Telepresence of Medicine: South Louisiana Talks to the World

I remember as a child watching television shows about the future, thinking how cool it would be if we could see someone while talking to them on the telephone, like on The Jetsons… or if someone could wave a wand over an abdomen to diagnose appendicitis, like Bones did to Captain Kirk. With current inventions like Skype and ultrasound technology on cell phones, these dreams are now a reality and can serve as a resource to provide medical care to an increasing population.

It’s estimated that the baby boomers coming of age and the implementation of the Affordable Care Act will add approximately 61 million people to the medical-needs population over the next 10 years. This growth brings challenges such as an increase in patients with falls, chronic conditions, high readmission rates and supply versus demand issues.

Chronic conditions are very expensive for healthcare systems in general, due to the lengths of stay and high readmission rates. The national average for all Medicare readmission rates is 19.6% with some diseases averaging as high as 26.9%. Supply versus demand issues include the traditional source of direct care workers being women between the ages of 25–53. It is projected that this age group will only increase by 1% instead of the 34% required to meet the rising demand.

The most efficient way to combat these challenges is with the assistance of technology. By accurately aligning the technology with patient needs, proper care can be administered with favorable outcomes.

Our company has taken a proactive approach by adding technology to its services, which highly impacts the communities we serve. The Acadian Companies, headquartered in Lafayette, LA, began operations in 1971 as Acadian Ambulance Service in response to a sudden crisis. Due to federal regulations, the swift departure of funeral homes from the ambulance transportation field brought on a nationwide emergency, and Acadian Ambulance began operations with two ambulances and eight medics. More than four decades later, Acadian spans the globe and has grown to more than 4,000 employees. It now consists of six subsidiaries that offer medical, safety, monitoring, transportation and educational services: Acadian Ambulance, Air Med, Executive Aircraft Charter, National EMS Academy, Safety Management Systems and Acadian Monitoring Systems. Two of these subsidiaries provide technology that impacts direct patient care outside of the traditional EMS setting. Acadian Monitoring Services (AMS) and Safety Management Systems (SMS) focus on different spectrums of care and have significant effects on the lives touched.

Technology can be divided into numerous categories. A general way to separate technology types is by their functionality. Those of specific interest in providing direct patient care are medical alert systems, telemedicine and telehealth.

Unfortunately, the lack of acceptance of technology is greatest in the group that requires it the most. A recent study by AARP showed that 34% of all adults over the age of 65 have an impairment that limits one or more basic physical activities, and that one out of three in this age group will fall each year. 

Acadian Monitoring Services enhances quality of life through innovative and progressive technologies. AMS provides medical alert systems, GPS fleet and asset tracking and management, advanced video security systems, access control systems, and security and fire alarm monitoring to clients and customers nationwide. AMS offers medical alert systems through its Acadian On Call division. No matter the type of emergency—whether it is a fall, seizure, stroke, heart attack, fire or burglary—help is just the push of a button away. These medical alert systems consist of three components: a small medical alert button that is usually worn as either a pendant around the neck, on the wrist like a watch or clipped to the waist; a medical alert base station that functions as a two-way speaker phone; and a monitoring center that responds 24/7 when the button is pressed.

When activated, the medical alert base station will automatically call the monitoring center that has access to the subscriber’s medical information, history and contact list. The dispatcher will then communicate with the subscriber and evaluate the situation. If it is determined that help is needed, the dispatcher will send EMS, fire, police or rescue.

Each of AMS’ three UL-listed, bidirectionally redundant central stations monitor 24 hours a day, 365 days a year. All have earned the coveted “Five Diamond” certification from the Central Station Alarm Association. This certification is awarded only to central stations that meet or exceed best practices on equipment, redundancy, staffing and protocols. All of AMS’ dispatchers are highly qualified EMD-certified EMTs and paramedics, trained in assessing the situation, pre-arrival instructions and getting help right away. The training our medical monitoring dispatchers receive meets and exceeds criteria set forth by the National Association of EMS Physicians.

Our highly trained staff provides customers with:

• Immediate professional emergency assistance;

• Confidence and security;

• Comfort from the anxiety of living alone;

• An enhanced quality of life;

• Information to maintain their independence;

• Peace of mind for the customers’ loved ones.

