This is the second part of a two-part story on telemedicine. Part one covered why many providers have committed to offering some of their care via videoconferencing. Here, providers explain the time-saving aspect of telemedicine and discuss how they plan to integrate telemedicine into their traditional workflows.
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Dispatching specialists to far-flung corners of Utah, virtually
BALTIMORE -- At the American Telemedicine Association's annual convention, Intermountain Healthcare demonstrated the telemedicine gear it is building into its communications infrastructure.
It really doesn't matter whether I'm doing translation services, telemed visits, e-visits or remote monitoring; a lot of the infrastructure is the same.
Self-commissioned and built with help from Blue Cirrus Consulting LLC, the system was commissioned to be inexpensive, replicable and modular. It uses small, low-cost cameras, speakers and CPUs coupled with large televisions in remote patient rooms. On the other end, in the telemedicine center, practitioners use standard, company-issued PCs with one upgrade: video cards that can support up to six monitors. The key technology that makes the system go? A complex call-routing system that ensures the right practitioners connect with a patient when they're needed.
Like at Mercy Health Inc.'s new facility, tele-ICU will be the first service that Intermountain will concentrate on expanding its telemedicine center, with plans to spread it to 12 hospitals and 260 beds by fall. In the works are plans to augment behavioral health, oncology and cardiovascular health service lines with telemedicine consults. Eventually, the health system plans to integrate remote video feeds for sign-language interpreters and even primary care. After that, what may turn out to be healthcare's biggest-paying trifecta of cutting costs, increasing patient satisfaction and care quality at once: keeping elderly patients living in their own space and out of nursing homes longer than they are today. Intermountain hopes to accomplish this via home monitoring by remote clinicians, a program it calls "tele-daily living."
Launching each new service takes more than just technology, though. Kim Henrichsen, R.N., vice president of clinical operations and chief nursing officer for Intermountain, detailed how Intermountain's medical leaders develop clinical pathways, protocols and guidelines around each type of care. Practitioners will need to be coached on using the technology itself as well as videoconferencing skills to make the most informed, effective care decisions. It also takes audiovisual pros to set up the cameras and monitors to promote natural communications as well as heavily involving IT staff to implement the gear and the infrastructure behind it, added Blue Cirrus senior consultant Dan Watterson, R.N.
Intermountain encourages practitioners to participate in the development and rollout of new telemedicine services when they see workflow gaps. The health system's vendor-supported Healthcare Transformation Lab in Salt Lake City serves as a proving ground for ideas and as an engineering facility where other technology pieces can be developed.
"It really doesn't matter whether I'm doing translation services, telemed visits, e-visits or remote monitoring; it turns out that a lot of the infrastructure is the same," said the lab's executive director and chief technology officer Frederick Holston. The lab ironed out the technology wrinkles and honed the human communications aspects of Intermountain's tele-ICU in advance of what will be an eventual system-wide rollout.
Next on his team's list: setting up videoconferencing in patient rooms outside the ICU. "We've got a hospital where we can take a few rooms where nurses are willing to be inconvenienced while we figure this out. Hospital administration is willing to let us work on it, put some patients in there and get some feedback."
Beating Boston's rush hour with telemedicine
Telemedicine can facilitate better patient care in urban areas, too. Despite the financial, technological and clinical challenges broad telemedicine rollouts pose for large health systems, project leaders hold steadfast to the belief they will reap dividends once they're up and running.
Ultimately, finding efficiencies in care workflows via telemedicine will open up hospital beds, said Taylan Bozkurt, operations and financial specialist at Massachusetts General Hospital's Department of Surgery. He worked on a telerounding pilot project in which MGH specialists performed video visits with recovering burn patients at Spaulding Rehabilitation Hospital, a little more than two miles away.
A four-and-a-half month pilot last year that will be permanently adopted between the two facilities showed that video consultations expedited patient recovery. That, in turn, quickened their eventual discharge. It showed up on the ledger both as gains in increased bed capacity and improved care quality. While the pilot covered only 17 patients and 45 MGH virtual physician visits, it saved more than $60,000 that Spaulding would have spent on ambulance transport for the patients between the two facilities for in-person visits. For Bozkurt, the program was an equivalent to new construction, except without the planning, zoning and bulldozers.
"Telerounding can lower operating costs while maintaining and, I think, improving the standard of care we deliver to our patients," Bozkurt said. "We can increase patient throughput and increase bed capacity at our institutions without adding brick-and-mortar rooms."