Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the...

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Select SLIDE MASTER to Insert Briefing Title Here 6-Jun-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific Regional Medical Command June 7, 2012 The views expressed in this presentation are those of the author and do not reflect official policy or position of the Department of the Army, Department of Defense, or the US Government.

Transcript of Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the...

Page 1: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Telehealth and

Telemedicine in the Pacific

Regional Medical Command Ms Suzie Martin

Regional Telehealth Director

Pacific Regional Medical Command

June 7, 2012

The views expressed in this presentation are those of the author and do not

reflect official policy or position of the Department of the Army, Department of

Defense, or the US Government.

Page 2: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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6-Jun-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 2 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

PRMC

TELEHEALTH

Connecting patients

throughout the Pacific

and Mainland US to

Specialty Services at

Tripler Army Medical

Center

Page 3: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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- Promote, Sustain and Enhance Soldier Health

- Train, Develop and Equip a Medical Force that Supports Full Spectrum Operations

- Deliver Leading Edge Health Services to Our Warriors and Military Family to Optimize Outcomes

This has been a dynamic, living document since 2001

America’s Premier Medical Team Saving Lives, Fostering Healthy and Resilient People

ARMY MEDICINE

Bringing Value…Inspiring Trust

Maximize Value in

Health Services

Effectively and efficiently provide

the right care at the right time to

promote a healthy population

and ready force.

Provide Global

Operational Forces

Agile and adaptive medical teams

ready to execute relevant,

responsive Health Services in any

operational environment and in

combination with any partnered

team.

Build the Team

A compelling place to serve

and a preferred partner in

leading joint interagency

health services.

Balance Innovation with

Standardization

A culture of innovation which provides

standardized solutions to support best

practices and optimal outcomes.

Optimize Communication

and Knowledge

Management

Leverage Communication to impart

knowledge and build meaningful, positive

relationships.

Patie

nt/

Custo

mer/

Sta

kehold

er CS 5.0

Inspire

Trust in

Army

Medicine

CS 3.0

Responsive

Battlefield

Medical Force

CS 2.0 Improved

Healthy and

Protected Families,

Beneficiaries and

Army Civilians

CS 1.0

Improved

Healthy and

Protected

Warriors

CS 6.0

Improved

Patient and

Customer

Satisfaction

IP 1.0

Optimize

Medical

Readiness

IP 8.0 Build

Relationships

and Enhance

Partnerships

LG 2.0

Improve

Training and

Development

IP 2.0

Improve

Information

Systems

CS 4.0 Optimized

Care and

Transition of

Wounded, Ill, and

Injured Warriors

IP 3.0

Implement

Best

Practices

IP 9.0 Tell the

Army Medicine

Story

LG 4.0

Improve

Knowledge

Management

LG 1.0 Improve

Recruiting and

Retention of

AMEDD Personnel

Inte

rnal P

rocess

Lea

rnin

g a

nd

Gro

wth

LG 3.0 Promote

and Foster a

Culture of

Innovation

IP 6.0 Improve

Quality,

Outcome-

Focused Care

and Services

IP 5.0 Maximize

Physical and

Psychological

Health Promotion

and Prevention

IP 7.0 Improve

Access and

Continuity of

Care

R 1.0

Optimize

Resources

and Value

R 2.0 Optimize

Lifecycle Management

of Facilities and IT

Infrastructure

R 3.0

Maximize

Human

Capital

EN

DS

M

EA

NS

W

AY

S

Re

sou

rce

IP 10.0 Leverage

Research,

Development and

Acquisition

Fe

ed

ba

ck A

dju

sts

Re

so

urc

ing

De

cis

ion

s

To deliver the

Strategic

Processes...

That

achieve

our

Strategic

Ends

We marshal

our

Resources…

And enable

our

People…

IP 4.0

Provide

Safe

Patient

Care

Slide 3

Page 4: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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BRIEFING OUTLINE

1. Services Offered

2. PRMC Telehealth Area of Operations

3. Cost Avoidance and Telehealth Encounters

4. Telehealth Staffing

5. Telehealth Office Functions

6. Highlights of Select Telehealth Programs

7. Challenges

Slide 4

PURPOSE: To provide an overview of the services, locations, functions and

scope of the PRMC Telehealth/Telemedicine Operations.

Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

Page 5: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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• Psychological Evaluation and Treatment

• Psychiatric Evaluation and Treatment

• Child & Adolescent Tele-Behavioral Services (CATS)

• Medical Evaluation Board (MEB) Support & Administrative Evaluations

• Soldier Readiness Processing Evaluations (SRP/RSRP)

• LExAyN Healthy Lifestyles Program

• Smoking Cessation Program

• Traumatic Brain Injury (TBI) Evaluation / Support / Treatment

• Speech Therapy

• Tele Critical Care Consultation (TCCU) and Remote Monitoring

• Pacific Asynchronous Tele-Health (PATH)

• Digital Echocardiography

• Pacific Island Health Care Project (PIHCP)

• Tele-Education

Services Offered

Slide 5 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

Page 6: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Pacific Telehealth Area of

Operations

Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected]

Japan

Guam

Okinawa

South Korea

Am. Samoa

Hawaii

Slide 6 June 2012

Page 7: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Pacific Telehealth Area of

Operations, Hawaii

Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] Slide 7 June 2012

Telehealth Services in

Hawaii: Behavioral Health

Child Psychiatry/Psychology

SRP/RSRP

TBI

Speech Pathology

Grand Rounds/CME

LExAyN

Smoking Cessation

Medical Consultations

MAUI

HAWAII

PENDING

Page 8: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Pacific Telehealth Area of

Operations, Am. Samoa

Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] Slide 8 June 2012

American Samoa: (Active & Reserve)

Services: Behavioral Health

TBI

Speech Pathology

Social Services

Case Management

PIHCP (with LBJ)

Page 9: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Pacific Telehealth Area of

Operations, Japan

Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] Slide 9 June 2012

Telehealth Services in Japan: Behavioral Health

PATH

TCCU

Page 10: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Pacific Telehealth Area of

Operations, Okinawa

Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] Slide 10 June 2012

Telehealth Services in

Okinawa: Behavioral Health

TCCU

PATH

Echocardiography

Page 11: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Pacific Telehealth Area of

Operations, S. Korea

Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] Slide 11 June 2012

Korea Brian Allgood

Army Community

Hospital (BAACH):

Services: Behavioral Health

TCCU

PATH

Page 12: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Pacific Telehealth Area of

Operations, Guam

Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] Slide 12 June 2012

Air Force – 36th

Medical

Services: Behavioral Health (Active/Guard/Reserve))

PATH

Navy – Guam Naval

Hosp

Services: TCCU

PATH

Echocardiography

Page 13: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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6-Jun-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] Slide 13 June 2012

Pacific Telehealth Area of

Operations, CONUS

Various Army Recruiting

facilities: CA, LA, MI, OH,

OK, TN and UT

BH Admin Evals

FT Wainwright, AK

FT Bliss & FT Hood, TX

Behavioral Health

MEBs/Other Evals

Page 14: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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-

100

200

300

400

500

600

700

800

900

1,000

$-

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

MAR 11 APR MAY JUN JUL AUG SEP OCT NOV DEC JAN 12 FEB MAR

Total Cost Avoidance Total # Encounters

TELEHEALTH ENCOUNTERS

Cost Avoidance and Encounters

Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] Slide 14 June 2012

Page 15: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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-

100

200

300

400

500

600

700

800

900

MAR 11JUN 11

SEP11DEC 11

MAR 12

LEAN & Tobacco

TBI

TBH Clinics

TCCU

Asynchronous

Telehealth Encounters

Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] Slide 15 June 2012

Page 16: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Telehealth Staffing

• Regional Director

• Regional Cell with Program, Clinical and Technical Advisors

• Clinical Champions for individual programs

• Government and/or contract staff for larger programs

– Tele-Behavioral Health

– CATS

– Tele-TBI

– TCCU

• System Administrators for various applications

– PATH

– PIHCP

• Shared manpower at most patient locations (clinical coordinators)

Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] Slide 16 June 2012

Page 17: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Regional Telehealth Office Functions

Slide 17 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

• Develop telehealth vision in PRMC

• Serve as consultant on all telehealth operations

• Program development and operations improvement

• Plan & direct technical and administrative operations

• Collect and report telehealth metrics

• Document standard operating procedures for region

• Allocate Government resources

• Proponent for telehealth contracting actions

• Train clinical staff on equipment, scheduling and promotion

• Monitor appropriate entries to electronic medical records

• Provide support to partnering facilities

• Track new technologies and assess I/T reliability

• Ready patient site & instruct patients; obtain informed consent

Page 18: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Tele-Behavioral Health • Full Spectrum Psychological

Evaluation & Treatment

• Psychiatric Evaluation & Treatment

• Soldier Readiness & Reverse

Soldier Readiness Processing

• Administrative Evaluations:

medical boards, mental status

exams, diagnostic variance memos,

fitness for duty assessments

• Psychoeducation

• Nurse Case Management

Telehealth Highlights

Slide 18 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

Page 19: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Increasing Capabilities and Access

• Serving multiple branches of service & Active/Guard/Reserves/Families

• 11 established patient sites – locally & around the world

• Fulfilling Psychiatry prescriber gap at smaller facilities

• Surge support locally and afar

• Absorbing unmet demand on island

• Addressing backlogs in Medical Board processing & BH evaluations

• Short term support to bridge staffing gaps

• Deployment processing enabler

• Determine fitness on demand

• Less impact on BH access at local clinic

• Lower cost alternative

• Patient travel

• Staff augmentation

Tele-Behavioral Health

Slide 19 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

Page 20: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Child and Adolescent

