The Latest in Remote Presence.

Telemedicine can help unclog crowded Emergency Departments.

There are basically two ways to run an Emergency Department. Most are designed like the Department of Motor Vehicles where you sign in and wait for service. The emerging way is to use the Grand Central Station model, where the ED is the service hub. People don’t hang out at Grand Central; they get quickly routed to the places they need to go.

Today’s most innovative EDs are using this hub approach to better serve patients – and remote presence plays a vital role in that process. For too long, Emergency Departments have seen themselves as the hospital’s front door, not the center of the entire enterprise. But a hub-style ED offers a host of benefits: more efficient workflow, better resource utilization, greater throughput, and higher quality care.

In a hub-style ED, the idea is to quickly triage and route each patient to the most appropriate care setting. How does telemedicine help? For starters, it provides better service for the ED’s most frequent users: behavioral health and pain management patients, plus those who rely on the ED for routine primary care. Because those patients aren’t in critical condition, they often sit for hours waiting to be seen. But with remote presence, they can get high-quality care without clogging up the ED. A remote physician can quickly make an assessment through devices like the RP-7i robot. That means that ED physicians have more time for patients with life-threatening emergencies.

It’s obvious that the most expensive resource in today’s ED is the provider. Highly trained ED physicians and nurses have more pressing things to do than treat sinus infections or try to determine whether a patient is depressed (especially when a behavioral health professional can be reached quickly with remote presence).

So the choice is clear: your ED can either be a plodding DMV or a fast-paced hub capable of delivering higher throughput and better care while improving the hospital’s bottom line.

At the AMA’s annual meeting in June, the New York delegation introduced a resolution urging the Department of Health and Human Services to review telehealth initiatives being implemented by major health insurance carriers like Blue Cross and United Healthcare.

The AMA is concerned that telemedicine as practiced by Optum Health (a subsidiary of United Healthcare) will siphon off business from local physicians who are willing and able to provide the same services.

The resolution specifically refers to the new NowClinic program (a joint venture of Optum and a software firm called American Well). NowClinic plans to provide patients with a 10-minute consultation with a remote physician for just $45, payable by credit card. It’s an arrangement that already has the approval of the New York State Department of Health.

The AMA’s reaction is a classic case of throwing out the baby with the bath water. By opposing what they see as essentially a low-cost “Skype-a-doc” program, the AMA is turning a blind eye to the high-end uses for telemedicine. It’s one thing to remotely diagnose a head cold. It’s quite another to provide cutting-edge telestroke and tele-ICU technology.

In the resolution’s long list of attorney-like “Whereas” clauses, we find this nugget of misinformation: “A face-to-face visit is needed to provide an initial examination sufficient to engage in an effective patient-physician relationship.”

That’s simply not true – and the AMA should be more careful in its pronouncements. Yes, it’s possible that a NowClinic physician in Sacramento can potentially cut into the profits and patient base of a doctor in Buffalo, but so can the nurse practitioner at the Take Care clinic at the nearby Walgreen’s pharmacy.

We can certainly understand some of the AMA’s reservations about telehealth services provided by insurers. But passing this resolution would be a big step backward for telemedicine in the U.S.

The N.Y. AMA recently passed a resolution seeking to limit the use of telemedicine in that state.

When patients hear the diagnosis “cancer,” the first response is often to panic. They’re ready to drive or fly anywhere to get a second opinion or learn more about the latest clinical trials and treatments.

But with telemedicine, they can get those expert opinions and therapies without ever leaving their local hospital. For example, the Trinity Health system in Michigan is now using remote presence technology to rapidly get second opinions from oncology experts throughout the region.

It all began with some creative thinking at St. Joseph Mercy/Port Huron, which adapted its telestroke robot to do double-duty for oncology. Physicians there discovered that some cancer patients were driving 120 miles round-trip to get second opinions – making a highly stressful situation that much worse.

“This is a very difficult time for patients,” says Kanu Dalal, an oncology MD at the Port Huron facility. “Using telemedicine for a second opinion can ease some of those fears – and it really expedites things when it comes to choosing and starting a treatment.”

