatrics, glaucoma, orbit, ocular plastic surgery). This tool allowed for the sharing of information and multimedia presentations, facilitating knowledge transfer, building consensus and enhancing mutual collaboration between institutions in a confidential and secure manner. There are ongoing talks to create a Latin American Ocular SIG on RUTE's network, comprising at least one Institution from each Latin American Country.

Objectives

Understand how tele-education can improve knowledge to medical residents.

Get to know an international multisite teleducation project for University Hospitals.

Kuhle Jennifer L.

Research Assistant

Dalmau Yaniz C. Padilla Wacker David P. Lindgren Scott D. Kopelman Todd Lee John F. University of Iowa, Iowa City, IA, USA

P102 Behavioral Assessments for Children with Autism through Telehealth

We compared outcomes of functional analyses (FA) conducted in home settings and through telehealth to evaluate the effectiveness of telehealth practices in delivering functional analyses, a type of Applied Behavior Analytic (ABA) procedure, to young children with autism spectrum disorders (ASD). Participants included 7 children with ASD receiving in-home behavioral assessment and 9 children with ASD receiving behavioral assessment via telehealth. Participants were between 2 and 6 years old and displayed problem behavior (e.g., aggression, property destruction, screaming). The functional analyses were completed within a multielement design to evaluate the environmental variables that maintained problem behavior. Each functional analysis included demand, attention, and tangible test conditions and free play as a control condition. Problem behavior resulted in 20-30 seconds of reinforcement during test conditions. In the in-home project, the functional analysis was conducted in the child's home by the child's parent with coaching from a behavioral specialist. In the telehealth project, the functional analysis was conducted at a regional Child Health Specialty Clinic (CHSC) by the child's parent with support from an onsite trained parent coach and coaching from a behavioral specialist via telehealth. Inter-rater agreement was assessed across 30% of the sessions and averaged over 90%. Mean number of FA sessions necessary to complete the FA was 14 for the in-home group and 20 for the telehealth group. Mean number of in-home visits from a behavioral specialist before completing the FA was 4 and mean number of visits to the CHSC from the participants was 5. A behavioral function was identified for 71% of the in-home participants and 89% of the telehealth participants. Preliminary data suggest that telehealth practices are effective in conducting behavioral assessments with children with autism spectrum disorders.

Objectives

Telehealth is an effective and efficient way to conduct behavioral assessments with young children who have an autism spectrum disorder.

The outcomes of functional analyses, an Applied Behavior Analytic procedure, conducted via telehealth are comparable to those conducted in-home.

Cullum Munro PhD 1

Professor of Psychiatry and Neurology

Grosch Maria C. 1 Hynan Linda S. PhD 1 Graham Lara L. 1 Parikh Mili R. 1 Shore Jay MD 2 Weiner Myron F. MD 1

1 University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA 2 University of Colorado Denver, Denver, CO, USA P103 Remote Assessment of Memory in Rural American Indians VIA Videoconference

Videoconference (VC)-based assessment of cognitive functioning has shown evidence of feasibility and reliability, although little is known about the psychometric properties of standardized memory tests administered using this medium across long distances.

Background: This study was designed to compare traditional face-to-face versus videoconference-based verbal memory testing among rural American Indians. It was hypothesized that VC- and face-to-face testing conditions would produce highly similar results.

Method: Sixty-two American Indian subjects (46 controls and 16 with dementia) ranging in age from 50 to 85 were tested on alternate versions of the Hopkins Verbal Learning Test-Revised, a popular clinical measure of verbal learning and memory. Test forms and test conditions were counterbalanced across subjects. Intraclass correlations (ICC) were calculated and mean scores were examined between test conditions.

Results: Scores from all three learning trials (ICC's = 0.56, 0.48, & 0.70), total words learned (ICC = 0.80), delayed recall (ICC = 0.72), and percent retention (ICC = 0.53) indices were all significantly correlated at the p < .001 level, although mean verbal learning and memory scores were slightly higher in the VC condition overall.

Summary: Remote assessment of verbal memory using VC technology produces results similar to traditional face-to-face testing in rural American Indians. These findings have implications for clinical as well as multisite research studies of cognitive functioning in rural populations.

Objectives

Discuss the use of clinical memory assessment in telemedicine environment.

Demonstrate application of videoconference-based memory assessment in American Indians.

