Maternal telehealth: innovations and Hawai'i perspectives.

Access to maternal-fetal medicine (MFM) subspecialty services is a critical part of a healthcare system that optimizes pregnancy outcomes for women with complex medical and obstetrical disorders. Healthcare services in the State of Hawai'i consist of a complicated patchwork of independently run community health clinics and hospital systems which are difficult for many pregnant patients to navigate. Maternal telehealth services have been identified as a solution to increase access to subspecialty prenatal services for women in rural communities or neighboring islands, especially during the COVID-19 pandemic. Telehealth innovations have been rapidly developing in the areas of remote ultrasound, hypertension management, diabetes management, and fetal monitoring. This report describes how telehealth innovations are being introduced by MFM specialists to optimize care for a unique population of high-risk patients in a remote area of the world such as Hawai'i, as well as review currently available telemedicine technologies and future innovations.

Integrating family and friend support, information technology, and diabetes education in community-centric diabetes self-management.

OBJECTIVE: Diabetes self-management (DSM) education, social support, and information technology interventions can improve patient engagement and health. A major challenge is animating, integrating, and accessing resources in under-resourced, rural communities. Set in an island community in Hawai'i, this study piloted a program that integrated friend-and-family support, community health services, telehealth-enabled DSM education, and mobile technologies by activating the community's social capital to support the program. MATERIALS AND METHODS: An action research approach informed the design and implementation of a community-based DSM program that included: friends and family support, telehealth classes, personalized consultations, Bluetooth-enabled blood glucose monitors, and text messaging support. Outcomes were evaluated using biometric data, surveys, interviews, and participant observations. RESULTS: The study spanned 9 months with 7 dyads, each with 1 individual with type 2 diabetes and a friend or family member. Six of the 7 participants with diabetes experienced reduced hemoglobin A1c percentages, with 3 reducing by more than 1%. The seventh participant maintained a hemoglobin A1c level within American Diabetes Association recommended ranges. DSM knowledge and self-care behaviors improved overall. Interviews and participant observations highlighted program strengths and social challenges associated with the interpersonal relationships between the members of the dyads. CONCLUSIONS: A community-centric diabetes program can enhance understanding of diabetes etiology, DSM activities, and communication skills for effective disease management support in under-resourced rural communities. Social capital among community members, leveraged with health information technology, can catalyze and integrate limited health system resources for DSM and social support as a cost-effective strategy to develop community-centric chronic healthcare management initiatives.

Exploring Key Elements for Successful Telehealth Implementation Within Severely Under-Resourced Communities: A Case Study in the Pacific Islands.

The intent of this paper is to identify and provide insight on key enablers for successful implementation of telehealth services in severely under-resourced and rural populations. The case study presented is in the context of the U.S. Affiliated Pacific Islands that represent resilient and innovative communities who face many challenges of isolation, tiny populations, and developing economies. Long-standing telecommunication hindrances and lack of supporting resources are fundamental barriers to telehealth advancement. New undersea fiber optic developments present opportunities for reliable connectivity needed for telehealth applications. This paper reviews the emergence of telehealth champions in the region and reviews key elements that contribute to rapid and successful implementation of telehealth applications and services.

Health Information Technology and Telehealth Challenges in the U.S. Affiliated Pacific Islands Region.

Small island developing states (SIDS) have much to gain from the use of Health Information Technology (HIT) and telehealth to improve care, improve population health, increase access to care, and lessen costs. At the same time, planning, implementing, and operationalizing HIT is costly and requires significant technical, human, financial and planning resource infrastructure to support implementation and operations. This paper provides a broad overview of how HIT and telehealth has evolved in the U.S. Affiliated Pacific Islands (USAPI) SIDS, the progress that has been achieved, the role of political affiliations and international assistance, and the many challenges that remain. The paper highlights the differences in treatment between the territories and the nations affiliated with the United States through the Compacts of Free Association (COFA), and the important roles of other donor countries, regional, and international organizations. The paper also raises questions of how advances in HIT and telehealth can be further achieved and sustained in the USAPIs. Finally, the paper identifies the need for the building of knowledge and skills to develop careful plans so pitfalls of silos, proprietary systems, and inadequate technical support can be lessened or avoided in the grand challenge of adoption and maturing of HIT and telehealth.

Pacific Association for Clinical Training: e-learning telecommunication infrastructure assessment in the U.S.-Affiliated Pacific Islands.

This article summarizes the key points of a technology and telecommunications infrastructure assessment conducted by the University of Hawai'i Telecommunications and Information Policy Group (TIPG) in partnership with the Pacific Association for Clinical Training (PACT). It includes an overview of telecommunications infrastructure and services in the U.S.-Affiliated Pacific Islands (USAPI) jurisdictions. The objective is to review the technical capacity, in the USAPI, to support PACT e-learning programs and activities. Telecommunication infrastructure is fundamental for successful and sustainable e-Learning programs. This article outlines the capabilities that may be available for multipurpose uses including health, education, research and other public service applications.

ICT capacity and human resource development in Island economies.

There is significant potential for Information Communication Technology (ICT) to play a major role in assisting economic and social development. However the technology, infrastructure, plans, and policies must be sustained and supported by people that have ICT skills, knowledge, and abilities. There are many facets in ICT capacity development in Island economies that this paper will touch upon: What are the best strategies for a country to develop a robust ICT skilled workforce at all levels which include the user, operator, administrator, and policy maker? What level of ICT education and training is needed? What are some of the challenges in delivering ICT education and training programs? What are some strategies for the design, development, and delivery of these programs? What are some examples of ICT capacity development programs in the Pacific Islands region?

A pilot evaluation of distance education modalities for health workers in the U.S.-Affiliated Pacific Islands.

BACKGROUND: Healthcare workers in many parts of the U.S.-Affiliated Pacific Islands (USAPI) have limited access to continuing education. Barriers to traditional on-site continuing education programs include the diversity of educational needs, limited health staffing, the distances between islands and associated high travel costs. A pilot evaluation of distance education modalities was conducted among USAPI healthcare workers. METHODS: Three distance education modalities (live videoconference, live audioconference and a recorded computer-based format) were evaluated in comparison to live lecture during two separate half-day educational programs in Pohnpei, Federated States of Micronesia, in June 2004. Participants from the USAPI included 59 nurses, doctors, dentists and other healthcare workers who were assigned to different educational modalities for two training modules (diabetes/oral health and metabolic syndrome). We conducted pre-and post-tests and obtained participant feedback. RESULTS: Comparison of pre-test and post-test scores showed statistically significant score increases among the live lecture and videoconference group for the diabetes/oral health module and among all three distance education modalities for the metabolic syndrome module. Participants expressed a high degree of interest in each of the distance education modalities. Computer-based training was well-accepted even by health workers with little prior computer experience. CONCLUSIONS: This pilot study validates the ongoing development and evaluation of distance education resources as part of a comprehensive approach to improving continuing education in the USAPI. The results have been used to guide continuing education efforts in the region.