Located on Santa Catalina Island, 26 miles off the coast of Long Beach, California, Catalina Island Medical Center (CIMC) is a 12-bed critical access hospital (CAH) that provides a variety of health care services to an isolated rural population. Unfortunately, the island lacks all types of specialty care services, making telemedicine services uniquely attractive. CIMC’s medical providers refer most patients in need of specialty care to the mainland. Patient compliance with these referrals is poor due to financial, logistic, and frequently language barriers, particularly for the low-income, predominantly Spanish-speaking population.
CIMC provides 24-hour emergency room services, acute care, skilled nursing care, swing-bed rehabilitation services, laboratory, imaging and physical therapy services, out-patient primary care, and mental health services to residents and visitors of Catalina Island. The public health programs currently provided through the clinic include the Child Health Disability Prevention (CHDP) Program, the Comprehensive Perinatal Services Program (CPSP), the Family Planning PACT program, the County Immunization Program, and the Public-Private Partnership Program.
Telemedicine Services - CIMC currently provides telepsychiatry services monthly and plans to introduce teleophthalmology services beginning in May 2007
Contact Information
Bryan Ballard, CEO
Catalina Island Medical Center, Inc.
100 Falls Canyon Road,
Avalon, California 90704-1503,
(310) 510-0700
amdcadmin@catalinaisp.com
Dawn Sampson, Grants Manager
Catalina Island Medical Center
100 Falls Canyon Road,
Avalon, California 90704-1503,
(310) 510-0520
amdcadmin@catalinaisp.com
Price Reed, Telemedicine Coordinator
Catalina Island Medical Center, Inc.
100 Falls Canyon Road,
Avalon, California 90704-1503,
(310) 510-0700
(903) 721-7894
Pricerad1@yahoo.com
Tehachapi Valley is a 8,700 square foot region in Southeast Kern County—a region that is in the 3rd largest and 7th poorest county in California, is 56th out of 58 in deaths due to coronary heart disease, 47th out of 58 in deaths due to diabetes, 57th out of 58 in incidence of Chlamydia, and 46th out of 58 in infant mortality. Our clinical telemedicine partner in this region is the Tehachapi Valley Health Care District, which is comprised of the 24-bed Tehachapi Hospital and two rural health clinics, located in Tehachapi and Mojave. Together, these facilities and its staff have been serving the residents of the Tehachapi area for more than 50 years. TVHD has benefited from a three-year research grant ($1.5 million) from the Agency for Healthcare Research and Quality (AHRQ) to demonstrate the effectiveness of technology applications on chronic disease management in rural communities. Diabetes was selected by the community partners as the first priority health condition to pursue in 2006-2007 and LLU serves as the telemedicine partner for this unique effort. TVHD was the first clinical site to select ARIS (the Automated Retinal Imaging System) as its digital camera to pursue improved retinal imaging of diabetic patients and possible glaucoma. ARIS is capable of acquiring high quality images, in stereo, without dilating the eyes and without a retinal photographer. This instrument was funded, in part, with development resources from the Department of Defense, through the National Medical Technology Test Bed. The military was searching for a solution that could be deployed in the front lines
Telemedicine Services – beginning in March 2007, teleophthalmology services shall be provided through the network.
Contact Information
Robert Duncan, Interim CEO
Tehachapi Valley Health Care District
115 West “E” Street
Tehachapi, Ca 93561
(661) 822-3241
rduncan@tvhd.org
Jamie Young, Assistant Hospital Administrator
Tehachapi Valley Health Care District
115 West “E” Street
Tehachapi, Ca 93561
(661) 823-3028
jamiyoung@tvhd.org
Weblink
www.tvhd.org
Ridgecrest Regional Hospital RRH is a full-service community hospital licensed for 80 beds and located in Ridgecrest, California, which is just east of the Southern Sierra Mountain Ranges in the Indian Wells Valley. The hospital provides medical care diagnostic, treatment and restorative services, using more than 65 physicians providing services to our patients. The facility employs nearly 400 staff members, and is proud to have hundreds of volunteers to serve in various capacities augmenting the hospital’s services to the community it serves. RRH has served as a telemedicine hub for the past five years, providing clinical TM services to Lone Pine and other small rural clinics in the area. During 2006, RRH provided more than 1,000 telepsychiatry visits, an unmet need in rural communities.
