Vermont's Network to Support Rural Trauma and Critical Care
How to Build a Telemedicine Network to Support Rural Trauma and Critical Care (M1A1)
Michael Caputo, MS,1 William Charash, MD,2,3 Barry Heath, MD,2,3 Terry Rabinowitz, MD,2,3 Michael Ricci, MD,2,3 Judith Amour, MA,3 Harry Clark, BS,3 Steve Taylor,3 Tara Pacy, RN, BA3
1Washington University School of Medicine, St. Louis, MO; 2University of Vermont College of Medicine, Burlington, VT; 3Fletcher Allen Health Care, Burlington, VT

Providing definitive care to severely ill or injured patients in rural communities can be hampered by lack of access to medical specialists. To address this problem in Vermont and Northeastern New York state, a telemedicine network was established to connect rural emergency departments to the level 1 trauma center. Telemedicine can be used to support rural communities. However the emergent nature of trauma and critical care requires a system design capable of providing medial services when and where they are needed. The Vermont Telemedicine Program has been successful in transitioning from scheduled events and consults to providing ad hoc support to rural patients needing access to specialty care at the level 1 trauma center. This implementation went through several phases before successfully becoming integrated into the process of care. This presentation will review the successes and failures encountered when implementing a telemedicine network for supporting critical care and trauma. Lessons learned will be presented along with case studies to illustrate the impact telemedicine can have on the quality and access of specialty care for rural patients.

Arkansas Telehealth Network
Center for Distance Health: Toward A Statewide Telehealth Network (M1A2)
Curtis Lowery, MD, Tina Benton, BSN, RN, Deanna Jackson-Moore, LCSW, Julie Hall-Barrow, EdD, Ann Bynum, EdD, Michael Manley, RNP   
University of Arkansas for Medical Sciences, Little Rock, AR

The Center for Distance Health at the University of Arkansas for Medical Sciences (UAMS) facilitates innovative responses to the demands for dynamic, contemporary health care in the rural state of Arkansas.  The Center for Distance Health is facilitating a unique collaboration between the states telehealth stakeholders to create a statewide teleheatlh network.  There are three primary telecommunication networks in the state:  the Arkansas Department of Health network, the Arkansas Division of Information Services network, and the UAMS network. Until recently, these networks were basically independent of each other.  However, these stakeholders and several others around the state are working together to integrate these networks, supporting efficient and effective utilization of resources.  Though a collaboration of this magnitude requires thoughtful facilitation, Arkansas has recognized the potential in telehealth to expand quality health care.  The state is already benefiting from the award-winning ANGELS program, a partnership between UAMS and Arkansas Medicaid focused on high-risk obstetrics.  The Center for Distance Health strives to eliminate disparities in health care.  A statewide integrated clinical network is a huge step in the right direction.

Results of a Multi-State Telehealth Network Survey
State of Affairs: Answering Key Questions on States' Telehealth Networks (M1A3)
Fatima Sharif, BA        
Office of Health Policy and Planning, Virginia Department of Health, Richmond, VA

In an effort to realize trends in other states’ telehealth networks, the Virginia Department of Health’s Office of Health Policy and Planning performed a survey by asking key questions of multiple state telehealth networks.  Areas of focus include non-profit status, financial support, management techniques, group purchasing capabilities, and member contracts. Recommendations were aggregated to provide to provide the survey results for “State of Affairs: Answering Key Questions on States’ Telehealth Networks.

A Novel Whole Slide Image User Interface Designed for Anatomic Pathology Workflow (M1B1)
Jonhan Ho, MD,1 Jeffrey Fine, MD,2 John Gilbertson, MD,3 Anil Parwani, MD, PhD,2 Drazen Jukic, MD, PhD1    
1Department of Dermatology, University of Pittsburg, Pittsburgh, PA; 2Department of Pathology, University of Pittsburgh, Pittsburgh, PA; 3Department of Pathology, Case Western University School of Medicine, Cleveland, OH

The clinicopathological assessment of a patient by a pathologist entails the synthesis of contextually relevant information to arrive at a diagnosis.  The incorporation of technologies such as whole slide images (WSI), into this workflow will requires awareness of this information and its sources.  We design and implement a novel WSI interface that presents WSI in clinical context.

Current anatomic pathology workflow was evaluated to identify information helpful to the analysis of the patient.  This included obtaining information from the clinician, laboratory information system (LIS), slide, and microscope.  Particular attention was paid to the visual scanning behavior at different microscope magnifications.  Based on these observations, a novel browser-based application was created that presented contextually relevant information to the pathologist when needed.

Through iterative cycles of development and testing, an application was created that offered pathologists a WSI-based sign-out experience similar to conventional sign-out workflow.  Pathologist feedback led to key changes in the application.  The application integrated and presented information traditionally provided by the LIS, slide, and microscope.  

Ethnographic considerations are important in the design of workflow-related WSI applications in anatomic pathology.  Optimally designed user interfaces should allow pathologists to efficiently analyze clinically relevant information in the diagnostic evaluation of a patient.

Using Virtual Telepathology Technology to Train Pathology Residents (M1B2)
Elizabeth A. Krupinski, PhD, Allison Tillack, Lynne Richter, MT, Jeffrey Henderson, MD, Achyut Bhattacharyya, MD, Katherine Scott, MD, Anna Graham, MD, Michael Descour, PhD, John Davis, MD, Ronald Weinstein, MD
University of Arizona, Tucson, AZ

We assessed eye movements of medical students, pathology residents, and pathologists examining virtual telepathology slides to determine if pathologists scan in definable ways that can be used to train novices on digital viewing. Readers are quickly attracted to regions of interest on virtual slides containing diagnostic information. There was a significant (F = 36.063, p < 0.0001) effect due to experience: pathologists generated the fewest saccades followed by residents, then students. There was a significant difference in saccade velocity (F = 29.898, p < 0.0001): the pathologist with the most experience had slower velocities than the other two pathologists. For saccade length there was a significant difference (F = 54.761, p < 0.0001): pathologists had the longest saccades followed by residents and students. For saccade distance there was a significant difference (F = 11.975, p < 0.0001): residents had significantly longer saccade lengths than pathologists or students. Pathologists spent significantly less time scanning virtual slides than residents or students, but had relatively prolonged saccades (p < 0.0001). Eye movement studies of scan- paths may be useful for developing eye movement profiles for individuals and for understanding the difference in performances between novices and experts viewing telepathology slides on digital displays.

Pathologist Cognitive Factors May Impact Telepathology Acceptance and Practice Integration (M1B3)
Dana M. Grzybicki, PhD, MD,1 Robb Wilson, MA,1 Russell Silowash, BS,1 Leslie Anthony, MA2     
1University of Pittsburgh School of Medicine, Pittsburgh, PA; 2University of Pittsburgh Medical Center, Pittsburgh, PA

Despite studies describing pathologists’self-reported satisfaction with and acceptance of telepathology for use in day-to-day practice, widespread implementation is absent. Anectodal clinical observations support the idea that pathologist comfort level with use of telepathology is an important factor affecting implementation, with junior pathologists demonstrating higher comfort levels than experienced senior pathologists. 

In order to test the hypothesis that a linear correlation exists between pathologist comfort level and experience level while interpreting cases composed of conventional glass slides compared to whole slide images (WSI), five subjects completed a self-administered, written questionnaire for each of 90 cases, indicating their assessment of case complexity and level of diagnostic confidence on ordinal scales and their diagnosis. Experience ranged from 12 years in practice to recently board certified in sub-specialty training.

Significant negative correlations existed between experience and case complexity and  between case complexity and diagnostic confidence ( p = 0.01). The mean complexity rating for cases examined solely by WSI tended to be higher for experienced pathologists.

These findings support a possible significant role for previously unexamined cognitive factors in pathologist acceptance of telepathology applications and their ultimate integration into practice.

Review of Telemedicine Applications in Diabetes Disease Management
Telemedicine Applications in Diabetes Disease Management: A Systematic Review (M1C1)
Ming Ying Lisa Chu-Weininger, PhD, MBA, MPH, MSLIS, EdS, FRIPH,1 Adol Esquival, MD, MS,1 LaSonya Knowles, BBA,2 Kim Dunn, MD, PhD1     
1School of Health Information Sciences, University of Texas-Houston, Houston, TX; 2MD Anderson Cancer Center, Houston, TX

Introduction: This study reviews the state of the art telemedicine applications in the
management of Type I and Type II diabetes milieus among children, adult, the  elderly, and the pregnant population. The review focused on telemedicine interventions applying educational,  diabetes self-management, and case  anagement or diabetes home-health care programs to reflect on the practical value of telemedicine in diabetes management.

