Telemedicine in Arizona has a long history. AZHHA recently sat down with The Mayo Clinic’s Bart Demaerschalk, M.D., Medical Director for Synchronous Services, Center for Connected Care, which partners with hospitals across Arizona to provide the highest quality care for patients via telemedicine, and in particular, telestroke. This is the second of a two-part blog.
AZHHA: How does telestroke improve patient outcomes?
Dr. Demaerschalk: Rather than transporting, we virtually transported the stroke experts to the patient. The stroke experts became part of the care team at those hospitals. There is less than one-minute response time. These specialists work directly with nurses and doctors at the bedside to elevate care, including the administration of recombinant tissue plasminogen activator or TPA, which must be given within four hours of the onset of a stroke.
AZHHA: I imagine if transport is a concern, that after four hours it becomes even more critical.
Dr. Demaerschalk: Correct. Prior to the program, fewer than 1 percent of patients were getting TPA. When these patients were engaged with telestroke program, this rose to 25 percent. We reduced air and ground ambulance transfers by 60 percent. The benefits to the patient are great. These patients stayed in their community, near their loved ones. It saved transport costs, patient received better outcomes, reduced overall cost of care. Even though there was an expense associated with the creation of the telestroke network (connectivity, organization, technology, management and consultations) money was ultimately saved with this paradigm of care.
AZHHA: How has telemedicine changed since you began?
Dr. Demaerschalk: The changes have been enormous.
Technology has changed. Initially, reports were that 5 percent of video telemedicine were impacted negatively by technological error. Issues are now less than 1 percent. Mayo telestroke & acute care have a 99.3 percent rate of achievement. Technology has come a long way in reliability and the cost has dropped precipitously. It’s much more affordable.
Providers have changed. Clinical providers of all types (physicians, NPs, nurses, PAs, allied health) are much more receptive to telemedicine.
Insurance and Medicare/Medicaid have changed. There is now parity of reimbursement, so it is equivalent to face to face consultations. Reimbursement has been granted by both government and private payers.
Credentialing has changed. Credentialing by proxy has reduced the administrative burden for providers who work with multiple care centers.
Patients have changed. Patients want technology. The Mayo Center for Connected Care provides online services to 1.25 million users, where they receive all of their information and medical records online via EPIC’s Electronic Health Records. The Mayo Clinic’s mobile application has 1.4 million downloads. More than 1.3 million secure messages have been exchanged between providers and patients. We provide asynchronous e-consultations, which prevent unnecessary clinical appointments. We provide remote patient monitoring via wearable devices for patients with multiple medical problems, congestive heart failure or chronic obstructive pulmonary disease. Surgical patients have telemedicine post-operative visits, which saves $1000 just by avoiding a clinical visit in uncomplicated cases.
AZHHA: What other care does Mayo provide via telemedicine, in addition to stroke?
Dr. Demaerschalk: We cover many different practice areas.
- Emergency Medicine: Rural hospitals aren’t staffed by a board-certified emergency physician (might be a Physician Assistant, family physician with emergency training or a nurse practitioner) to provide oversight, guidance and help whenever necessary. Robotic telemedicine contributes to assessment, diagnosis & emergency management & determine if a transfer is necessary
- Neonatology: newborns with immediate concern upon delivery (such as respiratory distress or a cardiac concern) in hospitals with no neonatology team are usually transferred hundreds of miles. Now, neonatologists and the team “beam in” virtually and become contributors to resuscitation immediately, on-site and save lives
- Tele-behavioral health and psychiatry
- Tele-intensive care unit
For a complete list, look at the Mayo Clinic’s telemedicine website.