Winter-Spring 2004

Telemedicine in Hawaii

composite of Hawaii video conference center maps
This graphic is a composite of the maps found on the project web site, which includes a full listing with more detailed information about each video teleconference center.

The Hawaii Unified Telehealth (HUT) project aims to improve the health of underserved populations in the state by facilitating health education through distance learning and intergenerational peer education. In this project, funded by the National Telecommunications and Information Administration's Technology Opportunities Program, videoconferencing technology is the tool used to overcome geographic barriers to health care education in Hawaii.

Hawaii is anchored in the center of the Pacific Ocean and is one of the most isolated archipelagos in the world. The population is spread across seven main inhabited islands, with expensive and time-consuming air travel being the primary means of transportation. There are also cultural barriers, which result in poor health in numerous underserved and minority communities. Hawaii is among the most ethnically diverse of states, having no ethnic majority and therefore has diverse health care needs and demands. The primary care providers across Hawaii may practice traditional Hawaiian medicine, allopathic care, or eastern medicine, to name a few. Many minorities do not feel empowered to ask questions and get involved in their health education in traditional Western settings of medical clinics and hospitals.

Cultural and geographic barriers are being addressed through implementation of videoconferencing solutions within existing community learning centers. These centers are located within communities, in homes, shopping malls, and community colleges. The project, started in October of 2001 and funded for three years, has connected fifteen of these centers to statewide videoconferencing (VTC) systems and a network of 68 public videoconferencing sites altogether. People from geographically separated yet culturally similar communities are able to meet and share experiences.

Presently, there are few VTC units in rural areas available for public use. Furthermore, the digital networks that provide connectivity to rural areas utilize different VTC protocols, and do not interlink to each other well. The HUT project addresses these issues by expanding digital network connections to rural and underserved communities across the state, and by increasing connectivity between digital networks. Additionally, partnerships are being formed that allow broader access to VTC units already in place.

Project participants help develop culturally sensitive health information resources. Community learning centers already promote community-sponsored programs, which are made available locally. With the addition of videoconferencing, other similar communities are able to participate in these programs, sharing their enthusiasm, ideas, and their own programs. This project directly benefits ethnic minority groups such as Native Hawaiians and Pacific Islanders. Collaborating organizations include the University of Hawaii John A. Burns School of Medicine, Hawaii Area Health Education Center, Hawaii Department of Health, Hawaii Rural Health Association, Pacific Resources for Education and Learning, Hawaii Primary Care Association and affiliated community health centers, community learning centers and Native Hawaiian organizations. This project facilitates community-driven and culturally sensitive health education and serves as a model for enabling geographically distant communities to provide peer education and inspiration to each other.

To date, employees of the various 15 connected learning centers have received formal training in VTC use and a written certificate of verification of their training, a skill that enhances their personal marketability for future employment. Many sites have been used for videotelecommuting to classes, relieving these students from the financial and logistical burden of flying between islands to attend their classes. The equipment has also been used for counseling, departmental meetings of different community based groups, academic groups, and health care providers. At this time a new "Ask the Doctor" program is being initiated via VTC to bring medical specialists directly to interested community groups. A central coordinator is available to aid in scheduling and in trouble-shooting. Use of the equipment is monitored, and surveys are being collected to find what community members feel is most beneficial about the system and what needs improvement. Public health statistics are being analyzed to determine the impact of this technology on the health of the communities in which it is placed.

Collateral benefits of deploying these VTC units, with technical training and logistical support, include: legislative testimony from rural areas, administrative meeting facilitation, and enhanced visibility of the community learning centers within their community and among the various funding agencies and related support organizations.

A group at the Video Teleconferencing Medical Center in Hilo, Hawaii
A group at the Video Teleconferencing Medical Center in Hilo, Hawaii

Kelley Withy, M.D, is the director for the Pacific Basin Area Health Education Center (AHEC). She is the Principal Investigator for the HUT project and an Associate Professor of Family Practice and Community Health at University of Hawaii John A. Burns School of Medicine. Dr. Withy trains medical students and residents; her research is in medical education effectiveness, cultural competency and recruitment of students to health and science careers.

Joshua L. Jacobs, M.D, Assistant Professor at the University of Hawaii School of Medicine, has been involved in several projects in medical informatics and continues to serve as an attending physician in Family Practice at an outpatient facility, providing direct patient care services.

Shaun Berry, M.D., is currently the Video Teleconferencing Centers (VTC) Director for the Hawaii and Pacific Basic Area Health Education Centers (AHEC) at the John A. Burns School of Medicine, University of Hawaii. Dr. Berry is also pursuing projects in smoking cessation and safe sun exposure in children.


I enjoyed this article. My partners and I are involved in a computer center and have been working with Recycle Hawai'i and the County of Hawai'i regarding e-waste concerns. We have had the opportunity to refurbish some computers and are in the process of placing them into community gyms or parks to allow them to serve the youth. We will offer some free training to the youth and the director so that they can improve their computer skills. These gyms are in underserved communities, which made me think that maybe we can partner and offer your health conferences via the internet. Please respond.

Barbara Radford

Posted by: Barbara Radford at April 28, 2004 11:32 PM
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