FUTURE OF HEALTH CARE IN THE INSULAR AREAS: A LEADERS SUMMIT
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1 FUTURE OF HEALTH CARE IN THE INSULAR AREAS: A LEADERS SUMMIT HONOLULU,HAWAII SEPTEMBER 28 -OCTOBER 2, 2008 PRESENTED BY: LUIS A. SYLVESTER HEALTH POLICY ADVISOR TO THE HONORABLE JOHN P. DE JONGH, JR. GOVERNOR OF THE US VIRGIN ISLANDS
2 United States Virgin Islands ~Overview~ Four (4) main islands: St. Thomas, St. Croix, St. John, Water Island and 70 smaller islet and keys Population: 108,448 residents (U.S Census) 60 miles east of Puerto Rico 1, 075 miles south of Miami, Florida
3 United States Virgin Islands ~Economy~ Tourism accounts for 70% of GDP In ,611,251 visitors 1, 917,878 cruise passengers 693,373 air passengers Manufacturing Petroleum Refining (HOVENSA) -3 rd largest in Western Hemisphere on St. Croix Textiles Electronics Pharmaceuticals Watch Assembly
4 United States Virgin Islands ~Health Facilities~ V.I. Government Hospital and Health Facilities Corporation operates : Roy Lester Schneider Hospital, St. Thomas (169) bed Acute Care Facility Charlotte Kimelman Cancer Institute (CKCI) Myrah Keating Smith Community Health Center, St. John Juan Luis Hospital, St. Croix (188) bed Acute Care Facility Cardiac Center will open October 2008 Department of Health has several public health clinics throughout the Territories Two (2) federally qualified Health Clinics run by non-profit corporations
5 United States Virgin Islands ~Challenges~ Healthcare manpower shortage Funding Constraints Unavailable and unreliable data collection Off-island travel for specialty care No interconnectivity among Territorial facilities
6 ROY L. SCHNEIDER HOSPITAL Joint Commission Accredited Certified by the Centers for Medicare and Medicaid Services (CMS) Employs approximately 700 individuals, including agency staff Provides a wide range of services to meet all of our clients needs Average daily census for 2008: 62 patients
7 MYRAH KEATING SMITH COMMUNITY HEALTH CENTER Located in Susannaberg on St. John Emergency Services available 24 hours/ 365 days per year Outpatient/Clinic Services Available Monday Friday ( 8am 8pm)
8 CHARLOTTE KIMELMAN CANCER INSTITUTE (CKCI) CKCI provides a comprehensive range of services (radiation oncology, medical oncology services, surgical consultations and support services) in one entity The Institute is equipped with state-of-the art technology: (Varian-Linear Accelerator, and Siemens- CT scanner, GAMMAMED High Dose Radiation Unit) The Benjamin Auditorium contains the latest audio and visual technology and telemedicine capabilities Prostate, Cervical, Skin and other Cancer screenings total approximately 400 persons Educational seminars are conducted on a variety of cancer subjects including Breast, Prostate, Cervical, Skin, Head, Neck and Nutrition CKCI has started Prostate Seed Implantation. Improved IMRT (Intensity Modulated Radiation Therapy The institute successfully passed in October 2007 the unannounced visit of the Nuclear Regulatory Commission
9 JUAN F. LUIS HOSPITAL Semiautonomous agency governed by its own Board of Directors Licensed by V.I Department of Health Accredited by Joint Commission Certified by CMS Contracts with all major health insurance companies in USVI Safety Net hospital
10 TeleHealth ~Connecting Island Health Care~
11 TeleHealth ~ Electronic Health Records~ Electronic Health Records (EHR) allows for the documentation and storage of health data electronically EHR can provide a seamless continuum of care from clinic to Acute facility, from provider to provider, and from island to island. Patients who use clinics often use hospital ER Patients with co mobility have more than one provider Inter-island travel is sometimes necessary for patients to receive care
12 Benefits of EHR Administrative efficiencies through decreased paperwork Reduction in adverse drug events Fewer duplicative treatments and tests Reduction in medical errors Improved coordination of treatment through timely access of health information Less reliance on patients memory Portability of health records
13 Disadvantages of Paper Records Incomplete Often unavailable Illegible Inconsistent Not interactive
14 Challenges to EHR Privacy Concerns Inter-operability of systems Infrastructure Investment (hardware, software and training costs)
15 Remoteness of Insular Areas Lack of easy access to specialty care centers (trauma, burn, etc.) High cost of travel for health care (Air ambulance travel, lodging) Challenge in recruiting specialists Unavailability of many advanced health care procedures Significant amount of care is received outside of insular areas Costs of providing health care are higher
16 Staffing Challenges Nursing Contracts nurses cost 12 million annually Medical Specialties - Radiologic Technologists, Radiation Therapists, Pharmacists, Medical Technologists and Physical Therapists Physician Staffing- Pulmonologists, Endocrinologists, Neurosurgeons, and Pediatric Intensivists
17 CIGNA Medical Health Insurance FY2007 GVI Expenditures Total Paid $ % USVI $35,198, % PR $1,191, % USA $29,051, % Total $65,441, % Members Location (zip) Claims Paid in the US Mainland % Of Total USVI $24,503, % PR $4, % USA $4,542, % Total $29,051, %
18 TeleMedicine Telemedicine refers to the use of various telecommunications by physicians and medical institutions that provide health care to their patients through electronic or digital means Allows collaboration between local providers and medical experts across the country Decrease the need to move patients off-island Enhanced recuperation due to family members availability Retention of healthcare dollars in the local economy
19 ~Juan F. Luis Hospital Activities~ Our current tele-health/communication activities include the following: We use a (PACS) system that allows us to transmit and receive medical information, including x-rays, CT scans, MRIs, etc. to/from facilities worldwide. The JFLH medical providers currently use this PACS to access medical information on their patients within and out of the facility. We are in discussions with mainland radiology "nighthawk" companies that will read/interpret our x-rays, MRIs and CT scans during off-hours when there is no radiologist on site We use Meditech as our clinical information system. Through the VIMI e-health initiative, we will be integrating JFLH's Meditech system with the clinical systems from the community clinics and physicians so that patient information will be shared between health care providers and patient information may be accessed whether the patient is in the hospital or in his/her physician's office We have the equipment and ability to do tele-conferencing but have not been utilizing it fully because we need additional band-with to enable the system to function effectively. We also have agreements with Cleveland Clinic and other mainland based hospitals to do tele-conferences at JFLH so that JFLH staff can have access to seminars/conferences provided by these institutions.
20 ~Roy L. Schneider (RLS) Hospital Activities~
21 RLS continues
22 Conclusion Telecommunication has the potential to bridge the physical distances and the health disparities that exists between the mainland and Insular areas As we improve the Territories Health Care System we see the potential to pursue opportunities in medical tourism
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