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Extending the Reach of Care Through Telehealth

August 17, 2014
by Cynthia E. Keen
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Experts from Manitoba and Minnesota share their perspectives on important new trends in telehealth on both sides of the U.S.-Canadian border
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Telehealth has finally overcome a major hurdle for widespread use with the proliferation of mobile tablets and smartphones and the ability to share high resolution photos and videos via low cost communications services throughout most of North America. With parity reimbursement laws in place in 19 states, and a bevy of bipartisan supported telemedicine legislation introduced in this session of Congress, including the proposed Medicare Parity Act of 2014, the financial obstacles relating to payment for telemedicine services are starting to crumble.

The scope of telehealth includes telemedicine services to patients, healthcare provider-to-healthcare provider specialist consultation, and health-related education. Professionals working in the field of telehealth expect it to proliferate in the next few years.The emphasis by the Affordable Care Act to have healthcare providers organize health care teams, technology, and knowledge around patients’ needs to achieve healthcare delivery’s full potential will be a stimulus to its expansion.

The upcoming Health IT Summit sponsored by the Institute for Health Technology Transformation (iHT2) being held August 19-20 at the Seattle Waterfront Marriott includes a panel on the topic of “Extending the Reach of Care through Telehealth." Since December 2013, iHT2 has been in partnership with Healthcare Informatics through HCI’s parent company, the Vendome Group LLC. HCI spoke with three of the panelists about their experiences and perspectives.

Canada spearheaded the pragmatic use of telemedicine in the early 1980s. Standard telephone lines slowly transmitted single video images – or “freeze frame” video – of injured people living in rural villages in Northwest Ontario and on offshore drilling rigs in Newfoundland. Physicians provided desperately needed triage advice and made assessments if evacuation would be need, and if so, at what level of urgency. Since then, every province has utilized telehealth in some capacity.

Trever Strome is an assistant professor in the Department of Emergency Medicine at the University of Manitoba College of Medicine. He also is a process improvement lead in the Emergency Program at the Winnipeg Regional Health Authority (WRHA). In this capacity, he works at identifying ways to leverage technologies to reduce unnecessary emergency department (ED) visits and to improve the efficiency of care for the patients who do present to the ED. This includes investigating how telehealth-related systems can help reduce ED overcrowding and prevent some ED visits altogether.

Approximately 60 percent of Manitoba’s residents--about 700,000--live in greater Winnipeg, according to 2013 estimates from Statistics Canada, with the remainder living in small towns in that vast 250,000-square-mile province. A Manitoba Telehealth network connecting 23 healthcare facilities started in 2002 to provide access to medical specialists to both patients and physicians living and practicing in rural areas.

Strome is currently researching ways to use telehealth by the emergency departments of community hospitals outside the Winnipeg region, including investigating ways for these departments to obtain specialist consultations during night and weekend hours. One of the objectives is to be able to minimize the need for costly emergency patient transport to tertiary hospitals.

Questions about when it is appropriate to use telehealth for emergency services today are being seriously evaluated . “We need to make sure that we are doing the right things, the best way for the patient,” Strome says. “Telehealth has a great set of technologies to use, but like any other medical intervention, we need to determine if and what is most appropriate. When implementing any telemedicine application that would be a substitute for an on-site visit to a healthcare provider, it is important to determine in advance if this is comparable to a face-to-face visit. We have done well providing telemedicine services to more remote healthcare centers, but it is important to start quantifying this experience to ensure that patients are receiving the best care possible.”

Pediatric patients living outside the five major cities of Montana are receiving better health care thanks to telemedicine, according to Doris Barta, director of telehealth services in the Partners in Health Telemedicine Network (PHTN) at St. Vincent Healthcare in Billings. She explains that “there are only 17 licensed pediatricians in Montana, all of whom practice in the state’s five largest cities. Children living outside these areas either receive care from primary care physicians and clinical staff working in rural healthcare facilities or travel great distances. In the last few years, we’ve really escalated tele-emergency care provided by pediatric intensivists. We have the only 24/7 staffed pediatric intensive care unit in the state. We believe that sharing this expertise has reduced the number of transfers of pediatric emergency department patients to tertiary hospitals.”

St. Vincent Healthcare also actively uses telemedicine to treat Native American children living on four reservations in the state. The U.S. Indian Health Service (IHS) does not have pediatricians on staff and contracts with St. Vincent to provide them. Pediatrician Dr. Santha M. Chamberlain, M.D. conducts regularly scheduled on-reservation clinics to treat the patients. Hands-on treatment is augmented with regularly scheduled telemedicine appointments. Telemedicine also connects pediatric specialists with these Native American children, as well as with children throughout the state.