Methods: A systematic search of publications indexed by the National Library of Medicine’s (NLM) PubMed database was performed using the search terms: telemedicine and diabetes to include all NLM publication types in English, without any date limits. Retrieved documents beyond the described review scope were excluded.

Conclusions: Majority of the studies reported improvement or significant changes in the efficacy of diabetes self-management, especially in glucose and HbA(1c) levels control. The most commonly applied technologies included self-reporting of iological data/meal patterns via telemedicine software, telephone, or web-based system, real time patient data for clinical decision support, medication dosage change, and for feedback to patients. The small sample sizes and short durations (3-6 months) of many of these studies may post concern over study reliability. The range of clinical efficacies reported was discussed in the light of practical implications to public health.

Analyzing National Long Term Care and CMS Billing Data to Assess the Use of Telehealth for Diabetes and CHF
Home-Based Progams for Management of Diabetes and Congestive Heart Failure (M1C2)
Jane K. Sponholz, PhD        
Grand Valley State University, Grand Rapids, MI

Using the 1982 current National Long Term Care Survey (NLTCS) data and the linked Centers for Medicare and Medicaid (CMS) historical billings file, this presentation will summarize the results obtained from studying NLTCS participants with chronic disease diagnoses of diabetes and congestive heart failure, their activities related to self-management of these conditions, and the use of acute care services by these participants. 

Over a 15 year period of time NLTCS has collected data which includes variables on perceived health status, residence in the community, home health visits, hospitalization, physician visits, chronic conditions, level of daily activities, and nutritional patterns.  This information, when analyzed in conjunction with the CMS historical billing data base for the same participants, provides correlations between a person’s health status, health utilization patterns, cost of Medicare/Medicaid reimbursed services, and the rational for supporting telehealth.

The purpose of this paper will be to present data that will enhance our understanding of the relationship between disease management, health status in a community setting, and the utilization of health care resources supporting home telehealth self-management.

Computer Assisted Decision Support (CADS) for Primary Care of Diabetes (M1C3)
Col. Robert Vigersky, MD,1 Robert Galen, MD, MPH,2 David Horne,3 Michael Cavotta,3 David Rodbard, MD4    
1Walter Reed Army Medical Center, Washington, DC; 2University of Georgia, Athens, GA; 3LifeClinic, Inc, Mentor, OH; 4American Institutes of Research, Silver Spring, MD

Explosive growth in the number of therapies for DM makes it extremely difficult for PCM’s to maintain familiarity with available options and algorithms. A CADS system using data from memory meters, current medications, and clinical practice guidelines would be expected to improve quality of care. We have developed a CADS system prototype which automatically interprets glucose profiles, prioritizes problem areas, and recommends changes in existing treatments. Therapeutic algorithms were developed by a focus group of endocrinologists and PCM’s interpreting blood glucose patterns from patients with diabetes. The CADS system receives input from: (1) An on-line patient module in which glucose data are uploaded, and medication history, schedule for glucose monitoring, and meal times are verified. Patients have access to graphical and statistical displays but not interpretations or recommendations; (2) A customizable administrator module which includes formulary information, a set of regimens and rules for warnings; (3) A customizable provider module which sets treatment goals, target glucose ranges, and glucose monitoring schedules. This module displays the data analysis and  recommended changes in treatment. The CADS system has been integrated into an existing web-site compatible with all glucose meters  (www.HealthSentry.net). Processes for further development, testing, clinical trials, and implementation will be presented.

Using Multiple Technologies to Build an Interagency Community of Practice in North Carolina
Using Technology to Build an Early Intervention Community of Practice (M1D1)
Juliellen Simpson-Vos, MEd, Joshua J. Alexander, MD       
The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC

Telecommunications and internet-based resources can play an integral role in creating a community of practice among professional serving the early intervention community.  This presentation describes how an academic rehabilitation program has combined with eleven service agencies serving children with special needs in Wake County, North Carolina to establish an interdisciplinary telehealth network.

This network combines the collaborative expertise of its participants through a website, listserv, and electronic newsletter. Real-time video conferencing units housed at each service agency have improved the quality of, and increased access to specialized services for young children with disabilities, their families, and those who serve them. 

Since December 2005, twenty video clinics, seven video consults, and ten networking/professional development sessions have been conducted involving children, parents, therapists, physicians, and early intervention personnel—offering a coordination of care unavailable through traditional service delivery models.  Listserv postings and electronic newsletters serve as communication tools to share best practice models, new research in pediatric rehabilitation and care, and programmatic updates.

This presentation will discuss the definition of a community of practice, technical and practical challenges to establishing and maintaining this network, lessons learned from the project, and its potential applications for statewide and national early intervention models.

Managing a Texas-Based telemedicine Program from North Carolina
Telecommuting to Virtually Manage a Telemedicine Program Using Advanced Communications (M1D2)
Lori Balch, Kevin Hopkins, MD, FACS       
Driscoll Children's Hospital, Corpus Christi, TX

Driscoll Children’s Hospital located in Corpus Christi, Texas, supports telemedicine clinical consultative services and a distance education network using high speed networks and advanced diagnostic tools.  The hospital has forged new territory by hiring its first truly virtual employee to manage this 33 county International Telemedicine network.  The program director lives over 1600 miles away in North Carolina and manages the day to day operations via a consumer level broadband cable connection in the home.  A video conference system, fax, phone, and web portal are used to support this telecommute. While telemarketing, freelance writing, and computer programming are obvious fits for telecommuting, managing people, technologies, and building virtual relationships within a clinical environment has been a true test for developing and maintaining a successful telehealth program in South Texas and Mexico.  This unique telecommute model is over two years  into operation and has been deemed a success by all parties.

This session will cover the technology, benefits, and inherent challenges associated with virtually managing a telemedicine program in a rural and large geographic area which crosses a US border into Mexico.

Technical Innovation in the Creation of Canada’s Largest Telemedicine Network (M1D3)
Ron Riesenbach, BSc, MSc, MBA, PEng        
Ontario Telemedicine Network, Toronto, Canada

Ontario’s Telehealth organizations have recently undergone a major transformation. CareConnect, North Network and Video Care have merged into a single entity thereby creating the largest, integrated Telemedicine network in Canada. The new organization, called Ontario Telemedicine Network (OTN), now serves 12 million people spread over 1 million square kilometers. OTN’s technical team now manages more than 700 videoconferencing end-points supporting over 30,000 clinical encounters and 6,000 multipoint/gateway sessions annually.

To meet the challenges of integrating three independent networks and of scaling to these large volumes, OTN engaged in a year-long planning and implementation program. Privacy and manageability targets were address by standardizing on a VPN-over-MPLS network. Reliability and security requirements were addressed by centralizing core IT assets in a data centre and by introducing dual-redundancy to key service components. Telemedicine scheduling software was upgraded to enhance performance and key features were introduced to allow thousands of end-users to self-schedule clinical, educational and administrative events. Finally, end-user technical service was enhanced by the adoption of elements of the ITIL framework and the creation of a geographically dispersed, but logically centralized Technical Service Desk.

Achieving the business objectives of the merger would have been impossible without state-of-the-art technical infrastructure. This presentation will detail the major challenges, will overview the resulting service architecture and will relate the lessons learned in the process.

A Multi-National Pediatric Practice - Driscoll Children's Hospital
Development and Maintenance of an International Telemedicine Pediatric Program-Update (M1E1)
Kevin S. Hopkins, MD, FACS,1 Lori Balch,1 Sharon Yon, MA,1 Francisco Lozano Lee, MD,2 Mauricio Sampayo, BSc,4 Pablo Villarreal Guerra, MD,5 Robert L. Hamilton,3 Julia Henion, RN1  
1Driscoll Children's Hospital, Corpus Christi, TX; 2Hospital San Jose Tec de Monterrey, Monterrey, Mexico; 3Hospital Infantil de Victoria, Ciudad Victoria, Mexico; 4Centro Medico Internacional, Matamoros, Mexico; 5Universidad de Monterrey División de Ciencias de la Salud, Monterrey, Mexico

This paper will present in detail, the 4 year development of an international pediatric telemedicine network between South Texas, Mexico and several other countries. Our hospital is the only Regional, Pediatric Tertiary Care Hospital in South Texas.