Telemedicine Services – Beginning in April 2007, RRH shall provide telepsychiatry and diabetes patient education services through the LLU network
Contact Information
Dave Mechtenberg, Chief Executive Officer
Ridgecrest Regional Hospital
1081 N. China Lake Blvd.,
Ridgecrest, CA 93555
(760) 446-3551
dmechtenberg@rrh.or
Earl W. Ferguson, M.D., Ph.D
Clinical Director, Telemedicine
Ridgecrest Regional Hospital &
Southern Sierra Medical Clinic
1041 North China Lake Blvd., Suite B
Ridgecrest, CA 93555
(760) 371-5088
ewferguson@starband.net
Roger Berg, BS, RRT-NPS, Manager
Cardiopulmonary Services & Telemedicine
Ridgecrest Regional Hospital
1081 N. China Lake Blvd.
Ridgecrest, CA 93555
(760) 446-0617
FAX: (760) 499-5867
r.berg@rrh.org
Connie Maclean, Telemedicine Coordinator
Ridgecrest Regional Hospital
1081 N. China Lake Blvd.
Ridgecrest, CA 93555
(760) 446-0617
FAX: (760) 499-5867
c.maclean@rrh.org
Weblink
www.rrh.or
Adventist Health, headquartered in Roseville, California, has health care facilities throughout California, Hawaii, Oregon, and Washington. This system includes 20 hospitals with more than 3,100 beds, 19,000 employees, numerous clinics and outpatient facilities, 16 home care agencies, and three joint-venture retirement centers. One such facility is Central Valley General Hospital (CVGH), a 49-bed acute care community hospital located in Hanford, California, serving 12 communities in Kings, Tulare, and Fresno counties. Our inpatient services include: 24-hour emergency services, sleep apnea center, imaging, laboratory, outpatient dialysis, obstetrics/women’s services, and intermediate care neonatal nursery in conjunction with Central California Children’s Hospital. In addition, we offer JobCare referrals and operate various health clinics with 10 locations, and 15 Central Valley Family Health clinics. The hospital is staffed by 246 physicians, 398 employees, and 82 volunteers.
Telemedicine Services – Clinical telemedicine services shall begin in March 2007 with the provision of teleophthalmology services. An ARIS automated retinal imaging system was also installed in this clinic, to screen for diabetes, glaucoma, and other retinal pathology. Additional services that many be considered include telepsychiatry and patient education in diabetes management.
Contact Information
Central Valley General Hospital
1025 North Douty Street
Hanford, CA 93239
(559) 583-2100
Gail Nickerson,
Director of Clinic Operations
(916) 774-7308
nickerg@ah.org
Weblink
www.hanfordhealth.com
Mountains Community Hospital is a 17 bed Critical Access Hospital (CAH) located in Lake Arrowhead, California, serving 30,000 residents and numerous tourists in the rural mountain communities of San Bernardino County. MCH provides a full range of services including: emergency, birthing center, 17 acute beds, 6 of which are swing beds, and 18 extended care skilled nursing beds. The hospital also operates a rural health clinic at two different locations and through a mobile van. The facility is one of the few rural hospitals that is accredited by the Joint Commission on Accrediting Health Care Organizations (JCAHO) and provides general medical, obstetrical, pediatric, and surgical services.
Telemedicine Services – In 2006, the hospital received a planning grant from the California Endowment to pursue telemedicine services. Preliminary site surveys have been conducted by LLU Telehealth Initiative and a delegation from the hospital staff attended the telemedicine orientation and training session conducted by UC Davis in the fall 2006. Recently, MCH has installed a digital radiology system that includes an internet based picture archiving system, which represents the first step into telemedicine. With this capability, the hospital now provides the community with continuous radiologist coverage and demonstrates how telemedicine and advanced computing technologies can enhance access to care.
Contact Information
Thomas Bachman, Director of Development (prospective originating site)
Mountains Community Hospital
29101 Hospital Road,
Lake Arrowhead, 92352
Tom.Bachman@mchcares.com
Weblink
www.mchcares.com
Mission
The Center for Pre-hospital Care, Education, and Research seeks to advance Loma Linda University Medical Center's mission “to make man whole” within the emergency medical services community.
Objectives
Background
The first phase of the Center for Pre-Hospital Care, Education and Research, and its DISCOVERIES project (2002) included the creation of a regional Emergency Telemedicine Command Center (ETCC) and network. The ETCC established a telemedicine ‘hub and spoke’ system within the emergency department that can maximize and leverage all the health care resources available at Loma Linda University Medical Center. Through this nexus, LLU can provide real-time telemedicine consultation service to nursing homes, mass gatherings, disaster scenes, and underserved areas.
