Michael Manley, RN, MNScOutreach and AR SAVES DirectorCenter for Distance HealthUniversity of Arkansas for Medical Sciences

TelemedicineIn Healthcare

Rural Areas Specialty Coverage

First e-ICU

Patients First

Utilizing Telemedicine Across the Healthcare Spectrum

Origins of ANGELS/CDH in AR

• In 2002, DHS approached UAMS with high risk OB support concept

• Innovative program was able to leverage federal dollars to increase access to care

• UAMS provides state match portion, resulting in requirement of no state funds

Arkansas Telemedicine Model

Offer Community

Needs-Based Services

Education & Training for Providers

Case Coordination & Evidence-Based Guidelines/Protocols

Evaluation and Quality Improvement

Telemedicine Network & Infrastructure

Centralized Tech Support & Scheduling Call Center 24/7

ARKANSAS

ASHLEY

BAXTERBENTON BOONE

BRADLEY

CALHOUN

CARROLL

CHICOT

CLARK

CLAY

CLEBURNE

CLEVELAND

COLUMBIA

CONWAY

CRAIGHEAD

CRAWFORD

CRITTENDEN

CROSS

DALLAS

DESHA

DREW

FAULKNER

FRANKLIN

FULTON

GARLAND

GRANT

GREENE

HEMPSTEAD

HOT SPRING

HOWARD

INDEPENDENCE

IZARD

JACKSON

JEFFERSON

JOHNSON

LAFAYETTE

LAWRENCE

LEE

LINCOLN

LITTLE RIVER

LOGAN

LONOKE

MADISON

MARION

MILLER

MISSISSIPPI

MONROE

MONTGOMERY

NEVADA

NEWTON

OUACHITA

PERRY

PHILLIPS

PIKE

POINSETT

POLK

POPE

PRAIRIE

PULASKI

RANDOLPH

ST. FRANCIS

SALINE

SCOTT

SEARCY

SEVIER

SHARP

STONE

UNION

VAN BUREN

WASHINGTON

WHITE

WOODRUFF

YELL

Obstetrical and Neonatal Sites

BOWIE Co.,Texas

Pediatric Sites

ARKANSAS

ASHLEY

BAXTERBENTON BOONE

BRADLEY

CALHOUN

CARROLL

CHICOT

CLARK

CLAY

CLEBURNE

CLEVELAND

COLUMBIA

CONWAY

CRAIGHEAD

CRAWFORD

CRITTENDEN

CROSS

DALLAS

DESHA

DREW

FAULKNER

FRANKLIN

FULTON

GARLAND

GRANT

GREENE

HEMPSTEAD

HOT SPRING

HOWARD

INDEPENDENCE

IZARD

JACKSON

JEFFERSON

JOHNSON

LAFAYETTE

LAWRENCE

LEE

LINCOLN

LITTLE RIVER

LOGAN

LONOKE

MADISON

MARION

MILLER

MISSISSIPPI

MONROE

MONTGOMERY

NEVADA

NEWTON

OUACHITA

PERRY

PHILLIPS

PIKE

POINSETT

POLK

POPE

PRAIRIE

PULASKI

RANDOLPH

ST. FRANCIS

SALINE

SCOTT

SEARCY

SEVIER

SHARP

STONE

UNION

VAN BUREN

WASHINGTON

WHITE

WOODRUFF

YELL

Obstetrical and Neonatal Sites Batesville Independence County Health Department Batesville White River Medical Center Blytheville Great River Medical Center Camden Ouachita County Medical Center Clarksville Johnson County Health Department Clarksville Johnson Regional Medical Center Conway Conway Health Department Conway Conway Regional Health System Crossett Ashley County Medical Center DeQueen Sevier County Health Department Dumas Delta Memorial Hospital El Dorado Medical Center of South Arkansas El Dorado AHEC South Arkansas Fayetteville Northwest AHEC Fayetteville Washington Regional Med Center Fayetteville Willow Creek Fort Smith Fort Smith AHEC Fort Smith St. Edward’s Mercy Medical Fort Smith Sebastian County Health Department Fort Smith Sparks Health System Harrison North Arkansas Regional Medical Center Helena Delta AHEC Helena Helena Regional Med Center Hope Hempstead LHU Hot Springs National Park Medical Center Hot Springs St. Joseph’s Mercy Health Center Johnson Willow Creek Women’s Center Jonesboro Northeast AHEC Jonesboro St. Bernard’s Medical Center Lake Village Chicot Memorial Hospital Little Rock Arkansas Children’s Hospital Little Rock St. Vincent’s Medical Center Little Rock UAMS Mena Mena Medical Center Mountain Home Baxter Regional Hospital Newport Harris Hospital Paragould Arkansas Methodist Medical Center Pine Bluff AHEC Pine Bluff Pine Bluff Jefferson Regional Medical Center Rogers Mercy Medical Center Russellville Millard-Henry Clinic Russellville Pope County Health Department Russellville Saint Mary’s Regional Medical Center Searcy White County Medical Center Texarkana Miller County Health Department Texarkana Southwest AHEC Texarkana, TX Wadley Regional Medical

