Rob Sprang, MBA - Director of Kentucky TeleCare Citation:
by Robert Pyke
Pyke, R. (February 2003). An Interview with Rod Sprang, Director of Kentucky TELECARE. Online Journal of Nursing Informatics (OJNI). Vol. 7, No. 1. [Online]. Available at http://ojni.org/7_1/pykeiv.htm.htm
Can you tell me how you became involved with Telemedicine and how you became involved with the Telemedicine program?
I had been in the communications industry, on the vendor side, for many years. Working with Sprint and MCI, and as a free-lance communications consultant, I helped businesses expand their use of communications services to solve business problems, including the development of international voice, video and data networks. UK was in the early stages of building a telehealth program, and I was hired to oversee its development and growth.
Can you tell me the history of Telemedicine at Kentucky and
the Telehealth and Telemedicine Center and how it has evolved?
The program began with a small group of top executives in the UK medical center. They were on the leading edge of this idea and felt that the University should become one of the early pioneers. They received their first federal grant in 1994 and began to build the program. Over time, the network spawned other telehealth networks in the state, and these networks eventually covered a broad area of eastern KY with over 40 network sites. After the successful passage of state legislation in 2000, the Kentucky TeleHealth Network (KTHN) was created. This was a statewide telehealth initiative that included all three medical schools in the state and many rural healthcare facilities. The University of Louisville was brought into the network along with several western Kentucky sites to create a true statewide telehealth network.
Tell me about training programs you offer. How many trainees have been through the program and what do they learn and take with them?
In 2001, we conducted over 23,000 contact hours of educational programming. This ranged from Grand Rounds to medical student education for students that are performing off-campus rotations and need to participate in weekly problem based learning programs. KTHN does a broad variety of other educational programming such as an ongoing child sexual abuse conference series, AIDS/HIV Update, bioterrorism response programs and many other topics.
Tell me what is going on with your program these days besides
training and providing daily consultations to the rural areas you serve?
We are launching a program to provide a unique psychotherapy service to hospice patients. This program helps the patient organize themselves and leaves a legacy for their family. It is a relatively new program called “Death with Dignity” and we are using inexpensive telehealth equipment that is installed in patient’s homes for the short duration of the therapy, and moved to the next patient after 2-5 clinical encounters. We are doing more correctional telemedicine at the federal and state level, and are expanding our work with the state department of Public Health to deal with the bioterrorism issue. We have also done some interesting work with POTS (Plain Old Telephone System) based videoconferencing. It has allowed us to expand clinical and educational services into places that normally could not afford traditional telemedicine or did not have access to high bandwidth communication lines required for such technology. We have expanded this technology into correctional facilities, state mental health hospitals, patient’s homes, nursing homes and other areas that previously could not benefit from telehealth.
What are the busiest clinical programs aimed at right now?
Dermatology, Infectious Disease, Radiation Medicine, Psychiatry
What else is going in Telemedicine in Kentucky ?
It is hard to name them all, but the most interesting are Correctional medicine, connectivity for pre/post op patients in the state’s facility for the most mentally retarded and the Death with Dignity project. Another exciting program is using POTS video systems for training our residents on psychotherapy from experts across the country who are shipped a small video system and can do the training from their desk. The unit is shipped around the country and many different presenters are used during the course of a semester.
What excites you the most about these projects? Do you have a favorite?
I am most excited about the pre-post op surgical applications at the state psychiatric facility. We are helping a population that is often ignored, and we are helping the nurses and physicians that dedicate themselves to those patients.
What about research?
We did much research on clinical and educational services. Everyone seems quite happy, so we have limited our research because telehealth is becoming more integrated into the medical practice. We occasionally have clinicians that wish to measure specific outcomes, but mostly we are collecting minimal quality assurance data. We have won national awards from the National Psychoanalytical Institute, APA and the international Ronald McDonald House Charities for our clinical and educational applications.
What is are you doing in the areas of Teleschool and Telehome?
