Large Health Systems
North Hawaii Community Hospital’s (NHCH) rural location limits access to certified critical care providers. Lack of access to ICU specialists may result in delayed treatment, which can adversely impact patient outcomes, or require transfer to Oahu for ICU care. NHCH’s four-bed intensive care unit (ICU) was previously managed by a single provider who had hospitalist duties throughout the facility. Transitioning from a sole provider to a collaborative team approach required implementation of modern video conferencing technology. Utilizing medical intensivists from QMC Punchbowl, remote evaluation of critical patients is now performed at the bedside, with communication facilitated by daily rounding, collaborative patient-centered treatment plans, and shared decision-making. The goal was to provide critically ill patients and families a team of healthcare providers including board certified critical care specialists, hospitalists, and critical care nurses with consistent, efficient, high-quality care 24/7. All patients consulted and admitted as ICU level of care were included in the new telemedicine-enabled rounding structure. The transition began in April, 2017 which included equipment installation, network upgrades, and physician/staff training. “Go Live” was May 1, 2017, with 1 patient daily then increasing to all ICU level of care patients on May 15. The collaborative team has defined a structured rounding process with nurse driven reporting, 24/7 ICU telemedicine support for significant clinical changes and collaborative patient care plans. Internal data has shown reductions in ICU length of stay, mortality rate, and air ambulance transfers to QMC Punchbowl since the program launched.
Matthew Koenig (firstname.lastname@example.org)
There are many patients needing long term care in Hawaii who are not able to find long term care beds and it can be a challenge to avoid costly readmissions to the ER. A long-term care telemedicine resource could be created for Hawaii to help address these issues. Telemedicine can help to ensure physician availability to these patients and can help to overcome time and distance barriers between patients and clinicians. Telemedicine can also improve the quality of care that patients receive and can help to cut down on the cost of hospital readmissions. The Healthcare Connect Fund may be able to offset some of the costs of creating a long-term care community telemedicine resource.
Dan Davis (email@example.com)
Wilcox hospital on Kauai is using telemedicine to address the shortage of specialist physicians on the neighbor islands. Their efforts to utilize telemedicine are led by a telemedicine steering committee. They are currently using telemedicine in neurology, nephrology, pediatric post-op care, and are also working on a pilot project utilizing telemedicine for psychiatric emergencies. Future expansion will include telepsychiatry to both inpatient and outpatient services.
Amy Corliss (firstname.lastname@example.org)
Information coming soon!
Children and Families
The Genomics Section of the Hawaii Department of Health in partnership with Telehealth Resource Centers developed a Hawaii-based Telegenetics Training program for genetics providers. The program is aimed for genetic providers to implement genetic services via video teleconferencing. The Hawaii-based program consists of 10 online modules, 2 online webinars, and one in-person session. The program conducted its first in-person session in October 2017. Although the program has had success, there is still a need to begin to develop train the trainer programs to expand training opportunities and a need to find more support for trainees to expand their telegenetic services upon completion of the program.
Sylvia Mann (email@example.com)
The Child and Adolescent Mental Health Division (CAMHD) of the State of Hawaii Department of Health serves youth with severe mental health issues statewide. To save costs and better serve patients and families, CAMHD began to use telehealth to conduct mental health assessments for patients and families. Since it has been using telehealth, CAMHD has increased its use of telehealth significantly and now regularly uses telehealth for care coordination and for use by child psychiatrists to work across geographical distances. In the future, CAMHD envisions using telehealth to bridge the gaps and distance between youth housed in residential services and their families.
Derek Vale (Derek.Vale@doh.hawaii.gov)
Shriners Hospital for Children – Honolulu is one of 22 Shriners locations in 3 countries and provides orthopedic, neurology, dental services. Through telemedicine, Shriners is able to provide doctors, nurses, therapists, parents and children the opportunity to evaluate, manage and coordinate care through video teleconferencing technology. The Shriners Hospital for Children – Honolulu has telemedicine partnerships with health care providers at locations throughout Hawaii and the Pacific, including Hamakua Health Center (Hawaii – Hawaii Island), Molokai Department of Public Health (Hawaii – Molokai), Guam Department of Public Health & Social Services (Guam), LBJ Tropical Medical Center (American Samoa), and Pohnpei Department of Health (FSM – Pohnpei). Additional clinics are being developed in Hilo, Kauai, Saipan, Republic of the Marshall Islands, Fiji, and Tonga. A video-based telemedicine session prior to referrals off-island have been shown to reduce parental anxiety, reduce unnecessary referrals, save costs for families, reduce length of stay in Honolulu, among many other benefits.
