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Alaska ATS-6 Telemedicine Early Innovation Future Promise Charles D
Alaska ATS-6 Telemedicine Early Innovation Future Promise Charles D
Obstacles to Health Care in Alaska The geographic setting and climate
Obstacles to Health Care in Alaska The geographic setting and climate
Broadband Communications On May 30, 1974 the NASA ATS-6 deployed its
Broadband Communications On May 30, 1974 the NASA ATS-6 deployed its
ALASKA ATS-6 TELEMEDICINE EXPERIMENT SITES
ALASKA ATS-6 TELEMEDICINE EXPERIMENT SITES
ALASKA ATS-6 TELEMEDICINE EXPERIMENT SPACE SEGMENT
ALASKA ATS-6 TELEMEDICINE EXPERIMENT SPACE SEGMENT
ALASKA NATIVE HOSPITAL, TANANA 3 GENERAL MEDICAL OFFICERS (GMOS)
ALASKA NATIVE HOSPITAL, TANANA 3 GENERAL MEDICAL OFFICERS (GMOS)
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9
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ALASKA NATIVE HEALTH CLINIC, FORT YUKON NURSE
ALASKA NATIVE HEALTH CLINIC, FORT YUKON NURSE
ALASKA NATIVE HEALTH CLINIC, FORT YUKON NURSE
ALASKA NATIVE HEALTH CLINIC, FORT YUKON NURSE
ALASKA NATIVE HEALTH CLINIC, FORT YUKON NURSE
ALASKA NATIVE HEALTH CLINIC, FORT YUKON NURSE
ALASKA NATIVE HEALTH CLINIC, GALENA COMMUNITY HEALTH AIDE PHYSICIAN
ALASKA NATIVE HEALTH CLINIC, GALENA COMMUNITY HEALTH AIDE PHYSICIAN
ALASKA NATIVE HEALTH CLINIC, GALENA COMMUNITY HEALTH AIDE PHYSICIAN
ALASKA NATIVE HEALTH CLINIC, GALENA COMMUNITY HEALTH AIDE PHYSICIAN
ALASKA NATIVE HEALTH CLINIC, GALENA COMMUNITY HEALTH AIDE PHYSICIAN
ALASKA NATIVE HEALTH CLINIC, GALENA COMMUNITY HEALTH AIDE PHYSICIAN
ALASKA NATIVE MEDICAL CENTER, ANCHORAGE SPECIALISTS AND DR
ALASKA NATIVE MEDICAL CENTER, ANCHORAGE SPECIALISTS AND DR
ALASKA NATIVE MEDICAL CENTER, ANCHORAGE SPECIALISTS AND DR
ALASKA NATIVE MEDICAL CENTER, ANCHORAGE SPECIALISTS AND DR
ALASKA NATIVE MEDICAL CENTER, ANCHORAGE SPECIALISTS AND DR
ALASKA NATIVE MEDICAL CENTER, ANCHORAGE SPECIALISTS AND DR
ALASKA NATIVE MEDICAL CENTER, ANCHORAGE SPECIALISTS AND DR
ALASKA NATIVE MEDICAL CENTER, ANCHORAGE SPECIALISTS AND DR
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Alaska ATS-6 Telemedicine Early Innovation Future Promise

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1Alaska ATS-6 Telemedicine Early 17consultation. The experiment indicated
Innovation Future Promise Charles D. that the use of the video for continuing
Brady. 1. education should result in a manifold
2Obstacles to Health Care in Alaska The increase in the effectiveness of the
geographic setting and climate of Alaska Community Health Aides. This
are significant barriers to health care. telecommunications capability contributed
To diminish the effects, delivery systems to the tying together of the far-flung
involving outreach personnel (Community health team into a cohesive, effective,
Health Aides, Physician’s Assistants, and and the efficient unit. 17.
nurses) have been developed. The systems 18ALASKA ATS-6 TELEMEDICINE EXPERIMENT
have had substantial impact, but their STANFORD UNIVERSITY EVALUATION. The
functioning has been hampered by Institute for Communications Research at
communication and transportation problems. Stanford University, under contract to the
2. 2. list Hill National Center for biomedical
3Broadband Communications On May 30, Communications, the value weighted the
1974 the NASA ATS-6 deployed its 30 foot project and submitted an extensive final
dish. This afforded the Indian Health report. The study concluded (see Executive
Service the opportunity to test the Summary): Satellite communication can
feasibility of applying advanced reliably provide audio and black and white
communication technology to the complex television signals of sufficient quality
problems of health care delivery in the to be useful in health care delivery in
Alaska environment. Telemedicine in Alaska rural Alaska. Useful consultations for
Probably first done when someone received practically any medical problem can be
medical assistance via HF radio. conducted using satellite video channels.