Home telehealth has included ADHD assessment of children in their home environment with POTS videosystems. The new Death with Dignity program will be in the homes of Hospice patients. We have telehealth in public schools, delivering clinical and educational programming.
What do you want to do, and in what direction would you like
to see your program go?
I would like to see telehealth move to every desktop, and become as ubiquitous as the telephone, but we are a long way from that. I would like to see that system integrate medical informatics, including radiography, labs, patient history and all other pertinent healthcare information with the telemedicine system. Referring and consulting clinicians would have seamless access to all the patient’s information necessary to maximize the patient’s care. One day, networks will blend together with easy interfaces that will allow clinicians from different states to share information, and “centers of excellence” will emerge to provide clinical support to anyone in the country via telehealth systems. In the interim, we will continue to make the best of divergent systems, and slowly move to a fully integrated system.
A lot of our readers are psychologists and counselors. What
are you doing in this area, and what do you see developing?
We have weekly child psychiatry clinics to hospitals and public school clinics across the state. We also perform regular peer review and psychiatry Grand Rounds. At least 3 times/month, the network broadcasts Child Sexual Abuse conferences that help train mental health professionals about this devastating problem. UK’s psychiatry residency program supplements their teaching with a weekly 1 hour educational program from experts across the county via POTS video technology. We also provide psychiatry to a federal prison and a state juvenile justice facility.
After the earthquakes in India someone emailed an item about a Japanese medical team using a portable satellite dish and digital camera to take and send a picture of an injury from the site. This is along the lines of KISS. I am convinced that one of the most exciting areas in Telemedicine is the potential role it may have in international health care and disaster responses. Tell me about what you and KentuckeyTelehealth and Telemedicine Center are doing in this area since 9/11?
We have worked very closely with KY’s Department of Public Health. We delivered 2, 2-hour lectures on bioterrorism agents within ten days of the Anthrax attack. One program reached 23 sites and over 400 clinicians. We have also delivered thousands of contact hours of bioterrorism related educational programming since that time. We are developing a dermatology response network proposal to help provide clinical support to anywhere in the state, since many bioterrorism agents manifest themselves as dermatologic conditions, and there are very few dermatologists in the rural parts of the state.
Looking ahead 1, 5, and 10 years from now, where and what
do you see in Telemedicine?
The future of telemedicine is fully integrated health information networks that offer access to 2 way interactive video, still image store-and-forward as well as all medical records, radiography, labs and any info needed to make an informed medical decision. This system will be accessible to all clinicians and patients (maybe even insurance companies), with appropriate password or other security measures. But it will take a long time to migrate to that.
What can we do to continue to promote Telemedicine in the U.S.?
We have tried to market to the clinicians and medical executives with limited results. We must make the general public aware of telehealth and its great benefits to provide improved access, improved conveneience and the potential to speed up the time to diagnosis and treatment. Once patients demand telehealth, clinicians will be obligated to provide the service. This also holds true for payors who are reluctant to reimburse for telehealth activities. If patients, companies and other purchasers of healthcare demand coverage for telehealth activities, the market will dictate that payment for telehealth will follow.
David Balch from Eastern Carolina said that Telemedicine, as we know it will disappear, meaning it will be commonplace and web based. What do you see happening?
As stated earlier, yes, but it will take a long time to migrate to that. The ATA annual conference is one way to keep up with world of use the medium of email and the Internet more to keep our peers up to date such as what Jim Hutchinson did in Georgia.
What do you want to say or add to your colleagues out there? And what word of advice can you offer?
Telehealth programs should not work in a vacuum. We have much to share with one another, and we need to share our successes as well as our defeats so we can learn from each other and support each other’s efforts. There are a limited number of programs that are very open with one another, and some of my best friends are my peers across the country who run comparable telehealth programs. We must also band together to create a powerful advocacy group to address the problems faced by our industry. If we don’t, the industry, and our programs will die.
One last question? How will Kentucky do in basketball this
If defense wins championships, then we’ll see you in the final 4.
Bob Pyke Jr.