Using Technology to Reinvent the House Call

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In the old days when physicians made house calls, they often had the advantage of knowing their patients. They were familiar with their past medical history, medications and test results because they had been their sole medical provider.

Although this model is a good one, it’s been impractical in the modern world—until now. Last year, the Colorado Regional Health Information Organization (CORHIO) and True North Health Navigation teamed up to provide Colorado’s first-ever mobile emergency medical unit with complete access to patient medical information.

True North and CORHIO designed the program to address a specific population—low-acuity 9-1-1 callers, with the goal of easing overwhelmed emergency departments and lowering healthcare costs. Since September 1, 2013, dispatchers in Denver alert the True North staff, which responds with a South Metro Fire Rescue medic unit to calls that meet specific criteria.

While en route, True North responders—primarily emergency department physicians—receive the patient’s medical history, including recent treatments and medications, via CORHIS’s Web-based health information exchange application. The secure network is linked to the medical records systems of hospitals, physicians and other healthcare providers throughout Colorado.

The mobile medical units are equipped with a variety of medical supplies, medications and a certified lab that can process blood and urine tests on scene. Responders are capable of providing advanced medical treatments, including suturing, splinting and catheter replacement.

“Essentially we’ve reinvented the house call so that we can properly treat urgent and semi-emergent medical conditions right in the patient’s own home,” says True North co-founder and Chief Executive Officer Mark Prather, MD.

While this is similar to other community paramedic programs, there are differences.

“We felt more comfortable trying to take the ER to the patient. To make an impact, we need to diagnose and prescribe,” he says.

Up to this point, the types of patients to be seen have been narrowly selected.

“We wanted to make sure we were seeing the right patients and not stepping on toes,” Prather says. “We see a couple of patients per day, but that’s on the slower side.”

The program has recently expanded to include assisted living centers and workers compensation patients.

Because the mobile medical unit is equipped with a lab, the physician-responder will be able to diagnose and treat patients at assisted living centers for a variety of ailments, particularly falls. Tests for urinary tract infections and even sepsis can be performed on scene. Thanks to a partnership with Walgreens, a first dose of antibiotics can be administered, if necessary—all without leaving the comfort of the patient’s own bed.

The program has also partnered with free-standing imaging centers that provide test results to the mobile medical unit’s providers’ iPads. All patient records are posted to the health information exchange and available to all the other participating practitioners.

“We have the operations piece down, the key now is to work on the payer model,” Prather says. In the Denver area, an ambulance transport costs roughly $1,000. The ER charges around $2,200. Of that, $200–$300 goes to the physicians. The cost of this alternative model is approximately $800 per patient, with $500 going to the fire department and the rest to the physician.

The fire department also saves money in the response. Typically, even low-acuity calls receive a fire apparatus with four firefighters and an ambulance staffed with two paramedics. The program now requires only the ambulance to be dispatched with the mobile medical unit, in the event the call was mistriaged or the patient wishes to be transported to the hospital.

“The nice thing about this system is that even if [patients] call 9-1-1, they still get the care they need,” Prather says. “We’ve adjusted the response.”