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AFHCAN Telehealth Innovations in Health Care
Stewart Ferguson, PhD Chief Information Officer (CIO)
Alaska Native Tribal Health Consortium
Alaska Native Tribal Health Consortium 2
“Telemedicine is the use of medical information exchanged from one site to another via
electronic communications to improve patients' health status.”
“… Telehealth ... is often used to encompass a broader definition of remote healthcare that
does not always involve clinical services. “
American Telemedicine Association
Alaska Native Tribal Health Consortium
Alaska Tribal Health System Medical Care Service Levels
• Alaska Native Medical Center tertiary care – Referrals to private medical
providers and other states for complex care
• 6 regional hospitals
• 4 multi-physician health centers
• 25 subregional mid-level care centers
• 180 small community primary care centers
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Alaska Native Tribal Health Consortium
ANTHC Vision: Alaska Natives are the healthiest people in the world.
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Alaska Native Tribal Health Consortium
• Alaska- 27 MUAs within the state – in 1998 Alaska ranked 48th among the states in the ratio of doctors to residents
• Hawaii – 17 MUAs within the islands • Idaho – 48 MUAs within the state • Montana – 63 MUAs within the state – all or parts of Montana’s 56
counties are Federally identified Health Professional Shortage Areas (HPSA’s), Medically Underserved Areas (MUA’s) or Dental Shortage Areas (DSA’s)
• Oregon – 66 MUAs within the state • Utah – 23 MUAs within the state – 20 of Utah’s counties are designated as
Primary Care Health Professional Shortage Areas (HPSAs), 25 are designated as Mental Health HPSAs, 21 are designated as Dental HPSAs.
• Washington – 53 MUAs within the state • Wyoming – 14 MUAs within the state – 18 of 23 Wyoming counties have
HPSA designation; all 23 counties designated mental health PSA’s.
Northwest/Pacific States
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Alaska Native Tribal Health Consortium
Telemedicine is one STRATEGY to
improve access, quality & performance
and to manage
costs & risk
Alaska Native Tribal Health Consortium
AFHCAN - by the numbers …
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199,562
82,274
3,953
2,335
Cases created
Patients served
Providers involved
Providers creating
ATHS (Alaska Tribal Health System) (1/1/2000 to 3/31/2014)
Since 2001 2013
36,229
22,982
1,686
914
Alaska Native Tribal Health Consortium
INCREASE ACCESS TO CARE BEST FOR PATIENT CARE REDUCES COST
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Alaska Native Tribal Health Consortium
Telehealth Impact on Extended Waiting Times (> 4 months)
Data courtesy of Phil
Hofstetter
47%
8%
3%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Pre-Telemed1991-2001(n=1216)
With Telemed
2002-2004
(n=276)
With Telemed
2005-2007
(n=210)
Pe
rce
nt
Ap
po
intm
en
t A
vaila
bil
ity
Wit
h 5
M
on
th o
r Lo
nge
r W
ait
Tim
e
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Alaska Native Tribal Health Consortium
ANMC Turnaround Time
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40% of cases are turned around in
60 minutes
60% of cases are turned around in
2 hours
80% of cases are turned around in
the same day
Alaska Native Tribal Health Consortium
• Diabetic Retinopathy is the leading cause of new blindness among adults
• Blindness due to diabetes can be eliminated by timely Dx and Tx
• ~ 4% of AI/AN’s with DM need laser tx to prevent vision loss
Alaska Native Tribal Health Consortium
Deployment of the IHS-JVN in Alaska using a portable
platform reversed a seven year decline in rates for the state
Joslin Vision Network (JVN) Portable JVN Pilot
0%
10%
20%
30%
40%
50%
60%
70%
DR
Exa
m R
ate
15% Increase
25% Decrease Portable JVN
implemented
Alaska Native Tribal Health Consortium
Pre-Operative Planning for Ear Surgery Using Store-and-Forward Telemedicine John Kokesh M.D., A. Stewart Ferguson Ph.D., Chris Patricoski M.D.
Comparison of surgical time (actual surgical time – estimated
surgical time) for telehealth and non-telehealth cases. Values in the
right half of the plot represent cases which took longer than planned (42% of telehealth
cases and 47% of non-telehealth cases); values in the left half represent cases that took
less time than planned (58% of telehealth cases and 53% of non-telehealth cases)
0%
5%
10%
15%
20%
25%
30%
35%
40%
-3 -2.5 -2 -1.5 -1 -0.5 0.5 1 1.5 2 2.5 3
Pe
rce
nt
of P
atie
nts
Actual Surgical Time - Planned Surgical Time (hrs)
NonTelemed
Telemed
The average
difference was not
statistically
different between
the two groups:
32 minutes for the
telemedicine
evaluation group
and 35 minutes
for the in-person
evaluation group
Alaska Native Tribal Health Consortium
Estimated Travel Savings from Telehealth for ALL Patients
Estimated annual savings from telehealth for all patients amounts to
about $8.3m with a total savings of $37.8m since 2003.
$0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
$9,000,000
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Specialty Care
Primary Care
Alaska Native Tribal Health Consortium 15 ATHS (Alaska Tribal Health System) (1/1/2000 to 12/31/2013)
0%
5%
10%
15%
20%
25%
30%
% C
ase
sTravel CAUSED (by Case Role)
Primary Care Specialty Care
Alaska Native Tribal Health Consortium
WHERE ARE WE HEADED?
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Alaska Native Tribal Health Consortium
The questions have changed … 10 Years Ago
“Should we do telemedicine”
“Will patients be satisfied”
“How do we do telemedicine”
Now “How do we integrate telehealth with the care environment”
“How can we support and expand telehealth capability”
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The Clinician’s Perspective … the New Limiting Step
Alaska Native Tribal Health Consortium
The Keys to the Future
Partnerships
Preparing and Supporting Rapid Growth
Integration with Health Care
Leveraging new Informatics Technologies
Continuing to demonstrate Value Proposition
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Alaska Native Tribal Health Consortium
Stewart Ferguson, PhD
Chief Information Officer
Alaska Native Tribal Health Consortium
4000 Ambassador Drive
Anchorage, AK 99508
(907) 729-2262
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