What Works: Outcomes Data from AFHCAN and ANTHC

TelehealthAn 8 Year Retrospective

Stewart Ferguson Ph.D.CIO, ANTHC

1/1/2001 to 12/31/2010(91,977 Cases)

49% of all physicians in Alaska are primary care physicians (2002 data)◦ U.S. average is 28%

Alaska is 48th in “doctors to residents” ratio◦ 65% are located in Anchorage◦ Shortages in many specialties

59% of the state’s residents are in medically underserved areas.

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Historically, Alaskan health care has incorporated a public health mission and primary care focus, and is less reliant on specialty acute care than other parts of the country.

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Store & Forward vs Real-Time Telehealth

Store & Forward

• Asynchronous Interaction

• Documents & Images• Electronic Medical

Records• Patient Education

• Radiology• Dermatology• Pathology• Oncology• Ophthalmology• Dental

• Cardiology• ENT• GI• Pulmonary• Rheumatology

• Psychology/ Psychiatry• Neurology• Speech therapy• Physical therapy

Clinical specialties for telemedicine

• Face-to-Face Interaction

• Immediate Feedback

Remoteconsultation

Real-Time (VtC)

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10 year Operational History◦ 22,000 cases in 2010

Whole Telehealth Solution◦ Design Manufacturing Deployment Installation Training Support Marketing

Installed Customer base includes:◦ Alaska: 248 sites, 44 organizations 37 Tribal organizations US Army sites (6) & US Air Force bases (3) State of Alaska Public Health Nursing (26)

◦ Other states and countries

0

5,000

10,000

15,000

20,000

25,000

30,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011(Proj)

Case

s Cre

ated

Cases Created per Year (by Role)

Primary Care Specialty Care

5

• Best for patient care• Increased access for care• Saves my organization money• Improves patient satisfaction

0% 10% 20% 30% 40% 50% 60% 70%

Best for patient care

Helps me communicate with a doctor

Saves my organization money

Most convenient to the patient

Improves patient satisfaction

Makes me more efficient

Gives me confidence in doing the right …

Increase access to care

High Users 29Medium Users 23

Low Users 51

• “Confidence” is a significant reason for using telehealth for Low and Medium Users.

• None of the High User Initiators listed this as a primary reason for doing telehealth.

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0%

5%

10%

15%

20%

25%

30%

High User Medium User Low User

Gives me confidence in doing the right thing for the patient

7ATHS (Alaska Tribal Health System) (1/1/2001 to 12/31/2010)

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Annual Travel Savings (by Case Role)

Primary Care Specialty Care

We only assume patients travel to nearest region

Quantity CostClaims Paid by Medicaid 4,482 ($269,894)Telemedicine Prevented Travel

Notes:• Travel is saved for 75% of all patients. • Assume all patients under 18 need an escort• Travel costs based on 1 week advance fares

3,662 $3,116,034

Net Savings Realized by Medicaid $2,846,140

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Note: For every $1 spent by Medicaid on reimbursement, $10.54 is saved on travel costs.

0

200

400

600

800

1,000

1,200

2003 2004 2005 2006 2007 2008 2009

Days

Preventing Lost Work/School Days

Work Days School Days

Since 2003, telehealth prevented an estimated 4,777 lost days at work, and a total of 1,444 lost days at school for the patients in this study.

11Data 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)

Perc

ent A

ppoi

ntm

ent A

vaila

bilit

y W

ith 5

M

onth

or L

onge

r Wai

t Tim

e

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%

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25%

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40%

-3 -2.5 -2 -1.5 -1 -0.5 0.5 1 1.5 2 2.5 3

Perc

ent o

f Pat

ient

s

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

13ATHS (Alaska Tribal Health System) (1/1/2001 to 12/31/2010)

0% 20% 40% 60% 80% 100%

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

ANMC Turnaround Time

Within 60 min.

Same Day

Within 24hrs

20% of all specialty consultations are turned around in 60 minutes.

50%-60% are turned around in the same day.

70%-80% are turned around within 24 hours.

• Speed of response is clearly more important to Initiators compared to Consultant

• High User Initiators - 43% rated this 5 out of 5 (“Extremely Important”)

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0%5%

10%15%20%25%30%35%40%45%

High User (Initiator) High User (Consultant) Medium User (Initiator) Medium User (Consultant)

When using AFHCAN for patient care – how important is the speed of reply of the consulting doctor?

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

Deployment of the IHS-JVN in Alaska using a portable platform reversed a seven year decline in rates for the state

0%

10%

20%

30%

40%

50%

60%

70%

DR

Exam

Rat

e

15% Increase

25% Decrease Portable JVNimplemented

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American Telemedicine Association2011 Mid-Year MeetingSeptember 19-21, 2011Anchorage, AK