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The Arizona Telemedicine Program was developed in 1996 by Representative Bob Burns, Chair of Appropriations for the House of Representatives. He had seen a demonstration of the telemedicine program in Georgia and felt that Arizona would benefit from such a program. The University of Arizona College of Medicine was the only medical school in Arizona. Dr. Ronald Weinstein, who has been called the “Father of Tele-pathology,” was asked to become the Director of the telemedicine program. He came to me, told me of the appointment and asked if I would be willing to work with him on the project for no change in title and no increase in pay! How could I refuse?

The telemedicine program was established in 1996 with a budget of $1.2 million to establish an 8 site pilot project. The state funding has continued and we have added to that funding with grants from OAT, RUS, Commerce, NLM, the military and strong support from the University of Arizona. Additionally, the program has developed a membership fee model that has resulted in creating a network of networks with connectivity to 64 sites within Arizona. We have one international partner – the University of Panama.

The Arizona Telemedicine Program training program is multi-faceted. Including our conference, we have probably trained over 1,000 people. We provide 2 ˝ days training for each new site we bring on board. The training is a telemedicine overview followed by business, legal, educational, clinical, administration, technical and hands-on training. We follow this up approximately 2 weeks later by sending our telemedicine coordinator and technology coordinator to the site to continue the training. All telemedicine equipment must be functional prior to our bringing the appropriate personnel down for training. Our target is the CEO, Medical Director, Telemedicine Coordinator, technical person and any physicians or other healthcare professionals who will be involved in telemedicine. We provide many 2-hour overviews for individuals or small groups interested in learning about telemedicine. We provide 1-day training sessions for individuals or groups wanting a more in-depth overview. These sessions are abbreviated versions of our longer training sessions. Although we have had groups from other states come in for a full day of training for which there was a fee, we are not currently running a formal training center for groups outside of Arizona. We run a national conference in November of each year on correctional telemedicine. We have national speakers, vendors and approximately 250 participants. This is our 4th year of running this conference. We have an excellent group of speakers within our program who travel frequently nationally and internationally giving talks about telemedicine. Finally, we give talks continuously to legislators, governmental agencies, community groups, hospitals and wherever else we are invited!

We are continuously testing new products and technologies. We have two wireless projects being tested on the Navajo reservations. We are expanding into school health. Dr. Weinstein is currently working on a product that will revolutionize telepathology! We are putting together a marketing effort to increase patient consultations. We are very active in national and international societies.

The Arizona Telemedicine Program hired Alison Hughes, Director of the Rural Health Office, part-time to be our Associate Director for Outreach. She knows the rural sites inside and out. It has been a great benefit to the program to learn the dynamics of rural communities. Rural communities are fragile. There is a lot of turn over in the hospitals not only in personnel but also in the corporations who own the hospitals. We travel frequently to our remote sites and try to keep telemedicine alive. Communication and personal contact are critical to this effort. We hold administrative meetings by video conferencing. We provide ongoing training for new employees. We have developed our program so that normal referral patterns are maintained. Our infrastructure allows any of our sites to interact with any other site. This allows rural sites to bid for contracts with other rural sites. It is not necessary for them to send their consults to our facility. We have a full time distance education coordinator. We frequently connect 14 sites together for interactive video conferencing for CME activities. We have moved into video streaming of grand rounds.

We have provided over 12,000 teleradiology consults and anticipate with new contracts we have negotiated we may have 20,000 to 30,000 teleradiology consults this year. Other clinical consults have exceeded 5,000. Although we have provided services in over 55 specialties, dermatology, psychiatry, orthopedics and cardiology are the most frequently utilized.

One of our original 8 sights was to be a prison facility. The Deputy Director for Inmate Health Services was so impressed with telemedicine, he has expanded it to all 11 prison facilities. The Maricopa County jail system just received a huge grant to bring telemedicine into 12 jail facilities. We continue to expand our network of networks.

