First of all, please tell me a little about yourself.

I am a registered nurse certified in Medical-Surgical Nursing and Case Management, and I've been the Telemedicine Coordinator for Shriners Hospitals for Children in Honolulu (SHCS) since its inception in 1999. I've traveled to Micronesia to facilitate the use of telemedicine by providing workshops and presentations, and I'm 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 been a member of the American Telemedicine Association since 2000 and I'm the Chair of the PICATA (Pacific Islands Chapter of the American Telemedicine Association). My 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.

How did you become involved with Shriners Hospital?

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 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 on getting the position.

What is the history of telemedicine at Shriners Hospital and how is your program funded?

In 1998, the Harry and Jeanette Weinberg Foundation offered Shriners Hospitals for Children, Honolulu a generous grant to start up a Telemedicine Program. This grant was seed money to purchase the equipment necessary to start a telemedicine program. With the Telemedicine Program we were able to reach out more frequently to the remote sites and also be more accessible to others.

Telemedicine consultations 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 consulted with the island's local physician. Screening of new potential patients, follow-ups on post surgical patients, and pre-admissions assessment for appropriateness and coordination were found to be successful using the telemedicine technology.

At this same time, Shriners Hospitals in Intermountain was piloting their own Telemedicine Program, and Intermountain's Chief of Staff got promoted to the Director of Medical Affairs at the Shriners Headquarters, which helped promote technology throughout the system. Also, the Chairman of the Board was a strong advocate for technology and advanced telemedicine further within the Shriners Hospitals system.

The original grant program was only to last for 18 months. After that the 18 months was exhausted, Shriners realized the value of the program to the hospital and the community. With corporate support and the success of the programs in Honolulu and Intermountain, the Telemedicine Program became permanent and is now fully funded by the Shriners Hospital.

What patient populations do you serve and what services are provided through the SHCH telemedicine program?

The SHCH provides pediatric orthopaedic teleconsultations and distance educational opportunities to patients in 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 two to three 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).

Which SHCH telemedicine program is most active?

The Telemedicine clinics with American Samoa have 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.

What hardware and software you are using in the Telemedicine Program?

We started off with a PictureTel Concorde 4500 with a document camera, a general hand-held examination camera, an electronic otoscope, an electronic ophthalmoscope, and stethoscopes. The PictureTel unit failed, and we've replaced it with a Tandberg 2500. We really 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 is your medical director and what are his interests in telemedicine?

Craig Ono, MD is the Director of Telemedicine. He is an orthopaedic surgeon and a Colonel in the Army Reserves. Dr. Ono is an advocate of telemedicine/telehealth. He believes in the program and is convinced of the benefits this technology has provided in healthcare and education.

What else are you doing in telemedicine concerning 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, and then have the hassle 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 compile them into a monthly calendar. This then is sent out to Shriners staff, contributors to the calendar, distance educators, public health and healthcare professionals, etc. Shriner's staff members now have opportunities available to them right in their 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 others in the Pacific Basin.

What research is the telemedicine program involved with?

Shriners has been collecting information on satisfaction surveys from the consultants, the patient/family, the facilitators, and the operational/technical support teams.

Where would you like the program to go in the future?

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 an "as needed" basis, 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.

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.

What's next for you 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.

How can we continue to support and advance 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.

David Balch, who recently retired from the Advanced Telemedicine Training Center at Eastern Carolina University, told me that he thought telemedicine as we know it would disappear, and that telemedicine would become so common on our desktop that we take it 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 calls to their physicians for medical advice, or emergency calls placed to 911 dispatchers are forms of telemedicine we take for granted. Telemedicine is just another tool to deliver patient care, and soon the novelty of it will pass.

If you had the opportunity to tell you peers about telemedicine what would you say to them?

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 is 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 in 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.

Is there anything else you would like to add?

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.