Telemedicine builds bridges. It allows general practitioners and specialists separated by hundreds of miles to consult on patients as if they were in the same room. It allows rural residents equal access to the expert care often found only in urban areas. It saves the healthcare industry millions each year by reducing patient transfers, and eliminates the need to transport prisoners for routine medical visits. This article profiles two award-winning examples of how telemedicine can be used to improve patient care and reduce costs: The St. Mark’s Hospital/VitalCom partnership in Utah and the NEC America/Texas Tech University partnership in western Texas.
The Healthcare Innovations in Technology Systems (HITS) Partnership in Technology Award, created by the Henry Ford Health System, Detroit, commended innovative partnerships in home healthcare, clinical information systems and telemedicine in 1997. The Henry Ford Health System, the National Managed Health Care Congress (NMHCC) and Healthcare Informaticssponsor the annual competition.
Two hundred miles of rugged land separate St. Mark’s Hospital in Salt Lake City and Allen Memorial Hospital in Moab, Utah, but medical professionals at each facility work as if they’re side by side.
Officials at St. Mark’s, a 306-bed tertiary facility, called on VitalCom, Inc., a wireless networked monitoring systems manufacturer in Tustin, Calif., to install a central monitoring system for 40 of their patient beds. A 24-hour dedicated monitoring staff at the hospital could then route vital sign data wherever they were needed in the hospital and page medical personnel in an emergency.
Once the system was in place, hospital officials recognized a potential for this same dedicated staff to monitor patients at its rural affiliate hospitals throughout the state, reducing costs for the affiliates. St. Mark’s again called on VitalCom personnel, this time asking them to connect St. Mark’s with Allen Memorial. The collaboration, with help from the University of Utah’s Telemedicine Outreach department and US West, yielded SiteLink, a wide area network routed through a fractional T-1 circuit connecting the two facilities. Unused bandwidth on the T-1 line was allocated for a local phone connection between sites to avoid toll charges and ensure constant availability of a phone line. VitalCom staff met early in the planning stages with nurses and physicians from St. Mark’s and Allen Memorial to devise monitoring procedures that would guarantee patient safety and efficient communication between sites. For their insight and innovation, VitalCom and St. Mark’s Hospital won the 1997 HITS award for telemedicine.
Now the monitoring staff at St. Mark’s view real-time images of physiologic waveforms and vital sign data for Allen Memorial patients and can send emergency pages to local staff in less than 10 seconds if necessary. This technology vastly reduces the need for costly patient transfers to tertiary facilities.
According to St. Mark’s Administrative Director for Business Development Mark Meadows, SiteLink guarantees better healthcare. "This [system] allows patients access to higher technology and a higher quality of care without a high cost. It has proven that there are things that can be done to fit the ’cost, quality, access’ model of healthcare."
The partnership effectively saved Allen Memorial. Although SiteLink only monitors two Allen Memorial patients at once, 67 were monitored in the first five months of operation: March to June 1997. Seventeen of those patients would have required transferring to another facility before, but because of SiteLink, only three were transferred. The 14 patients saved from transfer generated $79,820 in revenues for the hospital and saved $84,000 in transport costs.
This telemedicine system allows St. Mark’s to capitalize on its existing investment in a dedicated monitoring staff and extend it’s reach to smaller affiliates. "It gives us the ability to work outside the walls of our hospital and give something back to the rural facilities who often struggle with costs," Meadows says.
HITS runner up
In 1993, officials from the Texas Tech University Health Sciences Center (TTUHSC) teamed up with NEC America to solve the problem of reaching medically-underserved areas in western Texas. Their collaboration produced TeleDoc 5000, a self-contained, fully-integrated videoconferencing system for medical consultation, examination and education. This effort won NEC America and TTUHSC the 1997 runner up HITS award in telemedicine.
Built around NEC’s TC5000EX7 video codec (coder/decoder), the unit includes a single-chip camera, xenon light source, digital examination camera with endoscopic adapter, X-ray light box, storage, VCR, dual monitors, pull-out writing table and audio and video controls. Because the video codec is capable of boosting an existing signal by 6,000 feet, no modifications to facilities are generally necessary. The unit is fully mobile for transportation to various sites, and is virtually "plug-and-play" once the proper phone lines are installed. Philip Carter, product marketing manager at NEC America, Inc., says there are between 150 and 200 TeleDocs installed in rural hospitals and clinics across the country.
ReLinda Longan-Hargrove is NEC’s account manager for the southwestern U.S. (formerly the telemedicine application specialist) and she also is a licensed vocational nurse who has used the TeleDoc 5000 for patient consultations. She believes the equipment is a necessary addition to rural clinics. "When you don’t have adequate healthcare in a rural community, hospitals dry up. Patients are forced to drive to the nearest town for medical care, and many patients will go without care to avoid the expense." Longan-Hargrove says physicians also have access to continuing medical education credits via the TeleDoc, making it easier for them to stay in rural communities.
Another application of the TeleDoc began in 1994 with its use in the Texas Correctional System. The Texas Department of Criminal Justice (TDCJ) was battling the costly, time-consuming procedure of transporting prisoners, particularly those in rural west Texas, to other correctional facilities or clinics for medical care, and the all-inclusive unit seemed a good solution.
Now primary care practitioners at prisons easily consult with Texas Tech specialists 180 miles away, reducing the need for extra security during prisoner transports and saving about $35 per patient consultation. After successful completion of a pilot program at the Bill Clements unit, Amarillo, Texas, TeleDoc 5000 units were installed in all 23 west Texas prisons. "Usage just exploded when the TeleDoc started being used in prisons. We saw over 600 patients the first year," Longan-Hargrove says.
William Gonzalez, M.D., medical director of TTUHSC’s Department of Correctional Healthcare says the TeleDoc technology works well in the prison system. "We give regular consults and have cut down prisoner transports by at least 20 percent. We are able to provide tertiary care and teleconsultative services."
If a patient needs a teleconsultation, he or she is brought into a clinic at the prison for a preliminary appointment and in-house medical personnel complete any lab work or x-rays and take a brief medical history, according to Longan-Hargrove. "Patient preparation is important. During the consultation the presenting physician and the specialist both have the preliminary work-up in front of them. That way, the consultation goes quickly."
Gonzalez is quick to note that the consultation system is set up so only licensed practitioners may present and be presented to. "We try to duplicate contemporary medicine as closely as possible through this medium and use the same rules that contemporary medicine does."
Longan-Hargrove says the system is easy to use and customizable, whether it is used in prisons or rural clinics. NEC’s Carter agrees. "It’s an evolving product. We’re constantly making changes to adapt the equipment to the customer’s needs."
Telemedicine itself is evolving, and has more and more to offer the healthcare industry. Today, it brings specialty medical care to those confined by geographic and financial boundaries, opening a world of treatment possibilities. It gives rural physicians the knowledge they need to treat their patients confidently, and the freedom they need to remain in small communities. As telemedicine evolves, healthcare will too, and innovative partnerships like these will become increasingly necessary to keep pace with tomorrow’s technology.
Angela Erwin is editorial intern at Healthcare Informatics.