Web posted Friday, March 18, 2011

Technology makes Native care accessible

By Andrew Jensen
Alaska Journal of Commerce

  Dr. Stewart Ferguson, left, and Dr. Thomas Nighswander show off one of the telehealth carts created by the Alaska Federal Health Care Access Network. The tConsult software developed by the Alaska Native Tribal Health Consortium, which operates AFHCAN, is now aboard the International Space Station. Photo Courtesy of ANTHC    

An Alaska original has made it from the Last Frontier to the Final Frontier.

The state has seen plenty of hardware blasted into outer space from the Kodiak Launch Complex, which has put satellites in orbit and test-fired interceptors in missile defense tests.

A different kind of payload has now gone where no Alaska technology has gone before. The tConsult software developed by the Alaska Federal Health Care Access Network, or AFHCAN, is now in use on the International Space Station.

AFHCAN, better known as telehealth or telemedicine, is the product of a collaboration between federal agencies that brought together the Alaska Native Tribal Health Consortium, or ANTHC, with Indian Health Service, Veterans' Affairs, the Department of Defense, Department of Transportation, and the United States Coast Guard.

The telehealth project — which is operated by ANTHC — coincided with the transfer in 1998 of most medical care to the ANTHC and Southcentral Foundation. The Southcentral Foundation is a nonprofit organization of Cook Inlet Region Inc., one of the 12 Alaska Native regional corporations.

Forty years after the passage of the Alaska Native Claims Settlement Act, access to health care for rural Alaskans has never been better thanks to the ingenuity of the AFHCAN telemedicine carts and tConsult software.

The goal of AFHCAN when it was formed was to provide health care to the more than 300,000 federal beneficiaries in Alaska. Since then, the telemedicine carts — which now collect and transmit increasingly complex medical information — have spread to more than 300 remote Alaska locations and about 400 in total around the world, including Kenya and the Maldives.

AFHCAN telemedicine carts are in eight of the 12 Indian Health Service areas and all four corners of the Lower 48 from Arizona to Oregon and from Maine to Florida. The carts, which debuted nine years ago and cost about $25,000, originally had just four devices: an EKG, digital camera, scanner and an otoscope (used for looking inside ears).

Today, add-ons for the cart include a tympanometer (used to detect ear infections) with audiometer (hearing screenings); a digital stethoscope for heart and lung scopes; a vital sign reader that measures blood pressure, pulse, respiratory rate and temperature; and spirometer for assessment, diagnosis and follow-up for respiratory illnesses.

The components of the carts are either assembled in Anchorage or shipped to rural locations, where they can be assembled with only a screwdriver.

High-definition cameras allow for video conferencing between medical professionals, psychiatric evaluations and dental examinations. Increasing bandwidth in rural Alaska — the software was originally designed to run off satellite service or dial-up internet access — and software updates for compressing large files has also improved the capability of AFHCAN.

The tConsult software brings all the peripheral tools together to collect results, then send and receive medical records quickly and securely.

Mandi Constantine, director of program development for AFHCAN, said rural Alaska patients often can be seen and receive a diagnosis within the same day.

Constantine said 60 percent of telemedicine cases that come in are seen within the same day, and 30 percent within an hour.

"I can't get in within weeks," said Constantine, "but someone in Kotzebue walks in for a telemedicine consult and can get a turnaround within a day. Sometimes before they even leave, they get a response from a physician."

The telehealth program has been a boon for travel savings related to receiving medical care. Rather than fly to a regional hub such as Bethel or to Anchorage, many routine check-ups can be done remotely and illnesses can be diagnosed and treated before becoming serious.

ANTHC estimates that telehealth saved $5.5 million in patient travel costs in 2010, costs typically borne by either individuals or federal health programs such as Medicaid. The estimated savings in 2010 were a 60 percent increase versus an estimated $3.5 million in savings during 2009.

Those estimates don't reflect the additional savings such as fewer missed days of work for parents who accompany children to Anchorage.

During 2010, telehealth usage increased to more than 22,000 cases, a 50 percent increase from 2009. To date, the telehealth system has conducted 91,977 clinical cases since 2001.

Of the 22,000 cases in 2010, about 15,000 received care through the telehealth system.

An added benefit of the telehealth program is revenue to the ANTHC from cart and software sales. Constantine said revenue from selling telehealth products has allowed the consortium to fund an additional surgeon.

AFHCAN was ahead of the curve when it comes to the recent push toward electronic medical records as well. The consolidation of records allows for better coordination among providers, physicians and specialists.

"When you use telemedicine," Constantine said, "everyone knows who's treating what, what medications are being used. It's a really holistic way of treating people."

Constantine said current projects include more use of webinars and remote video training, including smartphone applications for iPhones and Blackberrys. Apps for new services like teledermatology are in the works.

After the surge in demand for the AFHCAN cart and software, Constantine said the focus now is to put the technology to the best use.

"We've changed our focus more to program development in the last two years," she said. "We're working with organizations to use it more effectively."

Dental demand

Another Alaska pilot project developed by the Alaska Native Tribal Health Consortium is also expanding. The dental health aide therapy program began in Alaska in 2006.

With more than 50 million Americans lacking affordable dental care — a problem particularly acute in rural Alaska — the W.K. Kellogg Foundation, along with Rasmuson Foundation and Bethel Community Services Foundation, funded the Alaska program.

In a study by RTI International released last November, more than half the children, 60 percent of adolescents and 77 percent of adults surveyed in five Alaska villages had untreated dental decay.

The RTI International study confirmed the benefits of the dental health aide program by conducting hundreds of patient satisfaction interviews.

The Kellogg Foundation then announced a $16 million grant to fund similar programs in Kansas, New Mexico, Ohio, Vermont and Washington. About 80 countries around the world use the dental therapist model. The Alaska program was the first of its kind in the United States.

Only 14 dental therapists are currently serving more than 25,000 people in rural communities, and an additional 12 dental therapists are nearing completion of their intensive training and will be ready to be deployed in rural Alaska. An ideal number would be about 50 to 60 therapists according to ANTHC.

"We have come a long way in four years," said ANTHC president and chair Andy Tueber. "We are confident that it will go much farther in the years to come."

Maybe even outer space.

Andrew Jensen can be reached at andrew.jensen@alaskajournal.com.