1. Native People for Cancer Control Telehealth Network Roy Colven Cara Towle Lisa R Thomas HollyAnna Pinkham March 12, 2007

2. Native People for Cancer Control Telehealth Network (NPCCTN): Overall Goal To reduce the gap between American Indians/Alaska Natives and other groups in cancer careTo reduce the gap between American Indians/Alaska Natives and other groups in cancer care To improve the results of cancer treatment in American Indians and Alaska NativesTo improve the results of cancer treatment in American Indians and Alaska Natives To support Native cancer survivors, their health care providers, and their familiesTo support Native cancer survivors, their health care providers, and their families

3. NPCCTN Funding Office for the Advancement of Telehealth (Health Resources and Services Administration)Office for the Advancement of Telehealth (Health Resources and Services Administration) $250,000 per year x 3 years$250,000 per year x 3 years

4. NPCCTN Partners South Puget Sound Intertribal Planning AgencySouth Puget Sound Intertribal Planning Agency Alaska Native Tribal Health ConsortiumAlaska Native Tribal Health Consortium Individual Tribes and their communitiesIndividual Tribes and their communities University of WashingtonUniversity of Washington Seattle Cancer Care AllianceSeattle Cancer Care Alliance University of Washington MedicineUniversity of Washington Medicine Children’s Hospital and Regional Medical CenterChildren’s Hospital and Regional Medical Center Fred Hutchinson Cancer Research CenterFred Hutchinson Cancer Research Center

5. NPCCTN Collaborations Tribal CouncilsTribal Councils Tribal organizationsTribal organizations Tribal Health Care ClinicsTribal Health Care Clinics Urban Indian Health Care Facilities, e.g., Alaska Native Medical Center, Alaska Federal Health Care Access Network, Seattle Indian Health BoardUrban Indian Health Care Facilities, e.g., Alaska Native Medical Center, Alaska Federal Health Care Access Network, Seattle Indian Health Board Cancer treatment facilitiesCancer treatment facilities NCI-funded Cancer Information ServiceNCI-funded Cancer Information Service Washington State Comprehensive Cancer Control Steering CommitteeWashington State Comprehensive Cancer Control Steering Committee

6. Telemedicine The use of electronic information and communications technologies to provide and support health care when distance separates the participants.” IOM 1996The use of electronic information and communications technologies to provide and support health care when distance separates the participants.” IOM 1996

7. Telehealth Telehealth encompasses a broader definition of remote healthcare that does not always involve clinical services. Videoconferencing Videoconferencing Transmission of still images Transmission of still images E-health including patient portals E-health including patient portals Remote monitoring of vital signs Remote monitoring of vital signs Continuing medical education Continuing medical education Nursing call centers Nursing call centers … are all considered part of telemedicine and telehealth.… are all considered part of telemedicine and telehealth. American Telemedicine Association http://www.americantelemed.org/

8. NPCCTN Activities Utilize telehealth technologies to provide education and consultative services and support to cancer patients and their providers:Utilize telehealth technologies to provide education and consultative services and support to cancer patients and their providers: Comprehensive Care PlansComprehensive Care Plans Pain related to cancerPain related to cancer Psychological issues related to cancer, including support group creationPsychological issues related to cancer, including support group creation Legal issues related to cancer diagnosis and end-of life issuesLegal issues related to cancer diagnosis and end-of life issues End of life care and planningEnd of life care and planning

9. NPCCTN Activities Facilitating virtual tumor board participationFacilitating virtual tumor board participation Supporting patient referrals and returns coordinationSupporting patient referrals and returns coordination Sharing educational resources between academic, clinical care, and tribal partners, such as continuing education and trainingSharing educational resources between academic, clinical care, and tribal partners, such as continuing education and training Continuous evaluation of services to determine value, satisfaction and impactContinuous evaluation of services to determine value, satisfaction and impact

