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Stewart Ferguson
Stewart Ferguson

Stewart Ferguson was interviewed on June 8, 2006 by Karen Brewster at his office at the Alaska Native Tribal Health Consortium (ANTHC) in Anchorage, Alaska. In this interview, Stewart talks about the development of the Alaska Federal Health Care Access Network Project (AFHCAN) telehealth program in Alaska, creating a telehealth system that meets local and technical needs, training health aide users, the benefits and challenges of telehealth, the role of health aides in driving program advances, and the future of telehealth services in Alaska.

Digital Asset Information

Archive #: Oral History 2004-17-36

Project: Community Health Aide Program Project Jukebox
Date of Interview: Jun 8, 2006
Narrator(s): Stewart Ferguson
Interviewer(s): Karen Brewster
Location of Interview:
Funding Partners:
U.S. Department of Health and Human Services, Health Resources and Services Administration, University of Alaska Health Programs
Alternate Transcripts
There is no alternate transcript for this interview.
Slideshow
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Sections

1) The development of the Alaska Federal Health Care Access Network (AFHCAN), and how he became involved with it.

2) The design and implementation of early telehealth projects in Alaska, and the roles of the Alaska Native Health Board and Native regional health corporations.

3) The effectiveness of early telehealth projects and the benefits of health aides using telehealth systems.

4) The use of telehealth systems, and advancements in their design and the equipment provided.

5) How the AFHCAN system is different from live videoconferencing, why it works better in the Alaskan context, and types of cases that telehealth is used for.


6) The organizational and management structure of AFHCAN and the role of the Alaska Native Tribal Health Consortium.

7) The development and funding of AFHCAN

8) The history of developing telehealth in Alaska, some of the people involved, and the changes in organization and technology that have occurred.

9) The importance of training the telehealth system users and managers, future goals for the program, and issues related to management of electronic data.

10) Management and transfer of electronic health related data.

11) Getting health aides and physicians to use the telehealth system, how the system works, and types of training provided.

12) What a telehealth cart looks like and what equipment is on it.

13) Equipment and tools on the telehealth cart and what they are used for.

14) Improvements being made on the design of a new telehealth system.


15) Touchscreen access to the telehealth system, creation of telehealth cases, and the effects of telehealth on rural healthcare.

16) How important health aides are as first responders in the villages, and the role that telehealth plays in their work.

17) The future of telehealth systems in healthcare in Alaska, getting support for the use of telehealth from all level of providers, and the abilities and limits of technology.

18) Use of telehealth systems for other healthcare, such as mental health services, and future possibilities for a variety of other purposes.

19) Connectivity issues in rural Alaska.

20) Key players in the development of telehealth in Alaska.

21) The role of the Alaska Telehealth Advisory Council, and Native regional health corporations modifying telehealth systems to meet their individual needs.

22) Physician use of telehealth systems and making the system easy to use.

23) Security issues in the management and transfer of confidential electronic data.

24) The importance of regional health corporation control over telehealth systems, and providing proper training.

25) How working with AFHCAN has influenced him personally, and how development of the system has been collaborative with users in the villages.

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Transcript

Section 1: Alaska Federal Health Care Access Network (AFHCAN)\ job -- director \ Alaska Native Tribal Health Consortium (ANTHC)\ AFHCAN -- mission\ AFHCAN -- beneficiaries\ agencies -- federal\ Native\ education\ college degree -- electrical engineering\ mathematics\ graduate degree -- biomedical engineering\ engineering -- medical applications\ Samoa -- work experience\ work -- computer network\ telecommunications\ telemedicine -- rural benefits\ Alaska -- coming to\ telehealth -- interest in\ AFHCAN -- employment\ AFHCAN -- startup date\ Alaska -- reasons for\ National Library of Medicine (NLM) -- project\ NLM project -- precursor to AFHCAN\ NLM -- funding source|

Section 2: National Library of Medicine (NLM) -- background\ telehealth -- federal funding\ telehealth -- studies of\ NLM -- study\ Village Telemedicine Testbed Project\ Village Telemedicine Testbed Project -- purpose of\ University of Alaska Anchorage (UAA) -- project management\ Pearce, Fred -- principal investigator\ Alaska Native Health Board (ANHB) -- contract with\ ANHB -- role\ telehealth system -- first\ Native regional health corporations -- proposals\ Native regional health corporations -- participation\ Native regional health corporations -- selection\ Ninilchik Traditional Council\ Bristol Bay Area Health Corporation\ Norton Sound Health Corporation\ Yukon-Kuskokwim Health Corporation\ telehealth system -- implementation\ telehealth system -- design\ telehealth system -- locations\ villages -- number involved\ NLM project -- outcomes\ NLM project -- expansion of|

