EMS, Telemedicine and Healthcare Integration

Editor's note: This piece is adapted from an interview series published by Medlert, Inc., in collaboration with experts in EMS and medical transport. The series is being published in the LinkedIn group, the Future of Medical Transport. Join the group to be part of the conversation.

A recent survey of 400 healthcare professionals found 46% reported using telemedicine technologies at work. The top technologies respondents reported using are:

• Two-way video (approximately 60% of respondents)
• Image-sharing tools (55%)
• Remote patient monitoring tools (<20%)
• Smartphones (<20%)

Although telemedicine is still in its infancy, it presents tremendous potential. Recent predictions suggest one in six doctors visits in U.S. and Canada will be virtual in 2014.

One Pennsylvania hospital has launched a pioneering EMS telemedicine pilot program that uses iPads to connect paramedics with hospital-based physicians for consults on some patients. These consults may help eliminate some ambulance transports and unnecessary hospital admissions and re-admissions, which are costly and increasingly scrutinized.

Telemedicine can help paramedics and the EMS industry capitalize on its value-add as a patient navigator within the integrated healthcare system of the future.

In a recent interview, Ed Racht, MD, the chief medical officer at American Medical Response (AMR), said, “When someone calls 9-1-1, those three little numbers set into motion a relatively expensive journey through the healthcare system.”

With telemedicine now able to connect paramedics directly to the healthcare system and physicians, EMS is positioned to become a critical part of integrated healthcare.

Paramedic home visits could become an essential part of helping chronically ill patients get back on track with a “programmed level of care, including what your ACO has defined, or your physician has defined,” said Racht. “This puts some of the biggest drivers in healthcare into the EMS providers’ wheelhouse.”

Racht started his career in EMS many years ago as the medical director for the Henrico Volunteer Rescue Squad. Racht sees being “a master at patient navigation logistics” as one of EMS’ greatest value-adds in healthcare.

“We probably do that better than anyone else,” said Racht. “In most urban and rural communities, I can get to your side at 8 minutes at least 90% of the time and with the right level resources.

“EMS is good at deployment strategies; good at surge capacity; good at figuring out solutions when historical processes don’t work,” continued Racht. “If the major trauma center goes on diversion because there’s a gas leak, EMS has the ability to figure out the next best option for that patient population very quickly.”

Patient logistics, including getting the right information to the right people, and getting patients where they need to go for care, is where EMS shines.

“In the good old days, you’d respond to a cardiac arrest and you had to know which hospitals you would transmit telemetry to,” said Racht. “The doctor would read the strip and give you orders on how to treat the patient. Then, EMS got very good at doing it by themselves with standing orders.”

Telemedicine opens up a host of new possibilities for connecting prehospital care with primary care and hospital-based care. Racht sees the future as one where paramedics can use EMS logistics systems to “talk to physicians, primary care physicians, the on-call emergency physicians right from the patient’s bedroom, or from a store, or from a street.”

Technology makes that possible, and it positions EMS front and center in integrated healthcare.

“Take, for example, a gradually deteriorating congestive heart failure patient who is at risk for readmission,” said Racht. “We can use the same skill set to identify their practitioners, how to get the patient back into the health maintenance plan and get them to the right level of care instead of just reflexively saying ‘you call, we haul.’

“We’ve seen the evolution of mobile integrated health programs and the utilization of a dispatch center as more of a triage center for patients. Health insurers are interested in what EMS providers can do,” added Racht. “I think what’s changing is that EMS systems are being recognized as just as valuable for the lower acuity, non-acute, unplanned care as they are on the high acuity, acute, unplanned care in terms of navigation.”

About the author
Susanna J. Smith is a freelancer writer focused on the future of healthcare and how new technologies are reshaping the healthcare industry. She is the content manager and a contributing blogger at Medlert Inc, a San Francisco-based software company that is developing mobile, cloud-based solutions for the healthcare ecosystem, including the EMS industry. Susanna holds a master’s in public health from Columbia University and has worked as a writer, editor and researcher for more than 10 years. You can follow her work at @SusannaJSmith and @Medlert.