Geography and shared cultural roots have played a strategic role early on in establishing this network initially for distance learning and Grand Rounds; however a strong marketing plan has propelled it forward to now involve physician and patient consultations, nursing education and even job interviews.

The network consists of videoconferencing systems with plug-ins over ISDN, the Internet, and Internet 2 with bridging from our hospital. Connectivity is to state children’s hospitals as well as other teaching hospitals in Northern and Central Mexico. We have also supported remote consultations via satellite and videophone for specific projects.

Currently, this project is supported by private funding and government grants. A thorough discussion of pitfalls, lessons learned, funding and sustainability will be presented.

A Multi-National Pediatric Practice - National Children's Center, Washington, DC
International Telemedicine: Developing a Model for a Global Pediatric Practice (M1E2)
Craig Sable, MD, FACC, Molly Reyna, BA, Oussama El-Baba, MHA, Gerard Martin, MD, FACC     
Children's National Medical Center, Washington, DC

Background: Children’s National Medical Center (CNMC) receives numerous in-patient referrals and second opinion requests from international hospitals every year.  We report a model to enhance international referral services and assess the financial sustainability of a global pediatric practice.

Methods and Results: CNMC has established clinical referral relationships with approximately 30 countries around the globe.  Referrals include remote patient assessment, second-opinion cases, physician consultation and transport to Washington, DC for inpatient surgical services.  Historically, these services were provided through exchange of information via phone, fax, mail, and through care provided onsite at the referral hospital.  In our new model, telemedicine links were established in 5 referral centers in 5 different countries.  Requested services include cardiology, neuro-oncology, and pre and post-surgical consultation. 

Telemedicine interaction includes live video conferencing and electronic patient data transfer.  Telemedicine is offered as an enhancement to current services, and has increased our second-opinion cases while leading to better management of our surgical transfer patients. We measure physician and parent satisfaction, and increased revenue as a result of telemedicine.

Tele-Education in North Africa: U.S. / Morocco Partnership for Children’s Health (M1E3)
Molly Reyna, BA,1 Craig Sable, MD, FACC,1 Najia Hajjaj-Hassouni, MD,2 Nezha Mouane, MD,3 Philip Hopkins1    
1Children's National Medical Center, Washington, DC; 2Faculty of Medicine and Pharmacy, Rabat, Morocco; 3University Pediatric Hospital Ibn Sina, Rabat, Morocco

Background: Millions of children in the developing world die or become disabled each year from preventable diseases and their complications.  Lack of access to basic health education and training is at the forefront of this problem.

Methods and Results: Children’s National Medical Center (CNMC) in Washington, DC partnered with the Rabat Faculty of Medicine and Pharmacy and the Hôpital d'Enfants Rabat, to establish an international pediatric tele-education network. Funded by the Mosaic Foundation in 2005, the two-year project focuses on improving health education, technology and healthcare staffing, critical components to improve the level of care available in the region.  Network links established between Washington, DC, Rabat and Casablanca enable live lectures, archived and streamed content, and patient data transfer.  To-date, we have successfully captured 50+ pediatric board review videos with PowerPoint presentation and translated the content into French, which is the preferred language for education in Morocco.  Requested topics include nutrition, gastroenterology, cardiac care, and mother-child health. 

Conclusions: Physicians and technical staff have created an effective partnership, and continue to develop technical infrastructure and educational offerings.  Project outcome measurements include: improved access to health information, decrease in provider isolation, and children with critical diagnoses have improved outcomes.

Computer-Assisted Diagnostics for Dermatopathology
Modeling of Content-Based Image Retrieval Tools for Dermatopathology Applications: "Diamond" Software (M1F1)
Drazen M. Jukic, MD, PhD,1,4 Simon King,3 Casey Helfrich,2 Anu Melville,3 Rahul Sukthankar, PhD, BSE,3 Adil Wali,3 Mahadev Satyanarayanan, PhD2  
1University of Pittsburgh School of Medicine, Pittsburgh, PA; 2Carnegie Mellon University, Pittsburgh, PA; 3Intel Research, Pittsburgh, PA; 4UPMC IMITS Program, Pittsburgh, PA

We have recognized significant opportunity to create transformational diagnostics support for medical imaging utilizing Intel’s Diamond software. It allows for efficient and rapid searching of large image sets for features that would help create knowledge out of image features “locked away” in digital imaging archives in dermatopathology. Diamond’s storage architecture for “early discard” in interactive searches makes possible for the real time interrogation of virtual slides and other digital images of diagnostic biopsies utilized in the detection of biopsies of pigmented lesions.  Creating open source toolkits that would allow for the efficient searching of these images for the purpose of computer assisted diagnostics would significantly improve the quality of care delivered.

Herein we present early data revealing the feasibility of such an application, with detailed workflow analysis and potential applications and deployment strategies. Although virtual slides promise to deliver new level of care in digital pathology, it is important to outline that today, an application is defined by ease of use and speed of acceptance.

We have conducted study investigating the needs and ideal interface characteristics for application of interactive computer-assisted diagnosis (ICAD) tools in dermatopathology. We also examine potential applications of this interface in diagnosis, education and quality assurance.

Visualization and Display tools Improve Patient Data Review
Data Visualization Authoring and Display Tools for Patient Data Review (M1F2)
James Ong, MS,1 Trinka Coster, MD,2 Kevin Leary, MD,3 Stephen Porter, MD,4 Ida Sim, MD5    
1Stottler Henke Associates, Inc., San Mateo, CA; 2U.S. Army Medical Research and Materiel Command, Silver Spring, MD; 3Uniformed Services University of the Health Sciences, Bethesda, MD; 4Harvard Medical School, Boston, MA; 5University of California San Francisco School of Medicine, San Francisco, CA

Current clinical information systems typically present patient data by the source of the data and require the clinician to individually request and mentally integrate this data to discern patterns that span data sources.  This requirement places unnecessary cognitive burdens on the clinicians and makes patient data review more difficult and time-consuming.  This presentation will describe the Intelligent Patient Data Review Assistant (IPDRA), a web-based, intelligent user interface that enables clinicians to visualize interactive, high-density graphical reports, or views, of clinically-meaningful subsets of the patient's history. For example, views could display data relevant to medical problems, body systems, or demographic groups relevant to the patient.  This system uses a data visualization library, called DataMontage, that displays information-dense collections of timelines, time-series graphs, and time-stamped notes.  This presentation will describe the software’s capabilities and their application to prototype an initial set of views for diabetes, hypertension, and the cardiac system. We will discuss various methods for designing views based on clinician input and on standard clinical guidelines.  We will also discuss data visualization features added to support interactive exploratory analysis, and wizard-based authoring tools designed to enable rapid view specification by clinicians.

Evaluation of a Desktop-Sharing Program for Healthcare Educational Videoconferences
Evaluation of Desktop Sharing to Supplement Healthcare Educational Videoconferences (M1F3)
Brendan P. Purdy, RN, MN(C),1 Sharon McGonigle, RN, MScN,1 Dan Allard, PEng,2 Lisa Ferraro, BSc,2 Brenda Laurie-Shaw, RN, MN,1 Peter G. Rossos, MD, FRCP(C)1   
1University Health Network, Toronto, Canada; 2Ontario Telemedicine Network, Toronto, Canada

Purpose: Image quality is essential for effective videoconferencing.  Poor image quality occurs when multiple images are viewed simultaneously at low resolutions. However, communication during educational sessions is facilitated by the concurrent viewing of both participants and presentations. We wished to determine whether using a desktop sharing application for slide transmission would reliably improve image quality, and enhance participants’ perceptions of educational videoconferences.

Methods: A desktop sharing application was selected (Bridgit ™) and evaluated over twelve weeks. Subjects (n=20) were gastroenterologists from three Canadian hospitals attending established, weekly, discursive, videoconferences.  High resolution pathology, endoscopy and other medical images were simultaneously viewed using Bridgit™. Data was collected primarily through a self-report questionnaire designed for the study.

