Solutions To ED Boarding

Telebehavioral or telemental health care took center stage at the 10th InTouch Telehealth Innovation Forum. Presenters demonstrated how telemental health programs are improving outcomes and lowering costs – from Critical Access Hospitals all the way to the nationwide HCA network.

A recent study by The Commonwealth Fund found that about 80 percent of mental health or psych patients present at EDs and primary care offices, where providers often lack the training to effectively treat them. And a study by the IAHSS Foundation revealed that many Emergency Departments board mental health patients for 24 hours or more. Some rural hospitals have wait times as high as 18 days.

At the InTouch Telehealth Innovation Forum, three providers outlined their solutions to this growing problem:

  • The 25-bed Illini Community Hospital in Illinois showed how telemental health technology is linking its community with a tertiary center 50 miles away – and with mental health practitioners as far away as Kansas City. Illini has already achieved a Press Ganey patient satisfaction score of 99 percent.
  • At the other end of the scale, HCA annually conducts 17,000 telemental health or behavioral care consultations across its vast network. The hospital giant has already dramatically reduced the ED backlogs of mental health patients.
  • The PeaceHealth system in Oregon now provides telemental health care to four hospitals – bringing pediatric services to one facility that had never offered them. PeaceHealth plans to widen its program to provide behavioral telecrisis consultations for two other Oregon hospitals.

Studies show that outcomes improve significantly when a behavioral care patient is seen within four hours. These three programs are providing much-needed guidance to other hospitals that are currently overloaded with mental health ED patients and are looking for both clinical and financial solutions.

TeleBehavioral Session

TeleBehavioral Session

Telehealth – A Dementia Care Solution?

Kudos to Linda Kaufman, RN, for a thought-provoking article in Executive Insight about how telehealth can improve care and lower costs for patients with dementia.

Kaufman cites some shocking numbers from the Alzheimer’s Association: the cost of care for Alzheimer’s patients this year is expected to top $226 billion – and that number could go even higher when you include those who suffer from Alzheimer’s plus chronic conditions like diabetes.

In Kaufman’s view, telehealth can play a pivotal role in lowering the staggering cost of care for dementia patients by reducing unnecessary hospital visits and improving communication between skilled nursing facilities and home health providers.

She even outlines how a fledgling telehealth program might be structured. Registered nurses could be available 24/7 for calls and video chats with family members providing dementia care. The nurse would use a series of algorithms and protocols to make recommendations to the caregiver. This early intervention could go a long way toward eliminating unnecessary ambulance transport and ED visits. It can also provide ongoing emotional support for stressed-out caregivers.

The Alzheimer’s Association estimates that there will be more than seven million Medicare-age dementia patients by 2025. Meanwhile, there are only about 1.6 million nursing home beds in the U.S., and Baby Boomers are retiring at the rate of 10,000 per day. It soon may be necessary to provide home-based care for huge numbers of dementia patients – and telehealth may be the only viable solution.


Telehealth Solution

Telehealth Solution

More On Ebola and Telemedicine

One of the main reasons why Ebola has been halted in the U.S. is that we’ve got the technology to help prevent its spread. For example, the New York physician who came down with Ebola checked his temperature daily and reported it (via cell phone) to other doctors. When his temperature hit 100, he knew it was time for quarantine.

So here’s the question: does West Africa have the cell network and 4G Internet reliability to effectively use technology to combat Ebola? The answer is a resounding yes.

Cell signals in West Africa are so reliable that Microsoft co-founder Paul Allen recently donated 10,000 cell phones to West African authorities and physicians combating Ebola.

In 2011, French Telecom and other providers began installing the Africa Coast to Europe (ACE) cable system. More than 10,000 miles of high-speed fiber-optic cable now connects West Africa with Europe.


West Africa fiber-optics

So there’s already an infrastture to support sophisticated telemedicine networks throughout West Africa. Everything needed to use an RP-Express robot is already in place.

In our view, there’s nothing to prevent telemedicine from playing a much larger role in the effort to stop the spread of Ebola.

An eBola Solution

In sci-fi movies, people infected with intergalactic viruses are usually treated by contagion-free robots. In similar fashion, technology is playing a role in the battle to prevent the spread of Ebola…but it needs to be deployed in a more robust way.

Currently, some of the CDC’s special biocontainment units across the country are using technology to connect Ebola patients and caregivers inside with consulting physicians and family members at remote locations. The most recent example is that of Dr. Richard Sacra, a U.S. doctor who contracted Ebola in Liberia and was taken to a biocontainment unit in Nebraska.

That’s a smart – but fairly limited – use of technology. Telemedicine would be immensely more effective if used in the danger zone. Imagine, if you will, that the government of Liberia has just built a special Ebola clinic equipped with telemedicine robots and supporting technologies. The robots could allow a remote clinician to watch the attending physician put on and take off protective apparel, reducing the risk of accidental exposure.

Robots can glide right into harm’s way, and obviously don’t require any of the fancy air filtration and ultraviolet light environments that are standard in U.S. biocontainment units.

Using robotic helpers would be an incredible “force multiplier” for the courageous doctors and nurses helping to contain the outbreak. It’s likely that fewer of them would be needed on the front lines, which would mean fewer quarantines for returning caregivers.

The prefix “e” (for electronic) is used everywhere these days: e-commerce, eBay, and so on. Maybe it’s time to thwart a deadly disease with an eBola strategy using telemedicine.



FDA Gets It Right

There are many healthcare pundits who feel that the Food and Drug Administration should relax its rules on Medical Device Data Systems (MDDS). But we applaud the FDA for living up to its century-old mission: putting patient safety first.

There are already plenty of smartphone apps that can monitor things like a diabetic’s blood sugar readings. The FDA classifies those products as MDDS because they simply collect data. But there’s a growing number of mobile apps that let physicians view things like sonograms and EKGs in realtime. As the FDA sees it, when a product crosses the line from mere documentation to active patient monitoring, the app is no longer an MDDS but a Class II medical device.

Not surprisingly, the makers of these mobile apps are complaining that the FDA is stifling innovation. The process of getting the FDA’s 510(k) clearance as a Class II medical device is expensive and time-consuming – and many mobile app vendors feel that it’s creating an unnecessary barrier to market entry.

But in our view, the FDA is simply weighing the risks and making patient safety the top priority. FDA guidance makes a clearcut distinction between a mobile app that lets a doctor view a X-ray on an iPhone and one that lets the physician consult with colleagues and make clinical decisions.

MDDS products don’t go through a rigorous vetting process. In contrast, our remote presence devices already have 510(k) clearance for a wide array of assessments, including pre-operative, peri-operative, post-surgical, cardiovascular, neurological, pre-natal, psychological and critical care examinations.

We have nothing against today’s glut of iPhone apps with groovy graphics. But we agree with the FDA that these products must be held to a higher Class II standard.

Remote presence devices used for active patient monitoring require a Class II clearance.
Photo courtesy of Saint Alphonsus Regional Medical Center.