Susan Yamamoto (firstname.lastname@example.org)
The Hawaii EMSC program works to promote EMS and trauma system development at local, state, and regional levels to adequately prepare for the care of children. This work is primarily accomplished through proactively assisting EMS directors, health care providers, clinical researchers, parents, teachers, and other child health advocates in their efforts to improve all aspects of children's emergency medical care. The Pacific Islands Emergency Medical Services for Children Region (PIER) Telehealth Open-Network project is a regional collaboration focused on technology to improve the emergency care of pediatric patients, no matter where that patient resides or travels.
Dwayne Lopes (email@example.com)
There is continued collaboration between the DOH public health nurses, the DOE school health assistants and school based health centers such as the Waianae Coast Comprehensive health center SBHC at Waianae High, Waianae Intermediate, soon to be at Nanakuli High; Koolauloa health center at Kahuku High; and other SBHC by Hawai`i Keiki programs. There is an opportunity to expand this collaboration via telehealth by having a SBHC or FQHC connect with the other schools within a complex to support chronic condition management such as asthma, diabetes, etc.
Joan Takamori, RN, MSN (firstname.lastname@example.org)
In 2009, Mind and Body Works, Inc. converted its existing private practice patients to telepsychiatry; and in 2010, received a contract from the State of Hawaii Department of Education (DOE) to diagnose and treat students with moderate to severe mental illness through telemedicine on the islands of Maui, Molokai, and Lanai. Starting in 2014, the contract now serves all Hawaiian Islands. Mind and Body Works, Inc. operates on a hub and spoke concept, where the hub is the Honolulu clinic and the spokes are either at the patient’s home or school. Through the DOE contract, Mind and Body Works, Inc. has been able to serve hundreds of students by regularly providing direct, ongoing services to youth at thirty different schools across Hawaii. Throughout their telemedicine journey, Mind and Body Works, Inc. has found that creating an authentic physician-patient relationship and appealing experience for patients is crucial, and needs to be prioritized in order to make telemedicine effective for the patient and the provider involved in the interaction.
Dr. David Roth (email@example.com)
Adult Mental Health
NASW Hawaii realized that many social workers on neighbor islands were having trouble finding someone who could supervise them for their social work licensure. This shortage of supervisors on the neighbor islands was contributing to a shortage of licensed mental health professionals in the state. NASW Hawaii approached the legislature in 2015 and asked them to make changes to HRS 467E which would allow social workers to obtain supervision electronically through video teleconferencing. Changes were made to the statute and social workers are now able to obtain supervision via video teleconferencing, even if their supervisor does not live on the same island. Additionally, some licensed clinical social workers (LCSWs) are providing therapy through telehealth, which allows for better access to care for clients in rural areas.
Sonja Bigalke-Bannan (firstname.lastname@example.org)
The Department has utilized telehealth for a few years, providing telepsychiatry services to its neighbor island facilities. It has recently been providing primary care services and is looking at expanding by establishing out of Department connectivity.
Wesley Mun (email@example.com)
When establishing and sustaining a telepsychiatry practice, it is important to identify community partners and establish academic-community partnerships. Both National and International collaborations can be beneficial for academic-community partnerships. It is important to integrate psychiatric and behavioral health services with primary care to better serve patients. There are many resources available for those who want to practice telemedicine, including the telepsychiatry toolkit from the American Psychological Association. Additionally, there are new evidence based practice guidelines for providing telepsychiatry for children and adolescents that were recently released by the American Telemedicine Association.
Dr. Dan Alicata (AlicataD@dop.hawaii.edu)
McKenna Recovery Center uses telecommunication for administrative and staff supervision. They have also increased the use of telehealth to clinical applications. The Center uses FaceTime and the Zoom with HIPAA subscription to provide telehealth services. Telehealth may particularly be of help in addressing the current opioid epidemic.