10. NPCCTN Staff Dedra Buchwald, MD, Principle InvestigatorDedra Buchwald, MD, Principle Investigator Roy Colven, MD, Co-Investigator/Project DirectorRoy Colven, MD, Co-Investigator/Project Director Cara Towle, RN, Project Manager and Technical LiaisonCara Towle, RN, Project Manager and Technical Liaison HollyAnna Pinkham (Yakama), Community Outreach Specialist for WashingtonHollyAnna Pinkham (Yakama), Community Outreach Specialist for Washington Lisa R Thomas, PhD (Tlingit), Research Scientist and Community Outreach Specialist for AlaskaLisa R Thomas, PhD (Tlingit), Research Scientist and Community Outreach Specialist for Alaska Rande Gray, Technical Specialist Deborah Friedman, MD, Consultant in Care of Cancer SurvivorsRande Gray, Technical Specialist Deborah Friedman, MD, Consultant in Care of Cancer Survivors Fransing Daisy, PhD (Cree), Mental Health ConsultantFransing Daisy, PhD (Cree), Mental Health Consultant Ron Whitener, JD PhD (Squaxin Island), Legal ConsultantRon Whitener, JD PhD (Squaxin Island), Legal Consultant Anajana Kundu, MD, Pain ConsultantAnajana Kundu, MD, Pain Consultant Ardith Doorenbos, PhD RN, End of Life ConsultantArdith Doorenbos, PhD RN, End of Life Consultant George Guilmet, PhD, Program EvaluationGeorge Guilmet, PhD, Program Evaluation

11. NPCCTN in Washington Prospective participants: SPIPA tribes + QuinaultProspective participants: SPIPA tribes + Quinault Next steps:Next steps: Meet with individual tribesMeet with individual tribes Understand needs at each partner siteUnderstand needs at each partner site Determine which NPCCTN services may benefit each partner siteDetermine which NPCCTN services may benefit each partner site Determine technical needsDetermine technical needs Tribal resolution at each partner siteTribal resolution at each partner site Collaboratively establish NPCCTN service protocolsCollaboratively establish NPCCTN service protocols

12. NPCCTN in Washington: Technical Plans K-20 Educational Telecommunications NetworkK-20 Educational Telecommunications Network 48 Public Baccalaureate sites 71 Community/Technical Colleges 307 K-12 sites 65 Library sites (proposed) 15 Private Baccalaureate sites (proposed)

14. NPCCTN in Washington: Technical Plans Benefits of K-20 Network membershipBenefits of K-20 Network membership Provides significant bandwidth for a fraction of commercial costs for all rural sites. Allows access to K-20 bridge for multi-point conferences. Provides toll-free calling within network or to Seattle area. Open network allows out of system calls. Result: Increased sustainability beyond grant funding.

15. Alaska NPCCTN updates

16. Alaska Partners CANCER IS THE LEADING CAUSE OF DEATH FOR ALASKA NATIVESCANCER IS THE LEADING CAUSE OF DEATH FOR ALASKA NATIVES 229 federally recognized Tribes229 federally recognized Tribes 16% of the population16% of the population 60% live in small remote communities generally without connection to a road system60% live in small remote communities generally without connection to a road system Needs and resource assessmentNeeds and resource assessment

18. Meeting with our Alaska partners January 2007January 2007 Alaska Native Tribal Health ConsortiumAlaska Native Tribal Health Consortium Alaska Native Health ResearchAlaska Native Health Research Alaska Native Medical CenterAlaska Native Medical Center Alaska Federal Health Care Access NetworkAlaska Federal Health Care Access Network American Cancer Society, AlaskaAmerican Cancer Society, Alaska

19. Alaska Native Health Care Alaska Tribal Health SystemAlaska Tribal Health System Village-based clinicsVillage-based clinics Regional hospitalsRegional hospitals Sub-regional clinicsSub-regional clinics Alaska Native Medical CenterAlaska Native Medical Center Contract care (Seattle)Contract care (Seattle) ANTHC is the largest Tribal self-governance entity in the USANTHC is the largest Tribal self-governance entity in the US Telehealth is recognized as an essential component to health care in AlaskaTelehealth is recognized as an essential component to health care in Alaska

21. NPCCTN and Alaska – service providers Virtual tumor boardsVirtual tumor boards CME for service providersCME for service providers Training for community health aidesTraining for community health aides Coordinate transfer of cancer patients between Alaska and SeattleCoordinate transfer of cancer patients between Alaska and Seattle Follow-up care for patients in the bushFollow-up care for patients in the bush Survivorship careSurvivorship care Palliative carePalliative care Support groupsSupport groups

22. Next steps Meet with Community Health AidsMeet with Community Health Aids Meet with regional and sub-regional clinicsMeet with regional and sub-regional clinics Meet with village clinicsMeet with village clinics Meet with Alaska Native cancer patients and their familiesMeet with Alaska Native cancer patients and their families

23. Gunalchéesh