How Houston EMS is using telemedicine to cut ED overuse

Telemedicine triage helps connect patients with needed primary care

A telemedicine ambulance triage system is helping Houston meet a high demand for emergency medical services, Neil Versel reports for MedCity News.

Emergency care as primary care

Ten years ago, Houston's emergency care wait times were among the worst in the country, and between 40 and 50 percent of patients seeking care at the local EDs actually required primary care services—an area of care for which the area faced a "severe shortage."

In addition, Houston had a "perception problem with emergency medical services delivered through the Fire Department," Versel writes.

Michael Gonzalez, deputy medical director for the Houston Fire Department, explained that while the system's fire trucks "are capable of giving the same care as an ambulance," people often feel as if there's been a mistake if they see a fire truck when they've called for an ambulance. According to Gonzalez, some patients even ask for an ambulance after a fire truck has arrived, which he said can further stretch scarce resources.

Moreover, Gonzalez pointed out that while the Fire Department and local EDs can provide primary care services on an episodic basis, ED physicians are not "built to handle" patients' chronic health needs.

Help from ETHAN

At the HIMSS17 conference in Orlando, Gonzalez and James Langabeer, a professor of clinical informatics at the University of Texas, discussed how a telemedicine system for ambulance-based triage has helped address the city's EMS system cope with the demand for primary care.

The program, called Emergency Tele-Health and Navigation (ETHAN), gives firefighters and EMTs 4G-enabled tablets that connect to 911 services, the University of Texas Health Science Center, a nurse line, a network of primary care clinics, and a taxi service for transportation.

Firefights and EMTs can use their tablets to consult with nurses at the call center, as well as a team of local physicians. In addition, the Fire Department has partnered with a local health information exchange to pull in patient records from local hospitals, providing EMTs and the clinicians access to patients' health history.

The Fire Department has full authority to decide whether to take a patient to an ED or instead try to resolve the issue via ETHAN, Gonzalez said. According to Gonzalez, these elements of ETHAN help get patients into medical homes, allowing them to receive regular care and avoid future emergencies.

According to Langabeer, EMS telemedicine has existed in a rudimentary fashion for decades but it has not been widespread or comprehensive. "We're using ours in a much broader way as an intervention for primary care-related incidents," he said.

Promising preliminary results

Preliminary results of the program, published in the Journal of Telemedicine and Telecare in December, "have been encouraging," Versel writes. According to the research, fire trucks and ambulances are back in service a median of 39 minutes after being dispatch, down from 83 minutes before ETHAN was launched. In addition, in the first year after ETHAN's launch, the share of people for whom EMS was dispatched who end up going to the ED fell from 74 percent to 67 percent.

Meanwhile, patient satisfaction with Houston EMS is at 88 percent, up from a baseline of 87 percent.  And when it comes to finances, the city is saving $928,000 annually with the new system, based on average savings of $2,468 per ED visit avoided (Versel, MedCity News, 2/22).

The blueprint for working with 'superutilizers'

 https://www.advisory.com/-/media/Advisory-com/Research/PHA/White-Papers/2016/32827_Advancing_a_Super_Utilizer_Program_cover430.jpg

Every population health manager develops a strategy to manage high-risk, high-cost patients. Superutilizer programs start small, but as they expand, leaders take the opportunity to re-evaluate program design—from appropriate patient recruitment through graduation

This guide providers a blueprint for implementing a superutilizer program and measuring its success.

Read the paper


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