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The
Indian Health Service and tribes have been introduced to telemedicine /
telehealth programs through grant projects and regional providers and
universities. The projects were created to provide the highest standard of
health care in rural, remote communities while still being cost effective.
Projects with different scopes and areas were undertaken in order to
determine the effectiveness of telemedicine within the IHS.
This
section provides a description of telemedicine / telehealth projects
associated with Indian Health Service units and tribal clinics. The descriptions arranged by area offices follow a short
summary section of each area.
October
2000 launched a noteworthy project, the McKennan Health System provided
obstetrical care to Pine Ridge, Sisseton and Rosebud.
The project used a 3-D ultrasound free-scan device to capture
images. The project was oriented towards lowering infant mortality and
morbidity rates, which are much higher at these locations than the
national average of 8.5 percent per 1,000 live births.
Another
project of note is Leech Lake's efforts to develop a community-wide
wellness program that offers distance education and medical services to
schools and clinics. The University of Arizona Telemedicine Initiative
offers a turnkey solution for telecom procurement and specialty services.
The State Legislature started the program by funding eight sites,
two of which were located on the Navajo Nation.
The University received two Rural Utilities Service grants to
expand services to the new Hopi Health Care Clinic and the Whiteriver PHS
Indian Hospital. The
Phoenix Indian Medical Center (PIMC) is expected to join the virtual
private network for support services offered by the University.
The
diabetic retinopathy screening programs by the Carl Albert Indian Hospital
and the Phoenix Medical Center served as test sites for equipment
developed by the University of Oklahoma and moved into a full clinical
operation in February 2000. Inoveon
is now the commercial supplier of the technology. Over five hundred expert
consult readings were performed during this trial.
Phoenix Medical Center uses different technology than Carl Albert,
which does not require the patient to have their eyes dilated. Having the
equipment placed in the waiting room increases screening since this allows
for the exam to be completed without interfering with the patient's
scheduled visit elsewhere in the clinic.
A similar site was deployed at Sells PHS Indian Hospital in
November 2000 and a third site outside of the US Southwest Region is being
planned.
The
Alaskan Federal Health Care Access Network (AFHCAN) started deployment in
September 2000 and eventually will provide equipment and short-term
support to 194 Alaskan villages. The project builds upon the success of a
continuing National Library of Medicine Alaskan Telemedicine Test Bed
Project that rolled out telemedicine, mostly ear, nose, and throat and
dermatology used in some 26 villages. Community Health Aides manage these sites and have recorded
over 6,000 consults. The high
number of consults is attributed to an evaluation model that examined the
effectiveness of ear treatment protocols.
Both projects have provided the Indian Health Service information
on how best to deploy telemedicine on a larger scale.
Not
all of the projects produced positive return for the Indian entity
involved in the project. This, however, can be attributed to deficiencies
in project development or the IHS/tribe not being adequately prepared for
assuming their responsibilities as end-users.
Nevertheless, all but one project though was able to recover with
some level of use. Overall, telemedicine has provided a positive impact on
the well being of Native Americans and will grow in use by the IHS.
Recommendations
·
Several IHS facilities have
low telemedicine / telehealth use levels for a variety of reasons. These sites provide the agency with test sites for developing
a national support team that could be deployed to encourage and support
new projects.
·
The national team should
reflect the crosscutting interests of the agency and reflect clinicians,
biomedical engineers, computer information specialists, and program
managers.
·
The national team should
create model deployment concepts and protocols to support service units
and tribes in the development, implementation, and suitability of new
programs.
·
The Indian Health Service
should involve tribes in the discussion on how to phase-in telemedicine /
telehealth options as a safety net for self-determination and ways to cut
costs. Another reason for
involving tribes is that they are eligible for federal and private sector
grants.
·
A training program could be
set-up for incoming clinicians assigned to a unit using telemedicine /
telehealth. A training
relationship could be set-up with a university that offers the clinical
the ability to see actual operations.
·
University settings that have telemedicine
centers for training may be possible partners for training and consulting
services based upon regional identity.
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