The mission of the caring, compassionate professionals who work in our central stations is to quickly assess the situation and calmly deliver pre-arrival instructions as needed, following any custom instructions customers may specify.

Technology drives Acadian Monitoring Services but also drives another division, Safety Management Systems, which can provide medical care in remote locations across the globe.

SMS utilizes technology for patient care by offering telemedicine and telehealth services to its remote onshore and offshore clients. While telemedicine and telehealth are very similar in nature in that they both provide healthcare at a distance and through information technologies, telemedicine focuses more on curative aspects while telehealth can encompass curative aspects as well as preventive.

Telemedicine and telehealth include an advanced videoconference system that allows for virtual examinations so employees can be examined, diagnosed and treated by a variety of medical professionals no matter where they are in the world.

Whether the situation is emergent or minor, patients have 24/7 access to multiple board-certified physicians, specialists, highly trained nurses and other physician extenders. Medical professionals can perform examinations, conduct diagnostic testing and follow the improvement of treated conditions.

The FDA-approved telemedicine unit projects high-resolution images in real time for accurate assessment. Using two-way video, the physician conducts visits between workers and remote paramedics. Virtual medical tools contribute to accurate examinations. With a special electronic stethoscope, the physician can listen to the heart, lungs and abdomen. An otoscope enables a view inside the ears, nose and throat, while a high-resolution camera magnifies the skin for examination.  Remote lab analyses can be conducted on the unit with the use of a handheld clinical blood analyzer called i-STAT.

Proactive health programs are only a call away with science-driven and personalized wellness plans available through SMS’ telehealth system. Nurses, both registered and practitioner, provide instructions through health assessments for each individual patient. Exercise regimens, sleep and stress management, tobacco cessation and supervision for chronic conditions such as diabetes and high blood pressure can be managed thousands of miles away.

A portable emergency medical card is personalized with each patient’s health information. The information on the card is stored on a secured server and updated remotely.

By bringing critical components of healthcare together, SMS is investing in advancing healthcare and reducing unnecessary transports and evacuations. Telehealth will increase patient access, quality of care, chronic disease management, health and wellness, and the retention and recruitment of skilled labor by keeping workers well.

When used in a patient’s home for management of chronic illnesses, telehealth has been proven to be an effective tool. One of the largest studies using telehealth in this manner was conducted by the Veterans Health Administration (VHA). Although it is an older study, the results were so impressive that it led to the full implementation of a telehealth program in most of their congestive heart failure (CHF) clinics in the VHA system. The two-year study included 795 veterans with complex chronic diseases, mainly CHF. The results were overwhelming with a 63% reduction in hospital admissions and 60% reduction in hospital bed days of care. Even though other studies since then have had similar results, the technology is still underutilized. This is mainly due to lack of reimbursement and the cost of the equipment.

Medicaid in almost every state recognizes in-home remote telehealth monitoring; however, very few actually reimburse for the equipment or the monitoring. On a federal level, there have been numerous bills introduced that allow for the originating site as the home but none have passed.

There are other devices available to allow our patients to remain at home. These devices include large-button telephones and medication dispensing devices like MedReady. Medication dispensing devices serve as a reminder for those who are on a medication schedule. 

With all the technology available, the key is to align the proper resources to the patient’s need and to monitor that need for changes to confirm that the alignment remains the same. Companies like Acadian are taking a proactive approach to ensure that the services meet this criteria and more. 

Bibliography

Meyer M, Kobb R, at al. Virtually Healthy: Chronic Disease Management in the Home. Disease Management, 2002 June; 5(2): 87-94.

Projected Future Growth of the Older Population. Administration on Aging, www.aoa.gov.

Falls Among Older Adults: An Overview. CDC, www.cdc.gov.

Occupational Projections for Direct-Care Workers 2006–2016. PHI, www.phinational.org.

Boomers Turning 65. AARP, www.aarp.org.

MEDPAR. Centers for Medicare & Medicaid Services, www.cms.gov.

Acadian, www.acadian.com.

Acadian Monitoring Services, www.acadianmonitoringservices.com.

Safety Management Systems, www.safetyms.com.

Faye W. Bryant, BSN, RN, is clinical services administrator at Acadian Ambulance.