Telehealth Services

(CATS)

– A collaboration with the

School Behavioral Health

Program (SBHP)

– Child Psychiatry,

Psychology & Social Work

– Medication Management

– Therapeutic Intervention

– Prevention & Resilience

– Unique Focus on Reserve

and Guard Families On

Remote Islands

Slide 20 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

Telehealth Highlights

Page 21: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Improved Access to Care

126 120

68

0 0

20

40

60

80

100

120

140

Time Away from Duty/Work Avg Time away from Duty/Work -Child only Appts

Total Time Required for BH Appointment

SBHT vs. Clinic (CAPS)

CAPS

SBHT

Because BH providers are “embedded” in the Military family’s community (i.e. the child’s school”)

access to BH care is greatly facilitated over traditional, clinic-based care. Parents report

significantly reduced time away from Duty/Work, and greater ease of access. This improves the

comfort and decreases stigma associated with seeking BH care.

Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] Slide 21 June 2012

Page 22: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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TBI/Concussion Clinic

– TBI Evaluation & Treatment

– Decision making on patient

movement to TAMC

– Rx Management

– Nurse Case Management

– Outpatient Psychiatry –

Evaluation and Treatment

– Speech Pathology

– Established TH infrastructure in American

Samoa for additional TBH & TH services

Telehealth Highlights

Slide 22 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

Page 23: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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A Success Story in American Samoa

– Joint facility with VA Outpatient Clinic

– 10% of island population of 67K eligible for care

– Great impact from military deployments

– Post Traumatic Stress

– Anger & Impulse Control

– Alcohol abuse & Sleep problems

– Isolated area with severely limited medical care

– Annual savings up to 8 times the annual cost

TBI/Concussion Clinic

Slide 23 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

Page 24: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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LExAyN Healthy

Lifestyle Program

– Lifestyle Change

– Low-intensity exercise

– Reasonable expectations

– Balancing emotions

– Healthy attitude

– Healthy, well-balanced

nutrition

Lifestyles

Exercise/Education/Emotions/Evaluation/Expectations/Empiricism

Approach/Accountability/Addiction/Assessment/Attitudes

Nutrition

Telehealth Highlights

Slide 24 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

Page 25: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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Tele-Critical Care Unit Remote monitoring and

management of patients and

clinical consultation

• Facilities lack full spectrum of medical and surgical specialists

• This limitation increases the risk of preventable morbidity and mortality

• Outcomes are improved when critical care specialists participate in care

• Telemedicine consultation is a validated means of providing CC consultation

Telehealth Highlights

Slide 25 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

Page 26: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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First TCCU Consult USNH Yokosuka

6 Jan 2012

First TCCU Consult USNH Okinawa

12 Mar 2012

Over 500 Consults

June – December 2009

• 100 Consecutive Consultations

• 9% T/F to TAMC for Dx and Tx

• 4% avoided EVAC to TAMC

Started 2 April 2001

with a research grant from

U.S. Army Medical Research and

Material Command

eICU TCCU 2/28/2011

First “Saved Life” at

US Naval Hospital (USNH) Guam

27 June 2003

First TCCU consult at

Brian Allgood Army Community

Hospital – Korea

7 July 2007

Slide 26 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

Tele-Critical Care Unit

Page 27: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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• Pediatric & Adult Medical & Surgical Consultation

• Heart Sounds

• Asynchronous Local/Overseas Hospital Academic

(ALOHA)

• Air Evacuation

Pacific Asynchronous

Telehealth (PATH)

Slide 27 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

Page 28: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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PATH Consult Volume

0

100

200

300

400

500

2004 2005 2006 2007 2008 2009 2010 2011

Adult

Pediatric

Total growth: 2004-11: 20%/year; 2000-04: 9%/year

Slide 28 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

Page 29: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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• Warrior Ohana Medical Home & PCMH

• PCMH Secure Messaging

• Diabetes Education

• Tele-Pain (ECHO)

• Child and Adolescent Telehealth expansion

• Tele-Pharmaceutical Consultations

• Tele-Bariatric

• GME & CME expansion

• Better Depression Program Follow-up

Programs Under Development

Slide 29 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

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Challenges

Slide 30 Ms Suzie Martin PRMC Telehealth / (808) 433-4500 / [email protected] June 2012

• Credentialing & Privileging

• Workload Crediting (provider & patient sites)

• TBH Scheduling

• CHCS/AHLTA interoperability

• Cross Service and Agency interoperability

• Patient site staffing

• Funding for expansion to non-BH

• Universal acceptance of TH technology/programs

Page 31: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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QUESTIONS?

Page 32: Telehealth and Telemedicine in the Pacific Regional ... · Telehealth and Telemedicine in the Pacific Regional Medical Command Ms Suzie Martin Regional Telehealth Director Pacific

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