Section 3: National Institute of Health (NIH)\ Village Telemedicine Testbed Project\ Alaska Native Health Board (ANHB) -- role\ telehealth system -- design \ telehealth system -- implementation\ telehealth system -- evaluation\ University of Alaska Anchorage (UAA)\ Pearce, Dr. Fred \ evaluation -- guidelines\ isolation -- reduction of\ cost\ evaluation guidelines -- key areas\ health care -- satisfaction\ telehealth -- customer satisfaction\ evaluation -- method\ method -- questionnaire\ method -- effectiveness\ evaluation -- results of\ health aide -- recognition\health aides -- skills\ telehealth -- use of\ use -- example\ injury -- wound\ suturing -- need for\ health aide -- lack of training\ doctor-- communication with\ images -- sending\ doctor -- response from\ fax machine -- use of\ telecommunications -- benefits\ Village Telemedicine Testbed Project -- focus\ focus -- ear disease \ tools\ scopes -- Ear Nose Throat (ENT) \ digital camera\ digital camera -- benefits of\ digital camera -- medical uses\ trauma\ wound management\ care -- chronic\ dermatology -- diagnosis\ diagnosis -- difficulty\ skin disease -- outbreak\ dermatologist -- lack of\ Alaska Native Medical Center\ dermatologist -- employment|

Section 4: telehealth systems -- use of\ use -- frequency\ use -- study of\ Kotzebue\ Maniilaq Association\ clinic -- village\ tools -- use of\ tools -- video otoscope\ tools -- digital camera\ data -- comparison\ tools -- preferences\ telehealth -- applications\ applications -- local control\ teleheath tools -- access\ access -- health aides\ health aides -- technological issues\ generations -- differences\ health aides -- surprises\ expectations\ health aides -- case study\ case study -- efficacy of technology\ case study -- outcome\ health aides -- longevity\ telehealth -- reaction to\ health aides -- feedback\ electrocardiogram (EKG) -- examination\ EKG -- training\ EKG -- tools\ EKG tools -- request\ telehealth -- response to\ technology -- response to|

Section 5: videoconferencing -- comparisons with\ Alaska Federal Health Care Access Network (AFHCAN) system -- comparisons with\ videoconferencing -- description of\ videoconferencing -- system requirements\ connectivity -- broadband T1\ videoconferencing -- scheduling\ videoconferencing -- challenges\ videoconferencing -- locations\ videoconferencing -- impractical\ connectivity -- limits of\ Alaska\ AFHCAN system -- logistics\ AFHCAN system -- design\ technology -- store and forward\ AFHCAN system -- description\ technology -- bandwidth\ bandwidth -- low\ AFHCAN system -- efficiency\ AFHCAN system -- asynchronous\ AFHCAN system -- evolution\ National Library of Medicine (NLM)\ AFHCAN system -- recognition\ recognition -- worldwide\ AFHCAN system -- advances in\ video -- emergence of\ AFHCAN system -- applicability\ telehealth -- cases\ cases -- types of\ cases -- response to\ cases -- non-urgent\ cases -- trauma\ cases -- urgent\ patient -- evacuation\ data -- sending\ case -- follow-up\ case -- decision|

Section 6: National Library of Medicine (NLM) telehealth project -- timeline\ Alaska Federal Health Care Access Network (AFHCAN) -- timeline\ AFHCAN -- organizational structure\ Alaska Federal Health Care Partnership (AFHCP) -- description of\ AFHCP --involvement\ AFHCP -- partnerships\ AFHCP -- proposal\ AFHCP -- management\ Alaska Native Tribal Health Consortium (ANTHC)\ ANTHC -- organizational structure\ AFHCP -- reorganization\ ANTHC -- management\ ANTHC -- collaboration|

Section 7: Alaska Federal Health Care Access Network (AFHCAN) -- funding\ funding -- history\ funding -- federal\ Indian Health Service (IHS)\ Department of Defense\ Veterans Administration\ Department of Transportation\ Health and Human Services\ funding -- management of\ Alaska Native Tribal Health Consortium (ANTHC)\ funding -- primary source|

