Calling the Family Doctor: Telemed Services Bring Exam Rooms to the People

     Most of people's "emergencies," as EMS providers well know, aren't really emergencies. They're aches, pains, strains and other minor things that can often be treated by simple measures like advice or prescriptions.

     That realization fits conveniently with the burgeoning of telemedicine. Increasingly, patients can connect remotely to advisors, specialists and even their regular doctors for routine treatment of routine problems.

     The approach taken by New York's SwiftMD illustrates the promise this model might hold: Users call a toll-free number or request assistance through www.SwiftMD.com at any time. Once it's established that their situation is not an emergency, a doctor is paged, and the customer is contacted back, generally within 30 minutes. The doctor confers with the patient and consults their electronic health record, then proffers a diagnosis and course of treatment. Prescriptions can be called in, and the patient is spared travel to a clinic or hospital and languishing in a waiting room.

     "Physicians inconvenience people and make them come to us, because that's how we make money," says SwiftMD CEO Elliott Justin, MD, a longtime emergency doctor. "But when I'm called by a friend or family member and asked for medical advice, I don't tell them 'I can't give advice over the phone' or 'I have to see you in the office.' I ask them pertinent questions and take care of their problem. So the vision of this business is for members to receive the care we'd want for our friends and loved ones. We're like having a doctor in the family."

     SwiftMD links patients and doctors by telephone and Web, with a video capability ready soon. Given its initial business-to-business focus, the company is also working with vendors who can put healthcare kiosk facilities into workplaces and stream information like vital signs directly. Individual users who have that information can relay it verbally or by e-mail.

     Prices are under $60 for consultations, plus a monthly membership fee. Plans call for the addition of midlevels (PAs and nurse practitioners) to offer lower-priced consultations, and for expansion outside the company's birth state of New York. By now, it should be operating in Pennsylvania as well.

     At the heart of SwiftMD's plan is a powerful EHR owned not by any doctor, but by the consumer. It is updated with each encounter, and users can access it anytime through a password-protected Web portal. This year they'll be able to add to it and preserve image files like x-rays, ultrasounds and other documents. SwiftMD will also offer computer-assisted diagnoses for common problems and resources for managing common risks (e.g., smoking-cessation programs, recommendations for managing hypertension).

     The implications of services like this for EMS could be profound. First, they could prevent countless transports for trivial problems. "We can really decompress the system by taking care of people at home and helping to manage demand," says Justin. But second, and less obviously, the remote presence of physicians could mean greater latitude and importance for providers in the field.

     "EMTs and paramedics can be a tremendous wasted resource," says Justin. "How many, right now, are transporting people for simple ankle sprains? A tool like this can let physicians actually go into the field and take care of people with the assistance of paramedics and EMTs. With telemedicine, we can take the exam rooms to where people are. It's a powerful tool for a system that's crashing."

     —John Erich, Associate Editor

     "When the user presses the Send key on the RFID interrogator's screen, the triage information is sent wirelessly to the Incident Commander and Command Center," Vasquez adds. "We estimate this saves 90% of the time usually spent on reporting the triage conditions of patients."

     The LifePac system consists of the RFID tags, handheld scanners, a wireless base station and open-source software. The LifePac software not only collects RFID triage data, but can organize it using geolocation mapping and three-dimensional imagery. LifePac units can also be wirelessly interconnected into a mesh network—one that's highly redundant with multiple signal paths, in contrast to conventional "hub and spoke" wireless networks that fail if the main signal path is lost—that can be deployed in remote locations. Data collected by the LifePac system can be fed back to a distant headquarters via telephone, broadband wireless or satellite.

     The Anaheim (CA) Fire Department has purchased thousands of VerdaSee RFID tags, and plans to provide all of its 12 fire stations with VerdaSee RFID interrogators. This year, the AFD will attach active RFID tags to its expensive fire equipment. In contrast to passive RFID tags, active tags broadcast their identity using onboard batteries. This will allow the department to know where its tagged equipment is at all times, in turn helping to track firefighters during incidents.

     "This same approach can be used to track EMS crews and medical supplies," Vasquez says. "Collectively, RFID offers the opportunity to significantly improve the accuracy and responsiveness of EMS, no matter how large or small the incident."

     For more, see www.verdasee.com.

     —James Careless