Telemedicine – Innovation at Work
Telemedicine is demonstrating progress throughout Vermont as providers embrace the technology and patients benefit from the expanded access to care.
The 2017 VAHHS Annual Meeting featured a break-out panel on telemedicine in which moderator Claudio Fort, CEO of North Country Hospital in Newport, led a discussion that also included providers currently using the technology in various ways.
Devon Green, VAHHS’ Vice President of Government Relations, was on hand to explain the legal framework that has helped spur adoption of and interest in the technology.
“Telemedicine used to be limited in use only to some facilities,” Green said. “In homes and in some community hospitals, providers would receive no compensation for providing telephone support. But now, with Act 64, payers including Medicaid must reimburse for it in most settings.”
Dr. Kevin Curtis, Clinical Director of Dartmouth-Hitchcock Connected Care, kicked off the discussion with an overview of how Dartmouth-Hitchcock uses telemedicine to serve Vermonters.
“Telemedicine can help us fill in gaps of care and deliver outstanding health care to our region, independent of patient location,” Curtis said. “Telemedicine is not a service or a medical specialty, but a tool to help deliver care.”
He gave a description of how DHMC’s tele-emergency program improves population health.
“Imagine in a hard-wired ER, two people join the bedside team—a surgeon and a nurse. It’s a bad trauma with a critically ill patient. If you’re at the bedside using telemedicine, it’s just like you have an additional doctor or nurse with you, offering procedural advice and helping with coordinating transport and referrals.”
Using these tools allows patients to stay in the setting where their care begins—often in a local community hospital—rather than transferring them some distance for higher levels of care, Curtis noted.
He also described a tele-neurology program that connects providers treating stroke victims to other ERs, as well as to cardiologists and neurologists.
“This type of system improves outcomes by speeding the decision to administer tissue plasminogen activator (TPA), which can dramatically improve outcomes,” he said.
Curtis went on to explain how Dartmouth can provide telemedicine services for intensive care, psychiatry, pharmacy and urgent care.
Dr. Mark McGee, chief medical officer at Brattleboro Retreat, described his organization’s success using telemedicine in mental health care.
“At Brattleboro Retreat, recruitment and retention of specialty staff is challenging,” he said. “We use telemedicine to gain access for our patients to critical high-quality specialty care.” People often evaluate telemedicine by trying to compare it to inpatient psychiatric staff providing on-site care, McGee observed.
“While all research points to no difference in outcomes between in-person psychiatry and telemedicine,” he said, “the reality is that our patients would get no treatment without the telemedicine. So I think that’s a much more important conclusion. We may be treating patients who have been waiting in the ER—without this, they would not be getting quality care.”
He added: “Our telemedicine is excellent quality. We only contract with providers whom we are confident have the best credentials. In a small rural town, we would not be able to recruit that quality of provider to come on staff.”
He said that patients respond positively to the services.
“There is a novelty and innovation component,” McGee acknowledged, relaying that a beaming patient once compared his treatment to The Jetsons.
McGee said telemedicine also helps staff deliver care in a timely, cost-effective manner.
“Telemedicine staff can initiate treatment, monitor patients and follow up with them. They can also assist in disposition planning. Research has suggested that using telemedicine can help divert or avoid an inpatient stay or decrease length of stay,” McGee explained.
He said that telemedicine clinicians support the ED staff.
“Managing disruptive behavior has taken a great toll on emergency staff and telemedicine can ease that burden,” McGee said. “Sometimes patients ask to be evaluated during non-work hours so that they may be discharged. Telemedicine means that our provider, who might live an hour or more away from the facility, won’t have to travel.”
McGee noted: “Physician burn-out is one of the largest issues facing medical staff, so this is important… But more importantly, the patient is getting high quality care—we’re expanding beyond our walls.”
Kathleen McGraw, Chief Medical Officer for Brattleboro Memorial Hospital (BMH), said telemedicine provides bench strength for her small hospital.
“While we do have someone on-call 24/7, for most types of surgeons, we’re single-threaded. We can’t have all of them on-call all the time. So for example, we use tele-radiology at night from various national vendors,” she relayed
McGraw noted that a neurologist recently left the hospital for another opportunity and left BMH uncovered for acute stroke treatment.
“Best practices suggest a neurological evaluation before using step-up TPA,” she said. “After evaluating different options, we ended up partnering with Dartmouth to do tele-neurology since January. While we did that to provide coverage for acute stroke, our ER physicians have found it really valuable to get specialty neurological advice for other conditions as well.”
McGraw said that her hospital has also used tele-psychiatry.
“We don’t have any psychiatrists on staff at all, so we were really struggling. Everybody in Vermont has been feeling that pain,” she observed. “Now we have the opportunity to have psychiatric input as to whether a patient needs to remain in the ER. We really appreciate that.”
McGraw mused “When I talk to patients after they use telemedicine, they have this feeling of ‘I was special.’ … They know they’re getting best-practice connections to experts and they don’t have to leave the area.”