The technology that makes telemedicine easy to use can serve the simple human dimension of a governing board's mission as well as operational or financial responsibilities. Comprehensive use of tools that bridge distance and time can make life a little more bearable for isolated people in stressful health care situations, be they patients or caregivers.
The burgeoning e-emergency service of Avera Health, mainly at critical access hospitals in five Western and Plains states, can "alleviate the nursing staff from being alone in the middle of the night with an emergency arriving in their ED before the local physician can arrive," says Deanna Larson, vice president of quality initiatives for the Sioux Falls, S.D., system. Usually, it's a nurse pushing the button to start the intervention, not a physician.
Cutting-edge technology does ease a learning curve that once involved complicated and time-consuming setup. "You don't even have to dial a phone, you just push a button and everything happens after that," says Jim Veline, Avera's chief information officer. "If you're a nursing supervisor working weekends once a month, and you're dealing with an admit into your emergency department, you don't need a cheat sheet or crib notes; you just go over and you push a button. It's really important to make it that easy."
Covering the ED in such times generally helps to relieve pressure on the thinly spread physicians in a small community. "In rural communities, the emergency room is primary care," Larson says. "There are only two or three physicians in that community and they work 24 hours a day, seven days a week. So trying to recruit physicians to a community of three, four, five thousand is becoming more and more difficult, and those who are there are getting worn out."
Health care organizations making full use of telemedicine see it as a way to give physicians access to colleagues to talk over medical situations and just stay in touch with their field, something taken for granted in population centers but often difficult to do in wide-open spaces. Videoconferencing that connects Aspirus Network physicians in Laurium, Mich., to specialists in Wausau, Wis., at the flagship hospital "allows us to become a virtual campus under the Aspirus name [with facilities] that are many, many miles apart," says Jean Burgener, vice president of post-acute care.
For physicians, the Avera e-emergency service is "giving them a collegial community to work within" and providing a setting in which doctors feel they can continue to grow as medical professionals, Larson says. "We're supporting them so we can aid in recruitment."
Telemedicine also gives specialists more options to plan how they reach patients over a wide area. For example, a pair of oncologists in Walla Walla, Wash., who were seeing patients at Grande Ronde Hospital had alternated on weekly trips there, until one doctor decided he only wanted to travel once a month. The LaGrande, Ore., hospital furnished the doctor with a control station and he started seeing patients remotely for one of the two monthly encounters, says Douglas Romer, executive director of patient care services. These are established patients who have met the doctor in person and need to see him at certain intervals as they undergo treatment.
The alternative would be for patients to make the trip to the physician's office, says Romer. "Can you imagine a patient having to travel 186 miles, and sit in a chemotherapy chair all day long and then go back over the mountain in the snow, nauseated because they just had chemotherapy? The patients do better having it here [in LaGrande]."
At times the need to be in touch with a specialist is critical, and the cost of airlifting can add financial shock to the physical emergency. "Each time we have to put a patient on a helicopter and fly to Boise or Portland, Ore., it costs about $26,000," Romer says. For fixed-wing transport, add the ambulance runs to the plane and to the destination hospital when it lands.
By keeping patients at Grande Ronde, the telemedicine service covering the intensive care unit alone has prevented 42 transports over a period of 30 months for a total savings of $1,035,972. In 11 months, the tele-oncology program has saved 159 patients a total of 27,348 road miles and $13,675 in travel expenses. Tele-dermatology has allowed 87 patients to be seen in their own community, saving them a total of 14,964 miles on the road or $7,500 in travel costs.
That savings accrues mainly to Medicare or private insurers, or to self-pay patients "having to mortgage their house to pay for a helicopter flight to a tertiary care center," says Romer. For the health care system generally, involving specialists via telemedicine limits duplication of testing and overutilization of tertiary services that can happen when patients are transported away from their primary care provider, he adds.
And local care is a plus in other ways. "The goal is to support keeping the patient in the local community," says Larson of Avera. "If we can avoid unnecessary transfers of patients who can be taken care of in the local community, we're really impacting that local economy and also the economy of the facility, therefore, increasing workforce opportunity."
Keeping care in LaGrande lifts burdens from families, not just individuals needing extra intervention, says Lynn Harris, Grande Ronde's board chair. "The program or two we started with, we could see that we weren't transporting patients, we were helping families, and so we've just incrementally grown the program," Harris says. "The benefits there are beyond financial."
At times, specialist or critical care at their physical locations can be impossible because the routes to them are impassable. "When the weather turns bad, it's amazing the interest in telemedicine," says Jerry Mourey, Aspirus vice president for information technology. That goes for physicians as well as patients. "It can really be treacherous in between some of these sites."
In LaGrande, "there's a pass on either side of us that's elevated, and there are times when we don't get out of town for 24 hours — roads are blocked," Harris says. For critically ill patients who can't be flown out or put into an ambulance, the ability to teleport distant doctors to Grande Ronde bedsides "is truly a lifesaver sometimes."
John Morrissey is a freelance writer in Mount Prospect, Ill.
For more on telemedicine, please see "Telemedicine Today," February 2012.