Lani Nagao (firstname.lastname@example.org)
It is possible to utilize telehealth in a collaborative care model as a solution for increased access, better patient outcomes, and reduced costs. With a telehealth collaborative care model, more patients can be seen in a more efficient manner. Using telehealth in a collaborative care model could also lead to improved outcomes such as reduced symptoms of depression, less physical pain, better functioning, and an overall better quality of life. The collaborative care model is a systematic evidence based approach to integrated care.
Jeffrey Akaka (email@example.com)
Military Medical Centers
The VA Pacific Islands Healthcare System utilizes telehealth to treat their patients. They use a secure web-based video conferencing tool called VA Video Connect which connects providers and veterans with any device at any location. Since a lot of patients do not have access to the necessary technology, the VA provides their patients with mini iPad equipped with 4G service. The VA Pacific Islands Healthcare System currently has 11 sites of services across the Hawaiian Islands, Guam, Saipan, and American Samoa.
Thandiwe Nelson-Brooks (Thandiwe.Nelson-Brooks@va.gov)
Tripler Army Medical Center uses telehealth to bridge staffing gaps during surge support, provide a lower cost alternative for care, and to lessen the burden of patients having to travel to receive care. Telehealth is also used at Tripler for behavioral health evaluations and fulfilling Psychiatry provider gaps at smaller facilities. Tripler uses a system called Pacific Asynchronous Telehealth (PATH). PATH is a web-based, HIPPA compliant, secure system. It can be used for provider-to-provider teleconsultation and for asynchronous store and forward services. PATH is also used for provider education and mentoring. Services provided via PATH have better response time than face-to-face specialty referrals.
Jennifer Mbuthia (firstname.lastname@example.org)
Online Care, Kiosks, Home Health
Ho’okele Home Care Services employs state-of-the-art iHealthHome™ technology to provide a comprehensive range of services. It serves as a wellness tool allowing a senior to manage and monitor vital signs such as weight, blood pressure and glucose levels. Using web-based communication systems, the iHealthHome creates a “virtual village” safety net of informed healthcare professionals, caregivers and family members. It connects the entire care team, integrates workflows, makes secure digital record-keeping available on mobile devices, and easily connects to sensors and wearable monitors in the client’s home.
Bonnie Castonguay (email@example.com)
This is a project designed to provide primary care medical services to the homeless population in East Hawaii.
Scott Daniels (firstname.lastname@example.org)
HMSA Online Care was launched in 2009 in partnership with American Well. HMSA Online Care connects patients to real-time online health care services via secure videoconferencing and web chat that is available 24/7, 365 days a year. In 2016/2017, of HMSA Online Care’s total visits, over 2/3 were for behavioral health services. Through HMSA Online Care, doctors can invite up to eight users, customize practice storefront and URL, schedule on-demand and future appointments, and access HMSA Online Care through HMSA’s Online Care Provider mobile application.
Dale Moyen (email@example.com)
DOCNow utilizes and leverages existing staff at their urgent care centers on Maui to serve Hawaii residents via telemedicine. Utilizing American Well’s telemedicine platform, DOCNow serves local residents and tourists for urgent care online and in DOCNow virtual locations in Times Pharmacy, KTA Superstores, Foodland, Rainbow Pharmacy, Wailea Pharmacy, Napili Pharmacy, Royal Kona Hotel, Westin/Starwood properties, and UHA. DOCNow also includes a virtual concierge that greets patients virtually and gathers demographic and insurance information, which is then entered into DOCNow’s EMR. Patients are then seen by one of the physicians in DOCNow’s brick and mortar clinics. DOCNow is a physician-owned, and locally run business that utilizes doctors based in Hawaii.
Paige Williams (Paige@docmaui.com)
Allied Health Care/Rural Health and Public Health
The UH Translational Health Science Simulation Center (THSSC) is the result on an innovative partnership between the University of Hawai‘i at Manoa School of Nursing, HMSA Foundation, Hawai‘i Pacific Health, The Queen’s Medical Center, and Kaiser Permanente Hawai‘i. Interprofessional education (IPE)is an important initiative supported by the Deans and Directors of the UH Council of Health Sciences. The THSSC's facility and distance technology tools are utilized to support IPE with simulation learning. These IPE simulation sessions focus on development of collaboration skills, appreciation for patient centered care, professional role understanding, communication and team/leadership skills. UH THSSC brings simulation, interprofessional team collaboration training, team training with actors, and disaster simulations to the classroom so that students can gain the experience, confidence and skills they need to provide quality care.
