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TELEMEDICINE IN THE EMERGENCY DEPARTMENT

BRUCE JANIAK, MD,FACEP,FAAP. TELEMEDICINE IN THE EMERGENCY DEPARTMENT. What is Ethica?. 50 skilled nursing centers 4 assisted living centers 5 centers currently with telemedicine 5 additional centers online in March, 2010. What is GA Partnership for Telehealth?. Telemedicine Sites.

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TELEMEDICINE IN THE EMERGENCY DEPARTMENT

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  1. BRUCE JANIAK, MD,FACEP,FAAP TELEMEDICINE IN THE EMERGENCY DEPARTMENT

  2. What is Ethica? • 50 skilled nursing centers • 4 assisted living centers • 5 centers currently with telemedicine • 5 additional centers online in March, 2010

  3. What is GA Partnership for Telehealth?

  4. Telemedicine Sites • Eatonton, Ga. • Sparta, Ga. • Oconee, Ga. • Adrian, Ga. • Douglas, Ga.

  5. The Concept • The Emergency Department is open 24/7 • The challenge is to identify applications that may prevent unnecessary trips to the ED while looking for applications that have a significant financial margin • The goal is to eliminate the need for an emergency visit

  6. Nursing Homes • Approximately 50% of transfers from NH’s to ED’s do NOT result in admission (Annals of EM) • Approximate cost of transfer approx $1000 (transfer) • Approximate cost of ED visit $500 (pts discharged back to NH)

  7. Empowering Factors • Georgia allows billing (if rural) • Liability coverage allowed • NH staff enthusiastically support • ED physicians frustrated with current system

  8. Barriers to Usage • Cost: $20k per telemedicine unit • Primary care doctors apathy • Hard to get NH nurses to use (as opposed to old system of calling primary care)

  9. Approach to Increase Use of Telemedicine • Explain $ advantage • Cost of ambulance • Cost of ED visit-direct • Cost of ED visit-indirect • Identify physician advocates • Identify nurse “champion” in each facility

  10. Cost of Ambulance • Charges are based on the type of transport plus the per mile cost • The cost reflect one way transport only.

  11. Current System • Sample size 5 nursing homes • 950 transfers over 5 years • Cost per ED visit (transportation, hospital and physician) $1500 • Five year costs 1,425,000

  12. New System • Capital expense (equipment) $100,000 • Leasing costs: $24,000 • Cost of emergency visits (665 x 1500) $997,500 • Cost of physician charges: $95,000 • Total cost: $1,216,500

  13. Summary for Five Facilities • Current system: $1,425,000 • Telemedicine system: $1,216,500 • Difference (amount saved): $208,5000

  14. Political Barriers • Attitudes of primary care docs-competition, financial concern, loss of control- • Attitudes of nurses- resistance to change, reluctance to learn new tool, time factor (call pmd vs move pt to telemed suite)

  15. Political Support • ED docs • NH nurses and patients and families

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