This is the first in a six-part series examining the potential role of telemedicine in the emergency medical services.
Though not quite the “final frontier,” telemedicine is a technology category that is rapidly expanding across EMS and healthcare. Telemedical applications (when wellness-oriented applications are included it is sometimes called telehealth) range from surgery and field consultations to home health and hospice, and operate at distances from across town to across the planet. My own team at Beyond Lucid Technologies was even invited by a NASA affiliate to submit a proposal for a telemedical solution that would to allow medical directors in Houston to monitor astronaut-patients on a manned voyage to Mars!
So many of us carry cameras in our pockets these days, but to date we’ve talked little about questions that include the value of telemedicine, its legality, and decisions about protocols, training and hardware.
Some states and counties are blazing future-focused trails. This past August New York Governor Andrew Cuomo signed a law that “streamlines the credentialing process for healthcare practitioners who provide telemedicine services to patients in New York state,” according to Crain’s Health Pulse. Conversely, a paramedic in Rowan County, NC, said cameras are a strict and vehement no-no in light of concerns about HIPAA-sensitive photos or videos inadvertently ending up online.
At the Hawaii EMS Information System users conference last April, I asked prominent EMS attorney Stephen R. Wirth—a lecturer at the event and partner at Page, Wolfberg & Wirth—whether there were best practices for the use of telemedical technology by EMS providers. He said there weren’t—telemedicine in EMS and fire remains a legal gray area. How, then, can an innovative agency leverage telemedicine to maximize quality and safety for both patients and providers, while simultaneously avoiding the risk of potentially opening a Pandora’s box of quality and legal problems?
Kevin Chason, DO, director of emergency management at Mount Sinai Hospital in New York City, described the use of cameras by EMS providers as “way ahead of the curve.” But he acknowledged significant cases that could justify cautious reliance on telemedicine, especially when coupled with an electronic patient care report (ePCR). These include:
• Documentation of injuries and quality assurance of patient care;
• Documentation of scenes and other factors that contribute to medical decision-making; and
• When allegations of EMS misconduct—for example, inappropriate treatment or excessive force—pose the risk of devolving into the word of the provider vs. the word of the patient.
EMS providers in Pittsburgh echoed the suggestion that multimedia might serve as a tool to defend against false accusations of negligence or misconduct and a means to roadblock frivolous lawsuits. Sadly, there are attorneys out there who seek to capitalize on the inadequacies of paper run records by dragging medics into court and then nitpicking on miniscule details they couldn’t possibly remember years later.
In future columns we’ll delve further into the technical and financial benefits of next-generation technologies for EMS, many of which have been vetted by and incorporated into adjacent industries like police and both hospital- and in-home care, but haven’t yet jumped into mission-critical EMS.
Any discussion of telemedicine’s value for emergency services is inadequate if it fails to mention the potentially transformative effect of care-at-a-distance applied to rural healthcare in the U.S. and abroad. Considering the ubiquitous tension between first responder resource availability and budget constraints, it is striking that a recent article entitled “5 Ways Telemedicine Can Boost Care in Rural Communities” failed to mentioned EMS once. This seems a major oversight. A senior official in the El Paso Fire Department explained to me last year that his agency had to take decisive legal action to reduce “frequent fliers” because “[they] are three hours from the nearest town,” and can’t afford to let abusers gum up the ambulance system. Many systems face similar challenges.