Baptist, Methodist Improving Outcomes With Technology
Telemedicine, or telehealth, is rapidly making an impact in the Mid-South, with the number of improving patient outcomes reportedly continuing to grow.
Telemedicine, the use of interactive audio, video or other electronic technology by a healthcare provider to deliver care to a patient, is being employed at two of Memphis' largest hospitals. Baptist Memorial Health Care is treating emergency neurological patients with telemedicine provider Patronus Neurology, while Methodist Le Bonheur Healthcare uses technology to connect in-demand specialists with pediatric patients.
Marcus Bamman, Phd
Kim Hallum-Stewart, Baptist's system administrator for neurosciences, said emergency department physicians and neurologists across the tri-state region wanted a teleneurology program to treat patients who present with stroke and other neurological disorder symptoms at times when a neurologist is unavailable.
They identified Patronus Neurology, a national provider of teleneurology services, as a partner to meet the needs of patients and fully integrate into the Baptist system.
The relationship has grown over the past two years, and successful incorporation into the patient treatment experience has led to growth from five hospitals to 10 hospitals in the Baptist system across Tennessee and Mississippi. Plans are underway to spread this platform across the 21-hospital system.
Lucas Elijovich, MD
The importance of teleneurology has increased simply because of numbers. According to Baptist's stroke medical director, Lucas Elijovich, MD, there are not enough neurologists equally spread out across the region, and telemedicine became the answer to deliver a uniform standard of care regardless of the patient's location.
"Some of these hospitals are in smaller communities that might not have a neurologist available 24 hours a day. But through this technology, these patients can be treated by world-class neurologists in minutes," said Baptist President and CEO Jason Little.
Because minutes really matter in stroke treatment especially, Elijovich said telemedicine is the best way to connect patients at any time of the day to a specialist so they can receive IV-tPA or tissue plasminogen activator, a common treatment used to dissolve clots in the brain. Patients in less urban areas are able to seek treatment at their hometown hospital and receive care close to home where they have the support of family and friends.
Patronus Neurology provides a fellowship-trained vascular neurologist within four minutes to evaluate the patient and prescribe treatment. According to Elijovich, last year 13 percent of Baptist stroke patients received IV-tPA treatment, compared with the national average of 5 percent. Studying the patient timeline - from presenting symptoms to thrombectomy - is where telemedicine can improve outcomes.
In concert with the Patient Placement Center, teleneurologists can diagnose patients, who can then be transferred for treatment quickly without having to wait for a neurologist in the emergency room, improving treatment time and saving lives. For easy communication between care providers in the Baptist system, the teleneurologists record their consults in the same electronic health record.
At Le Bonheur, the vision for telemedicine is to provide care for children any time, any place and on any device. There are three telehealth models at Le Bonheur - synchronous scheduled telemedicine visits (being offered by eight specialties currently), synchronous unscheduled care for acutely ill patients being transferred to Le Bonheur, and non-patient care activities like distant diabetes education, lactation consultation, educational seminars and conducting remote team meetings. Integrating telehealth at Le Bonheur has enhanced quality of patient care by improving access while keeping care family-centered.
Jay Pershad, MD
Jay Pershad, MD, medical director of Le Bonheur's telehealth program, said "about 15 percent of our patients reside in rural counties, and telemedicine is a unique way to leverage technology to improve access to our specialists." Virtual visits can save families time, inconvenience and expenses that come with traveling to Memphis.
One example is connecting a patient with chronic asthma at Le Bonheur's Tupelo clinic with a pediatric pulmonologist or allergy-immunology specialist in Memphis via a fully equipped telehealth cart, with a digital stethoscope and a high-resolution camera plus otoscope. Another scenario could be a follow-up evaluation for a patient with seizures or a complex medical condition like tuberous sclerosis at home by connecting him or her with subspecialists at Le Bonheur. Prior to telehealth, a patient and/or physician would have to invest considerable time and resources in traveling long distances.
Pershad would like to dispel five common myths associated with telemedicine in the medical community.
- First, telemedicine is not replacing in-person visits but rather complementing them when the face-to-face visit does not warrant a detailed physical examination.
- Second, telemedicine does not compromise on quality of care. Pershad sees telehealth as improving the patient experience, therefore creating value and convenience for families and increasing compliance.
- Third, telemedicine is expensive to implement. While there are start-up costs associated with the video conferencing software and hardware, the ability to increase capacity, enhance physician productivity, generate savings from lower windshield time for patients and specialists, and cost avoidance associated with better management of chronic diseases can offset these expenses over time.
- Fourthly, reimbursement for telemedicine is low. While there continues to be conversations with insurance companies, reimbursements have improved as there is more evidence showing the benefits of telehealth. Tennessee, Mississippi and Arkansas parity laws protect telehealth practitioners by requiring payers to reimburse telehealth visits on par with in-person encounters (not the case in every state).
- The fifth and final myth is that medical malpractice exposure is higher. Insurers like SVMIC cover telemedicine visits the same as in-person care, and Pershad adds that virtual visits may actually decrease exposure by permitting better evaluation of acuity of illness, when compared to traditional phone consultations.
After all, "if a picture is worth a thousand words, a video can be priceless," Pershad said.
As healthcare continues to evolve and move away from the fee-for-service model, telemedicine will continue to grow in popularity.
"Telemedicine offers a unique opportunity to address issues like readmission, ED overcrowding, chronic disease management through remote patient monitoring and improved population health by keeping patients outside the hospital," Pershad added.