Integrating Telehealth and the EHR

Versatile Technology
Close to five years ago, the Boise, Idaho-based Saint Alphonsus Health System began developing its telemedicine network for multiple applications among its four-hospital, 714-bed integrated healthcare system that have, as of January this year, saved the system $1.7 million in medical transport costs and has allowed more patients to be treated in their local communities.

“We wanted to develop multiple applications for a single technology so we didn’t have equipment that wasn’t being used very frequently, and so the project would be more sustainable,” says Tiffany Whitmore, director of system development and telemedicine, Saint Alphonsus Regional Medical Center (SARMC).

Saint Alphonsus has implemented 16 remote-presence robotic systems (the RP-7i and RP-Lite, a dual-purpose workstation, from the Santa Barbara, Calif.-based InTouch Health) in 12 sites that provide a broad swath of medical and social inpatient and outpatient specialty services, including telepsychiatry, maternal fetal medicine, sign language interpretation, and even genetic counseling.

“When we were first looking at technologies, we wanted something that was versatile and that we weren’t limited to a point to point connection, so having a technology that ran off of a wireless platform was something we were very interested in,” says Whitmore.

Nichole Whitener, health system research administrator, stroke center director, SARMC, the only tertiary referral center for stroke in Idaho, says its telestroke program was initiated to help decrease death and disability from stroke by getting patients treated sooner.

Four neurologists in this program use an encrypted laptop to control a robotic video conferencing device to perform different assessments like zooming in to see pupil dilation or directing a patient to repeat sentences to check for slurred speech. If a stroke has occurred, then a stroke medication can be prescribed in the recommended one to three-hour treatment window.

If the patient stays at the local facility, the SARMC physician dictates into that rural hospital system’s dictation line, which is transcribed and input into the EHR. But if the patient is transferred to SARMC, the physician dictates into the SARMC system and copies the referring site. However, communication is still a challenge.

“One limitation to telemedicine is that it is difficult for remote physicians to be the admitting physician, so they have to communicate very clearly to the physicians who are going to be admitting that patient,” says Whitener. “We just need to make sure that all information is communicated.” ◆