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.
Rural Specialty Health Telemedicine Initiative
Cook Children’s Medical Center top
Cook Children’s Medical Center (CCMC)
Steve Anderson
801 Seventh Avenue
Fort Worth, Texas 76104 www.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.
Specialty Access Through Telemedicine (SA++)
Harris County Hospital District top
Community Health Program/Specialty Access Through
Telemedicine (SA++) L.
Harris County Hospital District
2525 Holly Hall http://www.hchdonline.com
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.
Diabetes
Risk Reduction via Community-Based Telemedicine
(DiRReCT)
University of Texas Health Science Center at San
Antonio top
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.
The
Texas Telehealth Disparities Network
University of Texas Medical Branch Center to Eliminate
Health Disparitiestop
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
University of Texas Medical Branch - Galveston
top
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:
Patient satisfaction with telemedicine
services.
Expansion of contracts.
Web site completed.
Operation of clinics.
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.
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