Telehealth Program Going Mobile

Dignity Health, formerly Catholic Healthcare West, has been using robots in emergency departments and intensive care units in about 20 California hospitals for more than five years. Now, the hospital chain is hoping to broaden its telehealth capabilities through a new collaboration with a Texas company specializing in mobile health technology.

Dignity Health’s partnership with San Antonio-based AirStrip is aimed at creating a more comprehensive and intuitive workflow for physicians, said Jim Roxburgh, director of the Dignity Health Telemedicine Network.

“AirStrip is an open, decentralized, scalable system unlike a traditional, closed model that aggregates information to a central location and limits access to beds in the ICU,” Roxburgh said. “When we add AirStrip, we can transmit data more quickly to make faster decisions.

“If a specialist is not on duty, for example, the technology can transmit information about a patient’s condition, beam into a patient’s room and enable a practitioner to initiate a care plan right away,” he said. “It is about as close as a doctor can get to a patient without being in the same room.”

Dignity Health, the state’s second-largest not-for-profit health system, plans to introduce the new technology in five hospitals by spring:

  • Mercy General Hospital in Sacramento;
  • Mercy Hospital of Folsom;
  • Mercy San Juan Hospital in Carmichael;
  • Woodland Memorial Hospital; and
  • Mark Twain Medical Center in San Andreas.

Linking Existing and New Telehealth Systems

In 2013, approximately 13% of the nation’s adult ICU beds had teleICU coverage with a majority in academic and private hospitals, according to the New England Healthcare Institute.

Earlier this year, the American Telemedicine Association released a draft of Guidelines for TeleICU Operations that includes administrative, clinical and technical suggestions aimed at helping   practitioners develop effective, safe and sustainable teleICU practices. The recommendations focus on a network of audiovisual communication and computer systems to deliver critical care services.

Dignity started its venture into telemedicine with a cart accessorized with basic screening instruments, such as a stethoscope. It progressed to a relationship with InTouch Health, a Santa Barbara-based technology company that provides videoconferencing capabilities through a remote presence robot.

Robots can navigate to any destination without need for a person to guide them. They have the ability to transmit real-time data from multiple sources and locations to “virtual intensivists” — usually critical care specialists — using remote mobile devices, according to Roxburgh.

AirStrip will add a layer of sophistication, streamlining the capabilities already available through InTouch, said Matt Patterson, president of AirStrip.

“With InTouch’s audiovisual capabilities at the core, AirStrip could provide data that can be seen more easily, more clearly with diagnostic quality and more efficiently,” Patterson said. “The technology uses cameras to monitor data in real time with a rich interface and a single screen.”

One Hospital’s Expectations

Mercy Hospital of Folsom is no stranger to robotics. Remote devices have been used for obstetrics fetal monitoring and a robot has been on duty for some time in the ICU, said Denise Pimintel, an ICU registered nurse and teleICU coordinator at the hospital.

She said AirStrip adds to the hospital’s videoconferencing capabilities by providing intensivists with the ability to see the entire monitor in patients’ hospital rooms, including lab results, electronic health records, radiologic imaging and historical data — all in real time from any location on a mobile device or desktop computer.

“Without AirStrip, remote physicians would have to continually turn their eyes to the patient and then back again to the monitor,” Pimintel said. “Now there is less potential for translation errors, along with improved communication and fewer distractions while caring for patients.”

The technology would also make it easier to scroll back and forth through past and current data and does not require remote intensivists to log in each time to communicate with hospital staff.

Pimintel anticipates that the new capabilities would allow the hospital to improve quality by decreasing how many days a patient spends on a ventilator in the ICU and lower the rate of infections.

“We are not using AirStrip as a consultation-based collaborative tool, but rather as a way to give patients equal access to care and to bring providers to them,” she said.

“For Dignity Health, AirStrip ONE is being applied to enhancing telehealth workflows,” Patterson said. “The platform could integrate a variety of different monitoring, [EHR], imaging, communication and quality metric sources into a single application for Dignity Health clinicians to use at the point of care. This could readily be applied to advance telestroke, teleICU, and out-of-hospital patient engagement programs.”

The new system will be especially helpful for rural hospitals, Dignity officials said.

“The technology is ideal for rural hospitals, bringing specialists to a patient’s bedside; otherwise, we would have to transfer a patient to a larger center,” Roxburgh said. “Now we can keep patients local, which is good for the economy and for the patient and family, and avoids the risks of travel. We only have to move patients if they are critically ill.”

Telehealth Already Common Practice in Northern California

Northern California health systems have been using telehealth for years. This year Sutter Health, based in Sacramento, marked 10years of using teleICU services. The program has supported 150,000 Northern California patients — about 150 calls a day — across 18 hospitals in the Sutter system.

John Muir Health, which operates two acute care hospitals in Northern California, launched its teleICU program in 2007. After 18 months, John Muir reported a 45% reduction in ICU mortality rates and a 54% reduction in the average length of stay for ICU patients.

One of Sutter’s telehealth targets is reducing sepsis mortality rates, which it has done by 32% since 2008. Length of stay for sepsis patients dropped from 14.5 to 10 days, with an estimated cost savings of $88.6 million, according to Don Wreden, chief medical group transformation officer at Sutter Health.

Services are provided from two central locations in Sacramento and San Francisco, the latter also providing eICU to hospitals outside the Sutter network, including Marin General Hospital in Greenbrae and El Camino Hospital in Mountain View.

“The world is changing rapidly — more technology, more mobility of consumers who want access to care when they want it and where they want it,” Wreden said.

Sutter Health recently adopted MDLIVE, a Florida-based provider of telehealth services and software offering 24/7 access to patients who require care and advice related to short-term problems, patients requiring after-hours care and consumers who do not have a primary care physician. Patients have access to a doctor immediately or within a few minutes by telephone, email or videoconferencing (by appointment).

Later this month, Sutter will introduce an EHR video platform based at a Sutter Medical Foundation medical office in Elk Grove enabling patients to access their doctors via videoconferencing for follow-up visits for conditions such as rashes. Five physicians will participate initially.

Sutter is also initiating telepsychiatry using video to provide consultations connecting the health system’s Center of Psychiatry to patients in the hospital.

“The program will provide support to patients in remote areas and help compensate for a shortage of physicians,” Wreden said.

Telehealth, however, is not without its challenges, Wreden said, including an ever-changing regulatory environment and a reimbursement system that does not compensate physicians for video visits.

“We are building a home of clinical care with these tools, not to replace the personal physician/patient relationship but to supplement affordability and access,” Wreden said.

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