Ionospheric disturbances frequently Satellite video consultation can be
disrupt radio communications. In 1971 successfully carried out by health care
Lister Hill and the Alaska Area Native providers at all levels of training. The
Health selected communities to use NASA’s unique capabilities of the video
Application Technology Satellite 1 (ATS-1) transmission may play a critical role in
for audio communications. The “Doctor five to ten per cent of the case is
Call” program was instituted via selected for the video presentation.
satellite. 3. 3. Otherwise, there was little measurable
4THE ALASKA ATS-6 TELEMEDICINE difference between the effect of the video
EXPERIMENT. OBJECTIVES. The ATS-6 and audio consultation. Health care
experiment was planned to be smoothly providers were more concerned that
integrated with the existing health care reliable audio channels be acquired and
system and was designed in accordance with retained. They were less concerned about
the following primary objectives: To test having video because of cost. The H I S
and assess in the Alaska environment the was considered to be a valuable addition
effectiveness of the various capabilities and recommended it be extended to the rest
provided by video in assisting physicians of Alaska. 18.
to provide diagnostic support for primary 19ALASKA ATS-6 TELEMEDICINE EXPERIMENT
care providers (Community Health Aides, STANFORD UNIVERSITY EVALUATION Comments.
Physicians’ Assistants, and nurses) in a The Stanford effort was exhaustive. The
truly isolated and inaccessible report included an historical chapter to
environment. To test and demonstrate the give context and a final chapter on the
ability of indigenous community health implications for an operational service
aides to effectively use broadband and future research. An effort was made to
communications as a possible prelude to quantitatively evaluate the effectiveness
future studies of the trade-offs between of the project. In the final analysis, the
technological capability and level of quantitative values (e. g. , the five to
training. To evaluate the use of ten per cent critical role value given
interactive video for continuing education above) relied on subjective data. The
of Service Unit hospital personnel and participating physicians and observers
remote village practitioners. 4. were requested to estimate the effects of
5ALASKA ATS-6 TELEMEDICINE EXPERIMENT consultation on the long term outcome for
SITES. 5. 5. each encounter. (1, critical; 2, much
6ALASKA ATS-6 TELEMEDICINE EXPERIMENT better than audio; 3, slightly better; 4,
SPACE SEGMENT. SPACE. FORT YUKON OR no different than audio only; 5, worse
GALENA. TANANA AND ANCHORAGE. ATS-6. than audio only). This presenter noticed a
MONITOR. VIDEO. AUDIO. SPEAKER. RECORDER. reluctance on the part of the General
ECG. STETHOPHONE. AUDIOPHONE HEADSET. Medical Officers to admit that video made
NOTE: ATS-6 HALF DUPLEX; TANANA COULD SEND a significant difference in some cases in
VIDEO, ETC. TO FORT YUKON, GALENA, AND which it seemed obvious. This was
ANCHORAGE). AUDIO. SPEAKER. DATA TERMINAL. supported in the Stanford report where it
DATA TERMINAL. CAMERA DRIVERS. ATS-1. is noted that observers in Anchorage
DATA. TUCSON. HIS. REMOTE CAMERA CONTROL judged the video to be critical or much
(TANANA ONLY). 6. better than audio twice as often. (Of
7ALASKA ATS-6 TELEMEDICINE EXPERIMENT course they may have had their own
EQUIPMENT. MONOCHROME VIDEO CAMERA REMOTE biases.) This could have been because of
CAMERA CONTROL VIDEO TAPE RECORDERS VIDEO the great concern to always have good
AND AUDIO SCRAMBLERS ECG STETHOPHONE audio which was not at that time a
SIMPLIFIED CONTROL PANELS HUMAN INTERFACE certainty in Alaska. Perhaps they felt
DEVICES: MICROPHONES, LAVALIER MIKES HIGH that saying video was critical would be
RESOLUTION MONOCHROME MONITORS COLOR tantamount to saying that they would have
MONITORS FOR CONSUMER AND CONTINUING been doing less than the best for the
EDUCATION. 7. patient if the video were not available.
8ALASKA NATIVE HOSPITAL, TANANA 3 19.
GENERAL MEDICAL OFFICERS (GMOS). 8. 20ALASKA ATS-6 TELEMEDICINE EXPERIMENT
99. EVALUATION. Ideally, telemedicine would
10ALASKA NATIVE HEALTH CLINIC, FORT decrease cost and improve health impact.
YUKON NURSE. 10. Realistically, telemedicine increases cost
11ALASKA NATIVE HEALTH CLINIC, GALENA and, if done well, improves health impact.