Results:

1. Quality - 91% of participants rated Videoconference and Desktop image synchronousness as very good/excellent. 84.3% detected no distorted slides. 76.9% detected no disconnections.
2. Access - Attendance throughout the pilot was greater at the remote sites (58.2%).
3. Acceptability – 97% of participants preferred desktop augmented videoconference over non-augmented events.
4. Cost - Startup costs were negligible at participating hospitals.

Conclusions: This study strongly suggests that the use of desktop sharing to supplement videoconferencing is a technically reliable intervention that enhances healthcare collaborative education sessions.

Health Promotion and Wellness eLearning
11:15am - 11:45am

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Human Patient Simulation Training Improves Tele-Trauma Team Performance
Tele-Trauma Participant Improves Trauma Team performance on Simulated Trauma Scenarios (M2A1)
David G. Ellis, MD,1,2 Jennifer Brown, MD,1,2 Jeffrey Myers, DO,1,2 James Mayrose, PhD,4 Elizabeth Meinert,3 Fritz Sticht1   
1University at Buffalo (State University of New York) Department of Emergency Medicine, Buffalo, NY; 2Erie County Medical Center, Buffalo, NY; 3University at Buffalo (SUNY) School of Medicine, Buffalo, NY; 4Buffalo State University (SUNY), Buffalo, NY

Introduction:  Victims of trauma in rural areas are nearly twice as likely to die of those injuries than patients with similar injuries in urban areas. The low volume of seriously injured patients in rural areas and subsequent lack of experience by emergency practitioners may contribute to this discrepancy. The goal of this study is to show how simulations of trauma scenarios with and without a trauma center emergency attending physician (TCEAP) tele-trauma participant may increase experience and show possible areas of improvement in rural trauma team performance.

Methods: Eleven emergency medicine residents participated in 2 trauma scenarios each using the SimMan® Human Patient Simulator with and without a TCEAP participating in the resuscitation through synchronous videoconferencing supported in the trauma room by a wireless roll-about unit (Veraview/HealthCare Technologies). Trauma team performance was scored using the method of Holcomb (2002) based on 41 performance indicators in 5 categories of ATLS guidelines .

Results: Trauma team performance scores improved with TCEAP participation vs. without (44.24 vs. 39.02) while timed performance indicators were equivalent.

Conclusions: A model of tele-trauma scenarios using a Human Patient Simulator can be used to show potential trauma team performance benefits for severely injured patients in a rural setting.

Remote Mobile Robotic Technology to Manage Acute Strokes in the Emergency Room
Integrating Mobile Robotic Technology for a Tele-Stroke Application: Successes and Challenges (M2A2)
Alexander Nason, MBA, MHA, Benjamin Greenberg, MD, Eric Aldrich, MD, PhD, Rafael Llinas, MD     
Johns Hopkins Medicine, Baltimore, MD

The State of Maryland has begun to consider legislation mandating that all patients presenting with symptoms of an acute stroke be treated at a designated ‘Stroke Center'. As of September, 2006, only 3 centers in the state have reached that designation.

Johns Hopkins Medicine has implemented a tele-stroke program in an effort to meet the growing demand of this specialty service, particularly at its affiliated primary care hospital Howard County General Hospital, as well as alleviate some of the resource pressures that currently faces its own Stroke Team. Johns Hopkins Medicine recognizes that integrating technology to provide remote services and meet the demand is the most efficient and effective. 

In August, Johns Hopkins Medicine became one of the first stroke centers in the country to apply mobile robotic technology to manage acute strokes in the Emergency Room. This technology was first approached with skepticism, but its flexibility in the Emergency Room environment allowed it to be an appropriate solution.

This presentation will describe the technology implemented, the internal and external challenges in acceptance and deployment, and the business case and model being implemented at regional community hospitals, as well as at the Hopkins International affiliates.

An Online Tool Improves Patient Education and Motivation in Management of Chronic Diseases in Spain
Motivational Telehealth Model for the Management of Chronic Diseases (M2B1)
Eva del Hoyo-Barbolla, PhD(c), Marta Ortega Portillo, MSc, Maria Teresa Arredondo, PhD      
Life Supporting Technologies - Universidad Politécnica de Madrid, Madrid, Spain

Prevention of chronic diseases and compliance with treatments are big issues that need to be solved if we want systems to progress accordingly to policy plans and with a modern society. Personalized prevention information provides users and their environment with tools to manage their healthcare and chronic conditions with staying out of the healthcare loop. Education and empowerment of users are fundamental to provide them with a supportive environment and tools that allow them to respond and react to situations that can be handled with basic training of users. Hence the number of unnecessary medical calls to doctors can be dramatically reduced.

We have implemented a model able to provide tailored information that allows individuals manage their care plan and answer relevant questions from home. In order to build the system, we followed a methodology based on information tailoring and collaboration with healthcare professionals to map a medical intervention. The model provides personalized information according to the stage of both healthcare and technology attitude. To test the model, an e-health tool was developed and evaluated.

This tool is regarded as a potential use of ICT for a paradigm change in the promotion of healthcare. It’s currently being deployed in two pilots and the healthcare community and professionals who have tested it and argue it could be developed to satisfy other primary prevention initiatives (i.e. care during pregnancy, infectious disease prevention, injuries, etc).

Comparing Onsite, Online and Simulation Approaches to Accelerate Radiologist Training and Certification
Helping Providers Adopt New Systems Faster: Comparison of Training Models (M2B2)
Heather A. Haugen, RD, PhD,1 Charles L. Fred2       
1University of Colorado Health Sciences Center, Denver, CO; 2Breakaway Group, Denver, CO

Lack of user adoption is cited as the primary cause of 70% of failed enterprise application projects.

One of the nation's largest providers of outpatient surgery, diagnostic imaging and rehabilitative healthcare services, operating facilities nationwide purchased an enterprise radiology application.  Their challenge was to develop an effective and efficient certification process for over 1,500 employees in 91 locations.

Three training models were utilized: traditional training (TT) included 4-12 hours of passive demonstration at offsite location, onsite certification training (OC), and onsite certification plus online simulations (OC+S).  Certification of a facility was defined as each employee, based upon their role, being fluent in the subject application- a dramatic shift from traditional training models.

The length of time to reach proficiency was compared among the three groups.  The average time to proficiency in the TT group was 40 working days, in the OC group was 10 working days, and in the OC+S group was 5 working days. 

Onsite certification is feasible, dramatically reduces the cycle time to proficiency for each employee based upon role, and delivers a fully functioning facility utilizing the system within the designed workflow. This technique should be further investigated to overcome the challenges of poor adoption.

A Missouri Based Study to Test the Usefulness of Videophones in Telehospice
A Videophone Intervention with in-Hospice Caregivers: Clinical Outcomes (M2C1)
Debra Parker Oliver, MSW, PhD,1 George Demiris, PhD,2 Brian Hensel, PhD1      
1University of Missouri, Columbia, MO; 2University of Washington, Seattle, WA

The purpose of this study was to test the usefulness of videophones as a communication tool in hospice for caregivers. The underlying hypotheses are that videophones are a feasible tool for service delivery and allow for the potential development of an effective low cost intervention tool that can decrease anxiety of caregivers, and improve their quality of life. Measures included the State Trait Anxiety Inventory (STAI), and the Caregiver Quality of Life Index – Revised (CQLI-R). Caregiver perceptions and technological feasibility were assessed using observations and selected caregiver interviews. A total of 19 caregivers and their patients were recruited. Seven caregivers were female and twelve were male. The average age of caregivers enrolled in the study was 69.8 years. Findings indicate that the anxiety score significantly decreased (p< 0.05) for participants after experiencing the intervention. Differences in quality of life scores are not statistically significant. Overall, caregivers perceived the videophones as useful and as a communication tool that provided ease of mind. This pilot study demonstrates that the use of videophones in hospice care is feasible and promising as a tool that can enhance communication and reduce anxiety. The study lays the groundwork for clinical trials that will investigate the clinical outcomes resulting from interventions using telehospice technologies.

A Telehospice Study in Michigan to Improve Services and Reduce Caregiver Anxiety
Reducing Caregiver and Family Burdens Through Telehospice Care (M2C2)
Pamela Whitten, PhD, Brad Love       
Michigan State University, East Lansing, MI

The mid-Michigan telehospice venture is a research project designed to install POTS-based videophones in patient homes to improve the quality of care while reducing burdens on healthcare providers and family members. Researchers hypothesize that improved patient communication and access will reduce burdened feelings among healthcare workers and families, and that increased contact with various caregivers will improve patient satisfaction with hospice care.

