Telemonitoring Program
CHRISTUS Visiting Nurse Association of Houston
2905 Sackett Street
Houston, TX 77007

Sandy McNeely, RN, MSN
Ph: 713-630-5579
Fax: 713-630-5510
Email: Sandra.Mcneely@christushealth.org

Network Partners: The Methodist Hospital; community hospitals; cardiology, internal medicine, and family practice clinics.

Project Purpose: Examine a model for seamless transition between hospitalization, home care, and self-management for patients with Congestive Heart Failure (CHF) utilizing home monitoring technology; determine whether health care costs in a 60-day period are lowered among CHF patients who are home monitored; demonstrate improvement of clinical outcomes, patient quality of life and patient satisfaction through daily home monitoring of vital signs of CHF patients. Additional project activities: Development of CHF home telecare clinical pathway and CHF intervention decision tree.

Outcomes Expected: Decreased ER visits, hospitalizations, length of stays measured by: Generalized Linear Mixed Models (GLMM) analysis; telephone interventions success measured by: Trending data reports, descriptive
analysis; increased quality of life measured by: SF-36 Standard Tool, repeated measures of Analysis of Variance (ANOVA); high patient satisfaction measured by: Visiting Nurse Association (VNA) Patient Satisfaction Survey.

Service Area: Six southeastern Texas counties (Harris, Galveston, Liberty, Montgomery, Brazoria, Fort Bend) serving one Primary Medical HPSA, one Dental HPSA, three Mental Health HPSAs.

Services Provided: Since September 2001, home vital sign monitoring for CHF management: daily remote collection and evaluation of clinical data, telephone intervention protocol at first symptom recognition, and telephone teaching program. Others services include diabetes, chronic disease management, wound care, Ventricular Assistive Device (VAD) patients, remote medication
management; remote vital sign monitoring in a residential facility.

Equipment: Seventy HomMed Sentry Observer System units, one Central Station Monitor with Intel Pentium 500 MHz processor.

Transmission: Java application of Windows 95/98 NT platform using Oracle 8 data base server; dual communication modes via wireless pager technology or standard phone lines.

Cook Children’s Medical Center (CCMC) Steve Anderson
801 Seventh Avenue
Fort Worth, Texas 76104
www.cookchildrens.org

Andrea Smith, PhD, RN, CPNP
Ph: 682-885-2103
Fax: 682-885-1656
Email: andreas@cookchildrens.org

Network Partners: Cook Children’s Subspecialty Clinic in Abilene, Texas, is the single spoke partner.

Project Purpose: To: 1) implement Rural Specialty Health Telemedicine as a pilot project utilizing genetics as the chosen pediatric specialty; and 2) implement a mechanism to provide Continuing Medical Education (CME) in Cook Children’s Medical Center’s rural service area. Major project activities
include equipment selection, acquisition, and installation; training project participants in the use of the equipment; and project implementation, including the provision of genetic services and distance learning opportunities and the evaluation of those services and opportunities.

Outcomes Expected: Telemedicine: 1) increased number of referrals by at least 20; 2) increased number of patient encounters by 60%; 3) decreased costs of care; 4) increased time efficiency of service delivery; 5) patient families will choose to utilize telemedicine services, (all of which can be measured via
data analysis); and 6) patient families will be satisfied with telemedicine services (as measured by satisfaction survey). Distance Learning: 1) health care providers in outlying areas will have increased access to educational opportunities and Pediatric Grand Rounds (project implementation
provides the opportunity); 2) health care providers will utilize distance learning (measured by numbers of CMEs applied for); and 3) health care providers will be satisfied with distance learning services (as measured by satisfaction survey).

Service Area: Telemedicine: the primary service area is Abilene, Texas, in Taylor County, serving 1 HPSA and 2 MUAs. Distance Learning: overall service area is 110 counties in Texas, serving a total of 210 HPSAs and 139 MUAs.

Services Provided: Telemedicine: direct patient clinical assessment, counseling, follow-up within the scope of Genetics, video-conferencing for general medical consultation. Distance Learning: video conferencing for medical consultation and education and "anytime" access to pediatric-specific
education, collaboration with St. Jude Children’s Hospital on pediatric oncology protocols, business development consultation.