COMMUNITY HEALTH AIDE PHYSICIAN ASSISTANT. Therefore, evaluation becomes the problem
11. of weighing cost (measurable, computable)
12ALASKA NATIVE MEDICAL CENTER, against improvement in health impact (not
ANCHORAGE SPECIALISTS AND DR. MARTHA easily quantifiable). Health impact can be
WILSON, PROJECT DIRECTOR. 12. measured in terms of morbidity, mortality,
13ALASKA ATS-6 TELEMEDICINE EXPERIMENT disability, and satisfaction. The
OPERATIONS. The ATS-6 was available to the difficulty of quantifying morbidity,
Alaska Health Care Experiment for one hour mortality, disability, and especially
each Monday, Wednesday, and Friday. The satisfaction remains an obstacle. For
Health Information System (HIS) was used discussion purposes this concept can be
to identify some of the patients to be depicted in a diagram. 20.
seen. The Tanana physician normally 21TELEMEDICINE ECONOMICS. COST.
controlled the network and the MORTALITY MORBIDITY DISABILITY
consultations. The HIS health summaries SATISFACTION. II. I. HEALTH STATUS. HEALTH
were available for supporting IMPACT. III. IV. Acceptable Region -.
consultations. In some cases lectures HEALTH IMPACT VERSUS COST. The big
video tapes and interactive discussions question is, “Who pays for the increase?”
constituted program. There were 325 video However, assuming there is money
consultations during 104 scheduled available, there are other questions. How
transmission days. The satellite was moved does one quantify health impact? What is
to a position over India after it the maximum slope that can be accepted
approximately 9 months of availability. in Quadrant I? What is it the minimum
13. slope that can be accepted in Quadrant
14ALASKA ATS-6 TELEMEDICINE EXPERIMENT III? Is any move into Quadrant III
RESULTS. From the time the satellite and acceptable? (A question for HMOs?) If one
earth station equipment were made could quantify health impact, what dollar
available the schedule of medical value could be assigned to a unit of
transactions was met without fail. A wide health impact? In what areas of health
spectrum of medical problems were seen and care is the slope in Quadrant I the
evaluated. All ages and both sexes were lowest? Are there guidelines or heuristics
represented. Specialists consulted for answering these questions? Charles D.
included those in pediatrics, internal Brady. HEALTH IMPACT = CHANGE IN HEALTH
medicine, surgery, orthopedics, STATUS. 21.
ophthalmology, gynecology, dentistry, 22ALASKA ATS-6 TELEMEDICINE EXPERIMENT
otology, radiology, nutrition, and FUTURE PROMISE Rural Health. There is now
physical therapy. While some conditions considerable interest in applying
(e. g., orthopedic problems, acute trauma, telemedicine rural regions. The Indian
and cardiac conditions) lend themselves Health Service/Alaska Area Native Health
particularly well to telemedicine Service model of using indigenous people
management, it became clear that many as primary care providers (i.e., Community
other kinds of problems could also be Health Aides) as well as other health team
managed well in this way. Surprisingly members would have direct applicability in
much of the time was taken in management many areas, especially in the Third World.
of urgent problems. 14. Enhanced communication technology can
15Clues to. . .“ how sick the patient today enable any care provider to be
is.” Full motion video clues noted were linked to the any necessary specialist or
eye movement, gait abnormalities, patient knowledge source. The Alaska satellite
response to palpation, and visual evidence telemedicine projects have demonstrated
of patient distress, lethargy, etc. The that the inclusion of a Health Information
ability for the nurse, CMO, and specialist System in a comprehensive health care
to concurrently view and discuss an X-ray delivery system can significantly improve
of sufficient quality to enable expedited health status of a community. An
definitive care. Increased sense of alternative definition of telemedicine
security both for the patients and for the could be helpful in understanding how care
remote practitioners. ALASKA ATS-6 providers at various education levels in
TELEMEDICINE EXPERIMENT PERCEIVED BENEFITS widespread, even isolated, locations can
OF VIDEO. 15. be tied together in a more comprehensive
16ALASKA ATS-6 TELEMEDICINE EXPERIMENT and effective health care delivery system.
BENEFITS OF THE HEALTH INFORMATION SYSTEM. The following, final slide is an
All providers agreed that the HIS ability alternative definition submitted for
to provide an updated, problem oriented discussion. Charles D. Brady. 22.
medical summary for each patient at the 23ALASKA ATS-6 TELEMEDICINE EXPERIMENT
time of encounter is a substantial FUTURE PROMISE Alternative Definition.
advantage in supporting and updating Telemedicine - The practice of medicine
health care. The HIS was developed on the through the use of telecommunications to
Papago reservation in Arizona and was enable the transfer of health care
implemented in the Tanana Service Unit to information from the information source
support this project. 16. (usually the patient's location) to a
17ALASKA ATS-6 TELEMEDICINE EXPERIMENT knowledge resource for evaluation. The
CONCLUSIONS (AS SUMMARIZED BY DR. MARTHA telecommunication capability enables the
WILSON). The capabilities provided by knowledge resource and care providers at
broadband satellite communications can be the information source to interact and
effectively used in treatment and care of effect a remedial course of action. Three
medical patients in remote and isolated telemedicine consultation levels.
regions such as Alaska. Paraprofessional Equivalent to the AANHS model (e. g., Fort
personnel such as Community Health Aides, Yukon-Tanana-Anchorage Native Medical
having limited medical and technical Center consultation linkage). Charles D.
training, are capable of successfully Brady. 23.
presenting patients for medical
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