In addition, the project served to train healthcare providers—doctors, nurses, and counselors—and volunteers within a large regional health system to prepare them for future applications of telemedicine.

Data point out that patients enjoy using the videophone equipment and appreciate the augmented access to their care providers. Once they have gained a level of comfort with the technology, healthcare workers reported favorable impressions of the equipment when used for regular contact and scheduling visits. In addition, the videophones increased the amount of information able to be collected during regularly planned daily calls to home hospice patients.

Future research could examine the benefits of instituting a similar system as broadband connections become more prevalent in developed as well as rural environments.

Using Telemedicine to Help Transform a National Healthcare Delivery System
Indian Telemedicine Program: Marching Towards Transforming National Healthcare Delivery System (M2D1)
Murthy R.L.N., L.S. Satyamurthy, Bhaskaranarayana A.      
Indian Space Research Organisation (ISRO), Bangalore, India

Introduction: Providing healthcare to over one billion people spread over 3.2 million sq km is a daunting task for a developing country like India with 75% of the population living in rural and inaccessible areas.

Indian Telemedicine programme primarily spearheaded by ISRO and supplemented by other government, private and Trust agencies is aimed at augmenting the healthcare delivery system of the country  to take the benefits of modern medical care to the grassroots of the society.  How such an accepted application and utilisation are made possible and what are the directions for a successful management of such programs from concept to completion? What is the outcome of the programme and where is it poised to go?

Description: ISRO demonstrated the efficacy, utility and ease of operation to several stake-holders through proof of concept technology demonstration pilot projects in several states. ISRO’s thrust in the programme focuses on providing Technology & Connectivity for (a) Tele-consultation (b) Continuing Medical Education (c) Mobile Telehealth (d) Disaster Management Support. Technology development and utilisation and Efforts

Results: The SATcom network presently consists of 165 Patient Ends connected to 35 Speciality Ends with more than 100,000 Tele-consultations and few life saving instances. More than 70% of the patients surveyed have revealed a direct Cost Saving to the tune of 81%, in addition to the savings/relief in terms of the reduced travel and thus, the mental and physical strain avoided.

Conclusions: Indian Telemedicine initiative is poised for a national implementation by the health ministry by formulating policies and framework for bringing telemedicine into the mainstream of healthcare delivery system.   The paper discusses the model set by Indian Space Agency detailing the efforts in innovative procedures, administration, technical, managerial  and financial aspects of the programme.

Development and Implementation of a National Telemedicine/E-Health Grid
National Telemedicine/e-Health Grid: Towards Improvidng Healthcare Delivery in India (M2D2)
L. S. Satyamurthy, BSc,1 Ashok K. Sangal, BSc,1 Murthy L. N. R., BSc,1 Jagdish Kaur, MD2     
1Indian Space Research Organisation, Bangalore, India; 2Ministry of Health and Family Welfare, New Delhi, India

Introduction: It is a daunting task to provide Healthcare to over one billion people of India spread over 3.2 million sq.km., with 75% of India’s population living in rural areas and 75% of doctors practicing in urban areas.  Indian Telemedicine programme primarily spearheaded by Indian Space Research Organisation (ISRO) has made significant impact in the formation of a National Task Force (NTF) by the government with the objective of evolving a National Telemedicine Grid and the e-Health policy framework in the country.

Description: The National Telemedicine Grid (NTG) conceived by a technical working group to channelise the health information database and interconnect the Islands of Skills (specialists, administrators, managers) with the Mainland of Needs (the patients, the beneficiaries). 

Results: The NTG is configured into:
(a) Telemedicine/e-Health Network connecting around 600 district hospitals, 50 speciality hospitals, 100 medical colleges and training institutions.
(b) e-Health Web Portal as a repository of information by the Health Ministry. 

The National Telemedicine Grid is to be configured predominantly with the SatCom connectivity with wireless technologies and the state of the art digital systems.

Conclusion: The concept of National Telemedicine/e-Health Grid is slated for implementation by the Ministry of Health & Family Welfare (MoH&FW) during the coming years. The paper discusses the various aspects considered by the technical working group and the suggested configuration of the Indian National Telemedicine Grid and its implementation aspects.

National Telehealth Resource Center on Legal & Regulatory Issues (M2E1)
Robert J. Waters, JD, Jackie Eder-Van Hook, MS, Joseph Tracy, MS, Rob Sprang, MS     
Center for Telehealth & E-Health Law, Washington, DC

This 1-hour session will introduce the National Telehealth Resource Center on Legal & Regulatory Issues.  It will be an opportunity to describe the new Center, goals, and timelines.  It will also solicit input from the attendees about the type of information they might seek from a National Telehealth Resource Center.

Licensure Portability Iniatives in Nursing (M2E2)
Kristin A. Hellquist, BA, MS, Kevin Kenward, PhD       
National Council of State Boards of Nursing, Chicago, IL

NCSBN began work with the member boards of nursing on the idea of nurse licensure portability in the 1990s.  To-date, 23 states are a member of the Nurse Licensure Compact (NLC) and six years worth of experience has taught boards of nursing about portability of licensure issues.  NCSBN worked with the Gallup Organization on a formal evaluation of the NLC in 2006, and has perspectives to share from NLC members and non-members and nurse themselves on this portability of nurse licensure initiative. 

This evaluation affirmed several important facts about benefits of the NLC:

• The members of the NLC found tremendous value in belonging to the NLC, citing increased collaboration among regulators, and a true benefit to the publics they serve.
• Nurses overwhelmingly supported the idea of all states belonging to the NLC.  
• Increasing mobility by nurses, which gave better access to nurses in times of telehealth, disaster or other needs.
• Increasing the speed that nurses can be hired and allowing for rapid licensure verification.

Additionally, the evaluation highlighted opportunities for improvement regarding the NLC:

• Boards of Nursing (BoNs) wanted more direct information from the Nurse Licensure Compact Administrators (NLCA) regarding the operations, administration and the costs associated with joining and maintaining NLC-membership. 
• BoNs want detailed information surrounding discipline, investigations and data sharing issues. 
• Call for increased education of BoN staff, licensed nurses and other stakeholders regarding the NLC and its operation was also a recurring comment in the evaluation.  A survey finding correlated to this request was that 50% of surveyed nurses erroneously thought they were part of the NLC, even though they did not reside in a NLC state. 

This presentation will allow the telehealth community to hear directly from NCSBN related to licensure portability and its future.

Comparing Outcomes for Web-Managed Congestive Heart Failure Patients in Kansas City
Kansas City Cardiomyopathy Questionnaire in Web-Managed Congestive Heart Failure Patients (M2F1)
Abul Kashem, MD, PhD, Marie Droogan, RN, William P. Santamore, PhD, Carol J. Homko, RN, PhD, Joyce W. Wald, DO, Philip Berger, BS, Alfred A. Bove, MD, PhD  
Abul Kashem, Philadelphia, NJ

Improving health-related quality of life (HRQL) is a primary goal in the treatment of patients with congestive heart failure (CHF), yet few studies have explored correlates of HRQL among CHF patients using a Web-based Telemedicine System. We report on the association of demographic and pathophysiologic measures, social-cognitive measures, and environmental variables with HRQL as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) for patients with chronic heart failure (CHF).

Data were obtained from the baseline interview and electronic medical records of 44patients, 50 years of age and older who were enrolled during the first 12 months of a Web-based Telemedicine CHF disease management study.  Mean age was 53.2; 72.2% were male; 38.9% were black; and the mean New York Heart Association class was 2.3. KCCQ measures of symptom stability trended lower in control patients when comparedwith web-communicated patients (C-28.1%; Web-32.0%; p=0.12). Overall quality of life dropped in both group and the fall was greater in the control  group (16.3% vs. 2.2%; p=0.02). Overall clinical summary was improved in the web-communicated patients (∆0.64% vs. 3.47%; p=0.01).

Quality of life measurement by KCCQ in heart failure shows some benefit of a telemedicine disease management communication system.