Taleb Alexandre C. MD, PhD

Medical School

Queiroz Gustavo MD Avila Marcos P. MD, PhD Federal University of Goias, Goiania, GO, Brazil

P104 Telessaude GOIAS (Go Telehealth)

GO Telehealth is part of Brazilian Telehealth Program, designed to improve quality of care by Primary Care Teams from all over Brazil. It started January 2007 and serves cities that hold 4,6 million inhabitants (80,45% of the State). Eighty nine cities in the State of Goias (CenterWest region of Brazil) are served by GO Telehealth. There are 154 Primary Care Centers (Family Health Units) that comprise 542 Family Healthcare Teams (FHCTs) (General Practitioner, Nurse, Dentist, Community Care Agents). There are, overall, 2476 health workers connected to GO Telehealth. GO Telehealth offers tele-education (webconferences on selected themes demanded by FHCTs both live (with interaction) and on demand (lectures library). Teleassistance is also offered (second opinion, tele-EKG, visual threatening diseases screening). Data collected on August, 2010, shows that over 780 medical second opinions were performed, as well as 4,734 teleEKGs and 218 lectures were provided. There are more than 31,000 online library searches per month and the overall satisfaction of user is considered excellent. The model of implementation and the services offered are discussed as well as the limitations and difficulties faced so far. Strategies and lessons learned are presented.

Objectives

Understand Telessaude Goias Project and its goals.

Get to know how GO Telehealth is changing Small Communities' Primary Care in the State of Goias, Brazil.

Akematsu Yuji

Research Fellow

Minetaki Kazunori Tsuji Masatsugu University of Hyogo, Kobe, Hyogo, Japan

P105 Effectiveness of Telemedicine System to Medical Expenditures of Heart Disease Patients

Introduction: This article analyzes the effect of a telemedicine (tele-monitoring) system, which monitors health data of senior people at home, on medical expenditures in Nishi-aizu Town, Fukushima Prefecture, Japan, based on the medical expenditures of about 400 residents over five years. In particular, we focus on the patients with heart disease, because it is related to lifestyle-related diseases and their shares in the total Japanese medical expenditures is large. It is urgent to reduce its medical expenditures and other lifestyle-related illness. This paper analyzes how telemedicine reduces medical expenditures of patients with heart disease.

Methodology: We divide residents into two groups, users and non-users of telemedicine. Comparing medical expenditures of two groups, we use panel data analysis. However, patient with heart disease usually tend to have other lifestyle-related diseases, and this causes the endogenous problem of explanatory variables. Panel fixed and random effect models cannot solve the endogenous problem. Besides, tele-monitoring requires time: a lag exists for the system to be in effect. Regarding these issues, system GMM (Generalized Method of Moments) is applied to treat endogenous problem and also dynamic aspects of variables.

Result: Although ordinary panel data analysis such as fixed and random effect estimations do not indicate the significant effect on medical expenditures of telemedicine users comparing with non-users, system GMM estimation shows that medical expenditures of users are significantly lower than those of non-users by US$674.00 per year (per user).

Discussion: The estimation without considering endogeneity provided tele-medicine in this town does not effect to users with heart disease, while system GMM proves that telemedicine actually reduces medical expenditures of its users. This provides economic foundations telemedicine. The paper also analyzes success factor and obstacles of telemedicine in Nishi-aizu Town, which contributes other regions to start implementing telemedicine for practical purpose. Endogeneity problem is important in Health Economics, and empirical analyses must take this into consideration.

Objectives

Review the empirical analysis of a telemedicine system in Nishi-aizu.

Evaluate telemedicine and its effect medical expenditures.

Tsuji Masatsugu PhD

Professor

Minetaki Kazunori MA -Akematsu Yuji PhD University of Hyogo, Kobe, Japan

P106 Empirical Study of Emergency Medical Services for ACS Patients and Implications for Telemedicine

Introduction: Ventricular disease is one of the three major causes of death worldwide and is the second after malignant neoplasm in Japan. In ischemic heart disease, in particular, including acute myocardial infarction, initial treatment is extremely important and affects recuperation of patients and QoL after leaving the hospital. This article uses DPC (Diagnosis Procedure Combination) data and analyzes the effect of the combined required time such as staying in the emergency room (ER), confirmation of diagnosis, door-to-needle time and door-to-balloon time on the recuperation of acute coronary syndrome (ACS).

Methodology: The sample includes 110 patients with ACS at “S” Hospital in Kurume City, Fukuoka Prefecture, Japan, from April 2007 to October 2008. In estimation, outcomes of patients such as leaving the hospital (1) healthy, (2) transferred to another hospital, and (3) dead are taken as dependent variables. The following required times are included as independent variables: length of time in the ER; time required for diagnosis confirmation; door-to-needle time; and door-to-balloon time. This paper uses an ordered probit model and treatment effect model. In particular, the latter deals with the endogeneity problem.

Result: The results of two models demonstrate that a reduction in the above four required times affects significantly the recuperation of patients. The estimation result also shows that the confirmation of diagnosis time is affected by ACS diagnosis procedure at other hospitals, the first medical staff member to diagnose the patient, and differences in combinations of medical staff.

