Growing Menu of Telehealth Services Reaching Across the State
By Matt Westerfield
When it comes to treating a patient who is suffering from a possible stroke, not only is time of the essence but, more importantly, “time is brain.”
George Hemphill, foreground, ER nurse, communicates via eICU while ER tech Mark Collins and nurses Melissa Stevens, left, and Michelle Moore provide care.
“The longer you wait, the less likely you are going to help the patient, and the more brain cells are dying,” said Dr. Shirley Chen, assistant professor of neurology.
That can pose a daunting problem in a state like Mississippi, where most subspecialists like Chen are located in the Jackson area while Mississippi’s residents, who lead the nation in health disparities, are spread out across a rural state.
The challenge of assessing and diagnosing potential stroke patients where they live before making the time-consuming decision to transport them to the University of Mississippi Medical Center is one neurologists share with many other specialties. And answering that challenge is exactly what the Medical Center’s expanding telehealth services are designed to do. The growing number of services available under the umbrella of Telehealth all aim to leverage resources and extend the expertise of UMMC health-care providers statewide.
“Telestroke started as a spinoff of the Telemergency program to provide that additional specialist, but we’re now also seeing hospitals that use us to extend the availability of a stroke neurologist at their facility to 24 hours a day,” said Kristi Henderson director of Telehealth and chief advanced practice officer. “Our stroke neurologists are available, and we’ve put equipment into their offices and major work spaces so that they can have easy access. When they get a consult — it may be to our own ER or it may be to a facility 200 miles away — they can still provide a higher level of care and advice for patients in underserved areas.”
Chen came to UMMC last fall after completing a fellowship in San Francisco. She joins Dr. Rebecca Sugg, professor of neurology, in championing the benefits of Telestroke.
“We had a very active telestroke program where I trained as a fellow, and it was how we built bridges to the community and to far-reaching communities that otherwise we would really not be in touch with,” said Chen. “So we took full advantage of technology to provide care for patients that really don’t have good neurology and especially stroke care where they are. So I was interested in what they were doing here.”
Chen said she provides an average of two consults a day to other hospitals when she’s on call.
“If UMMC is going to serve the state, I think stroke care and outreach via Telestroke really has to happen. It’s the way to go,” she said.
But TeleStroke is just one tool in a rapidly growing toolbox. Henderson became director of Telehealth last summer and since then has worked to not only expand the number of telehealth services offered at the Medical Center but also to expand their reach to more rural hospitals and clinical sites across the state.
It all originated with one pilot project, Telemergency, in October 2003. In Telemergency, board-certified emergency medicine physicians in the UMMC emergency department are connected through a video network with nurse practitioners in rural hospitals that cannot afford to staff their emergency departments with emergency medicine doctors.
Initiated by Henderson and Dr. Robert Galli, professor of emergency medicine, Telemergency opened the door for the next batch of disciplines — radiology, neurology and psychiatry — to provide care electronically to sites remote from the Medical Center.
In December of 2009, UMMC launched Intensiview, a Phillips VISICU eICU program, a system that allows critical care physicians and nurses to monitor ICU patients around the clock remotely from an operations center in north Jackson.
The U.S. Department of Agriculture recently awarded the Delta Health Alliance a $699,142 grant to finance a network that will provide a secure interlinked eICU system between UMMC and four hospitals in rural counties of the Mississippi Delta. The hospitals receiving the link include those in Marks, Rolling Fork, Ruleville and Charleston.
In January, the eICU program became part of Telehealth, and shortly after the Holmes County Hospital and Clinics in Lexington implemented the eICU network.
Late last summer, Henderson began reaching out to every specialty that could benefit from telehealth or who already participated in some form of telehealth.
“Some didn’t even know they were doing telehealth; they were reading EKGs and in their mind that was not telehealth. So I brought everybody together, including legal and compliance, and provided an an update on what telehealth is, what the future of telehealth is, and what other states had done and what we could bring to the table. And to really look at it from a different perspective. How it could improve their efficiency, improve the health of their own patients.”
Making telehealth services available, from interpreting diagnostic tests to providing wound-care evaluations, improves efficiency and prevents unnecessary transfers, Henderson said.
“So as we try to focus on really being the best tertiary care hospital, we want to make sure we get the right patients to the right place at the right time — and that may be providing the medical consultant to other health facilities in other communities via telehealth,” she said.
Currently, Henderson and her Telehealth committee are working to standardize a menu of telehealth services that they make available to any interested clinical site around the state that has a need for a specialty. The idea is that those health-care providers can pick which service they’re interested in — teleallergy, telecardiology, telewound care — that will then be customized to suit their needs.
Henderson said she wants to reach the point where prospective patients can call the access center for an appointment and have the option of making that appointment at Grant’s Ferry, the Pavilion or another of UMMC’s Telehealth locations.
“That will be ultimately where we can provide better access for patients and make it as convenient as possible,” she said. “Our physicians who could see you here could also see you in your own hometown, and you not have to take off longer from work, get child care, all of the things that result in people missing their appointments and missing the care they need.
“We want to make this more sustainable,” she added. “Before it was piecemealed together, and now we can actually come in with a full package and our partners can have access to all of it. By coordinating all of our telehealth services, we are better able to serve the health-care needs of our state.”
Henderson said everyone she’s spoken with so far has been very supportive of the idea, and expanding reimbursement for telehealth is the next challenge. During the last six months she said a subcommittee has been working on reimbursement relationships and networking with Medicaid and Blue Cross to develop contract agreements.
“It is a part of our education mission as well. Residents are involved in telehealth and learning a whole new way of health-care delivery,” she said.
In the long run, Henderson envisions that the hub for Telehealth will be centralized to allow for scheduling of telehealth consults as well as distance medical education.
Physicians involved with Telehealth need to be able to continue their day-to-day operations, Henderson said.
“I want to make it easy and convenient for them. That’s why we’re working to install webcams in their offices, in their conference rooms or wherever they work the most so that they can do this as just a part of their day.”
Dr. Claude Brunson, senior advisor to the vice chancellor for external affairs, said there are also plans to equip the Mercy Delta Express mobile clinic with telehealth technology so that the nurse-led project has physician support. And TelEducation is another application they are looking into.
“We can have continuing education offerings here for busy providers around the state in real time,” he said.
“Without telehealth and without using the full spectrum of resources at our disposal, we will not be able to make an impact on the health disparities in this state in the near term,” Brunson said.
“We’re committed to improving health care across the whole state and getting people access to health care,” she said. “This is how we see it happening.”