An interview with Jana Lindsey, RN
Telemedicine Coordinator, Shriners Hospital, Hawaii.
by Robert Pyke
Pyke, R. (October, 2004). Editorial: An interview with Jana Lindsey, RN, Telemedicine Coordinator, Shriners Hospital, Hawaii, Vol. 8, No. 3 [Online]. Available at http://ojni.org/8_3/jana.htm
If I mention the word Shriners, what comes to mind? Grown men wearing their Fez hats and riding their mini bikes or Harleys in a parade doing figure eights?
Or do you think of the famous Shrine circus and the famed Shriners clowns?
Or do you think of the Shriners healthcare system, with 26 hospitals that has provided countless numbers of children with access to burn and orthopedic care?
Or do you think of an active telemedicine program?
Although all of the above are true, I really want to explore with you telemedicine at Shriners!
Jana, Aloha, First of all tell me a little about your self?
I am a registered nurse certified in Medical-Surgical Nursing and Case Management, and the Telemedicine Coordinator for Shriners Hospitals for Children, Honolulu. Coordinator of the Telemedicine Program since its inception in 1999, Ms. Lindsey has traveled to Micronesia to facilitate the use of telemedicine by providing workshops/presentations, and coordinating telemedicine clinics between Shriners Hospitals and its outreach population in the Pacific Basin Region. I have worked with the Department of Health ( Hawaii, Micronesia, and Polynesia), Tripler Army Medical Center, Hawaii Army National Guard, and various hospitals and healthcare organizations by providing and coordinating educational opportunities and administrative meetings for healthcare providers and the communities in these regions.
I have has been a member of the American Telemedicine Association since 2000 and is the Chair of the PICATA (Pacific Islands Chapter of the American Telemedicine Association). Her goal and personal passion is to promote and facilitate telemedicine in the Pacific Basin Region, which will enhance the provision of healthcare and education in these underserved areas.
Tell me about how you became involved at Shriners?
A colleague and classmate of mine who worked at Shriners notified me about a position that involved computers. I was a home care nurse at the time and there wasn’t enough work for me to keep busy. I took a half-time position at Shriners in Outcome Management (known as COMPlans at Shriners) and another half-time position working in their Outpatient Clinic. When the Outpatient Clinic Manager resigned, I got hired to fill this position, which included coordinating the and running the outreach clinics on the neighboring islands.
How did you become involved in telemedicine?
Shriners was advertising for a telemedicine coordinator, and not knowing what this was, I began surfing the Internet and found that this was an exciting career. Having the past of experience of managing the Outpatient Clinics, coordinating and operating the Outreach clinics, and having knowledge of the Shriners policies and procedures, it gave me an edge to getting the position.
Can you tell me a little of the history of telemedicine at Shriners?
The Shriners Hospitals for Children, Honolulu’s (SHCH) patient population is the State of Hawaii and islands in the Pacific Basin Region. To reach out to these children, the SHCH conducts Outreach Clinics to the neighboring islands of Hawaii 2 to 3 times a year and once or twice a year to the Micronesian islands (Guam, Common Northern Marianas Islands, Republic of Palau, Chuuk, Yap, Kosrae, Pohnpei, and Republic of Majuro) and Polynesia (American Samoa, Western Samoa, and Fiji).
In 1998, the Harry and Jeanette Weinberg Foundation offered Shriners Hospitals for Children, Honolulu a generous grant to start up a Telemedicine Program.
With the Telemedicine Program we were able to be reach out more frequently to the remote sites and also be more accessible to others. At this same time, Shriners Hospitals in Intermountain was piloting their Telemedicine Program. Intermountain’s Chief of Staff got promoted to the Director of Medical Affairs at the Shriners Headquarters and the Chairman of the Board being a strong advocate in technology advanced telemedicine further within the Shriners Hospitals system.
Telemedicine consultations have transpired with sites in Guam, Common Northern Mariana Islands/Saipan, American Samoa, Federated States of Micronesia (Chuuk and Kosrae), and the Republic of the Marshall Islands (Majuro). During these Telemedicine encounters, SHCH’s orthopaedic surgeon is a consultant to the island’s local physician who is presenting the patient. Screening of new potential patients, follow-ups on post surgical patients, and pre-admissions assessment for appropriateness and coordination have been successful using the telemedicine technology.
With Corporate support and the success of the Programs in Honolulu and Intermountain, the Telemedicine Program became permanent.
What services do you provide through the telemedicine program at Shriners at this time?
The Shriners Hospital, Honolulu provides Pediatric Orthopaedic teleconsultations and distance educational opportunities.
Do you have a favorite one or one you're really involved in?
The Telemedicine clinics with American Samoa has been the most active. I believe this is due to multiple reasons. The bandwidth is sufficient with few technical glitches; therefore the quality of the transmission is good. I believe that the most important reason that American Samoa is our most active clinic is that Shriners has a great interpersonal relationship with the orthopaedic surgeon and liaison in American Samoa.
Can you tell me about the demographics of your program who do you serve, the number of patients you serve and from where?
The Shriners Honolulu Hospital the area of service is the Pacific Basin region which includes the State of Hawaii, Guam, and Common Wealth of Northern Mariana Islands, Federated States of Micronesia (Kosrae, Pohnpei, Yap, Chuuk), the Republic of the Marshall Islands, the Republic of Palau, American Samoa, Western Samoa, and Fiji. Since the hospital opened in 1923, we have serviced over 22,000 children in our catchment area.
Tell me a little about the hardware and software your using?