What excites me the most about telemedicine is the champions we have found. There is a tremendous amount of talent within the state. The people on our team and our rural partners are incredibly dedicated and full of enthusiasm. We could not be a top telemedicine program without this dedication. The ultimate measure of success is that the patients are getting care they may not have received otherwise.

I believe the Arizona Telemedicine Program has more published papers on telemedicine than any other program in the country. Research is an integral part of what we do. As part of our telemedicine assessment, we never deploy a clinical service to a remote site without first doing a clinical trial in-house. We always evaluate equipment. Before we selected an electronic stethoscope, we brought in 3 vendors, patients with known heart disease and cardiologists. We had the physicians examine the patients with each of the stethoscopes and tell us which instrument they were comfortable with using to diagnose the patient. We continuously monitor the business end of things always looking for sustainability.

We just received a grant to put telemedicine into two schools in the Phoenix area. The equipment is installed and training is currently taking place. We expect to go live mid-April. In Tuba City on the Navajo Indian Reservation, we are currently providing tele-psychiatry to two high schools using wireless technology. Telehome health has been used by us mostly for ostomy care and for pre-transplant cases. Both have worked extremely well.

Our focus over the next year is rural health. We want to keep our rural sites alive and loving telemedicine.

We have a very active telepsychiatry practice. We hold clinics twice a week in our telemedicine facility. Additionally our Psychiatry Department has installed telemedicine equipment in their clinical area, is seeing patients, and is very supportive of the concept. We discovered that many people in rural sites are reluctant to enter the office of a psychologist or psychiatrist because of the perceived stigma of having a mental health problem. They are very comfortable entering the telemedicine suite of a rural hospital because no one knows why they are entering the room. It could be for any kind of clinical consultation. After the earthquakes in India someone emailed an item about a Japanese medical team using a portable satellite dish and digital camera to take and send a picture of an injury from the site. This is along the lines of KISS. I am convinced that one of the most exciting areas in Telemedicine is the potential role it may have in international health care and disaster responses especially after Sept 11,2001. Tell me about what you and Arizona Telehealth andTelemedicine Center are doing in this area?

The events of September 11th have certainly made many telemedicine programs think about the value of their program in providing rapid information and consultations to remote communities. We have been in communication with other programs in developing a global network of networks. We currently have a working model of a network of network within Arizona. We have established a telemedicine program in the Republic of Panama. To date most of the consultations are radiology and pathology. The telecommunications infrastructure is very unreliable at this time but we have received about 300 cases from Panama and they have done another 300-400 within Panama. Establishing an international program is a wonderful experience but takes a great deal of time away from your own program.

I agree with David Balch – the word “tele” will disappear. Telemedicine should be another way of practicing medicine. With the rapid development of better and less expensive equipment and telecommunications capabilities, telemedicine will become available to more and more healthcare facilities and ultimately into the homes of patients. The ATA annual conference is one way to keep up with the world of Telemedicine, yet I am convinced we need to use the medium of email and the internet more to keep our peers up to date such as what Hutchinson does in Georgia. The ATA on-line newsletter is fabulous. It contains very up-do-date information. The OAT list serve works well. I find I will respond quickly to issues that come to me on email. If I have to remember to go onto someone’s web site to check for information, it does not happen routinely. If I am looking for specific information on grants or some other subject, I will then search web sites.

Do not think that telemedicine is an easier way of doing things. Telemedicine takes a lot of time and work for it to be successful. There is more paperwork to deal with. The rural/remote healthcare professional must spend additional time with the patient rather than just sending them to the specialist. Not every rural facility is going to have telecommunications people. There is turnover in personnel and new people need to be trained. There needs to be lots of communication. Make certain you have enough personnel to address the many situations that arise. Budget a lot of money for travel. In additional to physically visiting your sites, it is important to be part of national organizations and attend meetings to keep abreast of what others are doing. We are very specialized within our program. It works for us but it is not the only way to do it. We are always eager to hear from others and make our program more efficient. Thanks to all who have already contributed ! to our success!