Assessing the Use of the Internet to Manage CVD Risk Factors for Inner City Patients in Philadelphia
Internet Telemedicine System Compliance Among Inner City Patients with CVD Risk Factors (M2F2)
Michele M. Masucci, PhD,1 Caroline Guigar, MA,1 William P. Santamore, PhD,2 Carol Homko, PhD,2 Alfred A. Bove, MD, PhD2    
1Information Technology and Society Research Group, Temple University, Philadelphia, PA; 2Temple Telemedicine Research Center, Temple University, Philadelphia, PA

This paper analyzes compliance patterns among inner-city patients using an Internet telemedicine system to manage risk factors for CVD.  The patient population included 79% African-Americans, 7 % Hispanics, 49% females; 66% unemployed and 49% with annual incomes under $15,000 – all had 10% or greater CVD risk (Framingham 10 year risk score).  An analysis of the first 91 days of compliance shows that 82% used the system at least once, and 57% met or exceeded the recommended weekly use of the system. Average training scores based on a 5 point Likert scale for 14 basic computer skills and use of the Internet telemedicine system were positively correlated (r = .28) with the number of times the Internet telemedicine system was used. Little variation in non-compliance was found among men and women; however, high compliance (defined as using the system more than the recommended once-per-week) was stronger among men (12%) than women (4%), even though nearly 30 percent of both scored 4 or higher averages for 14 basic computer skills.  We conclude that training is critical for mitigating digital divide barriers impacting system use among inner-city patients, and that more attention needs to be paid to the circumstances shaping compliance among women.

Digital Signage Solutions and Strategies in Healthcare
12:15pm - 12:45pm

Digital signage has emerged as one of the hottest audiovisual trends in the industry. There are numerous digital signage trade shows and publications hitting the scene. As a healthcare professional how can you apply digital signage in your facility? Learn what it really is and how to design digital signage to attract the audiences you want to reach. Find out what all the buzz about as Mike White, CTS, featured in ProAV Magazine's Fall 2006 issue, tells you how to implement a digital signage network that can help you deliver the right message, to the right people at the right time. White will share his experience based on numerous applications of digital signage for hospitals, retail centers, colleges, corporations, churches, even funeral homes. Notably, White was the chief designer and consultant on Lehigh Valley Hospital's impressive digital signage consisting of 16 60-inch plasma screens made into one functional video wall in the Pennsylvania hospital's lobby.

A Robotic Cauterization System for Trauma Care and Disaster Response
Design of a Robotic HIFU System for Battlefield Trauma Care (M3A1)
Jason Wheeler, MS,1 Stephen P. Buerger, PhD,1 Ralf Seip, PhD,2 Narendra T. Sanghvi, MS,2 Ronald Marchessault, Jr., MBA3    
1Sandia National Laboratories, Albuquerque, NM; 2Focus Surgery, Inc., Indianapolis, IN; 3U.S. Army Medical Research & Materiel Command, Telemedicine and Advanced Technology Research Center (TATRC), Fort Detrick, MD

A remotely-operated system for cauterizing internal and external wounds could save lives in battlefield trauma care and disaster response. A robotic High Intensity Focused Ultrasound (HIFU) system for vessel cauterization was designed for this purpose. The system consists of a robotic manipulator, a detachable actuated end-effector housing a HIFU applicator and imaging transducer, and a HIFU therapy planning and control strategy, and is designed to be compatible with the Army’s Critical Systems for Trauma and Transport (CSTAT). Robotic design of such systems is challenging because safe and intimate physical interaction with humans is required, the environment is uncontrolled, and position must be accurately controlled relative to the wound location. An intrinsically-backdrivable commercial manipulator was selected, permitting safe human contact. The manipulator places (and later retrieves) the end-effector in the appropriate location on the patient. The end-effector attaches to the patient using a suction mechanism and precisely servos the HIFU applicator and imaging array during diagnosis and treatment, which are performed under local or remote control using ultrasound imaging, Doppler, and video feedback. The applicator is capable of cauterizing vessels from the surface to a depth of 70 mm. Design is complete and prototype development continues in a Phase II effort.

Remotely Controlled Manipulators for Life Support Trauma and Transport Units
Integration of Serpentine Manipulators to a Life Support for Trauma And Transport Unit (M3A2)
Sylvain Cardin, PhD,1,2 Anthony Kolb,1 Michael Schwerin,1 Benjamin Brown,1 Troy Turner,1,2 Gary Gilbert, PhD,1,2 Howie Choset, PhD1  
1U.S. Army Medical Research & Materiel Command, Telemedicine and Advanced Technology Research Center (TATRC), Fort Detrick, MD; 2Carnegie Mellon University, Pittsburgh, PA

An earlier study conducted by Carnegie Mellon University in collaboration with the Telemedicine and Advance Technology Research Center (TATRC) explored opportunities to further advance the Life Support for Trauma and Transport (LSTAT) to a next generation through the addition of interfaces to advanced medical technologies, including robotics, information systems, sensors and other medical devices. A key finding and recommendation was to augment LSTAT with robotic manipulators.

Here we present the integration of a light-duty serpentine manipulator that can position a camera and physiologic sensors enabling observation and detailed inspection of a patient by a remote physician. With minor modifications to its control system and an end-effector that allows it to pick up other tools, the same robot arm can also provide additional functionality, acting as a modular component to the LSTAT.  Possible tools that could be use by the manipulator include ultrasound probe, needle guide, antiseptic and antibiotic sprays and high intensity focused ultrasound. In case of hemorrhagic patient, for example, this new device will allow rapid remote intervention if necessary. The integration of this new modular serpentine/LSTAT device to our robotic patient recovery trauma pod program will improve the chance of saving life in the battle field. 

The Trauma Pod: A Tele-Operated Surgery System (M3A3)
Pablo Garcia,1 Mark Noakes,3 Chetan Kapoor,4 Tim Ganous,1 Greg Elbert,2 Michael Treat,6 Jacob Rosen,1 Matt Hanson,1 Joe Manak,1 Chris Hasser5
1SRI International, Menlo Park, CA; 2General Dynamics Robotic Systems, Westminster, MA; 3Oak Ridge National Labs, Oak Ridge, TN; 4University of Texas, Austin, TX; 5Intutitive Surgical, Sunnyvale, CA; 6Robotic Surgical Technologies, New York, NJ

Background: The purpose of this research is to develop a rapidly deployable system, the Trauma Pod, that can perform surgical interventions, tele-operated by a remote surgeon, upon casualties who may otherwise die of blood loss or lose limbs before reaching treatment.

Description: We have prototyped a system capable of operating on a patient phantom through tele-operation and supported by semi-autonomous manipulators that perform the functions of the scrub nurse and the circulating nurse.  The system demonstrates the feasibility of performing a surgical procedure with no humans in the operating room. The speed of the nursing tasks involved, such as tool changes or supplies deliveries, is comparable or faster than that of humans. Tracking and counting of the supplies is performed automatically.

Conclusions: The use of robotics in the operating room has been limited to a surgical robot. Some of the support functions, such as the circulating nurse and the scrub nurse, can be automated to avoid the need for humans in the operating room. This capability can minimize the need for deployment of medical personnel to high-risk situations or act as a force multiplier to increase patient throughput using existing surgeon and nursing resources.

Improving Physician-to-Physician Communications Using New Online Communication Tools in Argentina
Making Physician-to-Physician Communications Easy with New ICTs (M3B1)
Giselle Ricur, MD, María G. Batiz, IT Eng, Roberto Zaldivar, MD, Hugo Micarelli, Matías A. Valdivia, SA, Luis A. Arcuri, DBA   
Instituto Zaldivar, Mendoza, Argentina

This presentation reports on the use of new applications over IP that have impacted on the way physicians work and communicate with each other regardless of their geographical location.

In order to facilitate instant communication (audio-video) between the attending and consulting physicians at the different Institutional sites, the use of video network cameras, remote computer access software (RCAS) and VoIP telephony was implemented. The slit lamps were fitted with dynamic IP video cameras, and the MPEG-4 images were projected onto the PC’s screen. The RCAS enabled both the attending and consulting physician to have complete control of the PC and see the still-images or video, regardless of their location. Videoconferencing capability was assured by VoIP freeware. Therefore, real-time consultations could take place on-demand, avoiding unnecessary patient or physician transfer between rooms, floors or buildings.

These applications have empowered our eye care basically by enhancing the efficiency and productivity of our daily work.  The fact that these tools run over IP has also helped bring down the operational costs. Therefore, they have enabled us to continue providing high quality eye care services for our patients, regardless of the geographic or time barriers of both physicians and patients.

