by: Bruce Carothers, Vice President of Telehealth Solutions for AMN Healthcar, July 14, 2014
I recently read a compelling but disturbing story about our fragmented care system from an ED physician who became a trauma patient while on a business trip. After being struck by a car, Dr. Charlotte Yeh was rushed to a local Emergency Department, where after 24 hours of testing and surveillance they concluded that since “nothing is broken, you can go home now.” However, Dr. Yeh was in terrible pain and unable to even stand up. It took another 2 days of back-and-forth “piecemeal evaluation” by multiple care providers before they learned she had suffered contusions of both sciatic and gluteal nerves. More than 2 years later, she is still recovering from her injuries which were unrecognized for almost 4 days of disjointed care.
Medical literature is filled with similar stores and reports about fragmented care. Physician services have grown from 20 specialties in 1970 to nearly 200 specialties today. Industry trends such as ACO’s and value-based payments are driving interest in topics such as patient-centered care models, collaborative medical teams and transition care management. All of these new solutions focus on improved clinical workflow, improved communication and coordination of care across the traditional healthcare silos.
A parallel challenge is the often fragmented nature of telehealth programs. Many times, telehealth programs are started by a physician champion within their clinical specialty area. A department chair for Neurology implements a Tele-Stroke program. Next, the Critical Care department puts in an e-ICU remote monitoring service. Meanwhile another unit receives grant funding to provide pediatric subspecialty services to remote clinics. How often do these clinical units work together to find a common technology platform? Even if they use different technology, perhaps purchased at different times, wouldn’t they benefit from sharing best practices and cross-training support staff? Unfortunately this multi-specialty collaboration is often lacking.
Telehealth programs – sometimes called virtual care – can provide tremendous benefits such as improved access to scarce specialty providers, especially in rural areas; reduced referral wait times and reduced avoidable readmits; and greater market coverage in hub-and-spoke models. But virtual care models require close coordination with referring physicians, local telemedicine coordinators, case managers and other professionals.
Does Telehealth help or hinder the move to collaborative care? One study found that telehealth programs “created a new context for team-based management, enabling members to communicate simultaneously when they otherwise would not have, thus fostering collaborative, multi-disciplinary patient management. This approach translated into more effective case management and decreased treatment time for patients.”
There are some notable success stories that demonstrate the value of telehealth collaboration. Mercy, a 40-hospital system based in St Louis, recently started construction on a 120,000 square foot Virtual Care facility for nearly 300 physicians and healthcare professionals dedicated to 75 clinical services. These clinicians could operate from disparate locations – as many of them do now – but a key driver behind the $50M investment in their new facility was the goal of clinical collaboration across service lines and improved care coordination.
AMN Healthcare provides staffing for many Telehealth providers, including health system programs and turn-key services offered by commercial vendors. We have observed that many successful telehealth programs have at least 1 common theme: collaboration between the on-the-ground and in-the-air physicians and nurses.
If the local medical staff avoid telehealth referrals or dismiss the recommendations of the remote specialty physician, the telehealth program will fail. On the other hand, if the local and remote medical staff work together to define patient referral criteria, clinical workflows and patient charting standards – and if they continue to refine these guidelines from ongoing operational experience – then many benefits can be realized.
Telehealth programs won’t be successful for long if they operate inside a silo. Just buying technology or just hiring an outside service provider is not sufficient. Gaining buy-in and support from the local medical staff is essential, not just at the beginning but during implementation and beyond, until the virtual care service is fully integrated into the local practice of medicine. Done right, telehealth can facilitate and accelerate the move to patient-centered collaborative care models.