The Arizona Telemedicine Program: Two Years Experience With a UniversityBased Telemedicine Program

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The Arizona Telemedicine Program Two Years
Experience With a University-Based Telemedicine
Program

• Elizabeth Krupinski, PhD,
• Ana Maria Lopez, MD,
• Ronald Weinstein, MD
• Presented at
• The American Telemedicine Association Conference
• April 18-21, 1999
• Salt Lake City, UT

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Goal

• To assess the Arizona Telemedicine Program (ATP)
  in terms of patterns of use, patient demographics
  and general satisfaction with the program.
• Periodic and consistent assessment is a long-term
  and on-going component of the ATP.

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Rationale I

• Continuous assessment of our Telemedicine Program
  provides a measure of Quality Control (QC) and
  Quality Assessment (QA).
• We can track progress of the program and changes
  in usage over time.

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Rationale II

• By assessing patterns of use of the Telemedicine
  Program at each of the remote sites, we can
  better determine what their individual needs are
  and how we can best meet those needs.

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ATP Telemedicine Sites
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Methods

• Detailed medical records are kept for each
  telemedicine patient.
• These records are analyzed on a monthly basis to
  track various aspects of the program.
• Statistics are compiled for the program as a
  whole and for each individual site.
• This poster only reports on telemedicine, not
  teleradiology cases

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Record Compilation

• The Site Coordinator at each remote location
  gathers the necessary patient information for the
  consult.
• The Telemedicine Coordinator at the AHSC hub site
  establishes a new patient record once the
  information has been received and a consult
  requested.

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Record Contents

• Patient consent
• ATP required forms
• Diagnostic information
• Written patient records
• Still photos
• Radiographs radiology reports
• Lab test results (e.g., autochem printout)
• EKG, EEG printouts
• Other relevant materials

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Required Forms

• Patient consent form
• Patient demographics form
• Patient history form
• Internal medicine
• Non-internal medicine
• Cardiology
• Initial psychiatric
• Follow-up psychiatric
• Billing/insurance form

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Case Volume

• We have conducted over 900 telemedicine and 1500
  teleradiology sessions to date
• We have been averaging about 60 telemedicine
  cases per month
• 56 are store-forward 44 are real-time
• 76 are initial consults 24 are follow-up
  consults

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Quarterly Case Volume
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Health Care Providers

• 70 clinicians at the AHSC ATP hub site have
  served as telemedicine consultants.
• 116 health care providers at the remote spoke
  sites have referred patients to AHSC for a
  telemedicine consultation.

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Referring Clinician Degrees
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Sub-Specialties Covered

• Cardiology Ophthalmology Peds. Orthopedics
• Dental Orthoped. Surg. Peds. Psychiatry
• Dermatology Orthopedics Peds. Pulmonology
• Endocrinology Otorhinology Peds. Rheumatology
• Fam. Comm. Med. Pain Clinic Peds. Urology
• Gastroenterology Pathology Psychiatry
• Genetics Peds. Cardiology Radiology
• Hematology/Oncology Peds. Dermatology Reprod/Infe
  rtility
• Infectious Disease Peds. Endocrinology Rheumatolo
  gy
• Internal Medicine Peds. Gastroenterology Surgery
• Medicine Peds. Hem/Onc Surgical Oncology
• Nephrology Peds. Infec. Disease Toxicology
• Neurology Peds. Nephrology Urology
• Ob/Gyn Peds. Neurology

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Patient Age Groups
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Patient Race
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Patient Employment
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Patient Insurance
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Case Turn-Around Time
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Types of Service
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Patient Information
Other than required forms (e.g., growth chart)
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Program Satisfaction

• Both referring and consulting clinicians have
  been quite satisfied with the quality of services
  they have been able to provide with telemedicine.
• Patients are also quite satisfied, especially
  with the travel time that they have been able to
  avoid by not going to see a specialist in person.

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Patient Benefits

• For the existing telemedicine sites, patients
  would have to travel on average about 165 miles
  to get to Tucson to see a specialist (min 60
  miles max 300 miles approx.)
• Travel cuts into work time and wages, and for
  many requires child care, animal care, making
  special plans, missing school and dealing with
  parking.

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Discussion

• The ATP is successfully using both real-time and
  store-forward technologies for a variety of
  sub-specialty consults.
• Regularly scheduled clinics have been set up for
  the more voluminous specialties.

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Discussion

• Including teleradiology, telepathology,
  administrative and CE broadcasts, the ATP has
  held nearly 3000 sessions since beginning
  operation two years ago.
• Efforts are underway to expand our services to
  other sites and to develop and maintain a
  self-sustaining, state-wide health care network.