BOWIE Co.,Texas

Pediatric Sites Fayetteville Mana Northwest Arkansas Pediatric Clinic Jonesboro Children’s Clinic

ANGELS Sites

Facilitates Acute

telemedicine

Coordinates Transports

Communicates to

Providers& Patients

Triage Call Center

Angels Call Center

In 2013:• Staffed by 6 appointment center specialists• Handled 206,481 phone calls• Processed 26,662 appointments• 1824 Urgent care visits avoided by triaging

ANGELSTelemedicine Program

TelemedicineConsults

Guidelines• 203 guidelines for best practices in

Obstetrics, Neonatology, & Pediatrics www.angelsguidelines.com

4,254 visits from 25 countries in 2013

Interactive Video Conferences

• High Risk OB• OB/GYN Grand Rounds• ONE Team nursing

teleconference• Fetal Anomaly

Interdisciplinary Management (FAIM)

• Peds PLACE

For a current listing and access information please go to - https://learnondemand.org/events.aspx

Education Courses

• On-site and via Interactive Video– S.T.A.B.L.E.– AWHONN Fetal Heart Rate Monitoring Courses– NRP– Breastfeeding mini-course– Nurse Certification Courses

• Inpatient OB• High Risk Newborn• Low Risk Newborn• Maternal/Infant

Online Education

• Launched December 2013

• Over 100 modules • >1000 users• 65 of Arkansas’ 75

counties with users• ANGELS content free to

Arkansas residents• Multidisciplinary

– Continuing Medical Education– Continuing Nursing Education– Continuing Pharmacy

Education

Patient Education Website

• To launch Summer 2014

• Allows for private discussion groups (HIPAA compliant)

• First educational initiatives will focus on maternal/infant education

Following Baby Back

Home

OB Psychiatry

Newborn Screening

Arkansas Fetal

Diagnosis and Management

Colposcopy

ANGELS Spinoff Programs

Center for Distance Health Programs That Create Access

Arkansas SAVES: Purpose

• Increasing subspecialty access to rural stroke patients

• Impacting stroke-related disability and mortality, and

• Enhancing emergent stroke support by consulting on the administration of tPA medication to eligible patients.

Arkansas SAVES: Rationale

• Rural hospitals without the support of a neurologist often forgo administration of tPA.

• The time needed to affectively administer tPA is often lost when transporting patients.

• Arkansas’ stroke patients are missing out on sub-specialty expertise.

ARKANSAS

ASHLEY

BAXTERBENTON BOONE

BRADLEY

CALHOUN

CARROLL

CHICOT

CLARK

CLAY

CLEBURNE

CLEVELAND

COLUMBIA

CONWAY

CRAIGHEAD

CRAWFORD

CRITTENDEN

CROSS

DALLAS

DESHA

DREW

FAULKNER

FRANKLIN

FULTON

GARLAND

GRANT

GREENE

HEMPSTEAD

HOT SPRING

HOWARD

INDEPENDENCE

IZARD

JACKSON

JEFFERSON

JOHNSON

LAFAYETTE

LAWRENCE

LEE

LINCOLN

LITTLE RIVER

LOGAN

LONOKE

MADISON

MARION

MILLER

MISSISSIPPI

MONROE

MONTGOMERY

NEVADA

NEWTON

OUACHITA

PERRY

PHILLIPS

PIKE

POINSETT

POLK

POPE

PRAIRIE

PULASKI

RANDOLPH

ST. FRANCIS

SALINE

SCOTT

SEARCY

SEVIER

SHARP

STONE

UNION

VAN BUREN

WASHINGTON

WHITE

WOODRUFF

YELLHub Site

HybridHub Site

Average Age of Stroke

Female Male0

10

20

30

40

50

60

70

80

90

100

92

86

65 6668

63

7168

726970

64

2008 2009 2010 2011 2012 2013

Based on Annual Data

Age

Overall Performance

Total Consults Activase % Activase Total Sites0

100

200

300

400

500

600

700

7 229

3

114

17 15 13

267

70

26 19

464

109

23 30

576

139

2440

611

180

29 40

2008 2009 2010 2011 2012 2013

Based on Annual Data

Min

utes

Adult Sickle Cell Clinical Program

• Program Background– Legislature support for Sickle Cell (2012)– UAMS given opportunity to develop program– 2013 Program development– Jan 2014 Adult Sickle Cell Clinical Program