Discussion: The American Heart Association (AHA) recommends that door-to-balloon time be shortened by half an hour. However, our results prove that other required times are also important. Besides, the confirmation of diagnosis time is affected by ACS diagnosis procedure at other hospitals, suggesting that sharing patients' information among hospitals and ambulances is effective. The paper thus discusses these networks, in particular, a mobile network such as e-ambulance.

Objectives

Review the empirical analysis of emergency medical services for ACS patients and telemedicine.

Evaluate ACS treatments.

Purdy Brendan P. BN MN(C)

Telehealth Coordinator

Smith Adam University Health Network, Toronto, ON, Canada

P107 An Assessment of Videoconferencing Units’ Energy Consumption and Restart Properties

Introduction: Computerized appliances (e.g. printers) following a period of inactivity may automatically enter “Standby-Mode”, which reduces energy consumption whilst allowing quick restarting. “Standby-Mode” represents 10% - 25% of healthcare's electricity requirements. This paper outlines a “Standby-Mode” energy assessment method for videoconferencing units (VCUs).

Objectives: Telemedicine practitioners from a Canadian academic health sciences center sought to measure two VCUs' power-consumption, start-up times and associated costs. Mobile and desktop VCUs were selected for comparative purposes.

Methods: (1) Mobile: Tandberg 880 MXP Codec, Westinghouse 32” LCD monitor and (2) Desktop: Tandberg 1700 MXP (Integrated 20" widescreen LCD) A ‘Watts-Up Pro Meter’ measured VCUs' energy consumption in both “Active” and “Standby” modes for an hour. Mean “Start-up” times for VCUs were measured using ‘Online-Stopwatch.com’.

Results/Findings: A notable difference was measured between the Mobile 32” and Desktop 20” VCUs' energy consumption during “Active” videoconferencing (149.7 and 85.3 kWh respectively). Conversely, power consumptions during “Standby-Mode” were 25.7 and 31.0 kWh respectively. Start-up times for VCUs from “Standby-Mode” and “Disconnection” were minimal (<1 minute) and comparable. Whilst, these findings suggest that smaller monitors reduce energy consumption during videoconferencing, the larger monitor was more energy efficient in “Standby-Mode”. This suggests that frequency of usage (idle/active time) be considered when procuring VCUs. Based on 2,000 annual operational hours, standby-mode energy demand constitutes at least 37% of total energy consumed. Minimum annual savings from unplugging mobile and desktop VCUs outside business hours were $12.34 and $14.88 respectively ($0.075 kWh). A timed power supply could disconnect devices automatically. Additionally, Telemedicine programs may replace energy inefficient VCUs components (e.g. AC/DC adapter).

Conclusions: This study demonstrates that Telemedicine programs should take VCUs' energy consumption into consideration during device procurement, maintenance, and studio design; in order to ensure sustainable “Green” practices. Broad implications for healthcare costs will be discussed. Next steps will be proposed.

Objectives

Awareness of videoconferencing units' power consumption in three operational modes.

Understand changes required to reduce “Standby” energy consumption in Telemedicine and across healthcare.

Marin Dylan R. BSc

Research Student

Mohan Permanand BSc , MSc, PhD University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago

P108 Personalized Holistic Mobile Diabetes Management System

Diabetes is a highly prevalent lifestyle disease that requires continuing medical care and education to prevent longer-term complications and imposes a high burden for individuals and society. The goal of the system is to create a holistic personalized approach to diabetes self management via the medium of mobile telephony. The system would incorporate the various forms of Diabetes as defined by the National Diabetes Data Group: Diabetes Mellitus, Gestational Diabetes and Impaired Glucose Tolerance (Prediabetes). This comprehensive Diabetes management system would encompass the management of the patient's blood pressure, blood glucose, nutrition, physical activity, medication and feet. The system would personalize information presented to patients based on the patient's profile and goals of their medical treatment process. The user interface consists of a Diabetes Dashboard which is presented to each patient on their mobile phone. The Dashboard would present to the patient the patient's current medical condition, ongoing prognosis and tailored information based on the patient's unique characteristics. The Dashboard presents a set of indicators to the patient which relate timely information of the patient's current medical status. Rule based inferences would be utilized in creating the recommendations based on the current attributes of the patients and the same mechanism would be used in the personalization of the display and layout of the Dashboard. This system would serve to reduce the risk of diabetes complications and improving the quality of life by allowing for intensive monitoring of blood glucose levels, treatment optimization and continuous medical care. The Patient should be allowed to have the same level (or even improved) of healthcare while continuing a normal active life instead of being stranded at the hospital. This system adds to existing mobile Diabetes management systems by incorporating a holistic management approach and the ideology of personalization. Personalization is an important aspect since the threshold levels and treatment goals vary for each patient and would serve to promote trust and compliance to health advice, enhance the effectiveness of the system and provide greater potential to engage and encourage individuals toward behavior change rather than general information.

Objectives

Demonstrate holistic management of patients with diabetes via the use of mobile devices.

