Take Inspiration from Flagship Programs & Innovative Telemedicine Applications
The use of technology to deliver healthcare or health information from a distance, otherwise known as telemedicine or telehealth, offers myriad benefits to the patient population, chiefly by increasing vital contact between patients and healthcare providers. In doing so, studies have consistently demonstrated improved clinical outcomes for a greater number of persons.
Are you aware of telemedicine’s role in the current healthcare landscape? While only 32 states have parity laws at this time, and much remains to be ironed out on the regulatory front, initiatives in telemedicine have been successful and have begun to address the healthcare crisis in America.
What’s more, these programs have created forward movement toward broader adoption of telemedicine technologies. The applications, as we hope you’ll see from a few examples, are endless. Keep in mind, the need for telemedical, as demonstrated in Part I of this series, is also endless.
Reinforcing Critical Care for Modern Medical Needs
Dr. Matthew McCambridge and his colleagues employ satellite technology, video conferencing, and off-site monitoring to care for patients in Lehigh Valley Health Network’s intensive care units. In collaboration with bedside specialists, patients are monitored through the night by additional intensivists and nurses from an off-site advanced intensive care unit. Research compiled from Lehigh Valley Health Network’s approach to critical care, published in the Archives of Internal Medicine, shows a 30% decrease in mortality, as well as decreased ventilator use.
In the U.S., 4.6 million adult patients are admitted to ICUs each year, accounting for 27% of adult hospitalizations. With mortality rates trending between 10% and 28%, or approximately 540,000 deaths annually, advancements in quality of care for ICUs is particularly important.
Numerous studies support the clinical benefits associated with tele-ICUs. These benefits, in addition to a reduction in mortality rate, include decreased frequency of ICU complications and decreased ICU length of stay. It’s also been found that employing tele-ICUs decreases medication errors, which account for 78% of all errors in the ICU, according to The Critical Care Safety Study: the incidence and nature of adverse events and serious medical errors in intensive care.
And tele-ICUs are not without economic benefits. Treatment of critically ill patients is estimated to account for 30% of acute care hospitals’ costs, which amounts to roughly $67 billion per year in hospital spending. While full implementation of the tele-ICU standard in community hospitals involves a costly investment, it could potentially save $5.4 billion annually, writes Dr. Alberto Coustasse and his team in the report, A Business Case for Tele-Intensive Care Units.
The Baby Boomer generation—20% of our population—has reached its golden years. The demand on ICUs is increasing. By leveraging advanced networks of video surveillance and conferencing with computer software technologies, remote specialists can enhance and extend the work of on-site specialists to provide a higher quality of critical care.
Can Emergency Medicine Get Any Faster? Yes!
Targeting a shortage of neurologists and hospitals able to treat stroke patients, one of the first applications of telemedicine, known as telestroke care, connects a designated stroke center to a network of smaller hospitals to provide stroke diagnoses and care services via telemedicine.
The results, studied and reported by Kaiser Permanente in July 2016, showed that stroke patients received the clot-dissolving drug tPA eleven minutes sooner, reducing the door-to-needle time to under an hour.
Several organizations have since raised the bar with in-transit telestroke services that outfit EMS with mobile devices linking paramedics with more immediate stroke diagnosis services.
“Some of these systems have CT scans in the ambulance and can give tPA right there and then,” said Lawrence R. Wechsler, MD, chairman of the American Heart Association/ American Stroke Association writing committee, in an interview with Medscape. “Others just use an iPad in the ambulance to connect to the stroke expert. Although you can’t make a certain diagnosis this way, you can make an educated guess just by assessing the severity of the deficit on the NIHSS [National Institutes of Health Stroke Scale], and this allows advice to be given on the best center for the patient to be taken to.”
Paramedics consulting with specialists via video on a tablet speeds up treatment time. “And every minute saved is a brain saved,” says John Halperin, MD, chairman of the department of neurosciences at Atlantic Health System’s Overlook Medical Center in New Jersey.
Enhancing Patient-Physician Collaboration in Chronic Care
The Chronic Cardiac Care program at Partners Healthcare At Home, located in Boston, telemonitors congestive heart failure patients, many of whom are newly discharged. Home-based patients use devices to routinely transmit their weight, blood pressure, and other vital signs to clinical decision support software. This service not only identifies patients needing interventions, but also enables as few as four nurses to care for 250 patients. Readmission rates for enrolled persons have decreased by 50%, with an estimated $10 million savings in healthcare costs.
Similar programs have been established elsewhere, which include telemonitoring of other chronic conditions. In Telemedicine to support coping resources in home-living patients diagnosed with chronic obstructive pulmonary disease: Patients’ experiences, authors Torunn K Vatnøy, Elin Thygesen, and Bjørg Dale report the importance of telemedicine services as providing trust and confidence and increasing both patients’ independence and ability to self-manage. Among improved clinical outcomes, the study has also measured and shown that telemonitoring “contributes to stress reduction caused by illness burden and facilitates living as normally as possible.”
Sue Beausoliel, vice president of operations at Partners HealthCare At Home says, “Remote patient monitoring does more than improve care coordination. It provides a tool for patients to actively engage in their own health management.”
A 2017 meta-analysis of research published in the Journal of Telemedicine and Telecare shows that “Telemedicine significantly increases mental, physical, and overall quality of life in patients receiving chronic HF [heart failure] disease management.”
“As the healthcare industry focuses more on improving patient experience and outcomes while reducing costs,” Beausoliel continues, “technologies such as home monitoring contribute toward improved quality of life. Instead of having to wait for the next appointment, this real-time data daily monitoring helps us connect with patients, track their health status, alert us to a problem, and intervene earlier before it becomes full blown.”
To learn more about telemedicine’s role in healthcare, and how your practice can get involved, watch for Part III of this series, The U.S. Healthcare Crisis: Telemedicine to the Rescue.
Get up to speed on telemedicine technology, guidelines, coding, and reimbursement. Pick up your copy of TCI’s best-selling Telemedicine & Telehealth Handbook for Medical Practices 2018.
A Business Case for Tele-Intensive Care Units. Alberto Coustasse, Stacie Deslich, Deanna Bailey, Alesia Hairston, David Paul. The Permanente Journal; p. 2014 Fall; 18(4): 76–84. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206175/.
Healthcare Cost and Utilization Project Statistical Brief #185: Utilization of Intensive Care Services, 2011, Agency for Healthcare Research and Quality, December 2014.
New AHA/ASA Statement on Telemedicine in Stroke – Medscape – Nov 09, 2016.