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Telehealth Applications at a Burn Center

Telehealth Applications at a Burn Center. Lynn D. Solem, MD, FACS W. Nicholas Sorensen, OTR Nancy Massman, MHHSA, MA Kathleen Schwartz, OTR Jody Rood, RN, BSN, PHN Nina Ames, BA Regions Hospital The Burn Center St. Paul, MN. History. Originally a Minnesota corrections system

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Telehealth Applications at a Burn Center

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  1. Telehealth Applications at a Burn Center Lynn D. Solem, MD, FACS W. Nicholas Sorensen, OTR Nancy Massman, MHHSA, MA Kathleen Schwartz, OTR Jody Rood, RN, BSN, PHN Nina Ames, BA Regions Hospital The Burn Center St. Paul, MN

  2. History • Originally a Minnesota corrections system • Corrections contract lost in ‘98 • Now a parasitic system

  3. Burn Centers • ~120 in United States • Serve large geographic areas • Long term follow-up essential • 12-24 months

  4. Long Term Sequelae • Hypertrophic scarring • Dryness • Itch • Decreased skin durability • Chemical and petroleum sensitivity • Susceptibility to sunburn • Cold and heat intolerance • Psychosocial issues

  5. The Burn Center at Regions Hospital • 18 bed facility • Established in 1963 • Serves: • Iowa • Minnesota • Wisconsin • Montana • North Dakota • South Dakota

  6. Range: Age = 1 - 92 years Burn size = 1 - 95% Telemedicine Burn Consults • Dec 1, 1997 thru Oct 4, 2000 • - 142 patients (~ 3 visits / pt) • - 473 visits Mean: • Age = 32 years • Burn size = 15% * *Includes one TEN’s patient and one frostbite patient.

  7. Facility Types • Hospitals • Clinic rooms • Conference rooms • ER • Clinics • Schools • Technical colleges • High schools

  8. Specialist Participation • 142 patients • 473 visits • Physician = 464 consults • Burn therapist = 345 consults • Clinical psychologist = 22 consults

  9. Telemedicine Burn Consults • Burn Areas Assessed - Arms 78 patients - Hands 71 patients - Trunk 67 patients - Lower extremities 55 patients - Neck 39 patients - Head 37 patients - Face 34 patients - Feet 19 patients

  10. Telemedicine Burn Consults • Patients evaluated by burn surgeon and burn therapist for: - Healing (open areas) - Range-of-motion - Therapy needs - Home care needs - Return to work or school - Scar maturation

  11. Telemedicine Burn Consults • Patients lived 54 to 680 miles from the Burn Center (one-way) • Mean travel: 536 miles (round) • Mean round trip cost: $174 (based on IRS @ $.325/mile)

  12. Telemedicine Burn Consults • Patients accessed local Tele-medicine facilities from 1 to 271 miles (one-way) • Mean travel: 72 miles (round) • Mean round trip cost: $23 (based on IRS @ $.325/mile)

  13. Telemedicine Burn Consults • Mean round trip savings per patient visit: • Miles = 464 • *Cost Savings = $151 *Does not include meals and lodging

  14. Financial Implications • Lost charges • Line charges • Professional charges • $210 / patient visit • Patient travel savings • $151 / patient visit

  15. Travel Savings(473 patients) • Travel (miles) savings 464 TOTAL 219,472 • Cost savings $151 TOTAL $71,423

  16. Lost Burn Center Charges ($) • Per patient visit ~$210 • Line & facility charges $34,668 • ~$73 • Professional charges $64,674 • ~$137 • TOTAL $99,342 • Per patient charges

  17. Lost Burn Center Charges ($) • Per patient charges

  18. Limitations • Referring physician awareness • Difficult to assess scar thickness • Cannot modify splints or garments

  19. Limitations • Reimbursement • Preparing to bill • Unknown collection rate • Will require several months

  20. Limitations • End user facilities • Conference rooms, not exam rooms • Confidentiality • Privacy • Technicians • Unfamiliar with equipment • Occasionally controls left with patient • Auto-focus cameras • Patient dressings

  21. Limitations • Inefficient use of time • Therapist • Physician • Psychologist

  22. Theoretical Advantages of Telemedicine • Improve access to health care • Speed referral process • Decrease provider isolation • Involve local provider in care and follow-up • Maintain the viability of rural health care facilities

  23. Is Burn Telemedicine Sustainable? • Requires a 3 pronged approach • Patient care • Administration • Education

  24. Conclusions • Burn follow-up can be successfully completed via telemedicine • Patients and families experience dramatic savings in travel expense • However, telemedicine visits are less time efficient for physician and therapist • And, reimbursement remains an issue • Result: telemedicine remains an expensive technology

  25. Future of Telemedicine in Burns • Expanded follow-up visits • Clinic visits ~ 2,000 annually • Telemedicine visits ~ 200-300 annually • Digital photos / email / phone consult • Consults to remote regions • Acute consults • 7 X 24 service

  26. Regions Burn Center St. Paul, MN

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