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iHT² Health IT Summit San Francisco – Case Study “Building A Sustainable Telemedicine Cooperative: The Arizona State-Wide Telemedicine Program” with Ronald Weinstein, M.D., Director, Arizona Telemedicine Program
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Case Study
“Building A Sustainable Telemedicine Cooperative:
The Arizona State-Wide Telemedicine Program”
Ronald S. Weinstein, M.D.
Director, Arizona Telemedicine Program Tucson, Arizona
President Emeritus, American Telemedicine Association
(Serial Entrepreneur)
Case Study
Case Study
1. Pre-Implementation Phase
2. Implementation Phase
3. Medical Services Telemedicine Telehealth mHealth, etc.
Case Study
I. Pre-implementation Phase 1. Mandate 2. Public Policy 3. Governance 4. Infrastructure 5. Sustainable Business Plan
1. Mandate AZ State Legislature (1996)
2. Public Policy 8 AZ Foundational Policies
3. Governance Non-Statutory Overarching Authority (Arizona Telemedicine Council)
4. Infrastructure Arizona Rural Telemedicine Network
5. Business Plan Application Service Provider (ASP) Model
GENERAL TOPICS ARIZONA CASE STUDY
Case Study MANDATE
Tucson
Arizona Legislature’s Challenge Charter Sites Case Study Infrastructure
Arizona Telemedicine Program - Corps of Engineers
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1998-2001
Arizona Telemedicine Program Telecommunications Utility
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2014
Case Study
Case Study
Case Study
I. Pre-implementation Phase 1. Mandate 2. Public Policy 3. Governance 4. Infrastructure 5. Sustainable Business Plan
1. Mandate AZ State Legislature
2. Public Policy 8 Foundational Policies
3. Governance Non-Statutory Overarching Authority (Arizona Telemedicine Council)
4. Infrastructure Arizona Rural Telemedicine Network
GENERAL CATEGORIES ARIZONA CASE STUDY
5. Business Plan (recurrent revenue stream) Application Service Provider (ASP) Model
Case Study Business Plan
Case Study
I. Pre-implementation Phase 1. Mandate 2. Public Policy 3. Governance 4. Infrastructure 5. Sustainable Business Plan
1. Mandate AZ State Legislature
2. Public Policy 8 Foundational Policies
3. Governance Non-Statutory Overarching Authority (Arizona Telemedicine Council)
4. Infrastructure Arizona Rural Telemedicine Network
5. Business Plan-continuous revenue stream Arizona Telemedicine Program-- Application Service Provider (ASP) Model Members – 55 healthcare organizations
GENERAL CATEGORIES ARIZONA CASE STUDY
Case Study
1. Training Program Training Centers
2. Marketing Program Health Fairs, NPR, etc.
3. Telemedicine Service Roll-Out Teleradiology, telepsychiatry, etc.
4. Assessment Programs Best practices, QA, provider satisfaction
5. Supplemental Funding TRC, International Programs
GENERAL CATEGORIES ARIZONA CASE STUDY
I. Pre-implementation Phase 1. Mandate 2. Public Policy 3. Governance 4. Infrastructure 5. Sustainable Business Plan
II. Implementation Phase 1. Training program 2. Marketing 3. Telemedicine Service Roll-Out 4. Assessment Programs 5. Supplemental Funding
Telemedicine Training Programs > 8-9 programs per year (since 2000) > 1200 trainees > 100+ healthcare organizations
Case Study TRAINING PROGRAM
“I think these lectures are a real plus for physicians like me, who
live in rural areas but are always interested in receiving new
information.”
Dexter DeWitt, MD
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Case Study
1. Teleradiology 25 hospitals; 1.3 M Cases
2. Telepsychiatry NARBHA-120,000 pateint encounters
3. Telecardiology Yuma RMC Neonatal Intensive Care Unit
4. Telestroke Mayo Clinic - 13 AZ rural hospital network
5/6. Telepatient-monitoring Banner eICU; Flagstaff CHF program
GENERAL CATEGORIES ARIZONA CASE STUDY
III. Telemedicined/Telehealth Services 1. Telemedicine 2. Telehealth 3. Telenursing 4. Telepharmacy 5. Tele-home health 6. Telemetry 7. Prevention 8. Distance education
“Telemedicine dramatically increases compliance with appointments if you can be
seen in your own community.”
Sara Gibson, MD
Telepsychiatry
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Telecardiology
“We see telemedicine as an important
opportunity to improve patient care.”
Bart M. Demaerschalk, M.D
Vascular Tele-neurologist Mayo Clinic-Scottsdale
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Telestroke
“It works. It saves people’s
lives.”
Jack Porter Former Mayor Bisbee, Arizona
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Telestroke
“We have the opportunity to
change the way health care is
delivered.”
Deborah Dahl, Banner Vice Presidnet
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$68,000,000 savings/Peter Fine, Banner CEO
Tele-eICU
Case Study
Tele-Home Health Care
Flagstaff Medical Center in Northern Arizona
Pilot project: 50 Patients with Hx Congestive Heart Failure*
• Decreased hospitalizations: 3.26 vs. 1.82 over 6 months
• Fewer days hospitalized: 13.98 vs. 5.13 days
• Cost saving: $92,317 per patient over 6 months
* Pts. provided with wireless devices to track weight, blood pressure and activity levels daily. Data automatically transmitted.
Brookings Institute Conference on Mobile Health
March 2014
Case Study
“Care Beyond Walls and Wires is the best thing
ever for me, and the best thing for my dad.”
Rita Yazzie
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T
Case Study Tele-Support Groups
“Telemedicine Is pivotal for diabetic
retinopathy.”
Mark B. Horton, M.D.
Case Study REMOTE SCREENING FOR DIABETIC RETINOPATHY
Case Study
1. Teleradiology 25 hospitals; 1.3 M Cases
2. Telepsychiatry NARBHA-114,000 encounters
3. Telecardiology Yuma RMC Neonatal Intensive Care Unit
4. Telestroke Mayo Clinic - 13 AZ rural hospital network
6. Telepatient-monitoring Banner eICU; Flagstaff CHF program
GENERAL TOPICS ARIZONA CASE STUDY
III. Telemedicined/Telehealth Services 1. Telemedicine 2. Telehealth 3. Telenursing 4. Telepharmacy 5. Tele-home health 6. Telemetry 7. Prevention 8. Distance education
7. Tele-medication monitoring University of Arizona College of Pharmacy
IHT2
Case Study
Why Telemedicine?
Gap Services
Urgent Services Mandated Services
IHT2
Case Study
“In some cases the patient can be treated locally instead of bringing the patient to us
by helicopter, which costs $10,000 to $20,000.”
Daniel M. Caruso, MD
Why Arizona?
Geography
Leadership Culture
IHT2
Case Study
University of Arizona
Land Grant University
“Land Grant University Mission for the Future”
Develop partner
relationships with communities and
industries.
Advance local and global impacts of
University of Arizona knowledge creation.
Ann Weaver Hart, Ph.D.
President University of Arizona
IHT2
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Barriers
Legal, regulatory
Reimbursement Culture
IHT2
Case Study
.>> Acute Shortages of Telehealth Service Providers
“Practicing Medicine on a Unicycle”
Telemedicine
1- saves live
2- reduces health-care costs
3- improves assess
4- managing chronic diseases
5- disease prevention
6- improves quality of life
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