Section 8: telehealth\ people -- key\ Pearce, Fred\ Alaska Telemedicine Project (ATP) -- development\ Eussen, Lori \ Patricoski, Chris\ telehealth -- history\ telehealth system -- challenges\ telehealth system -- connectivity\ telehealth system -- partnerships\ cohesiveness \ technology -- advances\ telehealth system -- organization\ organization -- changes\ Alaska Native Medical Center -- Ear, Nose, Throat (ENT) Department\ ENT Department -- support from\ AFHCAN -- changes\ partnerships -- evolving|

Section 9: National Library of Medicine (NLM) telehealth project\ lessons -- learned\ Stotts(?), Denise\ interviews -- health aides\ health aides -- suggestions\ telehealth system -- usage\ usage -- variation\ telehealth system -- future\ future -- goals\ ownership\ training --development\ curriculum\ distance education\ regional health corporations -- staff\ staff -- trained\ telehealth system -- integration\ telerad system -- radiology\ data -- compiling\ data -- outcome\ studies\ case studies -- development of\ telehealth -- multi-disciplinary\ images -- variety\ telehealth -- emergence of\ information -- transferring of\ information -- integration of\ AFHCAN\ electronic health records -- integration of\ Picture Archiving Communication Systems -- integration of\ data -- movement\ integration -- issues with|

Section 10: technology -- integration\ electronic health records\ Native health corporations\ data -- exchange\ health record -- access to\ data -- movement\ data -- access\ format -- standardization\ standard -- Health Level 7 (HL7)\ standard -- open\ lexicon -- variability\ funding\ Indian Health Service (IHS)\ telehealth -- solutions\ solutions -- Alaska\ solutions -- national\ Washington\ Arizona\ Tennessee\ electronic health record -- national\ data -- commonality\ records -- management\ forms -- paper\ forms -- faxing\ record management -- electronic|

Section 11: data -- electronic\ record management -- electronic\ health aides -- effect on\ health aides -- consultation with\ telehealth system -- use of\ village -- visit\ use -- observation of\ telephone -- similarity\ data -- capture\ data -- send\ telehealth system -- importance of\ clinic -- fire\ telehealth cart -- rescue of\ telehealth system -- shortcomings\ clinics -- lack of use\ timeframe -- limited\ technology -- acceptance of\ connectivity -- limit of\ system -- unusable\ users -- training\ use -- increase\ training -- timing\ training -- Information Technology staff\ cart -- building\ AFHCAN -- training group\ Constantine, Mandy\ trainers -- nurses\ curriculum -- “train the trainer”\ Native health corporations -- staff\ training -- on-site\ training -- length of\ training -- content\ staff -- empowerment\ training -- success\ Maniilaq Corporation\ Yukon-Kuskokwim Health Corporation\ US Coast Guard|

Section 12: telehealth -- cart\ cart -- description\ cart -- equipment\ computer\ monitor\ computer -- touchscreen\ telehealth case -- creation of\ cart -- standard\ carts -- number of\ digital camera\ otoscope\ scanner\ ECG\ cart -- decisions\ committee -- clinical\ committee -- membership\ regional health corporations -- clinical directors\ cart -- original\ cart -- redesign\ cart -- upgrade\ cart -- equipment\ cart -- set-up\ set-up -- easy\ cart -- size\ size -- standard\ cart -- deployment|

Section 13: Equipment -- description of\ timpenometry\ ear drum -- fluid\ ear pressure -- measuring\ ear problems -- treatment\ image -- limits of\ reflex response -- measurement of\ audiometry\ screening\ hearing loss -- measurement of\ writing spenometry\ pulmonary function -- testing of\ asthma -- diagnosis of\ stethoscopsy\ heart -- sound\ lung -- sound\ stethoscopsy -- challenges\ stethoscope -- placement\ placement -- importance of\ heart beat -- fetal\ dental care -- camera\ dental health aide program\ videoconferencing\ webcam\ camera -- zoom\ camera -- operation\ operation -- remote\ technology -- store and forward\ technology -- interactive\ monitors -- vital signs\ blood pressure -- measuring\ temperature -- measuring\ blood -- oxygen levels\ monitoring -- simultaneous\ data entry -- lack of\ typing -- lack of\ error -- removal of\ devices -- external\ devices -- plug-in|

