A comprehensive EMS telemedicine system


CarolinaFireJournal - By Michael Smith and Chad Guillot
By Michael Smith and Chad Guillot
04/26/2010 -

(This is part three of a three part series on telemedicine.)

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The problem of ED overcrowding exists in virtually every ED across the country and has been exacerbated by the downturn in the economy. Highly multi-faceted, some of its effects include:

ED OVERCROWDING

  • Long waits in the ED depriving needy patients of more immediate care, increasing pain and suffering and creating patient dissatisfaction;

  • Increasing the financial burden to hospitals by unnecessary visits by frequent fliers and non-payers;

  • A significantly higher cost to treat patients than is otherwise necessary;

  • ED staff displeasure with EMS for bringing in patients not really needing ED services; and,

  • Lowering of EMS morale by unnecessary calls and transports — the “EMS taxi service.”

One way to address these issues is by means of a “treat and release” program in which patients with minor medical problems are treated outside the hospital by EMS personnel and not transported to the ED. While seemingly a simply solution, this approach is fraught with problems related to licensure, liability exposure and reimbursement.

One way to address these issues is by means of a “treat and release” program in which patients with minor medical problems are treated outside the hospital by EMS personnel and not transported to the ED. While seemingly a simply solution, this approach is fraught with problems related to licensure, liability exposure and reimbursement.

An EMS telemedicine system allows a licensed health care professional (physician, nurse-practitioner, physician’s assistant) to directly oversee treat-and-release activities. The “virtual presence” provided by EMS telemedicine allows this person, with assistance from the medics, to examine the patient in much the same way as would be done if the patient were in the ED — or at a distant health care facility. By this means, the health care professional would truly be the primary decision-maker, with the medics playing a role similar to ED nurses. The configuration of BR Med-Connect allows the distant health care professional and the patient to freely interact with one another making the encounter highly lifelike. The remotely controlled camera allows the health care professional to visualize almost every part of the patient, seeing with both motion and full color.

An important advantage of the EMS telemedicine system is that everything is fully recorded, reducing liability exposure. In cases where the patient is reluctant to go to the hospital, the “virtual” presence of the health care professional and the recording capabilities provide great advantages. Additional savings may be realized by using a light truck instead of a full ambulance for a treat-and-release program, as is now being done in Tucson Arizona’s Alpha Truck program.

With regard to reimbursement, the current systems are highly disadvantageous to treat-and-release and represent a huge barrier to a successful treat-and-release program. Although treat-and-release would, in all likelihood, represent a cost saving for any payer agency and provide significant benefits to the ED overcrowding issue, without proper reimbursement, treat-and-release becomes a dead issue. In recognition of this, BR Med-Connect has already begun discussions with payer agencies to try to determine how this can be done. Time will tell which way this goes.

Statistical and financial metrics for the effectiveness of using EMS telemedicine for reducing ED overcrowding are simple to do, with data readily available from both the telemedicine system and the ED records.

The BR Med-Connect of the future

BR Med-Connect’s management team is now working on a set of long-range plans for the system, focusing on three principal goals:

  1. The importance of combining day-to-day EMS activities with more specialized activities (e.g.: STEMI, stroke, disaster response).

  2. Making enhanced EMS services available throughout the entire parish.

  3. Integrating all activities into one seamless, fully integrated system that fully merges with the hospital-based system of care.

An important part of this objective centers on the deployment of a highly advanced system of interfacility communications, presently under development at General Devices. This system will extend the utility of BR Med-Connect by allowing voice, data, images, reports, etc. to be freely exchanged throughout the BR Med-Connect network (field, ED, PSAP, cath labs, etc.), as well as beyond this network. Because of its simplicity of use, versatility and surety of message delivery, this system would be used for routine EMS and non-EMS interfacility ED communications (e.g.: for locating a much-needed surgical tool or exchanging information for interfacility transfers), as well as for non-routine activities (e.g.: 12-lead report distribution or disaster response coordination). This system would provide the highly fluid information-exchange platform essential to all three BR Med-Connect objectives.

Combining activities

Because of the greatly enhanced communications and information management capabilities BR Med-Connect provides, the separation of day-to-day events and special activities virtually disappears.

For example, the same system that is used for managing ordinary EMS calls is the same system that would be used for STEMI activities or disaster response. This is made possible by the integration of advanced EMS telemedicine functions with commonly used EMS functions. Because of the extensiveness of this integration, many different needs are met by just one system.

For example, whereas BR Med-Connect’s image capabilities will not be needed for routine calls, when they are needed for some special purpose, they are available from the same system that managed the routine call. Where point-to-point communications are needed for routine EMS calls, the same system provides multi-point communications for disaster response activities. This same system could also manage triage call-tag information, patient ID photos, ED status reports and syndromic surveillance information. Having one system to meet all needs insures that the system will be available when it is needed and people will know how to use it.

A Parish-wide service

Extending BR Med-Connect throughout BR Parish would mean providing ALL BR ambulances and primary care hospitals with BR Med-Connect equipment. Although not inexpensive, this cost is comparatively low when compared to personnel costs, the cost of monitors, vehicles and other commonly used EMS equipment, and the cost of the separate pieces of non-integrated ED equipment and systems.

Although as yet unproven, there are many reasons to believe such a system will be cost effective, possibly provide several cost-saving opportunities and also provide a higher level of service for the population of BR.

The seamless, fully integrated system

The intrinsic design of BR Med-Connect, particularly with an improved interfacility communications system, provides the means of implementing a seamless, fully integrated Parish-wide prehospital health care delivery system where the prehospital patient care record may be included in the complete patient care record.

Having such a system made available throughout the Parish will help to support and improve practices already in place, such as disaster response, communications for interfacility transports, syndromic surveillance, data gathering for comparative analysis, counter-terrorism activities, shared materials management and many other activities. Once such capabilities become available, there is little doubt that new applications will reveal themselves.

One can easily envision a natural or man-made MCI involving the moment-to-moment coordination of multiple EMS squads, multiple hospitals, other public safety agencies and large numbers of casualties and their relatives and friends. Consider how much better it would have been if photos of Katrina victims could have been quickly and easily circulated throughout all of the involved public safety agencies?

Conclusion

BR Med-Connect is now in its infancy, with a fully functional pilot program in place and its technology is largely proven. Without question, BR Med-Connect has a long way to go to fulfill the full extent of the vision of its planners. An immediate hurdle involves securing a firm financial footing, both through changes in reimbursement as well as securing funding for the planned expansion of the system. Also needed are refinements and protocols for new patient care methodologies such as stroke assessment and treat-and-release.

It is hoped that BR Med-Connect will fulfill the expectations of its planners and developers and will become a model for a paradigm shift in EMS, one that fully incorporates all the advantages of modern communications and information management technologies along with the latest thinking in prehospital patient care.

Michael Smith is president of General Devices and can be reached at 201-331-7075 or email [email protected] com. Chad Guillot is EMS Assistant Administrator at Baton Rouge EMS, and can be reached at 225-389- 5155, or e-mail [email protected]
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