How Telemedicine Expands the Reach of Emergency Care

Remote monitoring is bringing emergency care to patients outside the hospital.

At some high school football games in Mississippi this fall, players with suspected concussions will be evaluated on the sidelines via a telehealth link to the University of Mississippi Medical Center.

A trained coach or athletic trainer using a tablet will perform a standardized assessment in consultation with a UMMC physician to determine whether a player needs to visit the emergency room.

The teleconcussion program is just one of the ways telehealth is transforming emergency care.

Telehealth has become well established at UMMC, a Level 1 trauma center. Since its beginnings as the TelEmergency program in 2003, UMMC telehealth has expanded to offer more than 35 medical specialties in 69 of Mississippi's 82 counties.

“Patients like it because they’re getting the expertise from the academic medical center, and a lot of times it allows those organizations to be comfortable keeping patients at their local hospital,” says Alan Jones, chairman of UMMC’s Department of Emergency Medicine. “It helps those hospitals and keeps patients in their community. And we can get the patients who need to be transferred to larger centers transferred sooner.”

But telehealth is altering the landscape for emergency medicine in a variety of ways as far as providing effective treatments, determining the severity of an issue, following up on care and more.

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UMMC Tackles Diabetes Through Remote Monitoring

Keeping patients with chronic illnesses on track and out of the emergency room remains a core focus for telehealth initiatives. With a high rate of diabetes in the state, UMMC is tackling the problem through remote monitoring and coaching with remarkable success.

According to MedCity News, Mississippi had the highest percentage of adults diagnosed with diabetes in 2010 and spent $2.74 billion on diabetes-related medical expenses on its 3 million residents in 2012 alone.

Telehealth presents a unique opportunity for improvements in population health, according to Jones. “It can be an important way of making sure that precious resources are used appropriately,” he says.

By setting up a remote monitoring program with 100 participants in 2014, the state saved an estimated $300,000 by preventing ER visits or hospitalizations as a result of the disease. Remote physicians were able to diagnose nine new cases of diabetic retinopathy that may have gone undetected, MedCity News reports. If just 20 percent of the population took part in a similar remote monitoring program, Mississippi could potentially save $180 million a year.

Teletriage Streamlines Emergency Room Visits

Determining whether a problem requires a visit to the ER or could be better handled elsewhere presents a challenge for patients and healthcare systems.

Some healthcare organizations are putting a virtual provider at the front end of the ER process. That provider can see low-acuity patients through telemedicine and discharge them directly. In more severe cases, lab work and tests can be ordered so the ER doctor can treat them more expeditiously.

The University of Pittsburgh Medical Center (UPMC) Health Plan has documented savings of $86 per visit per episode of care when patients use telehealth for low-acuity visits, according to Natasa Sokolovich, executive director of telehealth at UPMC.

“Some populations use the ED as their first point of care. We’re trying to make patients aware that they can get care for a number of conditions remotely,” she says.

Patients statewide now can see a doctor 24/7 through UPMC’s emergency service AnywhereCare mobile app. About 90 percent of its users require no further follow-up, according to the organization.

George Washington University Taps Telehealth for Follow-up

For patients along the East Coast, it can take 16 to 40 days to get a follow-up appointment with a doctor after an ER visit, according to Neal Sikka, associate professor in the Department of Emergency Medicine at George Washington University in Washington, D.C.

So how do you cut down wait times and ensure patients get seen in a timely manner? To tackle that problem and cut wait times for appointments from weeks to days, GW instituted a program called ConnectER.

“We’re offering telehealth visits to bridge that gap,” Sikka says. “Within days, we’re connecting patients with ER docs to see if they’re improving, perhaps order a follow-up imaging study, or make sure antibiotics are working properly.”

Telestroke Treatment Gets a Boost with Remote Monitoring

Stroke and cardiology remain two of the most common use cases for telehealth in emergency medicine, though many hospitals treat a range of issues virtually, according to Sikka, who co-authored the primer on telemedicine produced by the American College of Emergency Physicians.

Nearly all states now have a telestroke network. A Kaiser Permanente study on telestroke care found an almost 75 percent increase in timely use of a clot-dissolving drug. Patients in the study were given a diagnostic imaging test 12 minutes sooner, and the drug was administered 11 minutes sooner. Time to treatment was cut to less than an hour.

Sikka cites in-ambulance telehealth among the up-and-coming use cases, as well as skilled nursing facilities and nursing homes to limit patient transfers.

Overcoming Telemedicine Connectivity Challenges

Despite progress, hurdles remain in telemedicine, the least of which is lacking connectivity to enable remote monitoring tech. While some areas still lack efficient broadband, connectivity has improved in the past few years, according to Sikka.

“Connections for video have really improved,” he says. “LTE, the 4G network, has really spread. We’re seeing a lot of video applications on mobile. And I think the user interfaces for a lot of those video applications have become simpler and more reliable, and they more consistently meet the security standards.”

Going forward, moves by the Department of Veterans Affairs to expand access and advancing legislation could help telemedicine progress. On the docket to influence telemedicine expansion in the near term is a bill in Congress set to address the ongoing problem of reimbursement, as well as the Furthering Access to Stroke Telemedicine (FAST) Act, which would provide Medicare reimbursement for telestroke services, and could be part of legislation taken up this fall.

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Sep 01 2017