TELEMEDICINE IN THE EMERGENCY DEPARTMENT

BRUCE JANIAK, MD,FACEP,FAAP

What is Ethica?

• 50 skilled nursing centers• 4 assisted living centers• 5 centers currently with telemedicine• 5 additional centers online in March, 2010

What is GA Partnership for Telehealth?

• Eatonton, Ga.

• Sparta, Ga.

• Oconee, Ga.

• Adrian, Ga.

• Douglas, Ga.

Telemedicine Sites

The Concept

• The Emergency Department is open 24/7• The challenge is to identify applications that

may prevent unnecessary trips to the ED while looking for applications that have a significant financial margin

• The goal is to eliminate the need for an emergency visit

Nursing Homes

• Approximately 50% of transfers from NH’s to ED’s do NOT result in admission (Annals of EM)

• Approximate cost of transfer approx $1000 (transfer)

• Approximate cost of ED visit $500 (pts discharged back to NH)

Empowering Factors• Georgia allows billing (if rural)• Liability coverage allowed• NH staff enthusiastically support• ED physicians frustrated with current system

Barriers to Usage

• Cost: $20k per telemedicine unit• Primary care doctors apathy• Hard to get NH nurses to use (as opposed to

old system of calling primary care)

Approach to Increase Use of Telemedicine

• Explain $ advantage• Cost of ambulance • Cost of ED visit-direct• Cost of ED visit-indirect

• Identify physician advocates• Identify nurse “champion” in each facility

Cost of Ambulance Gold-Cross Non-Emergent Emergent Per mile cost

ALS ( monitor, EKG, IV’s, resuscitative measures)

$485.00 $662.00 $11.10

BLS ( IV’s, O2) $404.00 $581.00 $11.00

Capital City Non-Emergent Emergent Per mile cost

ALS ( monitor, EKG, IV’s, resuscitative measures

$235.60 $373.03 $6.87

BLS ( IV’s, O2) $196.33 $314.13 $6.87

o Charges are based on the type of transport plus the per mile costo The cost reflect one way transport only.

Current System

• Sample size 5 nursing homes• 950 transfers over 5 years• Cost per ED visit (transportation, hospital and

physician) $1500• Five year costs 1,425,000

New System

• Capital expense (equipment) $100,000• Leasing costs: $24,000• Cost of emergency visits (665 x 1500)

$997,500• Cost of physician charges: $95,000• Total cost: $1,216,500

Summary for Five Facilities

• Current system: $1,425,000 • Telemedicine system: $1,216,500• Difference (amount saved): $208,5000

Political Barriers

• Attitudes of primary care docs-competition, financial concern, loss of control-

• Attitudes of nurses- resistance to change, reluctance to learn new tool, time factor (call pmd vs move pt to telemed suite)

Political Support

• ED docs• NH nurses and patients and families