Telemedicine Today: Part 2—Applications and Essential Steps

As we all know, today’s economic climate is not good, with cutbacks and budgetary restrictions the order of the day. Securing sound funding sources for initial and ongoing costs should be addressed in early planning, as should the opportunities for cost savings. Remember that the ambulance and hospital equipment costs for an EMS telemedicine system are directly related to needs and applications, and that even the most comprehensive systems, when compared to the cost of common equipment such as a monitor-defibrillator, are comparatively modest. The deployment of advanced broadband wireless systems now makes EMS telemedicine more affordable than is commonly thought.

4. Installation and training

Unlike an interfacility telemedicine system, an EMS telemedicine system has many more “moving parts,” such as ED staff, EMS and other ambulances agencies, medics, EMS and ED administrators, IT folks and specialty physicians.

For an example of the complexity of a multiagency EMS telemedicine installation, consider BR Med-Connect’s simultaneous installation of telemedicine workstations at five hospitals and its local Office of Emergency Preparedness. Each installation site required one or more representatives from the equipment provider, the hospital’s communications provider, IT, nurse training, ED coordinator, buildings and grounds, EMS, and the BR Med-Connect representative. All these people had to attend planning meetings, accomplish their parts on time and be available on the day of installation. Now multiply that by six! The planning that allowed this installation to be accomplished in less than two weeks, on time and without incident, was considerable and time-consuming.

Initial and ongoing training of ED nurses and physicians is a critically important but difficult task, considering their busy schedules and variable shifts. While the equipment itself should be easy to use, complications include fear of new technology, dealing with inherent technical limitations, situational stress and, of course, scheduling. Training is simplified in a fully integrated system that merges telemedicine with day-to-day EMS because the system is always in use.

5. Ongoing system testing and maintenance

Much like a hospital’s emergency generators, an EMS telemedicine system may not be used for days at a time, but still must work when needed. Regular testing and prompt repairs are essential, as nothing will kill an EMS telemedicine system faster than unreliable performance. One way to do this is to perform a simple test of connectivity and operation at the beginning of each shift, with any deficiency reported to the shift manager. Given the distributed nature of the system, managing all this is not a simple task and should be worked out in advance.

6. Internal policies and procedures

Just as with any patient care activity, hospital and EMS agencies must have clear policies regarding when these systems are to be used, who is given access to the information, how information is stored and who has overall responsibility, in addition to training and maintenance issues. While this is sure to be an evolutionary process, including this in the initial planning may avoid problems later.

7. System phase-in

When planning the actual deployment of an EMS telemedicine system, it may be advisable, particularly in terms of buy-ins, to introduce it gradually (in phases), beginning with the applications of lowest risk and highest reward. This approach has been successfully used in Baton Rouge.

What to Avoid

Some of the pitfalls to avoid when starting an EMS telemedicine system are:

No clear objective--“The competition has one, so we should too” isn’t a reason to pursue EMS telemedicine. If the system’s goal is just PR, as opposed to meeting real medical or organization needs, it’s better to spend the money on a good ad campaign. A successful program needs to address real medical or financial needs, as well as the needs of the other stakeholders.

No initial stakeholders--“Build it and they will come” is a shaky proposition and risks creating a system that may not satisfy needs subsequently identified. Need, organization and funding come first--the system comes later.

Ignoring the opposition--“Everyone except [fill in the blank] wants the system. Let’s do it.” All the players--EMS, ED nurses and docs, IT, administration and everyone else--must be in agreement and see a benefit, or the risk of failure is heightened. Sound planning and buy-in from meaningful stakeholders are essentials.