Section 14: telehealth cart -- upgrade\ cart -- design\ cart -- size\ cart -- small case\ case -- prototype\ case -- briefcase\ case -- equipment\ case -- standard\ case -- transportable\ house calls -- use for\ field treatment -- use for\ Coast Guard -- interest from\ Air Force -- interest from\ case -- waterproof\ case -- dustproof\ case -- request for\ Navajo Nation\ elder -- home visit\ electricity -- lack of\ conditions -- dusty\ power -- battery\ cart mobility -- solution|

Section 15: telehealth system -- cart\ cart -- touchscreen\ software -- design\ touchscreen -- buttons\ buttons -- size\ buttons -- color\ language -- simple\ use -- ease of\ telehealth case -- creation of\ telehealth system -- logging in\ telehealth -- choices\ case -- new\ case -- already sent\ case -- archived\ case -- respond\ choices -- limited\ colors -- consistent\ case -- creation\ creation -- method\ data -- adding\ images -- use of\ order -- flexibility\ information -- advance\ EKG -- interpretive\ patient -- age\ patient -- gender\ case -- practice\ case -- real\ case -- management\ evaluation\ answers -- stored\ data -- assessment\ case creator -- question to\ questions -- examples of\ satisfaction -- patient\ satisfaction -- job\ problems\ consultant -- question to\ travel -- patient\ travel -- effect on\ responses -- number of\ patient travel -- amount of\ telehealth -- success of\ expectations\ patient travel -- reduction\ Alaska Native Medical Center (ANMC)\ patient travel -- increase\ disease -- catching\ health care -- improvement|

Section 16: health aides -- duties\ duties -- number of\ health aides -- appreciation for\ health aides -- primary care\ health statistics -- Alaska\ death -- rate\ death -- trauma\ trauma -- villages\ accidents\ health care -- basic\ death -- premature\ disease -- heart\ disease -- diabetes\ health -- problems\ health aides -- care from\ health aides -- training\ training -- level of\ training -- continued\ telehealth system -- benefits\ health care -- effect on\ telehealth system -- reliance on\ AFHCAN -- open house\ health aides -- visit\ telehealth system -- response to\ telehealth system -- reliance on\ telehealth system -- use\ use -- expansion of\ expansion -- efforts\ health aide program -- support from\ community health aide manual (CHAM) -- telehealth section\ demonstrations\ training\ meetings -- statewide\ health aides -- involvement with\ training -- trainers|

Section 17: telehealth -- future\ telehealth -- routine\ data -- capture\ data -- movement\ data -- requirement\ physicians\ Alaska Native Medical Center\ Anchorage\ telehealth -- cases\ telehealth cases -- requirement\ telehealth -- expectations\ technology -- expectations\ information -- expectations\ provider -- needs\ needs -- meeting\ simple\ accessibility\ training\ system -- support\ technology -- advancement\ technology -- changes\ connectivity -- changes\ video -- access to\ telehealth systems -- advances\ priorities\ telehealth -- promotion of\ promoters -- health aides\ telehealth -- difficulties\ consultants -- support from\ support -- changes in\ telehealth -- acceptance of\ expectations -- meeting\ technology -- abilities of\ technology -- limits of\ technology -- advances\ resources -- limits of\ possibilities -- prioritization\ cost -- effectiveness\ demands -- reasonable\ staff -- shortage\ requests -- filling|

Section 18: need -- unmet\ mental health services\ video -- live\ Adler, Ron\ Alaska Psychiatric Institute (API)\ telehealth -- use of\ telehealth -- promotion of\ user -- needs\ needs -- meeting\ cooperation\ funding\ University of Alaska\ Alaska Primary Care Association\ health centers -- community\ work -- collaborative\ collaboration -- emphasis on\ technology -- limits\ limits -- lack of\ technology -- expectations\ mental health services -- reliance on telehealth\ psychiatrist\ patients -- see in person\ mental health services -- local\ patients -- monitor\ travel -- decisions about\ medication -- adjustment\ telehealth -- international\ telehealth -- standard\ videoconferencing -- use of\ videoconferencing -- Alaska\ regional health corporations\ Southeast Alaska Regional Health Consortium (SEARHC)\ technology -- overcoming\ connectivity -- broad\ mental health aides -- supporting\ telehealth -- creative uses\ families -- talk with\ live video -- use of\ pregnant women -- Anchorage\ care -- hospice\ family -- involvement\ telehealth -- possibilities\ telehealth -- public\ hospital -- consulting room\ clinics -- new\ room -- videoconferencing\ room -- private|

