An analysis of some recent telemed initiatives and interviews with thought leaders in the field suggest that telemedicine can transform U.S. healthcare into a cost effective system.
Among the initiatives examined are three – mobile poison consultations, Baby CareLink and a telestroke program – from Beth Israel Deaconess Medical Center (BIDMC) in Boston.
John Halamka, MD, an emergency medicine physician and BIDMC’s chief information officer, does about 600 poison consultations a year that take advantage of mobile technology. Parents typically will use their smartphones to take a photo of a mushroom or other plant that their child has ingested and email it to Halamka, who can then access a database available through his iPhone to identify the species, the toxins it contains and the appropriate treatment. Working with a regional poison control center, Halamka explained, the patient is then sent to a nearby emergency department or cared for at home depending on the plant ingested. “Here we have an extraordinarily cost effective, rapidly responsive medical service that offers significant benefits to large numbers of patients,” he said.
A second telemed initiative, called Baby CareLink, involves the placement of telemedicine units in the homes of low-birth weight babies who were patients at BIDMC, said Halamka. For families of a child who had been in the neonatal ICU, the hospital installs these home units at a cost of $2,000 per patient, allowing the hospital to discharge the baby one week earlier. Considering a NICU stay costs about $5,000 per day, the $2,000 telemed system replaces $35,000 in hospital costs, per patient ($5,000 x 7 days).
The third telemed initiative focuses on medical care for stroke patients, particularly in rural areas. Halamka pointed out the likelihood of having a neurologist available 24/7 in rural hospitals is small, which puts stroke patients at risk when they enter the hospital. BIDMC has an extensive telestroke program that offers consultation and the latest medical advice to ER physicians in these underserved communities. “The technology doesn’t need to be high-tech,” he said.
Simple tools, like Skype, allow telestroke program neurologists from BIDMC to participate in a virtual physical examination of a stroke victim. And with the help of a video camera, consultants can view head CT images, for instance, to help ER physicians make more informed diagnostic and treatment decisions. While some thought leaders believe it’s necessary to have a suite of expensive, sophisticated technology to offer telestroke services, Halamka said it’s often enough to use a smartphone, a webcam, or Apple’s FaceTime app to improve patient care and cut costs.
Like BIDMC, Ohio State Wexner Medical Center runs a successful telemedicine program, which was created about 18 months ago to support four rural critical access hospitals.
Also like BIDMC, Ohio State’s telestroke program is proving effective at reaching patients that are likely to not have access at their rural hospitals to stroke specialists.
“All these hospitals did not have access to neurologists with expertise in treating stroke. They never gave clot busting medication for stroke,” said Michel T. Torbey, MD, of the four rural hospitals now taking part in the telestroke program.
Clot-busting medications for stroke have to be administered within a narrow time frame to be most effective, noted Torbey, the medical director of the medical center’s neurovascular stroke center. Now, with remote access to Ohio State’s stroke experts, plus specially-trained nurses at the local hospitals, “the percent of patients receiving clot busting medication went from 0 percent to 20 percent,” he said.
Although it’s too early to do a cost analysis, a superficial look at the program’s results suggests it’s a money saver. Torbey said that before the program was put in place, any patient having a stroke was transferred to a specialty hospital to receive very expensive care. Now the transfer rate has dropped to about 50 percent as more patients receive top-notch care in their own community hospitals.