As one ‘spoke’ of this network, DISCOVERIES then developed a Mobile Telemedicine Disaster Vehicle (MTDV) prototype for emergency and disaster response. This vehicle is off-road capable and has been outfitted with state-of-the-art satellite communications and telemedicine connectivity. Such infrastructure can connect the ETCC with field resources at disaster incidents. Additionally, the MTDV has all the state-of-the-art technology of the ETCC, allowing it to function as a mobile command center in the event the emergency department or hospital is involved in a disaster. Additional medical equipment provides the ability to assess and treat patients on scene and support triage activities. Earthquakes, floods, and other disasters, including terrorist attacks, can result in multiple casualties, interruptions in transportation networks, communication infrastructure failures, and issues of contamination. These conditions may create an environment where it is not possible to bring patients to the emergency department. Several authors7-12 have recommended using telemedicine to assist with triage and provide care or consultation during such disasters. These assets have been accomplished over the years previous to the current IS leadership and has been clearly a highly successful venture.
The next phase of DISCOVERIES proposes to improve the medical community’s response to situations that overwhelm the emergency system by bringing the expertise of a tertiary care center directly to the patient. An initial step in this effort has been to connect the emergency department with the LLU Urgent Center, less than one mile away.
Need Description – CURE Project
Contact Information
Jeff Bender, Director,
Center for Pre-hospital Care, Education, & Research
Loma Linda University
Mountain View Plaza
11155 Mountain View, Suite 220
Loma Linda, CA 92354
(909) 558-7611
jbender@llu.edu
Weblink
http://www.llu.edu/llumc/prehospital/
As of 2005, there were an estimated 20.8 million residents with diabetes in the United States, representing 7.0 percent of the population. Out of the total pool of 20.8 million diabetic patients, some 1.5 million reside in California, representing 6.2 percent of the population. Approximately one-third of these afflicted persons are not yet diagnosed. This fact makes screening for diabetes extremely important.
There are 2.3 million residents in the San Bernardino and Riverside counties (U.S. Census 2000). In assessing the burden of diabetes, state-wide rankings of counties are used. The California average rate for diabetes is 6.22 percent and a median position of 23rd. Sacramento County reflects a 6.26 percent rate for diabetes, ranking it 24th of all counties. San Bernardino reflects a rate of 7.88 percent for diabetes, reflecting a rank of 51st of all counties. Riverside County reflects a rate of 8.33 percent of the population, with a ranking of 53rd. Clearly the burden of diabetes is sufficient for there to be a coordinated strategic effort to intervene, provide provider and consumer support, and generally raise the community level of awareness regarding this nearly preventable health condition.
All levels of government (federal, state, and local) as well as major health providers have adopted strategies to address the elimination of health disparities among vulnerable populations. In this state, the prevalence of diabetes represents a particular burden for african Americans, Hispanic Americans, and Native American residents, who carry a disproportionate share of the diabetes burden. The CDC reports that African Americans are 60 percent more likely to have diabetes than whites of similar ages. Diabetes is twice as common among Mexican American and Puerto Rican adults, as among non-Hispanic whites. The California Rural Indian Health Board asserts that “Diabetes is more of a threat to the American Indians than any other disease in history.”
The Diabetes Treatment Center (DTC) at Loma Linda University Medical Center has operated an approved American Diabetes Association Recognized Diabetes educational program since 1983. The mission of the DTC is to empower afflicted patients to live well with their health condition and to take ownership of their diabetes. The attached charts depict the level of patient compliance accomplished with our goal-centered approach to education and behavior modification.
The DTC is a core element in the Telemedicine Initiative at LLU. Four of our five rural clinical partners have selected diabetes detection and care management as a high priority health concern, emerging from the planning efforts in their regions. Our plans call for the provision of diabetic educational sessions, broadcasted to our rural sites, in Spanish and English, onto Native American reservations and then in other languages for the benefit of their patients. This will allow patients with limited English capabilities the opportunity to experience ADA-approved diabetic health education in their native languages. So much of diabetes management is reflected in environmental factors and family-linked practices and norms, we believe that culturally competent education, coupled with physician and health provider support will make a difference in health outcomes.
Debra Clausen, MSN, FNP. CDE, BC-ADM
Manager
Diabetes Treatment Center
Loma Linda University Medical Center
11285 Mountain View Ave., Suite 40
Loma Linda, CA 92354
(909) 558-3022
FAX (909) 558-3023
Email: dclausen@llu.edu
pager 4471 or dclausen@my2way.com
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Last Revised: Mon, Mar 26, 2007