Research shows that patients battling cancer prefer to be treated locally, yet they understandably want access to cutting-edge treatment. Remote presence can bring the best surgeons, oncologists and radiologists right to the bedside, ensuring that the patient gets expert advice without spending hundreds of dollars in travel costs.

Because the Port Huron Hospital is part of the Michigan Cancer Center Consortium, patients have access to every national clinical trial and treatment in use today. So they don’t necessarily have to book a flight to MD Anderson Cancer Center in Houston. (From Port Huron, you’d need to drive an hour to Detroit, where round-trip plane fares to Houston for two people would run about $1,000.)

Getting a cancer diagnosis is one of the toughest blows imaginable. The last thing a cancer patient wants to do is start calling travel agents. Remote presence brings a team of experts right to the patient’s home hospital and that’s truly a blessing. No second opinion needed.

About 10% of U.S. patients have limited English proficiency. By law, all hospitals that receive federal funds must offer some kind of interpreting service to those patients. Big medical centers usually have an on-staff interpreter proficient in the most needed languages like Spanish. Small hospitals often have to rely on a clumsy “he said/she said” solution, where the patient and provider pass a cell phone back and forth while a translator in a distant city tries to sort things out.

Sometimes an interpreter can’t be found at all – and that can have a negative impact on outcomes. In a recent study at two pediatric ERs, when a nonprofessional interpreter (such as a family member) was involved, there was a lot of miscommunication. And nearly 25% of those translation errors posed potential health risks for the children being treated.

That’s why many healthcare organizations are turning to telemedicine for solutions. With remote presence, hospitals don’t need to hire full-time interpreters because the language experts are available 24/7. Instead of a crackly phone call, patients get face-to-face communication (resulting in fewer errors). And you can find interpreters for a variety of languages, not just Spanish.

Here’s one scenario: Suppose a business traveler from Rio de Janeiro comes to the ER at a large medical center in Los Angeles. They’ve got an excellent Spanish interpreter on staff, but the man speaks Portuguese, not Spanish. The interpreter might get close to a decent translation, but close isn’t good enough in the ER. With remote presence, you can quickly connect the patient with a Portuguese interpreter in Boston.

Because of health reform, patient satisfaction now plays a key role in reimbursement. And a recent study in Annals of Emergency Medicine revealed that patients who had professional interpreters had satisfaction scores that were four times higher than patients relying on family members.

It’s all very simple. Remote presence boosts patient satisfaction, which in turn boosts reimbursement. That’s a language everyone can understand.

Perhaps the biggest reason patients are wary of telemedicine is that they fear that doctors will lose their personal touch and become too “clinical” and detached. But when patients experience all that Remote Presence has to offer, they’re often pleasantly surprised.

Maybe pop culture is to blame. For decades, our movies and TV shows have depicted omniscient machines making humans marginal, if not irrelevant. So when patients see a robot glide into the room, they assume it’s the medical equivalent of the Watson computer on Jeopardy – the all-knowing machine who does the doctor’s job faster and better. But remote presence is all about enhancing human interaction, not calling attention to machines. It can bring a physician in San Diego up close and personal with a patient in Atlanta – something that would have seemed amazingly sci-fi 20 years ago.

And after every remote presence consultation, patients don’t thank the robot…they thank the doctor, even if he or she is a continent away. Here are some examples:

• The parents of a newborn with a rare disease who wouldn’t have survived without early intervention from a remote presence specialist

• The man who could have had lifelong complications if a remote presence physician hadn’t coached an ED staff on how to administer tPA

• The stroke patient who was so moved by a life-saving intervention that he asked his remote specialist to be best man at his wedding

• A woman who might not have survived until morning rounds if her bariatric surgeon hadn’t done a remote presence check-up

Telemedicine isn’t about creating mechanized marvels to replace doctors. It’s about using technology to ensure that long-distance physician/patient encounters remain as warmly human as the first time your doctor asked you to say “Aaah.”