{"id":397,"date":"2015-09-28T14:52:31","date_gmt":"2015-09-28T14:52:31","guid":{"rendered":"https:\/\/feminem.org\/?p=397"},"modified":"2015-09-28T15:16:10","modified_gmt":"2015-09-28T15:16:10","slug":"seeing-patients-from-home-teleemedicine","status":"publish","type":"post","link":"https:\/\/feminem.org\/2015\/09\/28\/seeing-patients-from-home-teleemedicine\/","title":{"rendered":"Seeing Patients from Home: TeleEMedicine"},"content":{"rendered":"

I love working in the Emergency Department. If I am really being honest, I love BEING in the Emergency Department. I have been hanging out in emergency departments for most of my medical career and couldn\u2019t imagine practicing medicine in any other environment.\u00a0 <\/span>There is something about being in an ER that makes me feel like a real doctor.\u00a0 \u00a0<\/span><\/span><\/p>\n

However as my life has gotten more complicated (enter 1 husband, 3 kids, a full academic career and a hobby called FemInEM) the need to be IN an emergency department\u00a0for 8-12 hours at time has become rather inconvenient.\u00a0 <\/span>It has become harder and harder to ignore my cell phone for an entire clinical shift and expect that my \u201cother stuff\u201d will wait patiently for me until my shift is done.\u00a0 <\/span>My husband and kids are also growing weary of me going to the hospital on various overnights, weekends and holidays because \u201cthat\u2019s where the patients are.\u201d\u00a0 <\/span>I love my clinical shifts but missing my family for days on end just stinks.\u00a0 <\/span>Nevertheless, I accept this as the journey of a full-time FemInEM and, besides, are there any other ways to practice emergency medicine?<\/span><\/p>\n

Enter telemedicine. Telemedicine companies have been around for over 40 years. Most companies facilitate communication “direct to consumer” or “physician to another clinician” via a video or audio interface. Telemedicine companies are as varied as the patients they serve, with one source quoting over 450 telemedicine companies servicing over a million visitors last year.\u00a0 <\/span>Telemedicine is currently being used by hospitals, specialists, home health agencies and private practice MDs.\u00a0 <\/span>In 2011, the veterans health administration delivered over 300,000 remote consultations using telemedicine.\u00a0 <\/span>Telemedicine is a significant and rapidly growing area of health care.\u00a0 <\/span>Physicians generally evaluate a patient virtually, assessing the need for intervention or medication without a physical exam.\u00a0 <\/span>The lack of physical exam, or diagnostic intervention, is what limits the scope of practice of many telemedicine interactions. While any specialty, in theory, can avail themselves for a telemedicine consult, unless there is a clinician on the receiving end, consultations are limited to history and visual physical diagnosis.\u00a0 <\/span>This usually limits tele-emergency medicine to urgent care and consultation services. <\/span><\/p>\n

A few months back, I received a call from Tim Peck, the CEO of a telemedicine start up: Call9.\u00a0 <\/span>Call9 is a company that delivers tele-emergency medicine<\/em> to nursing homes by combining tele-physician services with onsite medical care.\u00a0 <\/span>This allows urgent and emergent medical interventions to be done at a nursing home or assisted living facility instead of an ED.\u00a0 <\/span>Through a web-based application interface of an off-site<\/em> board certified EM doctor with an on-site<\/em> attendant (RN, LPN or tech).\u00a0 <\/span>The emergency physician\u00a0conducts an initial clinical assessment, then directs the onsite attendant to perform immediate diagnostics, including point of care lab testing, ultrasound, EKGs, telemetry and vital sign monitoring. This integrated virtual\/hands-on solution allows patients to be treated within the facility instead of the ED.\u00a0 <\/span>If the medical emergency cannot be addressed in the facility the patient is transported via EMS to the nearest hospital.\u00a0 <\/span>However, the tele-physician continues caring for the patient and collecting data until the ambulance arrives.<\/span><\/p>\n

At the time of our first call Tim was looking for summer medical students with active EMT licenses to pilot his idea.\u00a0 <\/span>He explained that EMTs serve as the on-site medical providers for a Call9 consult and they would act as the the eyes, ears and hands of the ED physicians in charge on the call. \u00a0 <\/span>I was happy to find him a few medical students, but once we started talking my mind went straight to the physician job description. <\/span><\/p>\n

This is how I heard the job described:<\/span><\/p>\n