iHT² Health IT Summit San Francisco – Case Study “Building A Sustainable Telemedicine Cooperative: The Arizona State-Wide Telemedicine Program” with Ronald Weinstein, M.D., Director, Arizona Telemedicine Program

1. Case Study
“Building A Sustainable Telemedicine Cooperative:
The Arizona State-Wide Telemedicine Program”
Ronald S. Weinstein, M.D.
Director, Arizona Telemedicine Program
Tucson, Arizona
President Emeritus, American Telemedicine Association
(Serial Entrepreneur)
Case Study

2. Case Study
1. Pre-Implementation Phase
2. Implementation Phase
3. Medical Services
Telemedicine
Telehealth
mHealth, etc.

3. Case Study
I. Pre-implementation Phase
1. Mandate
2. Public Policy
3. Governance
4. Infrastructure
5. Sustainable Business Plan
1. Mandate
AZ State Legislature (1996)
2. Public Policy
8 AZ Foundational Policies
3. Governance
Non-Statutory Overarching Authority
(Arizona Telemedicine Council)
4. Infrastructure
Arizona Rural Telemedicine Network
5. Business Plan
Application Service Provider (ASP) Model
GENERAL TOPICS ARIZONA CASE STUDY

4. Case StudyMANDATE

5. Tucson
Arizona Legislature’s Challenge
Charter Sites Case StudyInfrastructure

6. Arizona Telemedicine Program - Corps of Engineers
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7. 1998-2001
Arizona Telemedicine Program
Telecommunications Utility
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8. 2014
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9. Case Study

11. Case Study
I. Pre-implementation Phase
1. Mandate
2. Public Policy
3. Governance
4. Infrastructure
5. Sustainable Business Plan
1. Mandate
AZ State Legislature
2. Public Policy
8 Foundational Policies
3. Governance
Non-Statutory Overarching Authority
(Arizona Telemedicine Council)
4. Infrastructure
Arizona Rural Telemedicine Network
GENERAL CATEGORIES ARIZONA CASE STUDY
5. Business Plan (recurrent revenue stream)
Application Service Provider (ASP) Model
Case StudyBusiness Plan

12. Case Study
I. Pre-implementation Phase
1. Mandate
2. Public Policy
3. Governance
4. Infrastructure
5. Sustainable Business Plan
1. Mandate
AZ State Legislature
2. Public Policy
8 Foundational Policies
3. Governance
Non-Statutory Overarching Authority
(Arizona Telemedicine Council)
4. Infrastructure
Arizona Rural Telemedicine Network
5. Business Plan-continuous revenue stream
Arizona Telemedicine Program--
Application Service Provider (ASP) Model
Members – 55 healthcare organizations
GENERAL CATEGORIES ARIZONA CASE STUDY

13. Case Study
1. Training Program
Training Centers
2. Marketing Program
Health Fairs, NPR, etc.
3. Telemedicine Service Roll-Out
Teleradiology, telepsychiatry, etc.
4. Assessment Programs
Best practices, QA, provider satisfaction
5. Supplemental Funding
TRC, International Programs
GENERAL CATEGORIES ARIZONA CASE STUDY
I. Pre-implementation Phase
1. Mandate
2. Public Policy
3. Governance
4. Infrastructure
5. Sustainable Business Plan
II. Implementation Phase
1. Training program
2. Marketing
3. Telemedicine Service Roll-Out
4. Assessment Programs
5. Supplemental Funding

14. Telemedicine Training Programs
> 8-9 programs per year (since 2000)
> 1200 trainees
> 100+ healthcare organizations
Case StudyTRAINING PROGRAM

15. “I think these lectures are a real
plus for physicians like me, who
live in rural areas but are always
interested in receiving new
information.”
Dexter DeWitt, MD
Case Study

