, Heritage writer
If you can’t easily get patients to a clinic, what do you do?
Take the clinic to the patients.
This year, a Kaiser Permanente grant to the Healthy Smiles Mobile Dental Foundation in Fresno, California, paid for a brand-new recreational vehicle that’s been transformed into a dental clinic on wheels, complete with exam space, X-ray machines, and dental equipment. Several hygienists and dentists work inside the clinic, cleaning children’s teeth, and filling cavities.
It’s a model that’s been researched in the medical literature — and, because of long history in mobile medicine, we know that it works.
Early innovations in mobile medicine
In the early 1970s, Kaiser Permanente undertook several projects to test the feasibility of mobile health vans to serve underrepresented communities. One was rural, one was urban.
The rural example was “STARPAHC” — short for Space Technology Applied to Rural Papago Advanced Health Care. Kaiser Permanente and NASA partnered with Arizona’s Papago Indian Reservation to test the practicality of the emerging field of telemedicine. The project used the real needs of a remote earth-bound population to see how technology and routines could work when providing health care for astronauts in outer space.
And in very urban Oakland, California, Kaiser Foundation School of Nursing student members of Kaiser Black Student Nurses’ Association served on a mobile Foot Health Clinic in 1972.
Our medical care keeps moving
In 1988, Kaiser Permanente launched a Mobile Health Education and Screening Program in the Kansas City area. The 25-foot mobile van traveled to Kaiser Permanente medical offices as well as community organizations, local businesses, and public health fairs, where staff checked blood pressure and cholesterol levels, gave lifestyle assessment quizzes, and provided educational materials on a variety of health topics.
In Southern California, Kaiser Permanente had a similar program that operated out of a 38-foot Wellness Care-A-Van. It traveled as far north as Bakersfield and as far south as San Diego, reaching out to people in their communities, testing blood pressure and body fat. Frayne Rosenfield, Member Health Education administrator and Worksite Wellness Program coordinator, was enthusiastic about the service: “The van has been very well received. We see approximately 120 people a day, and the van is out 5 to 7 days a week.”
Kaiser Permanente also used the mobile van model for immunization drives in the 1990s.
Kaiser Permanente’s 2001 Annual Report profiled a mobile bone-scan van used in the Mid-Atlantic states (complete with custom Maryland license plate “KPBONES”) to help members prevent and treat osteoporosis. It was staffed by Stephen Moki, radiology technologist and health educator, and Pat Brown, clinical assistant.
The Scan Van rotated among several Kaiser Permanente medical centers, spending 1 to 3 weeks at each facility before moving on. It proved to be a valuable outreach tool, and community organizations frequently called to request a visit from the van. Michael J. Moriarty, MD, vice president and associate medical director of Quality and Health Management, said, “I think that it helps to affirm our image as an innovator and a quality health care provider.”
Mobile health vans are in our future
In 2009, Kaiser Permanente in Hawaii celebrated the arrival of a mobile health vehicle. The 500-square-foot, 10-wheeled rolling clinic was fully wired, equipped with our electronic health record system, a digital mammography unit, and video telemedicine capability.
The vehicle was designed to roam the Big Island, providing glucose and cholesterol screenings, mammograms, urinalysis, testing for sexually transmitted diseases, and vaccinations for the flu and pneumonia.
Billy Kenoi, the mayor of Hawaii County, praised the service when it was formally blessed July 2.
“I come from a 48,028 square mile island with incredible geographical and infrastructure challenges,” Kenoi said, “and the delivery of this Mobile Health Vehicle will improve not only the health care available on the island of Hawaii, but ultimately, the quality of life for our island residents.”
The use of mobile health vans is now integrated into our health plan, visiting urban worksites and rural communities and saving members time and travel for many of their medical needs.
As Frayne Rosenfield said in 1988, “The van is out 5 to 7 days a week.”
That’s about as accessible as health care can get.
Also see: “Driver as Receptionist? Kern County union and management leaders work out innovative solution” to optimize mobile health van driver workload.
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, Heritage writer
How do you handle medical testing and care in a remote location? A really, really remote location – such as outer space?
This was one of the challenges that the National Aeronautics and Space Administration faced in the early 1970s – and it got help from one of our founding physicians and Kaiser Permanente, through what was then the Kaiser Foundation International[i] program.
“KFI to Help Develop NASA-Sponsored Health System”
Kaiser Permanente newsletter, August 9, 1972
Kaiser Foundation International became a major ($1.8 million) subcontractor to the Lockheed Missiles and Space Company to help design, develop and test a ground based remote health care delivery system.
