The Arizona Telemedicine Program: Two Years’ Experience With a University-Based Telemedicine Program Elizabeth Krupinski, PhD, Ana Maria Lopez, MD, Ronald Weinstein, MD Presented at The American Telemedicine Association Conference April 18-21, 1999 Salt Lake City, UT

Goal w To assess the Arizona Telemedicine Program (ATP) in terms of patterns of use, patient demographics and general satisfaction with the program. w Periodic and consistent assessment is a long-term and on-going component of the ATP.

Rationale I w Continuous assessment of our Telemedicine Program provides a measure of Quality Control (QC) and Quality Assessment (QA). w We can track progress of the program and changes in usage over time.

Rationale II w 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 Sites Tuba City Kingman Cottonwood Ganado Payson Springerville Whiteriver DOC - Phoenix DOC - Yuma Nogales Patagonia Douglas AHSC Kino Tucson VA AHSC Hub Telemedicine Telepathology Teleradiology

Methods w Detailed medical records are kept for each telemedicine patient. w These records are analyzed on a monthly basis to track various aspects of the program. w Statistics are compiled for the program as a whole and for each individual site. w This poster only reports on telemedicine, not teleradiology cases

Record Compilation w The Site Coordinator at each remote location gathers the necessary patient information for the consult. w 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 w Patient consent w ATP required forms w 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 w Patient consent form w Patient demographics form w Patient history form Internal medicine Non-internal medicine Cardiology Initial psychiatric Follow-up psychiatric w Billing/insurance form

Case Volume w We have conducted over 900 telemedicine and 1500 teleradiology sessions to date w We have been averaging about 60 telemedicine cases per month w 56% are store-forward; 44% are real- time w 76% are initial consults; 24% are follow-up consults

Quarterly Case Volume

Health Care Providers w 70 clinicians at the AHSC ATP hub site have served as telemedicine consultants. w 116 health care providers at the remote spoke sites have referred patients to AHSC for a telemedicine consultation.

Referring Clinician Degrees

Sub-Specialties Covered CardiologyOphthalmologyPeds. Orthopedics DentalOrthoped. Surg.Peds. Psychiatry DermatologyOrthopedicsPeds. Pulmonology EndocrinologyOtorhinologyPeds. Rheumatology Fam. & Comm. Med.Pain ClinicPeds. Urology GastroenterologyPathologyPsychiatry GeneticsPeds. CardiologyRadiology Hematology/OncologyPeds. DermatologyReprod/Infertility Infectious DiseasePeds. EndocrinologyRheumatology Internal MedicinePeds. GastroenterologySurgery MedicinePeds. Hem/OncSurgical Oncology NephrologyPeds. Infec. DiseaseToxicology NeurologyPeds. NephrologyUrology Ob/GynPeds. Neurology

Patient Age Groups

Patient Race

Patient Employment

Patient Insurance

Case Turn-Around Time

Types of Service

Patient Information * Other than required forms (e.g., growth chart)

Program Satisfaction w Both referring and consulting clinicians have been quite satisfied with the quality of services they have been able to provide with telemedicine. w 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 w 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.) w 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 w The ATP is successfully using both real-time and store-forward technologies for a variety of sub- specialty consults. w Regularly scheduled clinics have been set up for the more voluminous specialties.

Discussion w Including teleradiology, telepathology, administrative and CE broadcasts, the ATP has held nearly 3000 sessions since beginning operation two years ago. w Efforts are underway to expand our services to other sites and to develop and maintain a self-sustaining, state-wide health care network.