Examine personalization within the realm of mobile health.

Lee Kang Hyun

Director

Kim Yun Kwon Kim Hyun Hwang Sung Oh Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea

P109 The Application of Telemedicine in Geriatric Emergency Medical Services

Objective: To evaluation of the application of using the telemetry system in geriatric emergency medical services.

Methods: From January 2009 to December 2009, 212 geriatric telemetry using patients among 644 patients enrolled to this study. The patient's data was transferred from ambulances to emergency medical centers via emergency medical information center (EMIC). The patient's data were 3 lead ECG, BP, pulse oxymetry, respiration rate and body temperature. We compared the rate of medical control, contents of medical control and mortality in geriatric patients who used the telemedicine (group 1) and used telemetry in non-geriatrics (group 2).

Results: Among the 18,705 ambulance using patients, the telemedicine was used in 644 patients (3.4%) when transporting from an ambulance to a hospital. Among 644 patients who used telemetry system, 212 (32.9%) geriatric patients were taken telemetry system during ambulance transportation. The rate of medical control was higher in group 1 than that of group 2 (32.2% vs 11.3%, p = 0.001). The contents of medical control by using telemetry in prehospital emergency medical services were advising the medical treatment (94.0%), ambulance diversion (5.2%). The mortality in group 1 was higher than that of group 2 (5.4% vs 0.3%, p = 0.003).

Conclusions: In the application of using the telemetry system in geriatric emergency medical services, the need of medical control and mortality were higher in geriatrics group than that of non-geriatrics.

Objectives

To review the application of using the telemetry system in geriatric emergency medical services.

To evaluate a telemetry system in geriatric emergency medical services.

Yager Phoebe H. MD

Director, PICU Telemedicine Program; Associate Program Director, PCCM Fellowship

Cummings Brian MD Whalen Michael MD Noviski Natan MD Massachusetts General Hospital, Boston, MA, USA

P110 Pediatric Medical Simulation Training for Community Hospitals VIA Telemedicine

Introduction: Case-based medical simulation has been used to teach medical knowledge and crisis resource management skills to hospital personnel who manage critical events in real time. Effective teaching requires a facilitator with the medical background and teaching skills to create and run realistic scenarios and provide debriefing that promotes self- and team-reflection, and analysis and synthesis of information to improve performance. Care teams at community hospitals challenged with the initial stabilization of critically ill pediatric patients may feel under-prepared especially when pediatric medical crises are relatively rare. Using medical simulation training coupled with telemedicine to connect our pediatric intensive care unit (PICU) to three community hospitals (distances of 13, 100 and 1670 miles), we provided in situ, simulation-based teaching in pediatric emergency management. A PICU attending trained in medical simulation telecommuted to the remote hospital to facilitate the case scenario and debrief the participants.

Results: Feedback from a recent teaching session attended by twenty-three community providers was positive. Eighty-seven percent of responders to a satisfaction survey rated the educational utility as ‘very useful.’ One-hundred percent said they would be interested in participating in future training via telemedicine. Participants commented that future pediatric simulation educational training would “make people feel more confident in different situations,” “increase confidence when providing care and reduce anxiety,” and “improve [care] by training the team and making sure equipment is adequate and up to date.”

Conclusion: In-situ, simulation-based team training via telemedicine offers providers in community hospitals a unique opportunity to rehearse for rare pediatric emergencies. Direct feedback from physicians trained in pediatric critical care medicine and in medical simulation reinforces the learning process. Medical simulation has enormous potential toimprove quality of care in management of pediatric emergencies world-wide.

Objectives

To describe a novel use of telemedicine to provide in-situ, simulation-based team training to providers in community hospitals.

Medical simulation training facilitated by experts via telemedicine has the potential to improve quality of care in management of pediatric emergencies world-wide.

King-Smillie Melody RN, BScN 1

Regional Manager

Widmeyer Connie RN, BScN, CPMHN(C) 2 Hood Leah RN, BScN 2

1 Ontario Telemedicine Network, London, ON, Canada 2 Grey Bruce Health Services, Owen Sound, ON, Canada P111 The Development of a Rural Telecrisis Program

