Telemedicine is rapidly evolving, but solutions like the Houston Fire ETHAN Project leverage Panasonic’s rugged devices to dramatically improve ambulance-based triage. Learn how innovative solutions like this are elevating the quality of mobile healthcare professionals are able to deliver.
In 2007, USA Today called Houston a city in crisis when it came to healthcare. Houston had among the worst wait times in the country for emergency care, and 40 to 50 percent of visitors to emergency departments really just needed primary care, which the area also had a severe shortage of. Ambulance diversions were common.
More recent research found that similarly high numbers of nonemergency calls to 9-1-1 were for primary care-related issues.
The Texas city, the fourth-largest municipality in the U.S., also had a perception problem with emergency medical services delivered through the Fire Department.
“Our fire trucks are capable of giving the same care as an ambulance,” said Dr. Michael Gonzalez, deputy medical director for the Houston Fire Department, at HIMSS 2017 in Orlando, Florida. But, he noted that people feel like there has been a mistake if a fire truck shows up when they call an ambulance, and sometimes demand an actual ambulance. That further ties up scarce resources.
“We are not built to handle primary care issues,” Gonzalez said. The Fire Department, as well as area emergency departments, can certainly deal with primary care on an episodic basis, but emergency physicians simply are not in a position to follow up with patients to address chronic health issues.
Since late 2015, telemedicine for ambulance-based triage has greatly alleviated several of the problems, HIMSS attendees heard.
A program called ETHAN – for Emergency Tele-Health and Navigation – outfits emergency medical technicians with 4G-enabled tablets that connect to 9-1-1 services, the University of Texas Health Science Center, a nurse help line, a network of primary care clinics (for the purpose of getting people into medical homes) and even to a taxi service for transportation.
“We’re prepaying taxi vouchers on the premise that a Yellow Cab is a lot less expensive than an ambulance,” James Langabeer, professor of clinical informatics at the University of Texas, said during a joint presentation with Gonzalez.
The ETHAN system has allowed Houston EMS to offer mobile integrated healthcare, as defined by the National Association of Emergency Medical Technicians.
EMS telemedicine has been around in at least a rudimentary fashion since the 1970s, but Langabeer noted that 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.
Firefighters and EMTs access ETHAN on tablets they had already been carrying. On the other end of the line is the nurse call center, as well as a team of board-certified physicians in the Houston area.
The Fire Department has a partnership with the local health information exchange to pull in patient records from area hospitals so EMTs and the clinicians on the other end have some history of the patients they serve. These elements of ETHAN, Gonzalez said, have helped avoid repeat callers to 9-1-1 by getting people – many of whom had not seen a primary care physician in years – into medical homes so they can receive ongoing care to prevent future emergencies.
Fire Department crews have full leeway to decide whether to transport each patient they visit to a hospital emergency department, or to lean on ETHAN for an alternative disposition, Gonzalez said.
Preliminary results of the program, as detailed in a paper published in December 2016 in the Journal of Telemedicine and Telecare, have been encouraging. With ETHAN, ambulances and fire trucks are back in service and ready to take on a new case roughly 39 minutes after being dispatched. Prior to the introduction of the telehealth program, it took a median of 83 minutes to get a vehicle back in service.
At the baseline, 74 percent of people for whom EMS was dispatched ended up being transported to an emergency department. That declined to 67 percent in the first year after ETHAN went live.
Patient satisfaction with Houston EMS actually ticked up slightly with ETHAN, to 88 percent from a baseline of 87 percent. And, the city saved money at an annual rate of $928,000, based on the average savings of $2,468 per emergency department visit avoided.
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