AcuteCare Telemedicine Blog

Will Telemedicine Reduce the Wait at Hospital Emergency Rooms?

Waiting times at hospital emergency rooms has long been a problem.  Originally established to treat patients with injuries and illnesses in cases of extreme emergency treatment needs, todays hospital emergency facilities are packed with patients seeking treatment for every ailment from the common flu, minor cuts, sprains, strains, to severe injuries and illnesses.  As a result anyone who has ever had the misfortune to need to visit a hospital emergency room is well experienced in the art of waiting for treatment, in some cases, many long hours.

For years hospitals have attempted to stem the unrelenting flow of patients by diverting them to physician’s offices and off-site medical clinics and triage centers, still others post estimated waiting times on billboards and electronic signage located outside the hospital entrances.  The waiting goes on unabated.

To address this issue, a pilot study has been launched at UC San Diego Health System’s Emergency Department (ED) to use telemedicine as a way to help address crowding and decrease patient wait times.  The study is the first of its kind in California to use cameras to bring on-call doctors who are outside of the hospital to the patient in need.  The study, called Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency (EDTITRATE), brings telemedicine doctors to patients when the ED becomes busy.  An offsite doctor is paged, who then remotely links to a telemedicine station to see patients.  With the aide of an ED nurse, these patients are seen based on arrival time and level of medical need.

“This telemedicine study will determine if we can decrease wait times while reducing the number of patients who leave the ED without being seen by a physician,” said David Guss, MD, principal investigator and chair of the department of emergency medicine at UC San Diego School of Medicine.  “If the use of a telemedicine evaluation can be shown to be safe and effective, it may shift how care in the emergency department is delivered.”

“ED overcrowding increases patient risk and decreases patient satisfaction with emergency services,” said Vaishal Tolia, MD, MPH, FACEP, emergency medicine physician at UC San Diego Health System.  “Implementing telemedicine in the emergency department setting may improve the overall experience for both patients and medical staff.”

Medicare Recipients to Lose Telemedicine Services Benefits

Even though the availability of telemedicine has proven its value by lowering costs, increasing access and improving treatment and remote monitoring for chronic diseases, thousands of Medicare beneficiaries will soon lose access to telemedical services simply because of where they live, or more accurately stated, how government statistics identify where a patient lives.

Medicare patients from Hawaii to Puerto Rico to Minnesota will be redefined as living in “metropolitan” areas, precluding them from receiving Medicare coverage for video conferencing and other telehealth activities, even though 80% of beneficiaries live in urban counties such as those cut from the list.

“Congress has long overlooked the need for telemedicine services for residents of urban counties, despite the fact that they often suffer similar problems accessing healthcare.  Now, because of a statistical quirk, even more people will lose coverage of these services, reducing access and care,” said Jonathan Linkous, CEO of the American Telemedicine Association.

Originally, telemedicine technology demonstrated its most obvious benefits to rural communities, where specialized and chronic medical services and treatments were often not readily available without significant cost and inconvenience to patients.  However, the same cost/availability benefits have proven to be just as effective in urban areas and when chronic illness and extended, after hospital, care is encountered.

A study provided by the Commonwealth Fund shows that telehealth consultations are effective in reducing the amount of time patients spend in the hospital for care of chronic illnesses.  By examining data from large telehealth programs run by the Department of Veterans Affairs (VA), Partners HealthCare in Boston, and Centura Health, based in Colorado, researchers found that home monitoring programs can cut costs and raise patient satisfaction up to 85%.  Under the new guidelines, Medicare coverage will not be available for telemedicine visits to beneficiaries living in metropolitan areas–where over 80% of recipients live, resulting in cost reductions for the Medicare program.  Correcting this oversight will require an act of Congress, another incident of bureaucratic, regulatory interference with beneficial advancements in the delivery of healthcare to patients all around the country.

Given the increased involvement of government in the total delivery of health care in the coming years, this lack of insight does not bode well for reducing costs and improving availability to those who are most in need of the best in healthcare services.

Lock-Up, A New Market Niche for Telemedicine

Since Telemedicine first came on the scene more than a decade ago, the one market segment touted to be receiving the greatest benefit has been the rural community and their need for specialized medical disciplines.  Even now that the benefits are being realized across all geographic areas, the increased availability of specialist and chronic medical services to those in far flung outposts continue to be credited with the most obvious benefits.

But a new market niche is developing for telemedical services that may have escaped notice by those who first championed the positive features of telecommunication technology for the delivery of healthcare.  Employing telemedicine in correctional facilities is emerging as a new market segment, giving states and local jurisdictions the ability to get health consultation and treatment to inmates without the cost of securely transporting them to medical facilities.  Implementing telemedicine at correctional facilities has been a little deliberate and slow to take effect, but as the prison population grows and the costs associated with housing inmates become more of burden on tax payers at large, telemedicine is finding its way into places of confinement and behind the bars.  In addition, prisoners are aging and are becoming more susceptible to chronic, age related illnesses, increasing the need for more frequent ongoing medical services and treatment, many of which require physicians who practice more specialized disciplines that may not be readily available to a confined population.