The ground-based test unit will be installed at a sparsely populated site on earth to provide medical care to local residents. Trained physicians’ assistants will employ the unit to transmit medical information on residents of the area to physicians at an established facility many miles from the remote site. If the test program is successful, it may provide system technology to improve health care and medical services to remote areas on earth. Part of a four year NASA sponsored program, this concept, as applied to a remote area on earth, will be evaluated by NASA for possible use in advanced, long-duration, manned space missions.
The back story is that in late 1970 Morris Collen, MD, attended a Northeast Electronics Research and Engineering Meeting in Boston that included a session on medical electronics. At that conference he served on a panel with Dr. Walton Jones, Director of Biotechnology and Human Research at NASA.
Kaiser Permanente’s Dr. Collen, in addition to being a brilliant physician in the Kaiser Richmond shipyards during World War II, was also an electrical engineer and considered one of the fathers of the field of medical informatics. He pioneered the use of the “multiphasic” examination, a battery of prescriptive medical tests for incoming health plan members, which later became the Automated Multiphasic Health Test.
By late 1971 J.P. Nash, the assistant general manager of Lockheed, told Dan Scannell, Kaiser Permanente’s director of public relations, some exciting news:
“Very shortly NASA is expected to solicit proposals for the design, development and testing of a Test Bed System for an Area Health Services Field Unit. This requirement has grown out of a NASA program for which [Lockheed] has been under contract for about four years called Integrated Medical and Behavior Laboratory Measurements System. IMBLMS is a four-phase program leading to the development and operation of a space flight biomedical laboratory, for research experiment in long-duration manned space flight in post-Apollo programs . . .”
On Jan. 4, 1972, Dr. Collen wrote to Sam L. Pool, MD, at the NASA Manned Spacecraft Center in Houston:
“Of special interest to us . . . would be the development of a completely automated self-administered multiphasic health testing laboratory in which a person in space could perform everything himself, utilizing automated equipment which enters the data into the computer which is programmed to provide advice and instructions. We believe that it is now technically feasible to develop such a prototype and with our experience we estimate such could be done within two to three years at a reasonable cost.”
The project, as noted in the 1972 news story, would use a “sparsely populated site on earth” to test equipment, systems, and personnel. That location would be the Papago Indian Reservation [now known as the Tohono O’odham Indian Nation] in southwest Arizona, with the catchy space-age title “Space Technology Applied to Rural Papago Advanced Health Care,” known as STARPAHC. Lockheed issued a summary report in June 1974 that explained the “Part 1 – Design and Definition” of the project:
STARPAHC will prototype a ground-based demonstration of IMBLMS space technology with two primary program objectives: (1) to obtain data for application to future spacecraft design and (2) to improve health care delivery through application of space technology. STARPAHC is designed to improve the capability for delivering health care to the Papago Indians located on the Papago Indian Reservation in southwest Arizona.
The STARPAHC operational concept was based on utilizing the professional staff of the Sells Hospital, where the Health Services Support Control Center will be located, to provide direction and consultation to paramedical and technical personnel stationed at the remote clinics, Local Health Services Center, and the Mobile Health Unit. The interchange of information between the HSSCC, LHSC, and MHU will be accomplished by voice, data, and video communication links. Computer-based data management techniques will implement record keeping, data retrieval, and data analysis.
STARPAHC ended in 1977, and resulted in several advances in the nascent field of telemedicine. A 1979 article in Medical Care interviewed 47 individual care providers in the program, and concluded that the major problems were the unreliability of equipment and the time required for television consultations. The major benefit cited was improved access to health care for a population not previously receiving such care near their homes. Another positive outcome noted by non-physician providers was the linkage to physicians via television and voice communications from remote areas.
In 2001 the Arizona Health Sciences Library acquired important archival materials documenting the STARPAHC project and established the Arizona Archive of Telemedicine.
Telemedicine – terrestrial and beyond – has evolved considerably since the early 1970s. In 1980 Dr. Collen would serve as a member of the NASA Workshop on Space Shuttle Studies. And Kaiser Permanente is as deeply committed to exploring its applications now as it was when the field was brand new.
[i] In 1964 Kaiser Industries established the not-for-profit Kaiser Foundation International to administer foreign medical care programs. With Kaiser Permanente’s reputation on the rise, requests for consulting help started to come from places where Kaiser Industries didn’t already have a presence. Between 1964 and 1969, the international group was engaged for medical care projects in 15 African countries. When it closed down in 1975, KFI had been hired and paid for projects in 30 countries around the globe, including rural locations in California, Utah, and West Virginia. KFI was replaced by Kaiser Permanente International in 1996. Today KPI is a self-supporting subsidiary that offers educational programs about the Kaiser Permanente model and provides speakers at international conferences.
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