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Michael Manley, RN, MNSc Outreach and AR SAVES Director Center for Distance Health

Telemedicine In Healthcare Rural Areas Specialty Coverage. Michael Manley, RN, MNSc Outreach and AR SAVES Director Center for Distance Health University of Arkansas for Medical Sciences. First e-ICU. Patients First. Utilizing Telemedicine Across the Healthcare Spectrum.

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Michael Manley, RN, MNSc Outreach and AR SAVES Director Center for Distance Health

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  1. Telemedicine In HealthcareRural Areas Specialty Coverage Michael Manley, RN, MNSc Outreach and AR SAVES Director Center for Distance Health University of Arkansas for Medical Sciences

  2. First e-ICU

  3. Patients First

  4. Utilizing Telemedicine Across the Healthcare Spectrum

  5. Origins of ANGELS/CDH in AR • In 2002, DHS approached UAMS with high risk OB support concept • Innovative program was able to leverage federal dollars to increase access to care • UAMS provides state match portion, resulting in requirement of no state funds

  6. Arkansas Telemedicine Model Education & Training for Providers Centralized Tech Support & Scheduling Call Center 24/7 Offer Community Needs-Based Services Telemedicine Network & Infrastructure Evaluation and Quality Improvement Case Coordination & Evidence-Based Guidelines/Protocols

  7. ANGELS Sites

  8. Triage Call Center

  9. Angels Call Center In 2013: Staffed by 6 appointment center specialists Handled 206,481 phone calls Processed 26,662 appointments 1824 Urgent care visits avoided by triaging

  10. ANGELSTelemedicine Program

  11. TelemedicineConsults

  12. Guidelines • 203 guidelines for best practices in Obstetrics, Neonatology, & Pediatrics www.angelsguidelines.com

  13. 4,254 visits from 25 countries in 2013

  14. Interactive Video Conferences • High Risk OB • OB/GYN Grand Rounds • ONE Team nursing teleconference • Fetal Anomaly Interdisciplinary Management (FAIM) • Peds PLACE For a current listing and access information please go to - https://learnondemand.org/events.aspx

  15. Education Courses • On-site and via Interactive Video • S.T.A.B.L.E. • AWHONN Fetal Heart Rate Monitoring Courses • NRP • Breastfeeding mini-course • Nurse Certification Courses • Inpatient OB • High Risk Newborn • Low Risk Newborn • Maternal/Infant

  16. Online Education • Launched December 2013 • Over 100 modules • >1000 users • 65 of Arkansas’ 75 counties with users • ANGELS content free to Arkansas residents • Multidisciplinary • Continuing Medical Education • Continuing Nursing Education • Continuing Pharmacy Education

  17. Patient Education Website • To launch Summer 2014 • Allows for private discussion groups (HIPAA compliant) • First educational initiatives will focus on maternal/infant education

  18. ANGELS Spinoff Programs

  19. Center for Distance Health Programs That Create Access

  20. Arkansas SAVES: Purpose • Increasing subspecialty access to rural stroke patients • Impacting stroke-related disability and mortality, and • Enhancing emergent stroke support by consulting on the administration of tPA medication to eligible patients.

  21. Arkansas SAVES: Rationale • Rural hospitals without the support of a neurologist often forgo administration of tPA. • The time needed to affectively administer tPA is often lost when transporting patients. • Arkansas’ stroke patients are missing out on sub-specialty expertise.

  22. Average Age of Stroke

  23. Overall Performance

  24. Adult Sickle Cell Clinical Program • Program Background • Legislature support for Sickle Cell (2012) • UAMS given opportunity to develop program • 2013 Program development • Jan 2014 Adult Sickle Cell Clinical Program

  25. Program Overview • Transition Clinic • Facilitate patient’s transition from ACH to adult care • Annual sub-specialty multi-disciplinary clinic • Inpatient Consult Service • Registry • Database collecting valuable information concerning Arkansas Sickle Cell patients • 24/7 Triage Call Center supporting program (providers, patients, and community) • Educational program • Best practices for sickle cell disease treatment • Sickle Cell Outreach to AR Providers and communities • Directory of Arkansas Healthcare Providers • that manage Sickle Cell patients

  26. Telehealth and Sickle Cell • Current uses • 24/7 Triage Call Center Support for Providers, Patients and Community • Educating Healthcare Providers • Teleconference Presentations • Call Center encounters • Future Plans for Telemedicine • Building a Sickle Cell PCP Network through TM outreach • Telemedicine Clinic • Collaboration with PCPs • Consults for acute care treatment • Consults for best practices to use in daily practice • Follow-up with shared patients

  27. Telemedicine Consults in Arkansas Emergency Departments

  28. Trauma and Hand Sites 2014

  29. Image Repository Trauma Images can move between hospitals for trauma patient

  30. Patient HAND Arkansas Trauma Hand Specialist

  31. BURN

  32. TRIUMPH Tele-Rehabilitation Interventions through University-based Medicine for Prevention and Health

  33. TRIUMPH • Education-Guideline development, presentation and promotion. • 24-7 Call Center 1-855-PMR-MYTE (767-6983) • Telemedicine appointments for Arkansans living with Spinal Cord Injury and Traumatic Brain Injury

  34. Federal Communications Commission Rural Health Care Pilot Program Evolution of UAMS Telehealth Programs (2003-2014) (ONE) Team ObstetricalNeonatal Exchange CE for Nurses Triumph Tele-Rehab Spinal Cord Commission 20134,566 OB patient visits Fetal Echo (Clinic) TOUCH Telemedicine Outreach Utilizing Collaborative Healthcare(Neonatal Census Rounds) FAIM CME for MDs $102M BTOP Grant Award High-Risk OB & Neonatal Guidelines Completion of BTOP Grant Connecting 410+ Healthcare Sites 2003 2004 2006 2007 2008 2009 2010 2011 2012 2013 2014 • New Clinical Services: • Diabetes • Colposcopy • Resident-facilitated HROB Clinic • Spanish Translation Interpretation Services Telehealth KIDS Hand Trauma ANGELS 24-hr Call Center Service Stroke Assistance thru Virtual Emergency Support Adult Sickle Cell (Clinic) Guideline Smartphone Application Postpartum Hypertension Project HealthEducationAssessmentResearchTelehealth FY 2013: 594 consults, (tPA to151 patients) Tele-Nursery

  35. BTOP Broadband Technology Opportunities Program (BTOP) Awarded in 2010

  36. BTOP Sites

  37. BTOP Benefits in Arkansas Healthcare Higher Education/Libraries Public Safety Research & Clinical Trials

  38. Year 4: After Grant Funding Ends Current Healthcare Examples 3-1-2011

  39. Year 4: After Grant Funding Ends Current Education Examples 3-1-2011

  40. Telemedicine Broadband and Equipment Overview 454 sites total includes 33 colleges and universities, 15 home health sites and 1 public safety organization.

  41. Conclusion “Where you live shouldn’t decide whether you live or whether you die.” Paul Hewson

  42. UAMS-Where Telemedicine Lives!

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