This month, the Colorado Department of Corrections and the Denver Health Medical Center will launch a pilot program using high-definition video conferencing for inmates who need consultations in rheumatology, infectious disease, orthopedics and general surgery and because both Denver Health and the Colorado Department of Corrections have modern video conferencing systems, there are no up-front costs associated with the program for either party, which has been cited as a barrier to entry for smaller hospitals and prisons.

In Wyoming, telehealth services for prison inmates helps address challenges of distance and distribution of doctors. The Wyoming department of Prison Health Services has been able to dramatically increase the range of clinical services, including mental health and specialist services and in Louisiana they are on the verge of signing a contract to provide 17,000 annual checkups to thousands of inmates, increasing telemedicine by nearly 600 percent. Deputy Secretary Thomas Bickham said the department was caught slightly off guard when Earl K. Long Medical Center closed last month, seven months sooner than originally expected requiring state officials to expedite the process of providing new telemedical services to its inmates.

Department of Corrections is planning on awarding an increased number of contracts for telemedicine services, exploding the expenditures from $600,000 annually to more than 3.5 million.

Bickham said public safety is the primary benefit of utilizing telemedicine services rather than individual hospital visits.  “In the past, we would have to load them up, transport them to the closest LSU hospital, have them see that physician, then transport them back. What telemedicine allows us to do is to keep that inmate behind the fences at the institution. It allows us to get the same medical treatment at the same cost, and do it more efficiently and effectively, but most importantly it’s very protective of public safety because again you’re leaving the prisoner behind the walls in order to get treatment,” Bickham said.

The restrictive confines of lock-up facilities places an increased burden on costs and significantly complicates access to health care well beyond the inconvenience and expense that most free, rural patients experience, so it seems a logical migration for telemedicine to reach those who are even more isolated and entrapped by geography.

AcuteCare Telemedicine Welcomes Robert Silverstein to the Team

AcuteCare Telemedicine (ACT), the leading practice-based provider of Telemedicine services in the Southeast, announces the addition of Robert Silverstein, to their staff.  Robert joins ACT as Senior Sales Executive, with more than a decade of experience in the Hospital, Post-Acute and physician’s services marketplace.  A graduate from the University of Georgia in Athens, Robert’s career includes extensive experience in streamlined business processes, with a focus on telemedicine and telehealth solutions.

In his new assignment with ACT, Robert will be responsible for assisting the AcuteCare Team with expanding and promoting the highest quality Telestroke and other Teleneurology services available to clinical partners interested in generating improved care, additional revenue and improved cost efficiency.

“At AcuteCare Telemedicine, we recognize the value of technology in a rapidly changing world. As Telemedicine continues to become part of the mainstream lexicon of healthcare, we strive to make urgent stroke care far more accessible for a vastly greater number of patients”, said ACT’s COO Keith A. Sanders, M.D., “Roberts addition to the ACT Team will help ensure that our mission and leadership in Telemedicine services is maintained and expanded to include new partners.”

EMS Role is Critical to Stroke Treatment and Recovery

Each year, almost 800,000 Americans suffer a stroke, on average one American suffers a stroke every 40 seconds and one victim dies every 3 to 4 minutes making stroke the third leading cause of death in this country, after heart disease and cancer.

Innovations in the treatment of stroke have provided many new options for physicians and emergency room personnel over the past half-decade, but getting the stroke victim to the most effective treatment center still remains a critical element in a victims long term survival. EMS is a part of the success of any telemedicine program. Being able to quickly assess a patient to identify acute stroke symptoms is one thing – getting the patient to the closest most equipped hospital is another. Hospital associations and telestroke providers need to include EMS in the conversation as it will dramatically impact the lives in acute stroke events.  EMS teams must have a goal of getting potential stroke victims stabilized, evaluated, and to a primary stroke center in less than an hour.

To plan for an effective response, directors of EMS units should have a preplanned stroke protocol written for their teams, divide the EMS unit’s region into districts according to the nearest emergency department capable of treating acute strokes and maintain regular training sessions for EMS personnel.

The Utah Department of Health and The Bureau of Emergency Medical Services are leading the way in establishing effective procedures and communications to EMS personnel when it comes to transporting patients for the treatment of stroke. The Bureau has identified eight regional hospitals throughout the state as “Primary Stroke Centers”, hospitals that have undergone certification by the Joint Commission or DNV as specialized centers providing the highest level of comprehensive stoke care. This includes advanced time-critical emergency stroke care, including specialized radiology, neurology, and neurosurgery expertise, as well as complete inpatient treatment and outpatient rehabilitative programs for stroke patients.  In addition, 17 localized hospitals have been designated as “Stroke Receiving Facilities”, centers that have procedures, equipment, and protocols in place to provide time-critical emergency stroke care, in consultation with one of the Primary Stroke Centers.

For stroke victims, there is less than 4.5-hours after the onset of symptoms in which thrombolytic therapy offers an enhanced opportunity for a patient’s recovery.  Educating and training EMS and First Responders to identify, properly evaluate and transport victims to a Primary Stroke Center, or a Stroke Receiving Facility, is critical to the successful outcome of treatment for stroke victims.