Hawaii and Pacific Is Island Telehealth Experiences Innovations - - PowerPoint PPT Presentation

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Hawaii and Pacific Is Island Telehealth Experiences Innovations - - PowerPoint PPT Presentation

Hawaii and Pacific Is Island Telehealth Experiences Innovations in Policy, Technology and Applications Christina Higa Co-Director, Pacific Basin Telehealth Resource Center Social Science Research Institute University of Hawaii Brisbane


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Hawaii and Pacific Is Island Telehealth Experiences

Christina Higa Co-Director, Pacific Basin Telehealth Resource Center Social Science Research Institute University of Hawai’i

Brisbane April 3-4, 2019

Innovations in Policy, Technology and Applications

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Univ iversity of f Hawaii TASI Programs

“One” (Samoan) + “Ocean” (Chomorro)

“one sea/ocean” connectivity

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  • Pan Pacific Education and

Communication Experiments by Satellite (PEACESAT) 1969-2012

  • Re-Purpose – Recycle Test/Weather

Satellites (NASA’s ATS-1 & 3; NOAA’s GOES 2, 3 & 7)

  • ”Free” Public Service Communication
  • Multi-Propose – Collaboration

✓Distance Learning ✓Emergency Management ✓Telehealth

  • Notable: Kangaroo Network

– Royal Flying Doctors - Medical Chests

Our His istory ry in in the Pacific Is Isla lands

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Take Away fr from the PEACESAT Story ry

Maximize - Limited Small Island Resources Work Together – Collaborate across multi-sectors Innovate - Value repurposed/ recycled systems & networks “Free” connectivity spurred innovation of applications

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Take a moment to think about your initiatives…

How might your service be applied to another target community (rural/urban), health discipline; or another sector completely (disaster response, education, tourism), something else? What added value can you share with the platform you are using – whether it is technical or human resources?

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UH TASI Programs

  • Training: Pacific International

Training Desk

  • Health Informatics: Pacific Health

Informatics Data Center (PHIDC)

  • Telehealth: Pacific Basin Telehealth

Resource Center (PBTRC)

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Pacif ific Is Isla lands on the Worl rld Map

https://d-maps.com/m/world/centrepacifique/

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Marshall Islands American Samoa Federated States

  • f Micronesia

Palau Northern Mariana Islands Guam

  • Area larger than CONUS
  • 480K USAPI 1.4M HI Population
  • PBTRC: 1-State, 3 US Territories,

3 COFA with US

Hawaii & USAPI

State of Hawaii

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State of Hawai`i

  • 1.4 Million People
  • 8 Islands, 7 inhabited
  • O`ahu – 900K
  • Honolulu – Health Specialists
  • Interisland Travel by Air
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Telehealth in in Hawai`i

  • Island State – telehealth still

evolving?

  • Increasing adoption
  • Years of “Broken Record” Policy

Challenges ✓Reimbursement ✓Liability ✓Workflow/Workload ✓Licensing

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State of Hawai`i Stakeholders & Policy

Actions

  • 2016 Stakeholder Summit
  • US/State legislators, Providers,

Administrators, Researchers, Family Advocates, Payer, Vendors

  • White Paper Policy Challenges

Environment

  • Tipping point in our country?
  • Payment Reform: service/encounter

to quality performance

  • Bi-Partisan Support
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Tele lehealt lth Law - Act 226 ( (1/2017)

  • Requires telehealth parity
  • Malpractice coverage
  • Lifts restrictions on originating site

including patient home or work;

  • Definition: store and forward, remote

monitoring, live consultation & mhealth

  • Does not require presence of two

providers and a patient, appropriately;

  • Permits provider-patient relationship to be

established via telehealth by referral

  • (Provider must have HI Medical License)
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Take Away from the Hawai`i Story

Systemic Issues -- Stuck because of Policy; need to change Policy…right environment to do it. Law Does Not = Change…requires details, change takes time Co-design? Proposition of value: What is in it for each stakeholder? What’s in it for provider, patients, community, law makers?

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Emerging In Initiatives in in the US Affil iliated Pacific Is Isla lands

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Long Standing In Infrastructure Challe llenges and Barrie iers

Environment

Tiny Population/Markets, Poor Economies of Scale, Developing & Fragile Economies

Infrastructure

Vast Distances, Difficult and Expensive to Serve, High Travel Costs

Non-Communicable Disease (NCD)

Among highest NCD related deaths Regional State of Health Emergency Lack of Specialty Care, Costly Referrals

Telecommunication

Access/ Affordability/Reliable Lack of Enabling Telecom Regulation Monopoly Environments

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Telecommunication Cost Barriers