Equipment: Router, View Station FX - H.3232, Monitors & Cart, Medlink Cart for VC, Telemedicine Peripherals, 5 Megapixel Camera, MiniDV Video Camera, MGC25 VC Bridge.

Transmission: Fractional T1 up to 1.5 MB/s, ISDN up to 768 KB/s.

Community Health Program/Specialty Access Through Telemedicine (SA++) L.
Harris County Hospital District
2525 Holly Hall
http://www.hchdonline.com

Ann Teske
Ph: 713-873-3640
Fax: 713-873-2899
Houston, TX 77054-4124
E-mail: lenore_teske@hchd.tmc.edu

Network Partners: Harris County Hospital District Community Health Program, El Centro de Corazon (spoke), Baytown Community Health Center of HCHD (spoke), University of Texas Health Science Center at Houston Medical School (hub), Harris County Community Access Collaborative to share information and
products, and the University of Texas School of Health Information Sciences to coordinate the project evaluation.

Project Purpose: This pilot project will develop/demonstrate the efficacy of procedures and protocols using telemedicine equipment for consultation with dermatology and psychiatric specialties for patients seen at two community health centers in Harris County, Texas. Based on results of the demonstration, a plan will be developed to support and justify expansion of telemedicine at 10 other Hospital District clinics and up to 10 community organizations currently developing as Federally Qualified Health Centers (FQHCs).

Outcomes Expected: Grant evaluation will include pre/post data analysis comparing targeted clinics with clinics not included in the study, pre/post surveys of physicians/administrators, and patient satisfaction surveys. The
evaluation should identify perceived inefficiencies, barriers, provider / administrator satisfaction, patient satisfaction, and impact of the project on ER volume for specialty consults, number of consults for participating clinics, and number of patients retained by PCP following specialty consult.

Service Area: The project will serve clinics located in the Baytown MUA, which has a Primary Care HPSA designation, and Ripley MUA, which has Mental Health, Dental, and Primary Care HPSA designations.

Services Provided: No telemedicine services are currently provided, as this is a pilot project to implement the use of telemedicine to provide dermatology and psychiatric consultations. It is expected that the services will begin to be provided in March 2006.

Equipment: Image management software for three sites, Desktop Computers for two spoke sites, high-resolution cameras for two spoke sites, General Exam Camera for Dermatology site visualization at two spoke sites, and Router at El Centro de Corazon. Equipment associated and the location from which the
Specialists will transmit already exists and is being made available for the project. Both sites already have most of the required equipment and only the equipment that will be provided by the project is listed.

Transmission: At the time of the development of the project, it was expected that T1 lines would be used as the Transmission Method. This is being investigated as a part of the development process and may change over the course of the project.

University of Texas Health Science Center in San Antonio
7703 Floyd Curl Drive
San Antonio, TX 78229-3900
www.uthscsa.edu

Daniel E. Hale, MD
Amy L. Riojas, LMSW
Ph: 210-567-5283
Fax: 210-567-0492
E-mail: riojasa@uthscsa.edu

Network Partners: Rio Grande City Consolidated Independent School District (RGCCISD).

Project Purpose: The program implements a comprehensive diabetes screening program in the school system and then enrolls children at high risk for type II diabetes into a treatment program. The children at risk are
randomized into either a group that receives traditional treatment available in Rio Grande City or they are enrolled in a group receiving telemedicine consultations with a Pediatric Endocrinologist, Behavioral Therapist, and Pediatric Dietitian located at the University of Texas Health Science Center
at San Antonio, 250 miles away.

Outcomes Expected: Access to specialized therapy via telemedicine will affect the following measurable parameters: Weight (measure)—Scale (tool)
Blood Pressure (measure)—Blood pressure machine (tool) Blood lipid, glucose and insulin levels (measure)—Blood work (tool) Self Concept (measure)—Piers-Harris 2 Children’s Self-Concept Scale (tool)

Service Area: The UTHSCSA/RGC Telehealth Network serves children in the RGCCISD. This school district encompasses the communities of Rio Grande City, La Grulla and Graciasville: all located within Starr County. Starr County is designated a single county HPSA, a single county dental HPSA, a single county Mental Health HPSA, and MUA named Starr Service Area.

Services Provided: The UTHSCSA/RGC Telehealth Network has provided clinical telemedicine services and distance learning beginning in October, 2003. The Pediatric Endocrinologist, Behavioral Therapist and Pediatric Dietitian provide consultations to patients and families via interactive video-conferencing.

