The Arizona Telemedicine Program: Two Years’ Experience

With a University-Based Telemedicine Program

Elizabeth Krupinski, PhD,

Ana Maria Lopez, MD,

Ronald Weinstein, MDPresented at

The American Telemedicine Association Conference

April 18-21, 1999

Salt Lake City, UT

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.

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.

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.

ATP Telemedicine SitesTuba City

Kingman

Cottonwood

Ganado

Payson Springerville

Whiteriver

DOC - Phoenix

DOC - Yuma

NogalesPatagonia

Douglas

AHSCKinoTucson VA

AHSC Hub

Telemedicine

Telepathology

Teleradiology

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

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.

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

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

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

Quarterly Case Volume

020406080

100120140160180

Num

ber

of C

ases

2ndQtr97

3rdQtr97

4thQtr97

1stQtr98

2ndQtr98

3rdQtr98

4thQtr98

1stQtr99

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.

Referring Clinician Degrees

CNM3%

Other5%

MD58%

PhD15%

CFNP13%

PAC6%

Sub-Specialties CoveredCardiology 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/Infertility

Infectious Disease Peds. Endocrinology Rheumatology

Internal Medicine Peds. Gastroenterology Surgery

Medicine Peds. Hem/Onc Surgical Oncology

Nephrology Peds. Infec. Disease Toxicology

Neurology Peds. Nephrology Urology

Ob/Gyn Peds. Neurology

Patient Age Groups

Adult55%

Adolescent11%

Pediatric23%

Geriatric11%

Patient Race

Native American25%

Hispanic31%

White42%

African American1%

Asian American1%

Patient EmploymentUnemployed

18%

Prisoner13%

Infant9%

Student22%

Not In Work Force10%

Retired7%

Employed21%

Patient Insurance

Champus2%

Tobacco Tax4%

Prisoner13%

Private23%

None/Self9%

I H S15%

BC/BS6%

State Funds22%

Medicare/Medicaid

6%

Case Turn-Around Time

< 1 Wk40%

< 72 Hrs10%

< 48 Hrs9%

> 1 Wk20%

< 24 hrs21%

Types of Service

Routine Diagnostic Consult

38%

Second Opinion18%

Medication Check19%

Psych Therapy15%

Other1%

Psych Evaluation6%

Manage Chronic Condition

2%

Manage Acute Condition

1%

Patient Information

Lab Reports51%

Written*10%

Still Photos23%

Other4%

EKG/EEG/EMG2%

Radiographs10%

* Other than required forms (e.g., growth chart)

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.

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.

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.

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.