Site Name Connection Type Provided Connection Speed Cost USD Per/Mo. FSM (Chuuk) T1 Internet 1.544 Mbps $ 320 Standard ADSL Internet 1 Mbps download $ 400 256 Kbps upload RMI (Majuro) ADSL (Residential) 256 Kbps $50 1.5 Mbps $140 ADSL (Business) 3-7 Mbps $2,100 - $4,000 FSM (Pohnpei) ADSL 1.5 Mbps $600 VDSL 8 Mbps $10,192 Palau MOH Palau Telecom (Wireless on island, Intranet Management) 3 Mbps download ~$7,000 Off island via satellite (O3B) 1.5 Mbps upload Palau MOH PNCC (Wireless on island) - Off island via satellite (O3B) 4 Mbps download

  • 1 Mbps upload

~$5,000 American Samoa DSL (Residential) DSL (Business) 2 Mbps 10 Mbps $130 $700 CNMI ADSL Internet 9 Mbps download $325 1 Mbps Guam ADSL (Residential) Internet 50 Mbps download 2 Mbps upload $100

Amongst the highest worldwide

Mbps U/D

  • Mo. Cost

Palau 3/1 $7,500 US Hawaii 250/250 $1,200 US GDP (2017) Small Is. $4,000 US US $59,000 US 80X bandwidth for 6x cheaper

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  • Guam - Hub
  • Majuro, Kwajalein, Ebeye (RMI)

Pohnpei (FSM)

  • Chuuk, Yap (to be operational)

and the Palau connection installed in late 2017 Infrastructure Improvements:

Micronesian Under Sea Fiber Optic

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USAPI Telehealth Champion Building and Planning Workshop

September 13 to 15, 2016 Honolulu * Hawai`i

Region IX - Office of the Assistant Secretary for Health and Regional Directors Office worked with the Office of the Assistant Secretary for Planning and Evaluation (ASPE)

In 2010 Pohnpei was connected to fiber but didn’t know what to do with it…”our eyes were opened up to the possibilities of telehealth and numerous applications.”

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Telehealth in Pohnpei, , FSM

Telehealth Room

  • Pohnpei Hospital
  • Negotiated: Telecom

link 10Mbps $400 USD/mo. (form $5K)

  • No Budget? Local

NGO funding

  • Room? Re-purposed
  • Opening – 3 mo. after

workshop ✓Demonstration of Value ✓Attracts other local NGO funding

Pohnpei State: 36,000 Pop, FSM Capital, Connected to off island fiber

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  • MCH Telehealth - Teleaudiology
  • Pohnpei Hospital Telehealth Room (10

Mbps – Excellent Connectivity, $400/mo)

  • Hokkaido Cancer Center, Japan. Tele-

pathology for cancer diagnoses & life- saving interventions. Chuuk Pap Smears reads in Pohnpei

  • Shriners Hospital Consultations
  • Cardiology Consultation – Dr. Mahnke

(Store & Forward, Complicated Echo Studies)

  • Rheumatic Heart Disease Screening

and Possible Follow-Up via Telehealth

Pohnpei State Hospital Tele-Pathology

Image: Kaselehlie Press, Jan. 29, 2018

Telehealth in Pohnpei

  • Rheumatic Heart Disease

Screening: Handheld Ultrasounds

  • Tele-Consultation: neurological

referrals to Shriners Hospital for Children

  • Tele-Audiology: Maternal and

Child Health Care Services

  • Tele-Cardiology: store and forward

complicated cases

  • Tele-Pathology: Hokkaido Cancer
  • Institute. Tele-pathology for

cancer diagnoses & life-saving interventions, Chuuk pap reads

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Regional Collaboration in Medical Training

  • Pacific Islands: Gastroenterology

Australian and New Zealand Gastroenterology International Training Association (ANZGITA) Dr. Chris Hair; Fiji School of Medicine,

  • Dr. Mei Ling Perman; Pohnpei

Hospital, Dr. Payne Perman

  • Pacific Island TB Nurses' Network

(TB Case Consultation for USAPI Nurses) CDC/Australian Respiratory Council

Medical Education Mentoring Program Case Based Learning Well Received in Pacific Islands

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Take Away from the Pacific Story

Importance of Champions, even if cliché Infrastructure / Resource Constraints Common Telehealth issues (reimbursement,

liability, patient privacy) not yet overbearing concerns

Risk Management Assessment:

Severity of the resource constraints Dire health care needs Access to health information, consults Imperative for best care possible

Opportunities for Regional Collaboration

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Final Reflections….

Challenges * What are top challenges in your initiative? * What do the stakeholders say? How do you hear from them? Opportunities * How to meet Value Propositions? * What can you do to enhance it? * Who can you collaborate with?

Health care providers in most rural and isolated communities are often very innovative, creative, and willing

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Mahalo! Thank you for your Time.