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Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
Telemedicine in the Emergency Dept.
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Telemedicine in the Emergency Dept.

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by: Bruce Janiak

by: Bruce Janiak

Published in: Health & Medicine
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  • 1. TELEMEDICINE IN THE EMERGENCY DEPARTMENT BRUCE JANIAK, MD,FACEP,FAAP
  • 2.  
  • 3. What is Ethica?
    • 50 skilled nursing centers
    • 4 assisted living centers
    • 5 centers currently with telemedicine
    • 5 additional centers online in March, 2010
  • 4. What is GA Partnership for Telehealth?
  • 5. Telemedicine Sites
    • Eatonton, Ga.
    • Sparta, Ga.
    • Oconee, Ga.
    • Adrian, Ga.
    • Douglas, Ga.
  • 6. 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
  • 7. 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)
  • 8. Empowering Factors
    • Georgia allows billing (if rural)
    • Liability coverage allowed
    • NH staff enthusiastically support
    • ED physicians frustrated with current system
  • 9. 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)
  • 10. 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
  • 11. Cost of Ambulance
    • Charges are based on the type of transport plus the per mile cost
    • The cost reflect one way transport only.
    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
  • 12. 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
  • 13. 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
  • 14. Summary for Five Facilities
    • Current system: $1,425,000
    • Telemedicine system: $1,216,500
    • Difference (amount saved): $208,5000
  • 15. 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)
  • 16. Political Support
    • ED docs
    • NH nurses and patients and families

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