1. UA Telemedicine:
Connecting Across the State
2012 Alabama Broadband &
Telehealth Summit
October 19, 2012
Lloyda B. Williamson, M.D.,
Associate Professor
Psychiatry & Behavioral Medicine
University of Alabama –
School of Medicine

2. University of Alabama
 College of Community Health Science
 Institute for Rural Health Research
 Telemedicine

3. The Problem
 Disparity between patient’s needs and
health care provider availability
 Inadequate public transportation
 Inadequate insurance payment
systems
 Inadequate access to care

4. Resulting Status
 Limited specialty services to many
vulnerable populations
 Across multiple specialties
 In acute & chronic care settings

5. UA Telemedicine Initiatives
Funded Partners:
 West Alabama Mental Health Center
 USDA Grant - 4 Rural Clinics
 Verizon Foundation
Community Partner:
 DeKalb County Youth Services

6. West AL Mental Health Center
 Center in Demopolis, covers 5
counties: Greene, Hale, Marengo,
Sumter, Choctaw
 Critical shortage of psychiatrists
 Bristol-Myers $1.2 Million Grant -
telemedicine video-conferencing
equipment
 UA provide telepsychiatry services

7. WAMHC (cont.)
 B-M Grant: 2 fellowship positions
 Rural Public Psychiatry & Behavioral Health
 Absence of fellows UA psychiatrists
provide telepsychiatry services
 Benefits: fellows provide service
 Challenges: lack of fellows, inadequate
time for UA psychiatrist responsibilities

8. USDA Grant
Partnership with 4 rural clinics with goals
to provide
-telepsychiatry
-obstetrical consultation
- educational telemedicine (lectures,
case conference presentations & shared
rounds)
-cameras, monitors, & other equipment

9. USDA Grant Sites
 1) Carrolton Primary Care Clinic*
 2) Cahaba Medical Center Rural Track
Site
 3) Primary Care Center Monroeville*
 4) Parrish Capstone Rural Health
Center
*TERM Site - 17 wks for 3rd year med.
students (Tuscaloosa Experience in
Rural Medicine)

10. USDA Grant Benefits
 Psychiatry svcs to pts in rural areas
 Decrease travel time & cost for fuel
 OB/GYN consultation complex cases
 Timely pt appointments & tx
 Bridge gap of healthcare delivery
 Obtain CME credits through video-conf
 Fellows provide psychiatry svc
 Telesleep disorder consultation

11. USDA Grant Challenges
 Grant provided equipment ONLY, not
broadband or financial support
 No reimbursement for Facility Usage
Fee, no show, unpaid rental fee
 Unable to consistently fill fellowships
 No reimbursement from Medicaid for
services rendered for TeleOB, Tele
Nutrition---LOSS of GRANT $$$$$
 Not enough psychiatrists at CCHS to
provide telepsychiatry svcs

12. Verizon Foundation Grant
 $18,771 for Diabetes Self-
Management
 Follow CCHS model for pt education &
groups - ADA Certified
 Partner with Maude Whatley System

13. DeKalb County
 DeKalb County Juvenile Court
1 Psychiatrist
 Extensive pre-trial psychiatry evaluations,
assessment for juvenile sex offenders,
drug abuse offenders, etc.
 Spend $ for room & board, 2 deputies
transport across state for eval. & back
 4 - 6 weeks before assessment complete
 Contract delay due to April 2011 tornados

14. DeKalb County (cont.)
 2) DeKalb County Youth Services
2 psychiatrists
 1 social worker
 Svcs for children and adolescents
 Initial psychiatric evaluation
 Follow up psychiatric evaluations
 12 hours of consultation/mo. (3 half days)
 As of 05/2012 seen 185 youth

15. Dr. Thad Ulzen - Telepsychiatry

16. DCYS - Diagnoses
 Attention Deficit Hyperactivity Disorder
 Oppositional Defiant Disorder
 Depression
 Anxiety Disorders - PTSD
 Sexual abuse & neglect
 Parent - Child conflict
 Reactive Attachment Disorder
 Gender Identity Disorder

17. Current Needs
 Organizational vision
 Telemedicine infrastructure
 Guidelines, policies, & procedures
 Involvement of specialties
 Development of more relationships
 Expansion and maintenance
 ***Business plan – insurance billing
 - other possibilities
 Equipment & space

18. Evidenced Based-Practice

19. Questions
?

20. References
 American Telemedicine Association
Practice Guidelines for
Videoconferencing-Based Telemental
Health, October 2009
 Meyer, BC, Clarke, CA, Troke, TM,
Friedman, LS. (2012)“Essential
Telemedicine Elements (Tele-Ments)
for Connecting the Academic Health
Center and Remote Community
Providers to Enhance Patient Care.
Academic Medicine, 87: 1032 - 1040.

21. References (cont.)
 Ulzen, T, Williamson, L, Foster, P
Parris-Barnes, K. (2008) The Evolution
of a Community-Based Telepsychiatry
Program in Rural Alabama: Lessons
Learned – A Brief Report. Community
Mental Health Journal. February.