The Latest in Remote Presence.

HealthONE in Denver cuts ED wait times while improving behavioral health care through remote presence.

A recent study published in the Annals of Emergency Medicine revealed that behavioral health patients wait on average an astounding 11.5 hours before being treated or released.

These half-day waits are mainly due to the fact that many hospitals don’t even operate psychiatric wards anymore. And because reimbursement for behavioral health is among the lowest in medicine, many hospitals see these units as risky investments.

But the HealthONE hospital chain in Denver is bucking the trend by opening a new 40-bed psychiatric ward – one of the first in Colorado in quite some time. The new unit has implemented remote presence technology with a dual aim: to improve service to behavioral health patients while helping to shorten ED wait times. A remote psychiatrist can use the InTouch Telemedicine System and a device like the RP-Lite or RP-VITA to talk with the patient and make a timely diagnosis.

Dr. George Bussey, HealthONE’s chief medical officer, recently shared his organization’s strategic vision in an interview with National Public Radio. “ER wait times are often a function of how many people are in your waiting room and how many available beds you have,” said Bussey. “And if you have, for example, a 30-bed ED with five [behavioral health] patients who aren’t being moved out of beds, you’ve effectively turned yourself into a 25-bed emergency department, at which point you begin to get the backup.”

By directing behavioral health patients to a more appropriate care setting, HealthONE’s EDs can operate more profitably – and the shorter wait times give the organization a competitive edge over other area hospitals. Telepsychiatry also creates goodwill in the community. Patients love wait times that can be measured in minutes, not the time it takes to watch all three Lord of the Rings movies.

Making behavioral health patients wait 12 hours for treatment is downright medieval. Remote presence is helping them get the prompt, expert care they deserve – and helping EDs reduce wait times and improve the bottom line. You don’t have to be Carl Jung to understand why telepsychiatry is rapidly gaining momentum.

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.”

Health reform has given us a lot of buzzwords like “accountable care” and the warm-and-fuzzy “medical home.” They try to capture the essence of where reform is taking us: to a patient-centered system where collaborative care provides higher quality, better outcomes and lower costs. By tearing down silos and eliminating redundant tests, everybody wins.

That’s the grand vision anyway. But many healthcare organizations are having a tough time making the transition to this new approach.

To see how collaborative care is supposed to work, just look at the new telestroke program at the University of Cincinnati Neuroscience Institute and University Hospital. This teaching facility has long been in the top 25 of America’s academic medical centers – and the UC Stroke Team was started way back in 1987.

The new telestroke program is powered by ITH’s Remote Presence technology, connecting UC stroke specialists with physicians at UC Health’s West Chester Hospital and Dearborn County Hospital (just across the state line in Lawrenceburg, Indiana).

Here’s how the telestroke program meets the “triple aim” of health reform:

Higher quality care – Patients are quickly examined by a stroke specialist who can see and hear them right at the bedside.

Better outcomes – The program will save more lives – and provide higher quality of life – thanks to faster intervention and greater teamwork.

Lower costs – With Remote Presence, only the most severe stroke cases need to be transported to expensive tertiary centers – and many more patients can remain in facilities close to home.

“This is an important advance for us, and more importantly, for our patients,” says Dr. Opeolu Adeoye, director of the UC telestroke program. “This will allow them to stay closer to home at partner hospitals while still receiving the most advanced care available.”

Those words are almost like a mission statement for health reform. In the old paradigm, there would have been a number of time-squandering steps: local triage, transport to a stroke center, repeat diagnoses. But with telemedicine, the ED doctor, specialist and patient are all communicating in real-time.

Telemedicine is helping providers reach consensus in minutes, not hours. That’s what industry pundits call “collaborative care” – and what stroke survivors call a “miracle.”