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.