Lorrie Wong (firstname.lastname@example.org)
Aloha Kidney is a chronic kidney disease education program built to improve understanding of chronic kidney disease for patients to work better with their doctor, family, and friends in order to reach their life goals. Patients who understand how to manage their health can make better choices that align with their life goals and slow progression of chronic disease. Aloha Kidney conducts 6 classes at 2.5 hours each as part of the Kidney Disease Education (KDE) curriculum and offers classes in-person and via telehealth. Research on data collected by a health plan regarding Aloha Kidney patients displayed improved outcomes (progression slowed, transitions to kidney failure safer, transitions to end of life supported, and healthcare costs reduced).
Ramona Wong (email@example.com)
Today, there is a new and innovative delivery of care model that uses telehealth technology that has the potential to significantly improve the access of dental care for the most under-served and vulnerable populations by providing dental care in the communities where people live, learn, work and socialize. This delivery of care model is the virtual dental home. Currently, the Hawaii Department of Health, Pacific Center for Special Care, University of Pacific, School of Dentistry, and the West Hawaii Community Health Center is conducting a Big Island virtual dental home pilot project. In the past year, approximately 300 children were provided comprehensive dental care that previously did not have a dental home. In 2018, the virtual dental home pilot project will be expanded to Maui.
Andrew W.L. Tseu (Andrew.Tseu@doh.hawaii.gov)
Rural Health and Public Health
The Cancer Council of the Pacific Islands is comprised of appointed health leaders from the US Affiliated Pacific Island jurisdictions (USAPI). The CCPI has developed and participates in implementation of the Pacific Regional Cancer plan, which speaks to maintaining a USAPI regional format for discussing and addressing cancer. The Pacific Regional Cancer Plan is a long-term plan, designed to be coordinated in conjunction with Pacific Islands Health Officers Association (PIHOA) efforts to improving public health infrastructure and policies within the USAPI. The Regional efforts support jurisdiction efforts by leveraging resources, conducting assessments and training, providing technical assistance and some degree of uniformity in addressing cross-cutting issues that impact the resource-limited USAPI countries and jurisdictions.
The 2017-2022 Cancer Plan works collaboratively to support coordinated local efforts in health promotion messaging, education, support of evidence-based policies in cancer prevention, cancer screening, palliation and patient navigation programs for the USAPI, and develop regional policies regarding utilization of cancer data, provide regional technical support for all parts of the comprehensive cancer plan, and expands regional Cancer advocacy at the U.S. National level.
Part of the plan includes a coordinated, resource-appropriate telehealth component that will improve local capacity to prevent, screen, triage and, in some cases, diagnose certain cancers. The regional CCC program will work with colleagues at UH (Pacific Basin Telehealth Resource Center and other relevant Departments), HHS and the VA to help implement telehealth relevant to cancer control priorities.
Lee Buenconsejo-Lum (firstname.lastname@example.org)
Through donation from HMSA and American Well, the Ka‘u Rural Health Community Association’s (KRHCAI) Resource and Distance Learning Center was outfitted with a health kiosk in January 2017. Through this kiosk, all Ka‘u community members can access free telemedicine visits via HMSA Online Care. Until now, Ka‘u residents would often travel hours to the nearest clinic. This kiosk makes the KRHCAI’s Resource and Distance Learning Center a new and important destination for convenient and timely health care services.
In addition to providing better access to care, the kiosk will establish a new internship for clinical support staff (certified nurses aides, community health workers, and practical nurses) on how to educate others in under-served areas on the benefits of telemedicine technology.
Jessie Marques (email@example.com)
ECHO stands for Extension for Community Health Outcomes. Project ECHO clinics do not involve patients, just clinicians discussing case presentations. They use a hub and spoke model, with a hub of specialist clinicians discussing a case while others can join from remote locations to learn from case presentations and discuss and ask questions about their own patients. Project ECHO has been running for 20 months in Hawaii. There are four ECHO clinics here in Hawaii: Behavioral Health, Endocrinology/Diabetes, Geriatrics, and the Hawaii Alzheimer's Disease Initiative.
Deborah Peters (firstname.lastname@example.org)