Telemedicine in the Emergency Dept.

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by: Bruce Janiak

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Telemedicine in the Emergency Dept.

  1. 1. TELEMEDICINE IN THE EMERGENCY DEPARTMENT BRUCE JANIAK, MD,FACEP,FAAP
  2. 3. What is Ethica? <ul><li>50 skilled nursing centers </li></ul><ul><li>4 assisted living centers </li></ul><ul><li>5 centers currently with telemedicine </li></ul><ul><li>5 additional centers online in March, 2010 </li></ul>
  3. 4. What is GA Partnership for Telehealth?
  4. 5. Telemedicine Sites <ul><li>Eatonton, Ga. </li></ul><ul><li>Sparta, Ga. </li></ul><ul><li>Oconee, Ga. </li></ul><ul><li>Adrian, Ga. </li></ul><ul><li>Douglas, Ga. </li></ul>
  5. 6. The Concept <ul><li>The Emergency Department is open 24/7 </li></ul><ul><li>The challenge is to identify applications that may prevent unnecessary trips to the ED while looking for applications that have a significant financial margin </li></ul><ul><li>The goal is to eliminate the need for an emergency visit </li></ul>
  6. 7. Nursing Homes <ul><li>Approximately 50% of transfers from NH’s to ED’s do NOT result in admission ( Annals of EM) </li></ul><ul><li>Approximate cost of transfer approx $1000 (transfer) </li></ul><ul><li>Approximate cost of ED visit $500 (pts discharged back to NH) </li></ul>
  7. 8. Empowering Factors <ul><li>Georgia allows billing (if rural) </li></ul><ul><li>Liability coverage allowed </li></ul><ul><li>NH staff enthusiastically support </li></ul><ul><li>ED physicians frustrated with current system </li></ul>
  8. 9. Barriers to Usage <ul><li>Cost: $20k per telemedicine unit </li></ul><ul><li>Primary care doctors apathy </li></ul><ul><li>Hard to get NH nurses to use (as opposed to old system of calling primary care) </li></ul>
  9. 10. Approach to Increase Use of Telemedicine <ul><li>Explain $ advantage </li></ul><ul><ul><li>Cost of ambulance </li></ul></ul><ul><ul><li>Cost of ED visit-direct </li></ul></ul><ul><ul><li>Cost of ED visit-indirect </li></ul></ul><ul><li>Identify physician advocates </li></ul><ul><li>Identify nurse “champion” in each facility </li></ul>
  10. 11. Cost of Ambulance <ul><li>Charges are based on the type of transport plus the per mile cost </li></ul><ul><li>The cost reflect one way transport only. </li></ul>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
  11. 12. Current System <ul><li>Sample size 5 nursing homes </li></ul><ul><li>950 transfers over 5 years </li></ul><ul><li>Cost per ED visit (transportation, hospital and physician) $1500 </li></ul><ul><li>Five year costs 1,425,000 </li></ul>
  12. 13. New System <ul><li>Capital expense (equipment) $100,000 </li></ul><ul><li>Leasing costs: $24,000 </li></ul><ul><li>Cost of emergency visits (665 x 1500) $997,500 </li></ul><ul><li>Cost of physician charges: $95,000 </li></ul><ul><li>Total cost: $1,216,500 </li></ul>
  13. 14. Summary for Five Facilities <ul><li>Current system: $1,425,000 </li></ul><ul><li>Telemedicine system: $1,216,500 </li></ul><ul><li>Difference (amount saved): $208,5000 </li></ul>
  14. 15. Political Barriers <ul><li>Attitudes of primary care docs-competition, financial concern, loss of control- </li></ul><ul><li>Attitudes of nurses- resistance to change, reluctance to learn new tool, time factor (call pmd vs move pt to telemed suite) </li></ul>
  15. 16. Political Support <ul><li>ED docs </li></ul><ul><li>NH nurses and patients and families </li></ul>

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