A friend sent me a link to an article from emsresponder.com. The link took me through http://www.emstelemedicine.com/ which is the website of the company selling this technology.
My friends know that I’m sort of a technogeek. I have more electronic gadgets than you can shake a stick at. I should love this kind of thing, but I don’t. To me, it seems like a technological solution in search of a problem to solve.
I’m going to pick a few quotes from the article and comment. I urge you to read the entire thing and decide for yourself.
The call management protocol identifies this as an Alpha call, and instead of a BLS ambulance being dispatched, a light-duty truck with telemedicine capabilities staffed by two basic EMTs is dispatched. The team arrives on scene and assesses the patient’s condition. They determine that the burn is not severe, easily treatable on-scene, and that the patient remains capable of providing for himself/herself at home.
If the crew can determine all of that before setting up the whiz bang telemedicine rig, why do they need to bring the doctor in at all? You can bet that if the fecal matter hits the fan, the doctor is going to dump (no pun intended) responsibility right back on the crew.
By using their telemedicine system, the EMTs are able to provide a “virtual” visit with an ED physician, who examines the patient and, after a face-to-face conversation, convinces the patient that everything needed has been done and that there is no reason to go to the emergency department.
I don’t know about the hospitals in your area, but the ones in my area don’t have doctors sitting idly by waiting for the virtual telephone to ring. Residents, fellows, and attendings are buried in paperwork for patients that are in the ED. Where are they going to find time to do a “virtual” visit and then do documentation. The recording is NOT going to be sufficient for any purposes including “potential reimbursement” whatever that might be. Nor is it going to help litigation. In fact a friend of mine who is both a lawyer and a paramedic says that unlike with police in car video, this has the potential to increase, not decrease liability.
Furthermore, with the aid of follow-up telephonic care, the patient will be able to provide on-going self-care for the injury.
From where? Who is going to pay for the follow up care?
Best of all, reimbursement could be less than it would for a traditional call and still cover every aspect of the episode.
WHAT reimbursement? Right now reimbursement is pretty much based on transport, not treatment without transport. Would reimbursement, if the laws and regulations were changed to allow it, cover the cost of sending an EMS crew to a scene? How about the hospital? Many hospital EDs are staffed not by hospital employees, but by physicians groups that bill separately for each patient treated. How much payment is going to be authorized for a “home visit” that isn’t an in person visit?
The liability issues associated with treat and release are difficult to resolve because they are real. The cost of a judgment error by a medic is potentially high, and to many unacceptably high, both monetarily as well as professionally. To address these concerns, there is much EMS can do to insure the delivery of first quality care and “placing patients first” by means of training and sound treatment protocols. These are things that a highly professional, well organized EMS operation can manage — particularly if the issues of public expectation and reimbursement are resolved
Good point, especially the training and sound protocol parts. If a system does that sort of thing, I again have to wonder if a live on line consult with a doctor is needed. If a consult is needed, does it need audio and video of the patient?
The authors/proponents don’t even touch the consent issues that will exist in some states. Some states, such as Massachusetts, require all parties being audio taped to be advised of that fact and give informed consent. How will that work, I wonder.
Not to mention that some people won’t want complete strangers to set up cameras and microphones in their houses or places of business. There is that whole expectation of privacy thing.
Nor do the authors bring up any cost issues. At a minimum the ambulance is going to need some sort of constant data connection. Or as near to constant as the state of the art allows. Maybe in Tucson, which is pilot city for this, that might be free, but it’s neither free nor available everywhere. Citywide WiFi networks have turned out to be much more expensive and difficult to build and operate than was thought five years ago. Wireless (cell phone) connectivity costs anywhere from $50.00 per month, per device, and up. Who is going to maintain the equipment? Believe me, any technology that is not Mil Spec ruggardized, and most that is, will break in the 24/7 high use world of EMS.
The old joke is if you give an EMT, medic, or fire fighters, two bowling balls, they will lose one and break the other. And then claim that it happened on their days off. So, you’re going to need a full time tech support person or maybe you can add it to the duties of your existing IT staff. I’m sure they’d love that, after all they just sit around shopping on Ebay anyway.
In a unionized work force the terms “change in conditions of employment”, “compensation adjustment”, and “we aren’t going to do it without negotiating first” are going to come up. In fact, I’m told by my lawyer/paramedic friend that the TFD medics have flat out refused to use the system.
I’d like to see what the per ambulance and per ED costs are for this. I have to wonder if you add up the one time and annual cost of this system if it wouldn’t be cheaper to add a couple of ambulances to the complement.
I won’t even go into the utility and return on investment of having an all ALS system for “emergency” calls and relegating BLS to “non emergency” calls. That’s a debate for a whole different day.
There is definitely a place for technology in EMS, especially in the realm of documentation, risk management, billing, QA/QI, and research. This just isn’t it. This just seems like really expensive technology that will end up sitting in closets and holding doors open.