Such concerns eight years ago prompted Drs. Chris Gallagher, a cardiologist, and Eduardo Vadia, a pulmonologist, to join professional strengths and form Access Physicians, a provider group focused on supplementing patient care to hospitals that lack on-staff specialists. The need for their services was so great that within two years, the company grew from two to 50 physicians; it now employs 300 doctors.
As the demand increased, commutes to rural hospitals became more difficult, and they struggled to recruit elite doctors to physically serve these remote areas. It was then that Gallagher, Access Physicians’ president, and Vadia, the company’s managing partner, looked at telemedicine to expand their reach.
The doctors initially worried they would struggle to find tools reliable enough for critical care, where minutes often are the difference between life and death.
“We didn’t know if we could impact a patient, much less a healthcare system,” Vadia says.
But from the get-go, hospitals tapping the company for its technology and expertise have testified about the organization’s effectiveness.
“Once we started, we haven’t looked back,” says Susan McGrady, ICU director at CHRISTUS Mother Frances Hospital in Sulphur Springs, Texas, the first hospital to pilot Access Physicians’ telemedicine carts in 2013.
Access Physicians Makes mHealth a Seamless Deployment
Access Physicians now deploys internally developed telemedicine carts to 50 hospitals and three outpatient clinics across 12 states.
Initially, Gallagher and Vadia purchased a ready-made cart and spent three months trying to make it work. But the doctors were unable to get online, with Gallagher referring to the cart as “a $40,000 boat anchor.” Shortly afterward, they worked with a local vendor to create a cart. While that proved somewhat successful, the software was cumbersome, as it could take several hours to receive support, Gallagher says.
Finally, the physicians decided to develop their own telemedicine tool. Gallagher and Vadia’s team designed the carts to replicate an in-person doctor. A pan-tilt-zoom high-definition camera mounted at about 6 feet serves as the eyes. It can move up and down, and zoom in to read 12-point font from 15 feet across the room. It can see the patient, the flow loops on a ventilator and the drip rates on an IV pole.
A 27-inch Apple iMac monitor with its high-quality speaker system lets the patient and family see and hear the physician, and a USB stethoscope enables the remote physicians to conduct an exam with help from physically present nurses.
After five years, they’ve gone from 27 clicks to use the carts to none for nurses and one for physicians.
The carts also feature CyberPower UPSs, StarTech USB keyboards, an Apple Trackpad and an iPad for redundancy. Access Physicians provides internet for the carts via three redundant methods of connectivity.
Gallagher and Vadia’s team started building the carts in a garage, but the physicians wanted to be more involved in patient care than wiring carts. For help scaling their process, they turned to CDW, which now assembles the carts and ships them straight to hospitals.
And while the carts offer 99.999 percent uptime, Access Physicians provides round-the-clock support to mitigate downtime issues that may arise. “All technology fails,” Vadia says. “When that .001 percent arises, we need to be ready.”
Telemedicine Offers Rural Patients a Higher Level of Care
In addition to extending the reach of physicians, telemedicine technology gives nurses in rural organizations, like CHRISTUS Mother Frances Hospital, professional opportunities they might not otherwise have.
Working alongside remote specialists, nurses can learn new procedures and practice at the top of their licensure, says Anitha Sanderson, the hospital’s chief nursing officer. CHRISTUS Mother Frances sends nurses to train with neurologists so they can learn how to be an extension of the physicians during telemedicine exams.
Staff in rural facilities also get the chance to work on more complex cases. Since deploying Access Physicians’ carts, the hospital’s average daily census in the intensive care unit has gone up, which means they provide care for more patients as opposed to sending them to urban centers. “Telemedicine allows our staff to practice at a higher level,” McGrady says.
Access to more specialists has also helped CHRISTUS Mother Frances Hospital recruit more primary care physicians, because the doctors want to practice in a facility that can offer specialized care to patients, says President and CEO Paul Harvey.
And because such tools also allow more patients to stay in their local hospitals, more demand is built for nurses, lab technicians, pharmacists and other professionals at those facilities, says Deanna Larson, CEO of Avera eCARE.
Based in Sioux Falls, S.D., Avera provides ICU, emergency, pharmacy and hospitalist services via telemedicine to its acute- and long-term-care facilities, as well as to healthcare partners in 14 states. That translates into an overall economic boost for the community.
“It helps retain careers,” she says.
Remote Care Offers a Remedy for Burnout
In large urban facilities, there’s often a team of doctors who can support one another through the decision-making process in critical cases. Physicians in rural hospitals, however, often work in isolation.
Telemedicine technology provides critical collegial relationships, Larson says.
“Being there in the room with them changes their burnout levels,” she says. Such partnerships also often lead to better patient outcomes, Larson says. “With our physicians being available and ready to support their colleagues in the field locations, we’re saving lives,” she says. “Because we’re on video, we can be there immediately.”