1. ASR ANALYTICS, LLC Evaluation Study: Social & Economic Impact of BTOP Grant Curtis Lowery, MD BTOP Grant Principal Investigator Professor & Chair, Department of Obstetrics & Gynecology ANGELS Medical Director 8:15 – 9:45 a.m. October 22, 2013

2. Existing UAMS Telemedicine Programs Enhanced by BTOP ANGELS (Antenatal & Neonatal Guidelines & Education System) Evidence-based guidelines Education and support for OB providers via teleconferences Consultation Call Center available 24/7 Case Management Expansion of telemedicine network & clinics Tele-Nursery Tele-Colposcopy Prison obstetrics Evaluation and research AR SAVES (Stroke Assistance through Virtual Emergency Support) Links rural ER doctors to specially trained vascular neurologists via live, two-way video, available 24-hours a day

3. A national award winning telehealth program that serves as a model for other programs is the first of its kind to link three state agencies to serve a common purpose in statewide management of high-risk obstetrical patients, targeting the impoverished, the unhealthy & those at risk of having premature & low-birth-weight babies. ANGELS Antenatal & Neonatal Guidelines & Education System

7. The ANGELS mission is to ensure that every woman in Arkansas at risk of having a complicated pregnancy receives the best possible perinatal care.

9. ANGELS Telehealth Sites 2009 2013

10. ANGELS Telemedicine Sites – total of 30 Telemedicine visits Telemedicine OB ultrasound visits Fetal echocardiogram visits Tele-Nursery Sites – total of 25 Census rounds three times each week Provides follow-up on transferred patients, video connection with a postpartum mother at a delivery facility to her baby at Arkansas Children’s Hospital Consults by neonatologists or other pediatric sub-specialists Discuss co-management of patients to facilitate back-transfer Tele-Colposcopy Telemedicine Sites – total of 8 Colposcopy exams that help identify women with high-grade lesions requiring treatment * ANGELS Annual Report - 2012 ANGELS Antenatal & Neonatal Guidelines & Education System

11. Education and support for OB providers is offered through teleconferences High-Risk Obstetrics Case Conference OB/GYN Grand Rounds FAIM (Fetal Anomaly Interdisciplinary Management) ONE Team (Obstetric & Neonatal Nurse Education) Peds PLACE (Pediatric Physician Learning and Cooperative Education) A total of 268 continuing education hours were earned in 2012 by health care providers that attended these video conferences. * ANGELS Annual Report - 2012 ANGELS Antenatal & Neonatal Guidelines & Education System

12. The ANGELS model of telemedicine care has the distinction of being studied for replication across other disciplines and agencies to connect infrastructures within health care, higher education, research, and public safety across a single, unified network. ANGELS Antenatal & Neonatal Guidelines & Education System

13. ANGELS Consultations 2009-2012 BTOP Grant Awarded August 2010

14. AR SAVES links ER doctors to specially trained vascular neurologists via live, two-way video, available 24-hours a day. Participating hospitals are equipped with telemedicine technology, training for personnel, support for dedicated tele- stroke coordinator and ongoing education. Many rural hospitals, without the support of a neurologist, often forgo administration of a clot busting drug, tissue plasminogen activator (tPA). The window of time needed to effectively administer tPA is often lost when stroke patients are transported to a better-equipped, remote hospital miles from their home. AR SAVES increases access to subspecialty expertise through telemedicine technology, providing a coordinated assessment and care-based plan for Arkansas’ stroke patients. (Stroke Assistance through Virtual Emergency Support)

15. In 2012, Arkansas was the #1 state in the nation for per capita stroke deaths. From November 2008 - June 2013, 24% of more than 1,700 consults resulted in 417 patients being treated with tPA. This has saved health care dollars and decreased mortality and disability from stroke. AR SAVES currently has three hub and 40 spoke sites across Arkansas. * AR SAVES Annual Report - 2013 (Stroke Assistance through Virtual Emergency Support)

16. Total t-PA Delivery - FY 2013 Total Consults - FY 2013 * AR SAVES Annual Report - 2013

18. ANGELS Evolution 200220062008 Federal Communications Commission Rural Health Care Pilot Program Tele-Nursery 2007 2010 In 2012, there were 4,403 OB patient visits completed, many of them high- risk OB referrals from AR providers. FY 2013, there were 594 stroke consults with 151 patients receiving tPA. Stroke Assistance through Virtual Emergency Support 2011 Adult Sickle Cell Clinical Program Guideline Smartphone Application Postpartum Hypertension Project 2013 UAMS/CDH HIV TM Clinic