Understanding the Referring Clinician's Decision to Use Telemedicine
Assessing the Decision to Utilize Telemedicine: The Referring Clinician’s Perspective (M3B2)
Ana Maria Lopez, MD, MPH, FACP,1 Claudia L. Chavez, BS, BA,2 Elizabeth Krupinski, PhD,1,2 Ronald Weinstein, MD1,2     
1Arizona Telemedicine Program, Tucson, AZ; 2University of Arizona, Tucson, AZ

Background: The Arizona Telemedicine Program (ATP) is a large multidisciplinary telemedicine program housed in the southwest. The Program has served as a resource for both adult and pediatric specialty consultative services. Although some of these sites have utilized telemedicine for nearly 10 years, how the decision is made to refer the patient to telemedicine consultation is not well understood.

Hypothesis: We hypothesize that experience with telemedicine is likely correlated with increased utilization. In addition, other factors that may influence this decision include concern regarding reimbursement, clinical time pressures, and lack of comfort with the technology. 

Methods: The ATP recently initiated a web-based survey of their users. Users were randomly selected to receive an e-mail invitation to participate in an IRB approved self-administered survey. Participants were asked to describe their exposure to and experience with telemedicine as well as their interest in teleconsultations and  perceived benefit.

Results: Demographic data and responses were immediately entered into a database. Data were analyzed with standard statistical correlations. Models were created to enhance our understanding of the decision-making process.

Conclusions: This presentation will discuss the models developed and their impact on future telemedicine work in the communities served.

Improving Physician Adoption of Online Management for Hypertension
Hypertension Online Management: Identifying Key Factors for Physician Adoption (M3B3)
Alice J. Watson, MBChB, MRCP,2,3 Alastair G. Bell, BMChB, MRCP, MBA,1 Joseph Kvedar, MD1,3      
1 Center For Connected Health, Partners HealthCare, Boston, MA; 2Massachusetts General Hospital, Boston, MA; 3Harvard Medical School, Boston, MA

Managing elements of hypertension online offers the potential to deliver both higher quality and more efficient care.  Technologies already exist to facilitate patient self-monitoring, secure email communication with providers and online risk assessment.  Physician reluctance, however, has stalled widespread adoption of these tools. We carried out an online survey of 53 physicians and a series of 10 in-depth interviews to identify critical factors required for successful implementation of e-health services.

Current usage of online tools was very variable.  Although 50% of physicians surveyed used email to communicate with patients, patient demand generally drove this activity.  While physicians identified many aspects of hypertension care amenable to online management they argued that certain aspects of management needed to be performed in clinic. The majority believed home readings would not replace the need for clinic blood pressure measurement.  70% were prepared to adjust a drug dose, but only 30% were willing to initiate a new drug, using online tools.  Key requirements for adoption of e-health services included: demonstration of equivalent clinical outcomes; some level of reimbursement for online care; and integration with existing electronic medical records.  Physicians raised a number of concerns, including security, medico- legal liability and volume of patient communication.

St. Vincents' Telehome Health Outcomes for Heart Failure Patients (M3C1)
Pamela Whitten, PhD,1 Alicia Bergman, MA,2 Mary Ann Meese, RN,3 Karin Bridwell, MSN,3 Kim Jule, MHA3    
1Michigan State University, East Lansing, MI; 2Purdue University, West Lafayette, IN; 3St. Vincents Home Health, Indianapolis, IN

Introduction: In expanding its existing telemedicine activities, St. Vincent Health System of Indiana partnered with the Purdue Regenstrief Center for Healthcare Engineering to develop, implement, and evaluate telehome care services for patients who have been treated and released from the heart failure (HF) unit or prescribed home health and have an HF primary diagnosis. 

Hypotheses and Data Collection:  The hypotheses tested in this project included telemedicine patients evidencing (1) improved quality of patient care, (2) reduced length of stay and/or re-admissions (3) reduced cost of care.  In addition, the project tested descriptive research questions, including the impact of telemedicine on market segmentation, communication with referring providers, and system usability. Numerous data collection methods were utilized including pre and post surveys (e.g., SF-12, MLHFQ, OASIS items), interviews, and cost analyses.

Results: Data from the participants (n=50) indicated that there was a positive trend in patient care and outcomes for the telehome care patients.  Data from cost outcomes indicated more mixed results due to new resource requirements for telehome health. Patient and provider perceptions proved to be positive as is consistent with general trends.  However, data also emerged that contradicted traditional assumptions and could impact theory as well as practice.

Integrating Cardiopulmonary Monitoring into Home Telerehabilitation Services
A Case for Enhanced Monitoring Capability in Home Health Settings (M3C2)
Donald K. Shaw, PT, PhD,1 Beverly L. Newman,1 Paige M. Sarchet, OTR,2 Jing J. Mitchell, PT2     
1Texas State University, San Marcos, TX; 2Beyond Faith Homecare and Rehabilitation, Lubbock, TX

Introduction:  Physical therapists in hospital settings have immediate access to code carts, physicians, monitors and emergency services in cardiopulmonary arrest situations.  The same is not true for physical therapists in home health settings.  Emergency medical services are frequently distant from patients’ homes.  Electrocardiographic (ECG) monitors are not readily available with most therapists insufficiently trained to properly interpret ECG rhythm strips. 

Approach:  The Telehealth Program team at Texas State University-San Marcos was contacted to provide real time patient ECG surveillance for home health therapists working in the Lubbock, Texas area.  A screening algorithm was designed to identify patients at elevated sudden death risk with a plan subsequently implemented to mainstream these individuals into a distance monitoring program.  Four patients participated in the program; each patient having a complicated medical history.  No cardiopulmonary complications were encountered, however, frequent changes in therapy protocol were required based on ECG and vital sign data. 

Recommendation:  We recommend all therapists working with high risk patients have an automated external defibrillator and portable ECG monitor immediately available.  We further recommend these therapists be trained and regularly tested in ECG rhythm interpretation.  Alternatively, we suggest the use of telehealth monitoring services when such training is not available.

Telehealth Home Exercise/Disease Management for Heart Failure: A Pilot Study (M3C3)
Jill M. Winters, PhD, RN,1 Mary Ann Papp, DO, FACC,2 Susan Cashin, PhD,3 Heather Seubert, BSN, RN1     
1Marquette University, Milwaukee, WI; 2Medical College of Wisconsin, Milwaukee, WI; 3University of Wisconsin, Milwaukee, WI

Heart failure affects approximately 5 million Americans, it is the leading cause of death in the United States, and it is the single most costly health care challenge.  The purpose of this prospective 2-group experimental study was to compare effects of a 12-week telehealth home exercise rehabilitation and disease management program with usual treatment.  It was hypothesized that experimental participants would have greater improvements in functional performance, psychological well-being, and quality of life than those in the control group.  Thirty-six subjects with Class II or III HF were enrolled.  Subjects in both the experimental and control groups underwent submaximal exercise testing and were provided with an exercise prescription.  Experimental subjects received a recumbent stationary bike, Polar heart rate monitors, exercise logs, and telemonitoring equipment.  Daily monitoring of heart rate (HR), blood pressure (BP), oxygenation (SPO2), and weight were conducted for those in the experimental group, in order to insure that they are safe to exercise and assist in disease management.  Regularly scheduled televisits were held with experimental subjects providing telecoaching and telesupport.  Preliminary findings provide empirical evidence for the efficacy and effectiveness of this telehealth based home exercise program for persons with moderate heart failure.  Participant satisfaction has been high.

An Update on the FCC’s Universal Service Rural Health Care Support Program (M3D1)
William L. England, PhD, JD, PE, Daniel H. Johnson, MA       
Universal Service Administrative Company, Washington, DC

The Federal Communications Commission’s Universal Service program supports electronic communications for eligible rural health care providers, as provided by the Telecommunications Act of 1996. Since 1998, this program has committed over $175 million to over 3,450 health care providers.  This presentation will give an update on current program issues including eligibility, service coverage, the application process, best practices to insure full funding and the $100 million of new funding to be made available under the FCC’s Rural Health Care Pilot Project.  The presentation will also report and discuss program statistics including geographic analysis of program participation by state.

