Catholic health care system's telemedicine program provides backup for ER doctors

A new nurse was on duty a few weeks ago in the emergency room at the Phillips County Hospital in Phillipsburg, Kan., when paramedics arrived with a critically injured patient.

She immediately pushed the red button on some newly installed equipment. Seconds later, a seasoned ER nurse and board-certified doctor sitting at a bank of monitors 380 miles away in Sioux Falls, S.D., were using a high-definition camera and other diagnostic equipment to monitor the patient, give advice and document everything the on-site nurse was doing to save the patient's life.

"The [Phillipsburg] nurse who was on was brand new and she was being overwhelmed," said Michelle Peak, a more experienced nurse who hustled to the ER to help.

Peak said even after she arrived, having an off-site nurse wired in and taking care of the charting was a "huge help."

"It put us all a little more at ease," she said. "But the big thing was, we didn't have to take our hands off the patient."

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First in Kansas

The Phillipsburg hospital is the first in the state to sign up for a 24/7 telemedicine program operated by Avera Health, a Catholic health care system based in Sioux Falls. For a flat fee of about $65,000 a year, it and the other hospitals in the network can make unlimited use of the eEmergency system.

"We want people to use it when they need it," said Darcy Litzen, sales director for Avera's eCare suite of telemedicine services, which also include eICU and ePharmacy. "We don't want them thinking that it's going to cost them an additional $50 or $75 every time they hit the button."

With the addition of Phillipsburg, 89 rural hospitals in eight states across the upper Midwest are now using eEmergency, Litzen said. Another 10 are expected to come online soon, including Horton Community Hospital in northeast Kansas.

"I've been a firm believer in telemedicine since it first started evolving in the early 1990s," said James Noble, CEO of the Horton hospital.

Having emergency room physicians, nurses and other specialists available day and night at the touch of a button can help less experienced staff in rural settings be more decisive in situations where every second counts, Noble said.

"It just increases their level of confidence," he said. "It's real time. You've got your second opinion right there. And you've got that specialist who's an immediate backup for the family practitioner on call."

Having specialists in the room, even if it's via a video monitor, can also give patients increased confidence that they're getting the care they need, Noble said.

'It's scary to be there by yourself'

Dr. Donald Kosiak can sympathize with the Phillipsburg nurse who found herself overwhelmed. He's been there. With a medical degree from the University of North Dakota and graduate training at the Mayo Clinic, he confidently set up practice in the same small North Dakota town where his father and grandfather had practiced.

"There's probably nothing I'm going to see in this small town that would ever scare me," Kosiak said he thought at the time.

He was wrong. The first time he was called to the ER, it was to treat a 16-year-old boy who had collapsed at school after suffering cardiac arrest. Wanting help, Kosiak said he asked the ER staff about using the telemedicine equipment sitting in the corner to connect with a specialist.

"They said, 'Well, we'd have to dust it off and plug it in and remember how to use it, and then we'd have to call up to Bismarck, and they would have to dust their equipment off and call somebody. After about an hour, we might be able to make this work,' " he said.

Kosiak wasn't able to save the boy's life.

"I think we did all the right things looking back on it, but it's scary to be there by yourself and be the last and only line of defense for anything that comes through the front door," he said.

That experience motivated Kosiak to help develop the Avera eCare system, with funding provided by the Leona M. and Harry B. Helmsley Charitable Trust.

Holding on to patients

Backstopping onsite caregivers helps provide them confidence to treat patients they otherwise would be inclined to transfer to bigger hospitals and trauma centers, said Noble, the Horton hospital chief executive.

"I will tell you that right now, 99 percent of the time, we err on the side of caution and decide to transfer patients," he said.

But Noble said he believes that will change once the hospital is wired into the eEmergency system. If the hospital is able to reduce the number of patients it transfers, it would generate additional revenue and allow patients, many of whom are elderly, to recover closer to family and friends, Noble said.

Since 2009, rural hospitals using Avera's eEmergency service have treated approximately 2,000 patients who otherwise would have transferred to larger hospitals, said Mandy Bell, the company's development director. Avoiding those transfers generated about $15.8 million in savings and additional revenue for the hospitals, she said.

But many patients can't get the care they need in a rural emergency room, Bell said. When a critically injured, heart attack or stroke patient needs to be transferred, the eEmergnecy staff can help get it done quickly. While the onsite ER staff is caring for the patient, the Avera nurse can be on the phone with the ambulance service and the destination hospital coordinating the transfer.

"We've seen a remarkable reduction in time to transfer," Bell said.

Research indicates that advanced telehealth systems like those offered by Avera have the potential to produce huge savings, mainly by reducing unnecessary transfers and transportation costs.

A 2007 report by the Center for Information Technology Leadership found that equipping all the emergency rooms in the United States with telehealth technology could reduce patient transfers by almost 40 percent and cut transportation costs by nearly $540 million. The estimated savings, the report said, would be more than enough to cover the costs of installing the equipment.

There also is evidence that hospitals with telehealth systems have an easier time recruiting doctors and other providers, in part because it reduces the stress of being on call.

For those and other reasons, Dave Engel, chief executive of the Phillipsburg County Hospital, is sold on the idea.

"This is really what the future of health care will be," he said, "using technology to embrace the larger team of providers and specialists to care for individuals."

[Jim McLean reports on health issues for Heartland Health Monitor, a reporting collaboration among KCUR Public Radio, KCPT Public Television, KHI News Service and Kansas Public Radio. He is executive editor of KHI News Service.]


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