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Case Study

“Building A Sustainable Telemedicine Cooperative:

The Arizona State-Wide Telemedicine Program”

Ronald S. Weinstein, M.D.

Director, Arizona Telemedicine Program Tucson, Arizona

President Emeritus, American Telemedicine Association

(Serial Entrepreneur)

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Case Study

1. Pre-Implementation Phase

2. Implementation Phase

3. Medical Services Telemedicine Telehealth mHealth, etc.

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I. Pre-implementation Phase 1. Mandate 2. Public Policy 3. Governance 4. Infrastructure 5. Sustainable Business Plan

1. Mandate AZ State Legislature (1996)

2. Public Policy 8 AZ Foundational Policies

3. Governance Non-Statutory Overarching Authority (Arizona Telemedicine Council)

4. Infrastructure Arizona Rural Telemedicine Network

5. Business Plan Application Service Provider (ASP) Model

GENERAL TOPICS ARIZONA CASE STUDY

Case Study MANDATE

Tucson

Arizona Legislature’s Challenge Charter Sites Case Study Infrastructure

Arizona Telemedicine Program - Corps of Engineers

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1998-2001

Arizona Telemedicine Program Telecommunications Utility

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2014

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Case Study

Case Study

I. Pre-implementation Phase 1. Mandate 2. Public Policy 3. Governance 4. Infrastructure 5. Sustainable Business Plan

1. Mandate AZ State Legislature

2. Public Policy 8 Foundational Policies

3. Governance Non-Statutory Overarching Authority (Arizona Telemedicine Council)

4. Infrastructure Arizona Rural Telemedicine Network

GENERAL CATEGORIES ARIZONA CASE STUDY

5. Business Plan (recurrent revenue stream) Application Service Provider (ASP) Model

Case Study Business Plan

Case Study

I. Pre-implementation Phase 1. Mandate 2. Public Policy 3. Governance 4. Infrastructure 5. Sustainable Business Plan

1. Mandate AZ State Legislature

2. Public Policy 8 Foundational Policies

3. Governance Non-Statutory Overarching Authority (Arizona Telemedicine Council)

4. Infrastructure Arizona Rural Telemedicine Network

5. Business Plan-continuous revenue stream Arizona Telemedicine Program-- Application Service Provider (ASP) Model Members – 55 healthcare organizations

GENERAL CATEGORIES ARIZONA CASE STUDY

Case Study

1. Training Program Training Centers

2. Marketing Program Health Fairs, NPR, etc.

3. Telemedicine Service Roll-Out Teleradiology, telepsychiatry, etc.

4. Assessment Programs Best practices, QA, provider satisfaction

5. Supplemental Funding TRC, International Programs

GENERAL CATEGORIES ARIZONA CASE STUDY

I. Pre-implementation Phase 1. Mandate 2. Public Policy 3. Governance 4. Infrastructure 5. Sustainable Business Plan

II. Implementation Phase 1. Training program 2. Marketing 3. Telemedicine Service Roll-Out 4. Assessment Programs 5. Supplemental Funding

Telemedicine Training Programs > 8-9 programs per year (since 2000) > 1200 trainees > 100+ healthcare organizations

Case Study TRAINING PROGRAM

“I think these lectures are a real plus for physicians like me, who

live in rural areas but are always interested in receiving new

information.”

Dexter DeWitt, MD

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Case Study

1. Teleradiology 25 hospitals; 1.3 M Cases

2. Telepsychiatry NARBHA-120,000 pateint encounters

3. Telecardiology Yuma RMC Neonatal Intensive Care Unit

4. Telestroke Mayo Clinic - 13 AZ rural hospital network

5/6. Telepatient-monitoring Banner eICU; Flagstaff CHF program

GENERAL CATEGORIES ARIZONA CASE STUDY

III. Telemedicined/Telehealth Services 1. Telemedicine 2. Telehealth 3. Telenursing 4. Telepharmacy 5. Tele-home health 6. Telemetry 7. Prevention 8. Distance education

“Telemedicine dramatically increases compliance with appointments if you can be

seen in your own community.”

Sara Gibson, MD

Telepsychiatry

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Telecardiology

“We see telemedicine as an important

opportunity to improve patient care.”

Bart M. Demaerschalk, M.D

Vascular Tele-neurologist Mayo Clinic-Scottsdale

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Telestroke

“It works. It saves people’s

lives.”

Jack Porter Former Mayor Bisbee, Arizona

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Telestroke

“We have the opportunity to

change the way health care is

delivered.”

Deborah Dahl, Banner Vice Presidnet

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$68,000,000 savings/Peter Fine, Banner CEO

Tele-eICU

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Tele-Home Health Care

Flagstaff Medical Center in Northern Arizona

Pilot project: 50 Patients with Hx Congestive Heart Failure*

• Decreased hospitalizations: 3.26 vs. 1.82 over 6 months

• Fewer days hospitalized: 13.98 vs. 5.13 days

• Cost saving: $92,317 per patient over 6 months

* Pts. provided with wireless devices to track weight, blood pressure and activity levels daily. Data automatically transmitted.

Brookings Institute Conference on Mobile Health

March 2014

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“Care Beyond Walls and Wires is the best thing

ever for me, and the best thing for my dad.”

Rita Yazzie

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T

Case Study Tele-Support Groups

“Telemedicine Is pivotal for diabetic

retinopathy.”

Mark B. Horton, M.D.

Case Study REMOTE SCREENING FOR DIABETIC RETINOPATHY

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1. Teleradiology 25 hospitals; 1.3 M Cases

2. Telepsychiatry NARBHA-114,000 encounters

3. Telecardiology Yuma RMC Neonatal Intensive Care Unit

4. Telestroke Mayo Clinic - 13 AZ rural hospital network

6. Telepatient-monitoring Banner eICU; Flagstaff CHF program

GENERAL TOPICS ARIZONA CASE STUDY

III. Telemedicined/Telehealth Services 1. Telemedicine 2. Telehealth 3. Telenursing 4. Telepharmacy 5. Tele-home health 6. Telemetry 7. Prevention 8. Distance education

7. Tele-medication monitoring University of Arizona College of Pharmacy

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Why Telemedicine?

Gap Services

Urgent Services Mandated Services

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“In some cases the patient can be treated locally instead of bringing the patient to us

by helicopter, which costs $10,000 to $20,000.”

Daniel M. Caruso, MD

Why Arizona?

Geography

Leadership Culture

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University of Arizona

Land Grant University

“Land Grant University Mission for the Future”

Develop partner

relationships with communities and

industries.

Advance local and global impacts of

University of Arizona knowledge creation.

Ann Weaver Hart, Ph.D.

President University of Arizona

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Barriers

Legal, regulatory

Reimbursement Culture

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.>> Acute Shortages of Telehealth Service Providers

“Practicing Medicine on a Unicycle”

Telemedicine

1- saves live

2- reduces health-care costs

3- improves assess

4- managing chronic diseases

5- disease prevention

6- improves quality of life

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Case Study

For Copies

Please Contact

Angel Holtrust at:

aholtrust@telemedicine.arizona.edu

Thank you!

rweinstein@telemedicine.arizona.edu

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Case Study