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Published on November 6, 2007

Author: Mikhail

Source: authorstream.com

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OPERATIONAL TELEMEDICINE Naval Telemedicine Business Office :  OPERATIONAL TELEMEDICINE Naval Telemedicine Business Office August 2001 Captain Richard S. Bakalar, Medical Corps, U. S. Navy Code 21: Naval Telemedicine Business Office Naval Medical Information Management Center Bethesda, Maryland OUTLINE:  OUTLINE Strategies for Telemedicine Impact of Telemedicine on Readiness Next steps…Organizational Oversight Teleradiology Business Practices Operational Reachback Important Issues Strategies for Telemedicine Telehealth Business Models:  Strategies for Telemedicine Telehealth Business Models Contingency Care – Episodic Care Improved Access, Enhanced Quality Cost Avoidance (i.e. medevacs, expedited care) Focused Care - Point-to-Point Medical Links Uniform Enterprise Access to Specialty Care Reduced Command Marginal Costs Optimized Care - Global Tele-Health Network Improved Provider Productivity and Efficiency Minimized Enterprise Sustainment Costs (Navy/DoD) The Telehealth Investment: 1996 - 1999:  The Telehealth Investment: 1996 - 1999 Military Exercises & Demonstrations Business Process Improvement TRICARE Regional Support Initiatives The NNMC MIDN Telemedicine Project March 1996 - November 1999:  The NNMC MIDN Telemedicine Project March 1996 - November 1999 Contingency Healthcare Operations Enhanced Fleet Readiness, Force Health Protection and Quality of Life Aircraft Carrier Battle Group Prototypes Amphibious Ready Group Prototypes USNS COMFORT (TAH 20) Regional Tele-consultation US Naval Academy Telemedicine Testbed CareCentral - Digital Physical Exam Process Tool Teleradiology - Tele-Dermatology - Tele-ENT Tele-Mental Health Operational Ship Support TRICARE Region 1 Distance Learning and Medical Reference Web applications - Virtual Naval Hospital Fleet Video Teleconferencing Support Regional VTC Support for Integrated Residency Training Programs NNMC - Worldwide Military Tele-Consultation Center The Telehealth Investment: (continued) SHIPBOARD TELEMED EQUIPMENT UTILIZED:  SHIPBOARD TELEMED EQUIPMENT UTILIZED COMPUTED RADIOGRAPHY HANDHELD DIGITAL CAMERA SLIT LAMP CAMERA OTOSCOPE NASOPHARYNGOSCOPE ULTRASOUND VTC WORKSTATION The Telehealth Investment: (continued) 59 TMED CONSULTS Six Month Deployment: Oct 97 - Apr 98 :  59 TMED CONSULTS Six Month Deployment: Oct 97 - Apr 98 DERMATOLOGY 19 (32%) PSYCHIATRY 11 (19%) ORTHOPEDICS/HAND 8 (13%) CARDIOLOGY 4 ( 7%) OPHTHALMOLOGY 4 ( 7%) RADIOLOGY 4 ( 7%) ENT 3 ( 5%) IM, UROLOGY, OTHER 6 (10%) The Telehealth Investment: (continued) CONSULTANT CONCURRENCE:  CONSULTANT CONCURRENCE The Telehealth Investment: (continued) SMO’s CONCLUSIONS CAPT Mike Krentz, MC, USN:  TELEMEDICINE ENHANCES OPERATIONAL MEDICINE. TELEMEDICINE IS AN ESSENTIAL COMBAT SUPPORT SYSTEM. TELERADIOLOGY GREATLY IMPROVES CLINICAL EFFECTIVENESS. VTC IS CLINICALLY IMPORTANT AND COST-EFFECTIVE. SMO’s CONCLUSIONS CAPT Mike Krentz, MC, USN The Telehealth Investment: (continued) FLEET READINESS IMPROVEMENTS Contingency Healthcare USS CARL VINSON (CVN-70) * Nov 1998 – May 1999:  FLEET READINESS IMPROVEMENTS Contingency Healthcare USS CARL VINSON (CVN-70) * Nov 1998 – May 1999 Impact on Patient Medical Evacuations Prevented - 30% or 14 medevacs Cost avoidance $61,600 Saved foreign country unscheduled procedures Recovered Lost Man-Days Full duty days saved – 1,333 Light duty days save – 244 Changes in Pharmaceutical stock inventory Ship-to-ship teleconsults (VINSON to BOXER) The Telehealth Investment: (continued) Navy Medicine’s Next Steps:  Navy Medicine’s Next Steps Central Management - TM Business Office Modernize Digital Infrastructure Deploy Proven, Affordable Technologies Establish “Best Clinical Practices” Develop a BCA for Targets of Opportunity Organizational Oversight:  Organizational Oversight Requirements Definition: BuMED - Headquarters: Policy Makers/Specialty Leaders Theater Medical Information Program (TMIP) - Maritime (M) Validated requirements by functional users and their leadership Program Management: NAVDIRB - Capital Equipment Procurement (OP >$100,000) Naval Telemedicine Business Office (NMIMC Code 21- NTBO) CLINICAL NEEDS ASSESSMENT COLLECTION OF VALIDATED TM REQUIREMENTS TECHNOLOGY ASSESSMENT STANDARDIZE BEST PRACTICES TECHNICAL SUPPORT (TELEMEDICINE HELPDESK) LIAISON AND MARKETING Navy Medicine’s Next Steps (continued) Slide13:  NMLC Logistics MED 02 Operational MED 03 Healthcare NMIMC IM (M-CIO) OOMC Medical Corps MED 01 N931 Resources Specialty Leaders SHIPS MTF’s Fleet Marine Forces (FMF) MSC Hospital Ships NTBO Code 21 TMIP-M Code 23 Telemedicine Business Office +TM Administrative Support +Worldwide TECH HelpDesk +Best TM Medical Practices +Central Coordination/Liaison Navy Diagnostic Imaging and . . Radiotherapy Board +Capital Equipment Procurement . With Central Oversight +Equipment Utilization Budgeting and Workload Clinic's IT Support P2 & P6 P8 Funding IM Support Organizational Support for Telemedicine Stakeholders and Users Medical Centers NAVDIRB Navy Diagnostic Imaging and Radiotherapy Board (NAVDIRB):  Navy Diagnostic Imaging and Radiotherapy Board (NAVDIRB) Functional and Technical Advisory Board Chartered by BuMED Quarterly minutes are approved by the Deputy Surgeon General Leadership Chairman is the Specialty Leader for Radiology (NMC San Diego) LOGISTICS and ADMIN Support: The Role of the NAVDIRB Review Medical Imaging Equipment Procurement Ensure Appropriate Utilization of Purchased Equipment Manage the implementation of the Five Year DINPACS Fielding Plan http://www-nmlc.med.navy.mil/code03/DINPACS/dinpacs.htm Provide Technical and Functional Navy Guidance on Imaging QA/QC Issues NAVAL TELEMEDICNE BUSINESS OFFICE:  NAVAL TELEMEDICNE BUSINESS OFFICE Phase I: Computed Radiography (CR) Replacement of Wet Film Processors:  Phase I: Computed Radiography (CR) Replacement of Wet Film Processors Equipment Funding Network Security Risk Mitigation through Security Countermeasures Network Certification Process Coordinated Installation Process Project Management Pre-Installation Survey and 5-Day Installation Checklists User Training for Digital Imaging Must Standardize acceptance testing and quality control Sustainment (Warranty and Post Warranty Periods) Ship’s responsibility, for primary support Backup support from a Central Help Desk and Vendors Same repair process as other medical equipment Navy Medicine’s Next Steps (continued) Slide17:  1.Cassette identification (all) 2.Insert cassette in table + patient positioning 3.Exposure + processing previous cassette 4.Continue step 2/3 till last exposure 5.Process last cassette + release patient 6. Radworks V5.0 Review Workstation (2 PC’s) Fleet Systems: Operational Medical Digital Imaging and Reporting System (OMDIRS) Computed Radiography Note: Existing X-ray unit does not require replacement 1.Cassette identification (all) 2.Insert cassette in table + patient positioning 3.Exposure + processing previous cassette 4.Continue step 2/3 till last exposure 5.Process last cassette + release patient 6. Radworks V5.0 Review Workstation (2 PC’s) 7. Drystar Thermal Film Printer System Cost: Equipment: $320,000 Installation & Training: $15-20,000 6 7 Teleradiology Starter Kit Project Sustaining Base Tele-radiology Network:  Teleradiology Starter Kit Project Sustaining Base Tele-radiology Network Centrally Funded by the NAVDIRB Fielded 15 Radworks Film Scanning workstations Global Deployment from December 2000 through July 2001 Great Lakes Region – 3 locations (recruit training center) Pacific Region – 6 sites (Hawaii. Guam, Japan) Europe – 5 sites (Keflavik, UK and the Mediterranean Sea AOR) Bremerton - Diagnostic Workstation for USS LINCOLN & C. VINSON Additional shore sites to receive Computed Radiography USNH Guantanamo Bay, Cuba (CR and Diagnostic Workstation) NMC Portsmouth (Virginia) clinics - 3 new Fuji SMART CR units Fully Interoperable with DINPACS FY01 DINPACS - NNMC, NMC SD, USNH Sigonella and Rota Navy Medicine’s Next Steps (continued) Teleradiology