16. Case Study
1. Teleradiology
25 hospitals; 1.3 M Cases
2. Telepsychiatry
NARBHA-120,000 pateint encounters
3. Telecardiology
Yuma RMC Neonatal Intensive Care Unit
4. Telestroke
Mayo Clinic - 13 AZ rural hospital network
5/6. Telepatient-monitoring
Banner eICU; Flagstaff CHF program
GENERAL CATEGORIES ARIZONA CASE STUDY
III. Telemedicined/Telehealth Services
1. Telemedicine
2. Telehealth
3. Telenursing
4. Telepharmacy
5. Tele-home health
6. Telemetry
7. Prevention
8. Distance education

17. “Telemedicine dramatically
increases compliance with
appointments if you can be
seen in your own
community.”
Sara Gibson, MD
Telepsychiatry

18. Case Study
Telecardiology

19. “We see telemedicine
as an important
opportunity to improve
patient care.”
Bart M. Demaerschalk, M.D
Vascular Tele-neurologist
Mayo Clinic-Scottsdale
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Telestroke

20. “It works. It
saves people’s
lives.”
Jack Porter
Former Mayor
Bisbee, Arizona
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Telestroke

21. “We have the
opportunity to
change the way
health care is
delivered.”
Deborah Dahl,
Banner Vice Presidnet
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$68,000,000 savings/Peter Fine, Banner CEO
Tele-eICU

22. Case Study
Tele-Home Health Care

23. Flagstaff Medical Center in Northern Arizona
Pilot project: 50 Patients with Hx Congestive Heart Failure*
• Decreased hospitalizations: 3.26 vs. 1.82 over 6 months
• Fewer days hospitalized: 13.98 vs. 5.13 days
• Cost saving: $92,317 per patient over 6 months
* Pts. provided with wireless devices to track weight, blood pressure
and activity levels daily. Data automatically transmitted.
Brookings Institute
Conference on Mobile Health
March 2014
Case Study

24. “Care Beyond Walls and
Wires is the best thing
ever for me, and the best
thing for my dad.”
Rita Yazzie
Case Study

25. T Case Study
Tele-Support Groups

26. “Telemedicine Is
pivotal for diabetic
retinopathy.”
Mark B. Horton, M.D.
Case Study
REMOTE SCREENING FOR
DIABETIC RETINOPATHY

27. Case Study
1. Teleradiology
25 hospitals; 1.3 M Cases
2. Telepsychiatry
NARBHA-114,000 encounters
3. Telecardiology
Yuma RMC Neonatal Intensive Care Unit
4. Telestroke
Mayo Clinic - 13 AZ rural hospital network
6. Telepatient-monitoring
Banner eICU; Flagstaff CHF program
GENERAL TOPICS ARIZONA CASE STUDY
III. Telemedicined/Telehealth Services
1. Telemedicine
2. Telehealth
3. Telenursing
4. Telepharmacy
5. Tele-home health
6. Telemetry
7. Prevention
8. Distance education
7. Tele-medication monitoring
University of Arizona College of Pharmacy

28. IHT2
Case Study

29. Why Telemedicine?
 Gap Services
 Urgent Services
 Mandated Services
IHT2
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30. “In some cases the patient
can be treated locally instead
of bringing the patient to us
by helicopter, which costs
$10,000 to $20,000.”
Daniel M. Caruso, MD

31. Why Arizona?
 Geography
 Leadership
 Culture
IHT2
Case Study

32. University of Arizona
Land Grant University
“Land Grant University
Mission for the Future”
 Develop partner
relationships with
communities and
industries.
 Advance local and global
impacts of
 University of Arizona
knowledge creation.
 Ann Weaver Hart, Ph.D.
President
University of Arizona
IHT2
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33. Barriers
 Legal, regulatory
 Reimbursement
 Culture
IHT2
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.>> Acute Shortages of
Telehealth Service Providers
“Practicing Medicine
on a Unicycle”

34. Telemedicine
1- saves live
2- reduces health-care costs
3- improves assess
4- managing chronic diseases
5- disease prevention
6- improves quality of life
Case Study

35. Case Study
For Copies
Please Contact
Angel Holtrust at:
aholtrust@telemedicine.arizona.edu

36. Thank you!
rweinstein@telemedicine.arizona.edu
IHT2
Case Study