Program Overview

• Transition Clinic– Facilitate patient’s transition from ACH to adult care

• Annual sub-specialty multi-disciplinary clinic• Inpatient Consult Service• Registry

– Database collecting valuable information concerning Arkansas Sickle Cell patients

• 24/7 Triage Call Center supporting program (providers, patients, and community)

• Educational program – Best practices for sickle cell disease treatment – Sickle Cell Outreach to AR Providers and communities

• Directory of Arkansas Healthcare Providers– that manage Sickle Cell patients

Telehealth and Sickle Cell

• Current uses– 24/7 Triage Call Center Support for Providers, Patients and

Community– Educating Healthcare Providers

• Teleconference Presentations • Call Center encounters

• Future Plans for Telemedicine– Building a Sickle Cell PCP Network through TM outreach– Telemedicine Clinic – Collaboration with PCPs

• Consults for acute care treatment• Consults for best practices to use in daily practice• Follow-up with shared patients

Telemedicine Consults in Arkansas Emergency Departments

Trauma and Hand Sites

2014

Image Repository

Trauma Images can move between hospitals for trauma patient

Patient

Arkansas Trauma Hand Specialist

HAND

BURN

TRIUMPH

Tele-Rehabilitation Interventions through University-based Medicine for Prevention and Health

TRIUMPH

• Education-Guideline development, presentation and promotion.

• 24-7 Call Center 1-855-PMR-MYTE (767-6983)

• Telemedicine appointments for Arkansans living with Spinal Cord Injury and Traumatic Brain Injury

Evolution of UAMS Telehealth Programs (2003-2014)

2003 2006 2008

Federal Communications CommissionRural Health Care Pilot Program

Tele-Nursery

2004 2010

(ONE) TeamObstetricalNeonatal ExchangeCE for Nurses

Stroke Assistance thru

Virtual Emergency Support

2011

Adult Sickle Cell (Clinic)

Guideline Smartphone Application

Postpartum Hypertension Project

20132007

High-Risk OB &

Neonatal Guidelines

FY 2013: 594 consults,

(tPA to151 patients)

ANGELS 24-hr

Call Center Service

Telehealth KIDS

FAIM CME for

MDs

New Clinical Services:• Diabetes• Colposcopy• Resident-

facilitated HROB Clinic

Spanish Translation Interpretation Services

TOUCH Telemedicine Outreach Utilizing Collaborative Healthcare (Neonatal Census Rounds)

2009

Fetal Echo (Clinic)

2013 4,566 OB patient visits

Completion of BTOP Grant

Connecting 410+ Healthcare Sites

Hand Trauma

HealthEducationAssessmentResearchTelehealth

2012

$102M BTOP Grant Award

TriumphTele-RehabSpinal CordCommission

2014

Broadband Technology Opportunities Program (BTOP)Awarded in 2010

BTOP

BTOP Sites

BTOP Benefits in Arkansas

Healthcare

Higher Education/Libraries

Public Safety

Research & Clinical Trials

Year 4: After Grant Funding Ends

Current Healthcare Examples

ANGELS Home Health Arkansas SAVES

eICU Trauma Network Telenursery

3-1-2011

Year 4: After Grant Funding Ends

Current Education Examples

Coursework Sciences Health Training

Information Tech. Workforce Training Research

3-1-2011

Organization Broadband Provided or Enhanced

IAV Equipment

Stethoscope Jed Med DigiCam

Public PC

Area Aging Institutes 5 8 8 9 8

Arkansas Dept of Health

109 118 95 95 0

AHECs 9 11 10 11 11

Clinics 82 87 87 87 78

Hospitals 75 140 1 137 81

Mental Health Clinics 67 66 0 0 52

Therapy Centers 11 11 0 0 11

Libraries 0 8 0 0 8

Human Development Centers

6 6 5 5 0

Pathfinder 4 11 0 0 4

KIDS First 8 9 9 9 9

405 376 475 215 353 262

Telemedicine Broadband and Equipment Overview

454 sites total includes 33 colleges and universities, 15 home health sites and 1 public safety organization.

Conclusion

“Where you live shouldn’t decide whether you live or whether you die.”

Paul Hewson

UAMS-Where Telemedicine Lives!