The Impact of New OMB Performance Evaluation Requirements on Federal Telehealth Programs
Federal Telehealth Program Performance Evaluation: The Role of OMB (M3D2)
Dena S. Puskin, ScD        
Office for the Advancement of Telehealth, Rockville, MD

Federal health programs are under increasing pressure to demonstrate their contributions to improving the health of Americans.  The Office of Management and Budget evaluates all programs and makes their evaluation available on the web at Expectmore.gov.  This process has had a profound effect on how federal health programs are managed and evaluated.  Of particular importance has been the emphasis on improved performance measurement, especially related to health outcomes.  This session will discuss the impact of this process on one program, the Telehealth Network Grant Program, and its implications for other Federal Telehealth Programs.

Using RFID Technology for Tracking Patients, Medications and in Other Medical Applications
Potential Applications of RFID Technology in Medicine (M3E1)
Paul Fontelo, MD, MPH, Fang Liu, MS, Michael Ackerman, PhD      
Office of High Performance Computing and Communication Technology, Bethesda, MD

Radio Frequency Identification (RFID) wireless data technology has enormous potential use in medical care.  We conducted experiments on possible applications in patient care and medical record tracking, medication delivery, and patient specimen identification. With RFID technology, an electronic tag can store patients’ information, diagnosis, treatment, and other ancillary information.  These can be accessed instantly within the medical treatment facility.  Paper-based records could also be tagged with corresponding information. This will allow easy location within the hospital anytime. Tagged medicine containers can assist nursing care personnel in the timely and accurate delivery of medication that may reduce human errors. These can be done through patient-specific tags in medication containers and handheld RFID readers. RFID tags on specimens could provide accurate patient identification that can follow the patient from admission, surgery and pathology laboratory that may minimize specimen mix-ups.  These applications were developed in accordance with the FDA’s recommendations for implantable RFID medical devices by addressing issues of confidentiality, integrity, availability and accountability. RFID tags will only contain encrypted patient information, and only authorized RFID readers can read and display patient information. We expect that RFID will find extensive use in hospitals, healthcare centers and centers for elderly care in the future.

A Trauma Patient Tracking System for Mass Casualties and Disasters
Trauma Patient Tracking System (M3E2)
William J. Bergeron,1 Thomas F. Budinger, MD, PhD,2 Jonathan S. Maltz, PhD,2 Qiyu Peng, PhD2     
1Triton Systems, Inc, Chelmsford, MA; 2Lawrence Berkeley National Lab, Berkeley, CA

The development of a Trauma Patient Tracking System (TPTS) is currently funded to create a logistical tool for mass causality and disaster events. This system is designed to locate and track trauma patients during pre-hospital care, provide accurate positioning in both urban and rural environments, provide basic life status monitoring, and communicate this information in a timely manner to rescue, medical, and command personnel.

The TPTS includes a patient tag incorporating a combination GPS and RF module, a storage memory chip, a life status monitor, and an additional biosensor interface. The tags communicate via RF with emergency vehicle mounted or in hospital relay stations which in turn routes the data though any available Internet gateway. The patient data is then routed to our web based mapping engine or as raw data into other tracking or monitoring systems.

The system is designed to be adaptive to changing technology and is infrastructure non-specific. The technologies of positioning, short range RF, broadband wireless, biomonitoring, and tracking are all evolving at a rapid pace and are being adopted ad-hoc both commercially and publicly. These varying technologies must be incorporable into the core TPTS to ensure the ability for widespread use. The basic system design, with minor modifications, can also extend to in-hospital or in-home patient monitoring, clinical trial monitoring, or out patient tracking.

Using Remote Critical Care Units in Australia
Improving Access to Critical Care Decision Making with the Virtual Critical Care Unit (VICCU) (M3F1)
Monique Murphy, RN, BNurs, MHM,1 Stuart Stapleton, MBBS, FACEM,1 Patrick Cregan, FRACS,1 Laurie Wilson, PhD2     
1Sydney West Area Health Service, Penrith, Australia; 2CSIRO, Epping, Australia

There are many small isolated hospitals across Australia lacking critical care specialists. A solution using ultra broadband was established as a pilot project between the Area Health Service in collaboration with CSIRO to improve access to these services at the Blue Mountains Hospital (BMH). The resulting Virtual Critical Care Unit (ViCCU®) aimed to provide rapid access to specialist level decision support to clinicians at a peripheral hospital by way of ”telepresence”.

Immediate benefits were noted upon implementation of the ViCCU ®in the ED at BMH, with staff having access to specialist emergency medical consultation 16 hrs per day, 7 days a week.  The project was evaluated over an 18 month multi-method, before and after study, incorporating qualitative and quantitative data collection in 350 critically ill patients.  Statistically significant changes were found in patterns of patient separations with less local admissions and more transfers of critically ill patients and a significant increase in the rate of discharges for minor trauma patients. Structured interviews with clinicians reported that the use of ViCCU® allowed them to increase the decision support they provided to clinicians at BMH.

ViCCU® provides new and improved opportunities by which clinicians can remotely communicate about patient management.

Using Telemedicine to Support Rural Intensive Care Unit Patients
Telemedicine Support for the Rural-Based Intensive Care Unit Patient (M3F2)
Patricia Herr, RN, Mary E. DeVany, Marilyn Dahler-Penticoff, RN      
Avera Health System, Sioux Falls, SD

Remote electronic monitoring of intensive care unit patients improves the care received within the Avera system by decreasing predicted mortality and reducing predicted ICU length of stay.  The Avera facilities and partner facilities participating in this telehealth project receive around-the-clock active remote monitoring services provided by intensivists and critical care nurses, while the on-site physician and bedside team at each facility remains in charge of their patient’s care.  The Avera Health system was the first in the nation to implement remote intensive care monitoring in Critical Access Hospitals. 

This presentation will discuss the development and implementation of this telehealth application across the Avera Health system.  Data from recent outcome studies will demonstrate significant improvements achieved such as: 1) hospital mortalities 40% below predicted (based on APACHE III severity classification system) for ICU patients, 2) reduction of 30% in the predicted ICU length of stay time and 3) other related results such as decreased ventilator days and lower average blood glucose results. 

The Avera Health system has proven that it is feasible for remote intensive monitoring to be provided in small rural facilities as well as the larger urban hospitals, positively impacting the quality of care received in all communities served.

Using High Definition- enabled Telemedicine to Improve Healthcare Outcomes for Katrina Aftermath
2:00pm - 2:30pm

The MCLNO has received a funding donation from AstraZeneca (AZ) which is intended to "help increase patient access to primary care and improve healthcare outcomes to citizens in the aftermath of Hurricane Katrina." The goal of this initiative is to improve the delivery of healthcare to the impacted population of the New Orleans metropolitan area by increasing access to specialty care services, reducing travel obstacles, and providing a realistic 'continuum of care' solution. The health centers will offer primary care services, such as those offered by family physicians, pediatricians and internists, and, in some locations, specialty services as community needs dictate." One advanced technology planned for use is LifeSize High Definition video communications systems. A demo is planned and overview of plans for the program.

The Role of Research and Evaluation in Telehealth Programs (T1A1)
Nancy L. Vorhees, BSN, MSN, Renee Anderson, BA, Douglas D. Weeks, PhD, MS, BS      
Inland Northwest Health Services, Spokane, WA

In spite of considerable positive evidence accumulated over two decades, telehealth programs continue to be in the position of having to prove their value. Telehealth programs must incorporate evaluation strategies into program design, and also continue to perform research on the applicability of telehealth to different situations. Research provides the opportunity to assess the potential impact of telehealth in clinical or educational settings. Evaluations enable managers to determine whether a telehealth program is accomplishing its targeted goals and objectives. This session will provide examples of both evaluation and research. A randomized controlled trial will be described, comparing face-to-face Pediatric Advanced Life Support (PALS) instruction with instruction delivered via telehealth. The research project includes a comparative analysis of student cognitive, psychomotor skill performance, and confidence immediately following the class and after 12 months. A program evaluation will also be described, assessing the performance of a continuing education program for rural emergency medical services personnel. This evaluation uses qualitative and quantitative data to determine student satisfaction, as well as an assessment of knowledge development using pre- and posttests. Detail on research and evaluation methods will be provided, along with a discussion of how to integrate these methods seamlessly into telehealth programs.

A Systematic Review of Research Methodology in Telemedicine Studies (T1A2)
Pamela Whitten, PhD,1 Liv Karen Joha