Bringing Telemedicine to Integrated Health Programs

Telemedicine isn’t a new idea. But for many years, what seemed like a great idea in principle failed to live up to its potential in practice.

“Today we have a convergence of telemedicine and videoconferencing technology, smaller and more powerful mobile devices, widespread wireless broadband mobile data, and an emphasis on healthcare cost reduction, improved quality and patient satisfaction—the Triple Aim,” says Curt Bashford, president of General Devices, a New Jersey-based provider of telemedicine and other communications solutions for emergency care. “The evolution of mobile integrated healthcare and community paramedicine also are driving need. Together these factors are allowing us to provide telemedicine tools in an easy-to-use, secure and cost-effective manner for enhancing patient care.”

The potential for this realization is evident in the Parish of East Baton Rouge, LA, which launched an ambitious project more than a year ago with the help of General Devices and its e-Bridge Mobile Telemedicine and e-Net Messenger systems. The goal—equipping all of the parish’s hospitals, ambulances and EMT/ED staff with mobile telemedicine capabilities—may sound modest, but the results speak to the future of EMS. Patient care, both in and out of the hospital, is being improved.

Head First

East Baton Rouge EMS actually started its foray into telemedicine in 2009, but according to Deputy Shift Supervisor Bryant Hernandez, AS, NREMT-P, it didn’t get serious about using it until 2011. East Baton Rouge began with just two ambulances equipped with telemedicine technology and used it exclusively for secure messaging of text, pictures and 12-lead data. The ability to videoconference between the ambulance and hospitals existed, but it was hampered by the 3G technology in place at the time. East Baton Rouge’s telemedicine program has only really taken off more recently as it ramped up its Community Integrated Health Program (CIHP), which Hernandez also coordinates.

“The way all this took place was, our mayor took a trip to Israel back in the mid-2000s, and he saw a demonstration of the Israeli military using satellite phones and telemedicine from the front lines, so to speak, sending back information to the hospitals inside Israel. He was really intrigued by that and wanted to bring that kind of technology to Baton Rouge,” Hernandez explains. “But it wasn’t until the technology got to the point where it is now, as far as 4G and advances in cellular devices and HIPAA-secure telemedicine apps, that we were really able to dive head-first into the telemedicine program.”

East Baton Rouge focuses it CIHP on its high-utilizer group, made up largely of COPD patients, diabetics and alcohol- and drug-abuse patients, says Hernandez. Psych patients also make up a sizeable portion.

“We mainly use it to be able to keep patients from going to the hospital unnecessarily,” Hernandez says. “We’ll contact our medical director Monday through Friday, and on weekends or after hours we’ll contact emergency departments for medical direction. And we’re working out the logistics with hospitals here in Baton Rouge where they’re going to refer us to patients who are high utilizers of their emergency department. Once that takes place, the main telemedicine contact to manage that group will be those particular emergency room physicians. In this way, a hospital that refers us a patient will provide the doctors who will be responsible for coordinating their care with our CIHP by telemedicine. Hopefully that can reduce unnecessary transports." 

Hernandez notes psych patients are the most difficult for the CIHP to accommodate, because there is currently no mechanism in Baton Rouge to permit alternative transport destinations. Until the law changes, EMS is bound to transport psych patients to the ED only, not to psychiatric centers which might be more capable of handling those patients’ unique needs.

But, says Hernandez, where East Baton Rouge EMS has been able to aid psych patients with its CIHP is by helping them adhere to their medications. “As long as they’re on track with their medicines,” he says, “they don’t seem to need the emergency room as much.”

Profound Effect

So far the CIHP, with the addition of telemedicine, has had a profound effect on reducing patient transports among the high-utilizer group. According to data from East Baton Rouge EMS, in a recent six-month period the agency saw 2,000 patients who had multiple 9-1-1 transports. In all during that period, that group accounted for 7,168 calls with 5,514 transports.

But September 2014 offers a perfect snapshot of the impact the CIHP has had. East Baton Rouge EMS started with 14 clients who had a combined 164 calls in the six months pre-CIHP enrollment. Those patients averaged 27 calls a month combined. After enrolling in the CIHP, their total combined calls dropped to just 11, and those patients needed only two transports during the month.

Now East Baton Rouge is on the verge of expanding its CIHP to include CHF patients, says Hernandez, and the sky’s the limit for the program bolstered by its integration of telemedicine. “We’re being pushed by the hospitals to include pediatric asthmatics,” he says, “and they also want us to start doing prison screenings, which is going to be a good realm for our telemedicine. Basically a police officer will go out and make an arrest, and in certain instances that prisoner will have to get clearance from a doctor prior to getting processed at our jail. So we’ll go out and do on-site medical screening for that prisoner. We’ll be able to do that via telemedicine by getting in touch with the emergency room physician and doing whatever needs to be done as far as treatment of that patient before they’re sent to the prison.”

The transition to widespread use of telemedicine throughout its CIHP has been incredibly smooth, adds Hernandez. “Really, the biggest issue we’ve found so far is with lighting and camera motion. We’ve been working with our local university engineering department, and they’re devising ways help us make it better, such as developing a stand that’ll hold the iPad in place, along with some proper lighting for areas where it’s kind of dark and affects the picture quality.”

None of that would be possible without the special partnership East Baton Rouge EMS shares with General Devices. “Mobile telemedicine is not traditional telemedicine on wheels,” notes Bashford. “EMS and mobile health have special needs that General Devices has served for over 25 years.”