Business Practices Phase II: Teleradiology Issues:  Teleradiology Business Practices Phase II: Teleradiology Issues Naval Program Oversight (Data Flow Decisions) Role of NAVDIRB Functional Partners: Fleet/FMF, BUMED (NMIMC-NTBO), SPAWAR Technical Considerations Network Security and Patient Privacy Software Configuration Management Ongoing User Training and Equipment Sustainment Clinical Implementation Navywide Single Standard of Care for Clinical Services Business Rules: Standard Operating Procedures (SOP’s) Medical Leadership - Clinical Supervision Benefits are greater for the Clinicians, not the Radiologists! Image Quality / Data Compression Guidelines from Specialty Leader for Navy Radiology:  Image Quality / Data Compression Guidelines from Specialty Leader for Navy Radiology Single Standard of Care for Naval Radiology Services Status Quo is acceptable pending formal study Greatest Clinical Risk: subtle findings of indolent chronic diseases Formal study to evaluate image compression in the military Teleradiology Business Practices (continued) NTBO Technical Support Center Global Virtual HelpDesk:  NTBO Technical Support Center Global Virtual HelpDesk Staffing Considerations Role of the Central Technical Coordinator Mobile Field Engineers – installation, training and sustainment Three Tiered Support System Local Command level (technical champion) NTBO Central Technical Support Center Commercial Equipment and Software Vendors The First Year Experience Customer Service is key Documentation is critical to sustainment Technical Support and User Training must be supported New System Integration into existing infrastructure Teleradiology Business Practices (continued) NTBO Technical HelpDesk First Year in Review:  NTBO Technical HelpDesk First Year in Review Digital Imaging Tech Trouble Calls: March 2000 - June 2001 48 encounters documented in NMIMC Remedy Database Navy Ships - 30 occurrences from 13 ships (range 1-5 calls per ship) MTF’s - 19 occurrences from 6 sites (range 1-10 calls per site) 90% (43/49) were resolved without an on-site technical assist visit Average time of resolution less than 24 hours, range 1 hr to 66 hrs. Service was excellent, but documentation was inadequate only about 70% of the trouble calls were documented inadequate data collection on documented trouble calls data collection tool was not user friendly (inadequate user training) Revised, simplified process planned next year (2001-2) Teleradiology Business Practices (continued) Operational Reachback Medical Consultation Centers:  Operational Reachback Medical Consultation Centers National Naval Medical Center Naval Medical Center San Diego Naval Medical Center Portsmouth Navy Medical Centers Tele-consultation Utilization:  Navy Medical Centers Tele-consultation Utilization NNMC Bethesda in FY2000 Tele-Radiology (mostly Fleet Studies) Total: 2,424 or 202/month Tele-Mental Health (TRICARE Region 1) 375 Other Clinical VTC 96 Teledermatology (S/F) 65 NMC San Diego in CY2000 (10 months) Tele-Radiology Total: 951 McMurdo Station, Antarctica 420 Fleet Studies (before IP Port Closure) 505 Miramar 26 Operational Reachback (continued) NAVY e-HEALTH ISSUES IN TELEMEDICINE:  NAVY e-HEALTH ISSUES IN TELEMEDICINE Clinical Services Global Access to multimedia data (see VA’s VISTA system) Business Rules for Health Care Delivery Administrative Services Provider Credentialling and Privileging for Telemedicine Regional and Operational multimedia digital data archives Workload Credit for Tele-consults for providers Medical Reference and Education Virtual libraries - online and digital caches (CD-ROM/DVD) Online CME/CEU and Technician in-service medical training Technical considerations Remote Technology support (Virtual HelpDesk)/Tech Training Network Security/Patient Privacy (HIPAA Issues) Bandwidth allocation and data compression guidelines Questions ? ? http://navmedinfo.med.navy.mil/ntbo rsbakalar@us.med.navy.mil:  Questions ? ? http://navmedinfo.med.navy.mil/ntbo rsbakalar@us.med.navy.mil

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