Title: AFHCAN Project Telemedicine in Alaska
1AFHCAN ProjectTelemedicine in Alaska
Stewart Ferguson, Ph.D Associate Project
Director Director of Technology Darren Coolidge,
MCSE Senior Software Analyst Kari Lundgren,
PA-C Telemedicine Coordinator, SEARHC AFHCAN
Project Office Alaska Native Tribal Health
Consortium 907-729-2260 www.afhcan.org
2Alaska Telemedicine Testbed Project (ATTP)
- Funded by NLM Contract N01-LM-6-3540
- University of Alaska Anchorage (UAA)
- Fred Pearce, Ph.D. Principal Investigator
- 4 Regional Health Corporations
- 26 Village clinics
- Evaluate the impact of low-bandwidth telemedicine
systems on costs, professional isolation and
provider/patient satisfaction - 3,000 cases 9,000 images in 2 years
3Ear Disease
- Ear disease accounts for
- 31 of clinics visits for those under the age of
five - 59 of the antibiotic prescriptions for those
under the age of seven
4 NLM Project - Software
MS Outlook 98
Custom Form/ Leverage2K
Snapins
5AFHCAN VISION 235 federal and state sites health
care sites in Alaska linked in a telehealth
network Create needs based solutions Build
flexible systems Ensure sustainability Evaluate
solutions Coordinate with all telehealth in Alaska
AFHCAN MISSION To improve access to health care
for federal beneficiaries in Alaska through
sustainable telehealth systems
AFHCAN Project is managed by the Alaska Native
Tribal Health Consortium (ANTHC)
AFHCAN Project is a project of the Alaska
Federal Health Care Partnership
6Referral Patterns
ANMC (Specialist)
Elm. AFB (Specialist)
AFHCP
Region (MD)
USCG (MD)
RMT
PRIVATE (Non-Federal)
Village (CHA)
7AFHCAN Partners
- IHS - 194 sites - 97,000 beneficiaries
- VA - 1 site - 65,000 beneficiaries
- US Army, US Air Force - 9 sites - 47,000 military
and dependents - USCG - 4 sites - 3,000 beneficiaries
- Alaska PHN - 26 sites
8AFHCAN Sites
9Organizational Issues
- 235 Sites
- 38 Organizations
- 32 Native Non-profit Health Corporations
- Designed as a four-year project (1999-2002) with
a 30 million dollar budget - Multiple Federal funding sources (DHHS, HIS, DoT,
DoD )
10Subregional Center
Initial Entry
Both Initial Secondary
Secondary Care
Secondary Tertiary Outsourced Care
Harborview ANMC Providence AK API Private
MD/Dental
(Limited Entry) Petersburg Wrangall Skagway Ketchi
kan
The SEARHC Clinical System
11Walk before running approach
What is the use of running when we are not on the
right road? Old Saying
12OrganizationalChartCommunications
TELEHEALTH Team
EXECUTIVE BOARD CEO / Commanders ANMC, VA, USCG,
3MDG, BACH, 354 MDG
STEERING BOARD AFHCP Planning Board Chairman,
AFHCP Project Officer, AFHCP Business
Office Director, ANMC Data Manager, and Clinical
and Tribal Representatives
AFHCAN Partners
Clinical
Training
APO
Technology
Business
Informatics
13Wanted Simple Solution.Needed Orthogonal Design
- 38 Autonomous organizations
- Many server platforms - Unix, Linux, WinXX
- Many client platforms and browser
- Many servers apps - web, database
- Multiple HIS
- Distributed / Disconnected servers - (SF between
servers)
14AFHCAN Technology
15AFHCAN Referrals
16AFHCAN Technologies
17Cart
18Equipment
19Details
20Touchscreen
21Video Otoscope
22Digital Camera
23Digital Camera - LCD
Image Quality
Better
Ease of Use
Worse
Sony FD90
Nikon 990
24AFHCAN Software - Design Goals
251b) Make it Medical before Telemedical.
- Single, intelligent interface to all devices
- Rapid access to medical devices
- Smooth / accurate display
- Color accuracy, compression factors
26A properly designed system can improve the
quality of health care delivery without saving or
sending a single byte.
27Simplified User Interface
28Make it Easy to Use
- Can and will be used by a diverse user population
- 67 of sites staffed by Community Health Aides,
21 staffed by Nurses or P.A.s (Initial
Providers) - Roughly 10 of sites staffed by MDs (Specialists)
29Two Basic Types of Users
- Initial provider?
- Ease of acquisition more important
- Specialist?
- Ease of acquisition less important
- Data more important
30Make it Robust
- Accept poor (unreliable) connectivity
- Accept low bandwidth limitations
- Function over satellite connectivity
31State Machine
32drinks
Software
The web is a stateless system.
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3410 Soda
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36Patient ID
Patient ID
37State Machine
- Reusable Code
- Independent testing of modules (machines)
- Robust - State info stored on server
- Scaleable
- Customizable - by machine or in wiring
- Standards-based data exchange
38Web-based Programming Considerations
39Distributed Architecture
- 38 Autonomous organizations
- Many server platforms - Unix, Linux, WinXX
- Many client platforms and browser
- Many servers apps - web, database
- Multiple HIS
- Distributed / Disconnected servers - (SF between
servers)
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41Satellites
- Add 0.6 seconds to roundtrip delay
- Cause web pages to load in 5 - 40 seconds
- Solutions
- Remove need for frame sets
- Caching locally
- TCP/IP registry tweaks
- No HTTP/Redirects
42Technology Used
43Technology
44ACKNOWLEDGEMENTS
Technical Expertise and Design Tom Bohn Jim
Rogina David Young Chris Patricoski, MD AFHCAN
Statewide Committees Funding Sources DHHS -
OAT VA U.S. Army IHS Legacy NLM / UAA
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