At the Health IT Summit of the Institute for Health Technology Transformation, held in August in Seattle, Washington, speakers from health care facilities and professional groups around the country gathered to compare notes on the summit’s theme, “Unleashing the Power of mHealth and Telemedicine.” Among them was Joseph Tracy, vice president of telehealth services at Lehigh Valley Health Network (Allentown, Pennsylvania).
“The way we’ve used telehealth has been not to replace services that can be done in person, but to augment them,” Tracy says of LVHN’s approach to the emerging field. “Providers need to stay and support their communities, but for certain specialties, it takes a huge population of patients to support yourself, and you just won’t find that in rural areas or small towns.”
Deep Roots
LVHN’s telemedicine program has deep roots, with its origins in a remote monitoring program for home care that commenced about eight years ago. “That program has continued, and still exists today—we have about 150 monitoring devices that can be placed in patients’ homes,” Tracy says. Then, six years ago, LVHN constructed their advanced intensive care unit (AICU) as another application of remote monitoring; today, 140 ICU beds across the health system can be monitored from an off-site location by five staff members, including an intensivist, three critical care nurses, and a unit clerk.
“The board-certified intensivist in the ICU at night has every health information technology tool he or she would have at the bedside, and can use high-definition video to go into each room to work with the nurses, residents, and fellows, and to talk to the families and the patients,” Tracy says. “And every device, with the exception of the IV pumps, in our ICU feeds the EMR directly, so every minute the system is updated on every patient’s vitals. If a patient’s blood pressure were to drop, or temperature to spike, the doctor in the advanced ICU could direct resources to their bedside immediately.”
Tracy has seen firsthand the runaway success of these programs; in fact, according to a 2010
Archives of Internal Medicine study of LVHN’s remote ICU monitoring, relative mortality has been reduced by 30% since the inception of the program.
1 He notes, “The off-site monitoring did not replace a single person at the bedside, which is an important point. Under this program, the nurses actually get more direct patient care time because they are validating the information in the EMR rather than having to key it in.”
Subsequent Programs
In subsequent years, LVHN went on to establish a teleburn program that extends across 39 sites, three of which are industrial. The program enables LVHN clinicians to evaluate burn patients to determine whether they require an emergency transport to a burn center. “It’s the same phone call they would have made before, but now they use a secure socket connection to us for uploading images and some limited demographic information,” Tracy says. “I’ve seen conversations where without those images, the patient might have been sent home—and when a severe burn gets infected, it can require two surgeries to repair rather than one. This service is good for the patients, but it’s also good for the payors.”
LVHN also leverages standard videoconferencing technology to extend the geographic reach of its genetic counselors, and videoconferencing is used internally for psychiatric emergency evaluations—nearly 100 of them monthly, Tracy says. “Putting a provider on the road is never a good thing because you’re taking them away from other patients,” he says. “We’re using technology to make better use of that precious resource.”
In late spring of 2011, LVHN launched an infectious disease (ID) telehealth program that connects patients in small community hospitals with ID specialists to determine whether the patients need to be transferred. “Out of the first 38 consultations, only five were transferred,” Tracy notes. “So we were helping the smaller hospitals keep patients in their home towns by providing access to our specialists.” The health system is also in the process of launching a telestroke program, with the first site expected to be online by January 2012.
Eventually, LVHN plans to add a telewound program to its roster as well, modeling it after the teleburn program but offering access to long-term care facilities instead of hospitals. “If we can model that after the burn program, it will be super-efficient for everybody and will do good things for those in a nursing home,” Tracy says. “It’s always good to start with a couple of locations and build your model, and then expand from there.”
On the Horizon
Tracy expects the need for telehealth programs like those established by LVHN to intensify as health care reform’s provisions continue to take hold. Using the example of home health monitoring, he observes, “You want to be better able to manage your patients when they’re discharged from the hospital, because if they come back within a 30-day window, you’ll be penalized. I see this kind of remote monitoring being a more important piece of health care going forward.”
Telehealth also provides a means by which the complex economics of increasingly specialized care can be managed, Tracy notes. “Initiatives like these are going to have to become more widespread,” he says. “The government is expecting more in terms of quality and value, so we’re going to have to take care of these patients in ways we haven’t before.”
Most importantly, Tracy says, the use of telehealth enables all patients to receive the best possible care, irrespective of their geographical location. “What telehealth does is equal the playing field in terms of access,” he says. “It doesn’t grant anybody special access, but it makes it so the only limit on access to a busy neurologist is the number of timeslots he has to see patients in a day. It’s nice to think that someday when I retire I’ll be able to live wherever I want and still have that access, which is more than a lot of people have today.”
Cat Vasko is editor of HealthCXO.