Eastern Aleutian Tribes March 2014
Eastern Aleutian Tribes, Inc. (EAT) provides Medical, Dental, and Behavioral Health services in federally qualified health centers in the eight communities of Adak, Akutan, Cold Bay, False Pass, King Cove, Nelson Lagoon, Sand Point, and Whittier, AK. EAT was formed in 1991 as a tribal health consortium serving seven Aleut tribes from the Aleutian Islands and Alaska Peninsula.
EAT's service area comprises over 100,000 square miles of the most beautiful, remote, and challenging locations in the world. EAT is the only health care “safety net” provider in the Eastern Aleutian region of Alaska and the Kenai Peninsula community of Whittier. EAT’s service area is comprised of mostly highly remote pristine wilderness. Only one of the 8 sites is on the road system, and access to that clinic is limited by regulated automobile use of an operational railroad tunnel.
An overview of a modern telemedicine network in Alaska’s Eastern Aleutian region EAT (Eastern Aleutian Tribes) Telemed Cart deployment activities The Communities Challenges and Successes from Deployment Outcomes and Benefits of an Upgraded Network
Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones , wireless tools and other forms of telecommunications technology.
EAT deployed original AFHCAN (Alaska Federal Health Care Access Network) telemedicine carts in 2004, and upgraded the systems in 2008. By 2010 replacement of failed components became increasingly difficult and considerably improved telemed technologies had emerged. The bulky outdated carts only allowed for store and forward information. In 2012 the USDA funded the purchase and deployment of new telemed carts for all 8 EAT clinics.
EAT telemed systems are configured with peripherals that include video cameras, medical cameras, ECG and vital sign monitors that provide real-time video and data transmission to providers in Anchorage or elsewhere. EAT Community Health Aides, Nurse Practitioners, Physician Assistants, and Behavioral Health Aides all have access to the carts and network for their respective diagnostic and treatment needs. The new telemed carts have the capacity to capture images; EKGs; vital signs; and readings from a spirometer, otoscope, and TeleSteth.
The new telemed carts enable pharmacy, cardiology, dermatology, psychiatry and other specialty services to be provided remotely to our rural clients. Primary partners actively delivering these services include: Alaska Native Tribal Health Consortium: provider of our State’s most comprehensive urgent, emergent and primary care service offerings; Alaska Psychiatric Institute: provider of a broad array of acute and therapeutic behavioral and mental health treatment and recovery options; and specialty medical care services; Southcentral Foundation: statewide provider of medical, dental, vision and specialty care services.
FUNDING: $422,000 grant award from the USDA Rural Utilities Service’s Distance Learning and Telemedicine Loan and Grant Program in August 2012 . EAT provided $127,000 matching funds. PURPOSE: To fund an expansion and upgrade of Telemedicine delivery carts to enable direct real- time visual diagnoses and provider-to-patient communication and to support provider-to-provider consultation. EAT was given three years to complete the project.
Picture by Edward Smith
Transportation & Shipping: New telemed carts were initially shipped as air cargo from Phoenix to Anchorage, then disassembled by EAT staff from the size of a refrigerator to the size of a washing machine. A charter plane was required to get the carts to Sand Point, where they were then loaded on a barge for transport to Cold Bay; King Cove; False Pass; and Akutan. Nelson Lagoon’s cart required further disassembly for transport by small aircraft.
Picture by Edward Smith
Installation: Occurred on first day of arrival at each site. This included re-assembly of telemed carts; placement area preparation; and testing of all hardware and software components. Training: Occurred on second day of each site visit. Consultant GlobalMed provided group training for provider staff. EAT I.T. staff provided a second round of individual training sessions for providers and other clinic staff.
Seven of the eight sites in this project are scatted throughout an island chain with some of the most ferocious weather on the planet, stretching 1,200 miles westward from Anchorage, the nearest urban area. Most air travel within the region and between Anchorage involves single or twin prop small aircraft. This means that a patient coming into Anchorage for medical treatment must fly between 4 and 6 hours to reach Anchorage, with a refueling stop in between. Other sites are only accessible by The Alaska Marine Highway. The weather is a huge factor in determining immediate medical treatment or the lack thereof, as storms from the Bering Sea can close down the entire Chain for days on end, with winds of 60-80 MPH a normal occurrence.
The total population of the EAT service area is 3,340 persons. 1,323 of them are Alaska Native IHS eligible beneficiaries who primarily use the EAT health care delivery system. 3,000 to 5,000 seasonal fisheries workers also access EAT services March through October.
Picture by Edward Smith
The Aleutian Islands region of southwestern Alaska is dominated by volcanic peaks, rugged coastlines, powerful oceans, and severe weather. It is also an area so rich with varied abundant natural resources that people have thrived on these lands for 10,000 years. The Native people of the greater Aleutian Islands region refer to themselves by two names, Unangax ̂ and Aleut.
Sand Point Aleut Dancers
Picture by Edward Smith
Weather Local deployment schedules were consistently delayed throughout the project as regional transportation was routinely impacted by dense fog; volcanic eruptions; high winds and other adverse weather conditions. Housing Predictable housing was a recurring challenge throughout this effort as the remoteness of Aleutian communities is typified by limited public accommodations; frequent “no vacancies”; poor or no utilities infrastructure and often facilities in need of repair.
Picture by Edward Smith
Access: A 40 ft. fishing tender vessel was used as alternative transportation in Cold Bay due to inclement weather – no flights for 3 days. Boarding the vessel required descent of a 30 foot vertical ladder in howling wind and rain. The community of Akutan has no paved or improved roads. Telemed cart components needed to be transported nearly a mile on a series of boardwalks.
Picture by Edward Smith
Completed deployment September 2013, nearly 2 years ahead of schedule. Providers gained functionality with minimal training. Carts in regular use within 5 months of deployment
Positive feedback from patients who were pleased with not having to travel to see a specialist. Outside provider partners were impressed with new images, vitals and patient engagement afforded by these technologies.
Patients have relationships with a wider network of care providers. They have more access to more highly trained personnel as well as better access to second opinions and specialized care from inside and outside the current network of providers without leaving their communities. Patients experience more frequent real-time contacts with their health care providers. This is especially important in the treatment of chronic disorders. Practitioners are better able to monitor patient progress, ensure that the patient is following instructions properly and check that the patient understands the recommendations. This has led to more effective treatment solutions and better recovery statistics .
Examination by high-definition camera has improved the accuracy of diagnoses. Patients can be examined and interviewed by their doctors and specialists without costly and hazardous travel, with more timely care. Medications can be managed more efficiently and better monitored. Video allows physical, occupational and speech therapy specialists to evaluate and guide patients with techniques remotely for speedier recoveries. Care providers at the clinic sites have experienced benefits that indirectly improve health care in the region. This technology enables them to collaborate in interview situations, practicing alongside and learning from more experienced practitioners. They have access to ad hoc training and are better able to collaborate with each other, resulting in improved patient care.
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