Access to specialized medical expertise is economically challenging due to the island’s remoteness and its limited fulltime population. Telemedicine - the remote delivery of certain healthcare services, such as specialized assessments or consultations, over the telecommunications infrastructure – is seen as one way to bridge medical care gaps and distance for St. John. In 2009, telemedicine was introduced on St. John at the Myrah Keating Clinic through a partnership with Cleveland Clinic Florida in Weston, Florida.

The project was funded by a local philanthropist and St. John Rotary for three years. At the end of the three years, funding was then transferred to the Department of Health. The department was unable to justify the monthly payments, and the contract with Cleveland Clinic expired February 21st, 2013, at which point the leased equipment was returned to Florida. In its final year, there were 90 visits to the clinic that involved using the telemedicine link. When St. John set up its telemedicine link with the Cleveland Clinic in 2009, telemedicine was very much in its infancy. In a 2013 interview with The St. Thomas Source, the Myrah Keating Director noted that the majority of patients who would have benefitted most from the telemedicine link had medical issues which required bloodwork, something not possible to perform and analyze at the time through telemedicine. Through developments as recent as 2017, “digital diagnostics” technology now makes this possible. If St. John were to implement a new and improved telemedicine program utilizing digital diagnostics, residents and visitors could again be on the cutting edge of medical technology but this time likely could utilize it in a more beneficial way. Great strides have also been made in the capabilities of mental telehealth since 2009, and integrating this as a component of a telemedicine program on St. John could be a key way to increase and improve mental health options available on the island. This would increase the value of the investment that will be required to initiate and maintain the systems.

IMPLEMENTATION STEPS: 1. Create a project committee charged with researching telemedicine providers and resources and which providers and services could be made available on St. John. The Cleveland Clinic is a good starting point, since it already has a history with telemedicine on St. John 2. Inventory existing equipment to see what can be reused and what needs to be replaced. For instance, a T1 line was previously installed at the clinic 3. Seek outside funding for telehealth and telemedicine services on St. John and determine a method to create a sustainable funding stream to allow the project to continue indefinitely and to update its technology as needed

Key Players: Dept. of Health; Schneider Regional Medical Center; Medical Providers Alignment: IS, HHS RSFs Cost: > $500,000 Timeline: < One - Three Years