Rural healthcare providers face a variety of challenges in providing health services to their communities, the most immediate being transportation and the shortage of human resources. In the current Ontario healthcare environment, fiscal constraint has served to reinforce the urgency to consider innovative alternatives to service delivery. Telemedicine technology provides an opportunity to deliver quality healthcare to patients both efficiently and effectively. It has further afforded the opportunity to broaden access to emergency care for those living with mental health issues without leaving their home communities and support systems. The Telecrisis Program of Grey Bruce Health Services, has enabled clients to access the regional mental health crisis team for crisis consultations from their local hospital's emergency room, rather than traveling to a designated psychiatric facility for assessment. ER physicians can use telemedicine to access the Crisis Team for assistance in determining whether a client meets legislated criteria for involuntary admission to hospital. If admission is not required, follow-up is arranged at the time of the initial telemedicine consultation in their community. In partnership with the Ontario Telemedicine Network (OTN), the crisis team developed a pilot project that utilized a multi-pronged approach to crisis mental health assessment and treatment. It included a needs assessment of 10 rural community hospitals affiliated with the designated psychiatric facility in the catchment area, a written invitation to those hospitals to join the project, face-to-face meetings with potential partners and complimentary provision of telemedicine equipment assessment and training from OTN. A key component was the development of the clinical telemedicine protocol and patient handouts. The Telecrisis Program has successfully expanded from four to eight community hospitals as well as primary health practices. Lessons learned from this regional crisis team are being shared with others across the province.

Objectives

Steps to consider for implementing a rural telemedicine mental health crisis program.

Lessons learned from implementing a rural telemedicine mental health crisis program.

Devasigamani Raj MS, MBA

Doctorate Student

Tamil Lakshman S. PhD University of Texas at Dallas, Dallas, TX, USA

P112 On Developing Successful Business Models to Deploy Telemedicine Solutions for Diverse Demographics

The opportunities and challenges in establishing Telehealth enabled medical services that span across multiple industries such as medical services, secure and reliable broadband access, high definition video communications, appropriate medical devices and applications. This presentation addresses each of these verticals so that small to medium medical service providers can easily adopt a model that best suit their current needs and is flexible enough to be enhanced to meet their future needs. Examples of the models built for different customers by the University of Texas, Quality of Life laboratory is presented to highlight each critical component required to implement a successful and compliant service model that will be embraced by providers, payers and patients. The presentation is substantiated with detailed financial analysis to demonstrate viable and sustainable service models that can be implemented quickly with the least amount of interruptions to the providers' existing schedule. The presentation also discusses Telehealth enabled medical service models best practices and the associated components required for compliance of the HITECH Act. Telemedicine industry is poised to take off in a big way in transforming the way healthcare will be delivered, akin to the transformation to online banking in the 90's with understandably significant challenges. Understanding what these challenges are, is critical to overcome them, and for the successful implementation of an effective and efficient solution. Results of studies of various demographics such as provider and patient ages in rural central Texas and urban Dallas metropolis provide ample data to analyze and discuss the trends for widespread deployment of telemedicine services. A summary assessment of the ecosystem comprising of patients, providers, networks, applications, devices and the regulations associated with the telemedicine solutions shall facilitate in faster adoption of telemedicine services to enhance people's life style.

Objectives

Provide a Financial analysis that demonstrates viable and sustainable service models that can be implemented quickly.

Answer real questions about efficacy, costs, security, privacy, ethics, risk management and return on investment for diverse demographics.

Grady Brian MD

Director TeleMental Health

University of Maryland, Baltimore, MD, USA

P113 Contractual Versus Fee for Service Telepsychiatry Reimbursement in Maryland

Outpatient Mental Health Fee for Service reimbursement in Maryland has had limited support by psychiatrists. Fee for service arrangements require mental health providers or their organizations to assume the majority of financial risks, mainly missed opportunity costs. Following the initial introduction and success of the State and Federally funded pilot telepsychiatry projects beginning in 2005, some rural counties in Maryland have been engaging in contractual telepsychiatry contracts. The University of Maryland department of psychiatry has entered in several telepsychiatry contracts. One contract is the result of a federal grant where the State pays University psychiatrists a flat hourly rate whether or not patients appear for appointments; the originating site is not fiscally responsible for any part of the professional fee. Two other hourly rate telepsychiatry contracts are with originating sites directly; the originating site pays the entire professional fee. This presentation will provide appointment data and compare the show rate for originating sites responsible for telepsychiatry payments to those that are paid for as part of a grant. Secondly based on data from these contracts, a fee for service rate, adequate to meet the local salaries is estimated. How the estimated rate compares to the current Maryland Public Mental Health System Telepsychiatry rates, authorized September 6, 2010 will be offered.

Objectives

How the nature of reimbursement may affect patient show rates?

Can a fee for service based telepsychiatry reimbursement work in Maryland?

