UC Health—the University of Cincinnati Academic Health Center—is a two-hospital integrated health system that encompasses the University of Cincinnati Medical Center in Cincinnati and West Chester Hospital in nearby West Chester, as well as the University of Cincinnati Physicians medical group, a post-acute care facility, and an ambulatory surgery center. UC Health, with $1.3 billion in annual revenues, was formed as an integrated health system in the fall of 2010, though Cincinnati Medical Center had been in existence for nearly 200 years. The health system, with over 1,000 beds, sees more than 35,000 inpatient admissions per year, and more than 120,000 ED visits. Meanwhile the University of Cincinnati Physicians encompasses more than 800 board-certified physicians, and is the largest physician group of its kind in the region. The integrated system is affiliated with the University of Cincinnati School of Medicine.
Leaders there, including Anya Sanchez, M.D., enterprise director, special projects, and Pam Kimmel, R.N., director of telehealth, have been working with the Cincinnati-based Intelemage to strengthen and expand their telehealth program. Sanchez and Kimmel spoke recently with HCI Editor-in-Chief Mark Hagland regarding their organization’s ongoing journey into telehealth. Below are excerpts from that interview.
Tell me about your partnership with Intelemage and the recent expansion of your telehealth program?
Anya Sanchez, M.D.: We’ve been working with the people at Intelemage for a few years now. They’re an image exchange-based company that we had been using for tumor board uses. Physicians would review images collaboratively through their tumor board. But a few years ago, our stroke team expressed interest in using that system as a platform for our telestroke program. Also, one of the things that we’re doing that’s of note is that we’re piloting other program types, too. We’ve just rolled out a video visit program for primary care, and have launched a telenephrology consult service with a local hospital as well.
When did you start the telestroke program?
Sanchez: In April 2012.
Pam Kimmel, R.N.: We engaged 18 physicians who share call. About half are neurologists, and the other half are ED physicians with neurocritical care training. They currently provide care to all the surrounding hospitals in the Cincinnati area, about 18 hospitals. And they travel by car to those facilities. And we were covering hospitals in rural areas by phone. So we began implementing telestroke in those facilities first. It was more of a robot-based model initially and that was expensive, but through the partnership with Intelemage, we were able to expand to all the hospitals. It’s a product that’s device-agnostic and allows the images to be shared as well as a video link that can be shared, encrypted for HIPAA security reasons.
So a patient comes into an ED and if that patient has stroke symptoms, is cared for through the telestroke program?
Kimmel: Yes, and the patient receives a CT scan, which is pushed to the Intelegrid, which is the product platform. That’s the image exchange component of the platform. Once that CT image is pushed to Intelegrid, it creates a case for both hospitals to see. So the emergency room in one facility can watch a video and the stroke physician can see it.
A CT tech does this?
No, all the background work is arranged by our program manager here, working with Intelemage. So it doesn’t require any special person; just normal workflow.
And a series of CT scans is performed on the patient?
Yes, and the physician can see the images as well as the patient, and ED physician, in the remote location.
One of the advantages, obviously, must be the simultaneous or instantaneous ability of the remote specialist to see the patient live via the connection, and to view the images immediately after they’ve been produced?
Yes, it allows the physician to examine the patient and view the images live.
How many images are in any given stack, usually?
For one study? It’s a large number. It can be in the 20-30 range of slices.
How many telestroke consults have taken place so far, through the program?
Over the past year, from our eight rural hospitals, we’ve had 300 calls, and of them, 100 of them have led to telestroke consults. The stroke team here takes an average of about 3,000 calls a year, from among the eight hospitals we have up and running, for the small hospitals. What we’re doing now is that some of our busiest hospitals, where our physicians are doing the majority, the vision is to be able to have ubiquitous telestroke coverage, so that every facility could have telestroke, not just the remoter ones. In the future, we’ll be able to do a telestroke consult at any site they’re arriving at. Even among the larger hospitals, most don’t have stroke specialists. We had had since 1987, telephone telestroke coverage. We’ve had longstanding relationships of that sort.
This all will improve the potential for tPA administration, correct?
Yes, this improves that and adds to the comfort level of the local physician administering tPA, knowing that he has had that specialist consult. And even in larger and urban hospitals, the time is shortened to reach the stroke neurologist.
When were you fully live with video consults?