Remote Triage: Penn Medicine Develops a Central Telehealth Hub

The medical system uses remote care as a triage system for neonatal patients and those with minor injuries.

Penn Medicine has overcome physical distance by centralizing one of the largest telehealth hubs in the United States.

With its Center for Connected Care, the University of Pennsylvania’s health system combines four telehealth services — its 15-year-old telehealth service for the critically ill (Penn E-lert eICU), a tele-homecare service for the chronically ill, a telemedicine service that connects obstetricians with trauma surgeons to help critically injured pregnant women, and a tele-urgent care program that helps reduce the number of physical visits. By doing so, the health system, which serves patients in Pennsylvania, New Jersey and Delaware, will consolidate a telehealth practice of 50 employees at Penn Medicine Rittenhouse in center city Philadelphia.

Doctors and nurses will determine the severity of patients’ conditions and whether they can be treated remotely, without traveling to a specialty center, explains Dr. John Gallagher, trauma program manager at the Penn Presbyterian Medical Center.

“What I think the telehealth piece adds is a certain level of triage,” Gallagher says.

By bringing its telehealth services together, Penn Medicine allows a cancer patient awaiting a bone marrow transplant to speak with a remote transplant physician and a local physician via videoconference, or a stroke specialist to consult remotely with an ER doctor who’s treating a stroke patient in person.

Participants in Penn Medicine’s telehealth program at home are often monitored post-hospitalization. They enroll with high-risk conditions such as heart failure, respiratory failure or cirrhosis of the liver, explains Dr. William Hanson III, Penn Medicine’s chief medical information officer.

Patients at home submit data over a cellular network from devices like electrocardiogram (EKG) monitors and blood pressure cuffs that inflate, measure readings and share data with physicians automatically over the internet.

“Patients who are gaining weight inappropriately or having blood pressure issues are flagged in a software system, and we know to reach out to them before they get into trouble and need to be readmitted urgently,” Hanson says.

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Telehealth Helps Penn Monitor Obstetrics and Neonatal Care

Over the last three years, Gallagher has seen the telehealth program prove valuable for patients with minor injuries or those that are pregnant.

For obstetrics, the platform includes a maternal fetal monitor, a video monitoring system and audio system so that the Penn Presbyterian telehealth hub can communicate in real time with the obstetrics unit.

“We've actually had two cases where we've delivered and done a C-section here at Presbyterian and also had the neonatal team and obstetrics team come over, but the initial interaction was through the telemedicine system,” Gallagher says.

Moving Beyond Fragmented Telemedicine Systems

Expect to see telehealth centralization in larger institutions compared with smaller hospitals, says Chilmark Research analyst Brian Eastwood. Health systems like Boston’s Partners HealthCare, Philadelphia’s Mercy Health System and NewYork-Presbyterian are centralizing their telehealth services.

“Large integrated delivery networks and academic centers have the scale for it, they have the footprint, and they can contract with the vendors to be able to get that bulk of both equipment and potential users,” Eastwood says.

Still, many telehealth systems remain fragmented.

“Centralizing services is still relatively new,” says Lynne Dunbrack, research vice president for IDC Health Insights. “Telehealth services are often fragmented by specialty and whether the services are designed to support patients that are hospitalized or at home.”

Whether it’s on a military vessel, a cruise ship or in space, look for telehealth to continue to grow and make an impact.

“You can use telemedical care in post-op care; you can use it in end-of-life care,” Hanson says. “There are a lot of ways in which telemedicine can really significantly change the way that we care for patients today, and the technology gets better and better every year in terms of the fidelity of transmission.”

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Jun 13 2018