Roehrich Rikki MS Center for Health and Technology UC Davis Health System, Sacramento, CA, USA

P114 Telemedicine in the Media: Attribute Agenda Setting in California's Print News

Despite the increasing use of telemedicine as a means to administer treatment to patients, many individuals remain unfamiliar with the term and rely on media coverage as their first exposure to the concept of telemedicine. In order to better understand how telemedicine is depicted in the media, this study investigates California newspaper articles from a two year time period to identify the substantive and affective attributes that comprise print media coverage of telemedicine. Attribute agenda setting is an extension of classical media agenda setting theory that focuses on how aspects of a particular topic are covered. Articles were identified by searching California NewsBank using the search terms ‘telemedicine’, ‘telehealth’, ‘e-health’, and ‘ehealth’. Eleven articles-published between November 7, 2004 and November 7, 2006-were selected for analysis. From these, a total of 206 descriptions were identified and a qualitative content analysis was conducted in order to determine the major attribute categories for descriptions of telemedicine. Seven categories were revealed, including descriptions of: the technologies used for telemedicine, the ability to provide access to medical services, details of implementation, the quality of medical care, financial aspects, the convenience of using telemedicine, and other descriptions. Of these, over half of the descriptions focused on the technology or access attributes of telemedicine. All descriptions were also quantitatively coded for the level of affect. A Chi square analysis revealed that while descriptions were predominantly positive across all of the articles, urban-based news sources tended to discuss telemedicine in a more positive tone than rural-based sources. Through the emphasis of the access and technology attributes, there is support for the premise that these attributes may become the most salient attributes to the audience. As the tone is predominantly positive, additional research is necessary to determine if this may serve to prime the audience to accept telemedicine.

Objectives

Discuss media perception of telehealth.

Identify the substantive and affective attributes that comprise print media coverage of telemedicine.

Quashie Rene JD

Associate

Center for Telehealth and E-Law (CTel) and Drinker Biddle & Reath, L.L.P., Washington, DC, USA

P115 The New Centers for Medicare & Medicaid Innovation: How it will Change Telehealth

Abstract Withdrawn

Reynolds Eliza 1

Student

Grujovski Andre 2 Wright Tim 2 Foster Michael 2

1 University of Maryland, College Park, MD, USA 2 InTouch Health, Santa Barbara, CA, USA P116 Review of Robotic Telemedicine in Intensive Care Units (ICU)

Background: There is a ± 30,000 physician shortage of Intensivists in the USA, < 1/3^rd ICUs have any Intensivists, < 1/6^th have Intensivists on-site 24 hrs/day. Telemedicine provides an option to improve ICU quality of care. Alternative Tele-ICU technologies include highly complex systems like Phillips (VISICU), Cerner, IMDsoft versus less complex technologies such as carts or remote presence utilizing medical robotics (InTouch Health, Santa Barbara, CA). To date, there is little known about the utilization of robotics in the ICU. The purpose of this study is to develop a beginning understanding of ICU robotic utilization.

Process: Robotic utilization was reviewed from 06/01/2009 to 05/31/2010 via the InTouch Health Fleet Monitoring System. Only robots known to be exclusively deployed in ICUs were studied. Data was analyzed by facility, robot, month and time of day. The study group was further segregated to high volume users, which makes up this study. Data is presented by time of utilization.

Results: 56 robots were designated ICU, of which 20 were found to be high users. The 56 robots accumulated 8652 sessions, the 20 high volume users accumulated 6709 (77.5% of total) Of the 6709 high volume sessions, 4810 (72% of high volume) were between 6:00am and 5:59pm, 1899 sessions (28%) between 6:00pm and 5:59am in a bi-modal pattern.

Discussion: The hourly utilization pattern closely mimics real-world bi-modal work process in the ICU: 3/4^ths from morning to mid-day, 1/4^th evening, and very little activity from midnight to 6:00am. The utilization of robots in the ICU appears substantial and seems to follow routine ICU daily work patterns.

Conclusion: Medical robots are being utilized in routine ICU work flow. Further studies are necessary to evaluate impact and outcomes.

Objectives

Gain an appreciation for the deployment of medical robots in the Intensive Care unit.

Learn about the daily ebb and flow or work in the ICU.

Figueira Renato Minelli

Professor

Alkmim Maria Beatriz M. Universidade Federal de Minas Gerais, Belo Horizonte - MG, Brazil

