What Works: Outcomes Data from AFHCAN and ANTHC Telehealth ??  What Works: Outcomes Data from AFHCAN and ANTHC Telehealth An 8 Year Retrospective Stewart Ferguson Ph.D. ... •

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  • 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 states residents are in medically underserved areas.

    2

    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.

  • 3

    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)

  • 4

    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.

    6

    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

    9

    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%

    5%

    10%

    15%

    20%

    25%

    30%

    35%

    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)

    14

    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/ANs 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

  • 18

  • 19

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

    What Works: Outcomes Data from AFHCAN and ANTHC TelehealthAn 8 Year RetrospectiveALASKAs PHYSICIANSSlide Number 3AFHCAN TelehealthWhy do you do Telemedicine? (All Users)Why do you do Telemedicine?Slide Number 7Slide Number 8Medicaid Study: 2003-2009Decreased Travel = Cost SavingsLost Work Days/ School DaysTelehealth Impact on Extended Waiting Times (> 4 months)Pre-Operative Planning for Ear Surgery Using Store-and-Forward TelemedicineJohn Kokesh M.D., A. Stewart Ferguson Ph.D., Chris Patricoski M.D.Slide Number 13How important is the speed of reply?(% Extremely Important)Diabetic Retinopathy Joslin Vision Network (JVN)Portable JVN PilotDoing what we never imagined Slide Number 18Slide Number 19