Section 19: telecommunications\ connectivity -- Universal Services Fund (USF)\ telephone -- fees\ connectivity -- subsidized\ connectivity -- remote area\ connectivity -- access\ corporation\ connectivity -- price of\ connectivity -- paying for\ connectivity -- equal access\ Anchorage\ village -- connectivity\ school -- connectivity\ lines -- sharing|

Section 20: telehealth -- Alaska\ telehealth system -- development\ people -- involved\ National Library of Medicine (NLM) project\ Pearce, Fred\ Hall, Rich\ Alaska Native Medical Center\ Sherry, Paul\ Alaska Native Health Board (ANHB)\ ANHB -- partnership\ Alaska Native Tribal Health Consortium (ANTHC) -- involvement\ AFHCAN -- management of\ health corporation -- leadership\ leadership -- support from\ Kashevaroff, Don\ ANTHC -- Board of Directors\ AFHCAN -- steering committee\ Stevens, Senator Ted\ Canal(?), Liz\ funding -- availability\ project -- stabilization\ funding -- Indian Health Service (IHS)\ requests -- meeting\ requests -- national\ Carroll, Mark\ IHS -- national coordinator\ telehealth -- model\ telehealth -- promotion\ opportunities\ systems -- integration\ systems -- effectiveness|

Section 21: Alaska Telehealth Advisory Council (ATAC) -- formation of\ ATAC -- purpose of\ telehealth -- statewide issues\ telecommunication -- companies\ hospitals\ Mental Health Trust Authority\ Nicewinder, Tom\ ATAC -- facilitator\ ATAC -- reporting to\ ATAC -- importance of\ State -- health commissioner\ Medicaid -- regulations\ regulations -- changes\ telehealth -- paying for\ insurance -- reimbursement\ leadership -- State\ telehealth systems -- additional\ Providence Hospital\ Boucha, Kathe\ teleradiology\ Sivits, Herb\ Alaska Clinical Engineering Services\ AFHCAN -- regional partners\ local -- needs\ systems -- local\ systems -- development\ corporations -- individual efforts\ telehealth -- acceptance of|

Section 22: telehealth -- response\ physicians -- response\ response -- variability\ telehealth -- struggles\ physicians -- support from\ physicians -- working with\ physicians -- encouragement\ telehealth system -- demonstration\ hospital -- administration\ telehealth -- adoption of\ telehealth case -- first\ excitement\ apprehension\ telehealth -- usefulness\ email -- use of\ system -- comfort level\ system -- convenience\ system -- easy|

Section 23: email -- security\ telehealth -- security\ security -- healthcare\ security -- regulations\ regulations -- Health Information Portability Accountability Act (HIPA)\ security\ privacy\ health care -- data\ data -- movement\ data -- protection\ data -- encryption\ signature -- electronic\ recipient -- verification\ data -- validation\ email -- encryption\ email -- image\ image -- control of\ virus -- presence of\ email -- storage\ server\ personal computer\ telehealth system -- security\ security -- electronic\ security -- procedures\ telehealth -- servers\ servers -- security\ security -- importance of\ confidentiality -- changes in\ radio -- uses of\ information -- knowledge about\ village -- concerns\ health care -- importance of\ security -- lack of interest\ telehealth case -- encryption\ data -- protection\ data -- backup\ server -- ownership\ control -- local\ data -- ownership|

Section 24: health corporation -- empowerment\ control -- local\ telehealth -- success\ training -- success\ lessons -- learned\ telehealth -- users\ training -- needs\ training -- constant\ health aides -- training\ training -- desire for\ staff -- shortage\ training -- distance\ training -- increase\ telehealth system -- future\ telehealth system -- standard\ training -- importance of\ regional health corporations\ data -- management\ training -- users\ training -- cart builders\ training -- software managers\ training -- server managers\ training -- improvement of|

Section 25: telehealth -- personal influence\ career -- satisfaction\ job -- quality\ staff -- quality\ dedication\ passionate\ technology -- cutting edge\ job -- fulfillment\ travel -- village\ health aides -- working with\ work -- importance of\ NLM project -- staff\ Rawls, Rob\ Stotts, Denise\ telehealth system -- design\ telehealth -- software\ telehealth -- cart\ cart -- building\ work -- hands-on\ AFHCAN -- growth\ villages -- consultation with\ staff -- hiring\ staff -- improvement\ system -- improvement|