P117 Developing Telehealth Implementation Strategies Based on Economic Aspects

Since July/2006 the Telehealth Center at the University Hospital of Federal University of Minas Gerais (CT/HC-UFMG) provides telehealth services for public primary care in 609 municipalities in the state of Minas Gerais, Brazil. Until August/2010 about 412,000 electrocardiograms (ECG) and 12,000 offline teleconsultations have been done. During this time, it was possible to identify the most important factors affecting the economical sustainability of the service. Since one of the objectives of the services is to reduce the referral cost of patients to secondary level, the break-even-point (BEP) for the system was calculated supposing two situations (i) considering the offer of ECG analysis and teleconsultations (present situation) and (ii) considering only teleconsultations. BEP is given by: \documentclass{aastex}\usepackage{amsbsy}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{bm}\usepackage{mathrsfs}\usepackage{pifont}\usepackage{stmaryrd}\usepackage{textcomp}\usepackage{portland,xspace}\usepackage{amsmath,amsxtra}\pagestyle{empty}\DeclareMathSizes{10}{9}{7}{6}\begin{document}$$[{\rm C}_{\rm f}^{\rm p} + {\rm C}_{\rm v}^{\rm p} * {\rm n} = {\rm C}_{\rm v}^{\rm r} * {\rm n} * \eta]$$\end{document} where and are fixed/variable costs of telehealth provider, n is number of activities (ECG + teleconsultations or teleconsultations), is referral variable cost and η is efficiency of activities defined as number of avoided referrals divided by total number of activities. Considering THC/UFMG values for situation (i) = 23,670 US$/month and = 2.67 US$/activity and for situation (ii) = 11,210 US$/month and = 9.53 US$/activity, = 26.72 US$/referral and η = 70,9%, the BEP for situation (i) was 1,457 activities/month and for situation (ii) 1,191 activities/month. The average monthly numbers of activities at CT/HC-UFMG in 2009 were 13,000 ECGs and 400 teleconsultations. From these figures is possible to conclude that to quickly reach the BEP, a telehealth service (i) should increase the efficiency offering different types of activities to avoid referrals, (ii) should have a high number of activities offering services of high demand (in THC/UFMG offering telecardiology) and (iii) should offer services for remote regions where referral costs are higher.

Objectives

Discuss the breakeven point with telemedicine spending.

Review telehealth costs.

