Our Health in Our Hands, Tribal Telehealth Care

March 12, 2019

For years, Alaska Native people sought to manage their own Tribal health care system. When the Alaska Native Tribal Health Consortium formed, that goal had been reached, and the work was just beginning. With Tribal health care in Alaska no longer directed by Indian Health Service administrators in Maryland, ANTHC had the flexibility to manage services that would enable Alaska Native people to chart their own course to good health.

“We knew if we had that authority, we could move in a more agile way,” said Roald Helgesen, a Tribal health care leader from Sitka who was named CEO of ANTHC in 2011.

From the beginning, ANTHC’s leaders prioritized a proactive approach to health and health care, in ways designed specifically for Alaska Native people and the communities where they live.

The telehealth initiative grew out of a 1997 partnership between the University of Alaska Anchorage and the Alaska Native Health Board. Called the Village Telemedicine Project, this early tech venture deployed telemedicine equipment to four regional hospitals and 20 village clinics, providing for the first time a regular connection between rural patients and medical specialists.

Tribal health organizations asked for connections in more communities.

“A lot of our village clinics didn’t have computers,” said Chief Information Officer Stewart Ferguson, who continues to lead ANTHC’s telemedicine program today. “We didn’t have connectivity. It was very, very nascent. But clearly people saw the value.”

Buoyed by this initial success, the Alaska Federal Health Care Partnership sought and received Congressional funding to build a telehealth system that would be used throughout the Tribal health care network and at remote locations. ANTHC eventually took on management of the collaborative, inter-agency project.

When the telemedicine program went live in 2001, dial-up internet was the best that could be hoped for in many rural communities. Live videoconferencing simply wasn’t an option. So Ferguson and his team pioneered an asynchronous approach called “store and forward.” Images and information were digitally packaged and sent like an email to providers who could then remotely review and prescribe treatment for each case. The project also included custom workstations designed to take up no more than 4 square feet of clinic space, with touch screens (ubiquitous today, but rare at the time) and a user interface designed to be easy for community health aides to operate even with limited computer literacy.

“The adoption was quite fast,” Ferguson said. “By 2003, we had the equipment out to 248 sites.”

As connectivity improved, the system expanded to include real-time videoconferencing along with store and forward. Initially used primarily for otology and cardiology, today the telemedicine system is used across multiple specialties. Double-blind studies have established its accuracy and efficacy. Now that more villages are getting broadband, Ferguson said he expects telehealth to reach even further into both clinics and homes, with expanded options for behavioral health, palliative care, post-discharge support for NICU babies and their families, and even trauma care.

While Alaska’s Tribal health care system addresses today’s health matters, it’s actively trying to prepare for what may be on the horizon. ANTHC’s Clinical and Research Services program studies issues, trends, and questions that impact the health of Alaska Native people. Recently, Helgesen said, the Consortium has been looking closely at adverse childhood experiences. Alaska Native people are more likely to experience the social factors that are increasingly linked to negative health outcomes in adulthood. More and more, research indicates that community and culture can have a meaningful impact on physical and behavioral health.