Equipment: The equipment at UTHSCSA is a 27” Trinitron color television with PolyCom 512 Viewstation Videoconferencing unit, RGCCISD elementary schools use a PolyCom VSX 7000 unit with a 32” Toshiba color television.

Transmission: Connections are made using IP and/or ISDN connections at 384 KB/s bandwidth.

UTMB Center to Eliminate Health Disparities
301 University Boulevard
Galveston, TX 77555-0129
www.utmb.edu/cehd

Barbara E. Breier, PhD
John F. Thomas, PhD, ABD
Ph: 409-266-9536
Fax: 409-772-5064
Email: jofthoma@utmb.edu

Network Partners:
The University of Texas Medical Branch.
The University of Texas at Brownsville.
The University of Texas Health Center at Tyler.

Project Purpose: The primary purpose of this proposal is to reduce or eliminate disparities in health care through the development of a telehealth network in three distinct and geographically distant areas of Texas: Galveston (Galveston County), Brownsville (Cameron County), and Tyler (Smith County). A secondary purpose is to determine if the appropriate use of telehealth can reduce health disparities and improve access to health care.

Outcomes Expected: Community assessment conducted by individual community coalitions that have identified condition or delivery system components that will be the focus of a telehealth delivery project in each site.
Established telehealth delivery pilot projects aimed at reducing site-specific health disparities identified by community coalitions.

Service Area: 3 Counties across Texas: Galveston County PMSA 12, CMSA 79; Cameron County MSA 6, HPSA and MUA; Smith County MSA 24.

Services Provided: UTMB has a long-standing history of advancing the use of telecommunications technology for the purpose of improving health care delivery to rural and underserved populations of Texas. UTMB’s services comprise the largest operational telemedicine operation in the world, with over 300 locations and over 60,000 patient encounters annually.

Equipment: Still to be determined by outcome of community assessments and pilot projects identified in communities.

Transmission: OC-3 at 20MBps from UTMB out to subsites; subsites have full T1 capabilities and ISDN to potential pilot project applications in communities.

Electronic Health Network (EHN)
301 University Blvd.
Galveston, TX 77555-0145
www.digitalmedicalservices.com/default.htm
www.utmb.edu/telehealth

Glenn G. Hammack, OD, MSHI, FAAO
Ph: 409-747-5290
Fax: 409-747-5297
Email: gghammack@utmb.edu

Network Partners: Rural hospitals, state universities, distance education programs, telemedicine services through agreements with counties, community mental health centers, state prison system, and cruise lines.

Project Purpose: The project goals were as follows: Collect and analyze data on patient satisfaction and outcomes research; develop business models for corporate, remote, extreme environment, correctional system, and indigent care settings; develop protocols for primary care telemedicine and the various specialties; identify roles and necessary preparation of telehealth professionals; provide consulting services for the practice and technology of telehealth; rebuilt website; continue to operate telemedicine clinics; and establish sustainability.

These goals were accomplished by maintaining a clear focus on collaboration with both external and internal entities. Good relationships with physicians and administrators on and off campus have been instrumental in spreading the practice of telemedicine. Additionally, the integration of telemedicine practice into existing UTMB systems has saved a tremendous amount of university resources and showed that telemedicine practice can flourish within an academic research center. The long-term aim to combine all the telehealth activities at UTMB under one department was finally realized in December 2004 with the creation of the Electronic Health Network (EHN).

Outcomes Expected:

1. Patient satisfaction with telemedicine services.
2. Expansion of contracts.
3. Web site completed.
4. Operation of clinics.
5. Program sustainability.

Service Area: Eastern and coastal Texas, state wide and world wide through various contracts. EHN (formerly The Telehealth Center) has contracts with Brazoria, Liberty, and Fort Bend counties to provide primary and
specialty care. Brazoria County has 9 MUAs and no HPSAs. The entire county of Liberty County has been designated as an MUA and as an HPSA. Fort Bend has 5 HPSAs and 11 MUAs.

Services Provided: Telehealth assistance: shared resources, expertise, information, distance education, telemedicine services.

Equipment: 177 telemedicine stations with Polycom videoconferencing equipment with appropriate medical peripherals.

Transmission: Connectivity: private IP network over dedicated T1 lines, which carry voice, data, and video.