Abstract Author Index

A

Abbiatti, Michael, S32

Abreu, Monica Pena, P35

Ackerman, Michael, P9

Adán, Consuelo B D, P101

Adelsheim, Steven, S59

Adler, Jamie, S4

Agha, Zia, P86, S21, S66

Aguilar, Enrique, S3

Aiello, Lloyd M., S25

Aiello, Lloyd Paul, S25

Akematsu, Yuji, P105, P106

Ali, Qasim, P38, S8, S41, S45

Alkmim, Maria Beatriz M., P35, P117

Allegra, Mary T., S28

Alonso, Gabriel, S68

Alpsten, Tobias, S51

Alverson, Dale, P5, S13, S31

Anderson, Kristine, P14

Andersson, Hans, S55

Angjellari-Dajci, Fjorentina, S58

Anolik, Rachel B., P67

Antoniotti, Nina, S7, S15, S56

Armstrong, Katie A., P56

Armstrong, Thelma McClosky, S45

Astapova, Elena, S58, S61

Au, Sylvia, S55

Augenstein, Jeffrey, S68

Augusterfer, Eugene F., S27

Avila, Marcos P., P104

Azarbayejani, Ali, S39

B

Bacahui, Jacob, S1

Bani, Erdeta, P62

Bapat, Ashok, P96

Barnsley, Jan, S3

Barrigan, Cynthia, S27

Barsotti, Ryan, P86, S66

Bashshur, Rashid, S39

Batista, Sonia M., P59

Beaton, Jennifer Mills, S5

Beebe, Michael K., S61

Bekteshi, Flamur, S8

Belard, Arnaud, S41

Belard, Jean-Louis, S27

Benton, Tina, P80, S32

Bisio, Jean, S70

Blanchard, Peter, S7

Boedeker, Ben, S1

Bondi, Mark, P23

Bonds, Celeste, S59

Bonham, Caroline, S59

Borgdstadt, Debbie, P95

Bornemeier, Renee, P80

Borrelli, Alice, S6

Branson, Sheila, P25

Brechtelsbauer, Bradley, P27

Brennan, David, P98, S14, S21

Brenner, Megan, P20

Brienza, David, S40

Brigell, Emily, S4

Brim, William, S18

Britton, Bonnie, S20

Brooks, Elizabeth, S66

Brose, William G., P54, S57

Brown, Arlene Stredler, P5

Brown, Ed, S32, S56

Brown, Eric, S38

Buis, Lorraine, P7

Bun, Sitha, P23

Burdick, Anne E., P59

Burns, Clare, P21

Bursell, Sven E., S33

Busch, Terry, P95

Bush, Carol, S49

Bush, Nigel, S50

Buss, Kimberly, P24

C

Cady, Rhonda G., P8, S65

Cafazzo, Joseph A., S3, S11

Camacho, Ruben, P51

Campbell, Michael, S58

Capistrant, Gary, S46

Caputo, Michael, S45

Carey, Julie, P54, S57

Carrera, Anibal, P48

Carroll, Patricia, S52

Casscells, S. Ward, S53, S61

Castillo, Roberto C., P51

Cattell-Gordon, David C., P25

Caudill, Robert L., P34

Cavallerano, Jerry, P91, S25, S33

Chang, Aileen Y., P67

Chang, James, P37

Chao, Wen L., P88

Chaum, Edward, P89

Chen, Edward, P55

Christiansen, Kathryn, S4

Chula, Michelle, S64

Ciulla, Robert, S50

Clarke, Malcolm, P58, S45

Cleary, Daniel J., S61

Cober, Karen, P32

Cohen, Glen, P18

Cohn, Ellen, S57, S69

Cole, Stacey L., P19

Constable, Ian, S25

Cook, David, S41

Cook, Greg W., S37

Cooper, Lakeya, S3

Corlin, Debbie Landau, S7

Cornacchione, Jennifer, P61

Cowboy, Elizabeth, S9

Coye, Molly, S70

Crane, Maria, S1

Cress, Tammy, S60

Crowell, Ellen, P27

Crowley, Eileen, S32

Cruz, Daniel A., S44

Cullum, Munro, P103

Cummings, Brian, P42, P110

Cuyler, Robert, S2

D

Dagva, Mungunchimeg, P87, S53

Dahl, Deborah, S35

Dalmau, Yaniz C. Padilla, P102

Dang, Stuti, S3

Danicourt, Wendy, S67

Dappen, Alan, S47

Davis, Daniel, S47

Davis, Theresa M., S44

Day, Tamara, P1

de Folter, Joost, P58

Deibert, Wendy, P92

Demiris, George, P1, P15, P52, S12

Demuth, Barbara R., P96

Denardo, Shirley, P44, P45, P46

Desai, Nirav, P53

Devasigamani, Raj, P112

Dharmar, Madan, P19

Dicianno, Brad E., P2

Diffenderfer, Brian, P92

Dixon, Mandi, P80

Doarn, Charles R., S8

Dolan, Brian, S19

Dolney, Derek, S41

Donaldson, Nick, P93

Doolittle, Gary, S41

Dowiatt, Peter, P40

Drude, Kenneth, S54

Durrani, Hammad, P47, P57

Dutton, Richard, S68

E

Eastwood, Kathryn, P41

Ecahavarría, Alejandro, P70

Edsinger, Aaron, P93

England, William, S38

Erickson, Catherine, S65

Ermold, Jenna, S18

Erps, Kristine A., P33

F

Fairman, Andrea D., P2

Farbstein, Aron, P19

Farrell, Shawn, S60

Feast, Joshua, S39

Feig, Denice S., S11

Ferguson, Stewart, S48, S53

Fidler, Janel, P86, S66

Figueira, Renato Minelli, P35, P117

Finkelstein, Stanley, P8, S65

Firouzan, Patti, S69

Fish Shannon, P54

Flanagan, Ryan, P49

Floto, Elizabeth, P86, S66

Forducey, Pamela, S60

Fore, Chris, S59

Foster, Michael, P116

Frank, Allegra K., P49

Franklin, Ed, S32

G

Gagnon, Marie-Pierre, P70

Gagnon, Samantha, P78, S5, S65

Gahm, Gregory, S50, S62

Gallagher, Bridget, S28

Gantenbein, Rex E., P5

Gao, Q., P99

Garwick, Ann, S65

Gaughen, John R., P25

Gaur, Pramod, S51

Genc, Sahika, S61

Gessow, Eugene, S23

Ghose, Sankalpo, P10, P67

Giarrizzi, Dana, S63

Gibson, Robert, S45

Gibson, Sara F., S2

Gilbert, Gary R., S37, S61

Gilbreath, Allison, P73, P78

Givens, Gregg D., P27

Godleski, Linda, S10

Goldberg, Jason, S3

Goldberg, Joisabel L., P23

Golden, Adam, S3

Goldstein, Felissa, S34, S58

Goldyne, Marc, S47

Gondal, Zafar I., S8

Gooch, Kirstan N., P23

Goodrich, David, P60

Grady, Brian, P113, S26

Graf, Donald A., P13

Graham, Lara L., P103

Green, Nancy, S36

Greenfield, William, P77

Greenwood, Deborah, P24

Groneman, Brooke, S49

Grosch, Maria C., P103

Grujovski, Andre, P116

Grundfest, Warren S., P81

Grundler, Gerard, S36

Guo, Huayuan, P12

Gupta, Rajendra Pratap, S51

Gutierrez, Mario, S6

Guy, Paula, S34

Guzic, Brenda L., P96, P97

H

Haas, Nina M., P76

Haggard, Rebekah, S71

Hall, Whit, P74, P75, P77

Hall-Barrow, Julie, P77, S23, S52, S65

Hamian, Araz, P69

Hamilton, Nancy, S67

Hammom, Lisa, S49

Hankins, Andrea I., P24

Hanna, Mona, S34

Harms, Kristin, P24

Harris, Bernard, S5

Harris, Julia, S3

Harris, Yael, S22

Hartman, Linda, P31

Hartman, Linda M., P39

Hayden, James, P96

Hazaray, Sunil, S15

Heil, Lori, P80

Hilty, Don, S2

Hirsch, Phil, S18

Hitt, W.C., S49

Hodgkins, Candace, S67

Hofacre, Bettina, P83

Hoffman, Kenneth Jay, S18

Hogan, William, S23

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