We started off with a PictureTel Concorde 4500 with a document camera, general hand held examination camera, an electronic otoscope, an electronic ophthalmoscope, and stethoscopes. The PictureTel unit blew out, and we’ve replaced it with a Tandberg 2500. We’ve only use the document camera and general hand-held examination camera. As a pediatric orthopaedic hospital, we found no or little use for the other peripheral devices. We don’t use any particular software packet other than what comes with our Tandberg 2500 unit.
Who are your medical director and what are his interests and what is he doing in telemedicine?
Craig Ono, MD is the Director of Telemedicine. He is an orthopaedic surgeon and a COL in the Army Reserves. He believes in the program and is convinced of the benefits this technology has provided in healthcare and education. Dr. Ono is an advocate of telemedicine/Telehealth.
What else are you doing in telemedicine as far as distance education grand rounds and CME?
Shriners Medical Staff presentations for the orthopaedic residents are now being video teleconferenced to the hospital where the residents are during the time of our conference. In the past the residents weren’t attending the lectures. We’ve learned that the reason for the poor attendance was because it was inconvenient for them to rush over from one hospital to the next for 45 minutes to listen to a lecture, then have the hassled of finding parking on return. Since we’ve been video teleconferencing the presentations to them, more residents have been attending. In addition to video teleconferencing our Medical Staff presentations, I pull together video teleconferencing presentations from other hospitals and compiled them into a monthly calendar. This then is sent out to Shriners staff, contributors to the calendar, distance educations, public health and healthcare professionals, etc. Shriner’s staff now has opportunities available to them right in our own hospital. Since I’ve been working with the Department of Health, and other organizations such as the Environmental Protection Agency and Center for Disease Control, these programs are also available to the Shriners staff and others out in the Pacific Basin.
What research is the telemedicine program involved with?
Shriners have been collecting information on satisfaction surveys from the consultants, the patient/family, the facilitators, and the operational/technical aspect.
How is your program funded?
The program started up with a Harry and Jeanette Weinberg Grant. This grant was seed money to purchase the equipment necessary to start a telemedicine program. The telemedicine program was a grant program to last only for 18 months. After that the 18 months was exhausted, Shriners realized its value to the hospital and the community. Now the Telemedicine Program is fully funded by the Shriners Hospital.
Where would you like the program to be going?
In 1 year? I am currently expanding the program to reach all the islands in the Shriners Hospitals, Honolulu catchment, and have regularly scheduled telemedicine clinics. The telemedicine clinics have been on “as needed” bases, and getting a remote presenter has been a challenge. We have put into next years budget for travel to the outer island of the State of Hawaii so I can be the remote presenter for our orthopaedic surgeon in Honolulu. Although this doesn’t completely eliminate travel (because I would still have to fly to the patient’s location), this is just a baby step. It is a lot cheaper and more efficient use of time for me to travel, than it would be for the surgeon to go, or for 5 to 10 children to come over with their escort.
In 5 years? Within 5 years, I am hoping that the families and the local healthcare providers will get comfortable with the process. The next step would be to contact/employ a remote site presenter locally to facilitate the telemedicine consults to eliminate travel. I would also like to see consults requested and coordinated by the remote sites instead of Shriners being the initiator of all the clinics.
10 years? Not sure. It depends how far we get.
David Balch, who recently retired form the telemedicine center at Eastern Carolina old me that he thought telemedicine as we know it would disappear, that would be so common on our desk top, that we take telemedicine for granted, what do you think?
Dr. Balch has a lot of experience and insight. He has been involved with Telemedicine for quite sometime now, and I see him as one of my mentors. He’s right. Patient’s calls to their physicians for medical advice, or emergent calls placed to 911 dispatchers is a form of telemedicine we take it for granted. Telemedicine is just another tool to deliver patient care, and soon the novelty of it will pass.
How can we continue to support and continue to grow telemedicine programs?
The way we can support and advance telemedicine is through educating and assisting other programs. I believe that telemedicine isn’t advancing because of people’s fear of the unknown. The only way to conquer the unknown is to make it known.
If you had the opportunity to tell you peers about telemedicine what would you say to them now?
If you’re in telemedicine for the money, your heart will eventually be revealed. I could make more money as a nurse, but my passion is to help on a larger scale, to reach out and minimize disparities. Everyone is entitled to a life that provides them the opportunity to reach their highest potential, and not restricted by barriers.
Always keep an open mind instead of putting up more barriers of our limited thinking, stating that it can’t be done. If it is something you believe in, ask yourself how you can make it happen. Don’t give up. It is just a matter of being the right time and finding the right way. Don’t be afraid to get out there and network to build a human infrastructure. I believe in the power of synergy.
What's next for Jana in telemedicine?
I don’t have a game plan. Although I like to plan everything I get involved with, I tend to go with the flow and adjust accordingly. If something doesn’t work, I try something else. Currently, my radar is tuned on finding a way to get everyone involved with some form of telemedicine. For the Pacific, I would like to see telemedicine develop in the areas of HomeCare, advocacy groups, corrections, and education. I would like to gain the support of the insurers and the policy makers to advance telemedicine.
Is there anything you want to do?
I’ve had very good mentors. Many of them have started from the ground up. One thing I’ve noticed is that most people heading the telemedicine programs are very creative and enjoy their work. This is a fun career. I don’t like to refer to it as my “job” because I have fun playing with all these technical toys and meeting and working with all kinds of interesting and caring people.
Jana, thanks for you time, I wish you continued success!
You can contact Jana at
Honolulu Shriners Hospital
1310 Punahou St .
Honolulu , HI 96826-1099
Phone: (808) 941-4466
Toll Free: 1-888-888-6314
Fax: (808) 942-8573