1. TELEMEDICINE IN THE EMERGENCY DEPARTMENT BRUCE JANIAK, MD,FACEP,FAAP

3. What is Ethica? 50 skilled nursing centers 4 assisted living centers 5 centers currently with telemedicine 5 additional centers online in March, 2010

4. What is GA Partnership for Telehealth?

5. Eatonton, Ga. Sparta, Ga. Oconee, Ga. Adrian, Ga. Douglas, Ga. Telemedicine Sites

6. The Concept The Emergency Department is open 24/7 The challenge is to identify applications that may prevent unnecessary trips to the ED while looking for applications that have a significant financial margin The goal is to eliminate the need for an emergency visit

7. Nursing Homes Approximately 50% of transfers from NH’s to ED’s do NOT result in admission ( Annals of EM) Approximate cost of transfer approx $1000 (transfer) Approximate cost of ED visit $500 (pts discharged back to NH)

8. Empowering Factors Georgia allows billing (if rural) Liability coverage allowed NH staff enthusiastically support ED physicians frustrated with current system

9. Barriers to Usage Cost: $20k per telemedicine unit Primary care doctors apathy Hard to get NH nurses to use (as opposed to old system of calling primary care)

10. Approach to Increase Use of Telemedicine Explain $ advantage Cost of ambulance Cost of ED visit-direct Cost of ED visit-indirect Identify physician advocates Identify nurse “champion” in each facility

11. Cost of Ambulance Gold-CrossNon-EmergentEmergentPer mile cost ALS ( monitor, EKG, IV’s, resuscitative measures) $485.00$662.00$11.10 BLS ( IV’s, O2)$404.00$581.00$11.00 Capital CityNon-EmergentEmergentPer mile cost ALS ( monitor, EKG, IV’s, resuscitative measures $235.60$373.03$6.87 BLS ( IV’s, O2)$196.33$314.13$6.87 o Charges are based on the type of transport plus the per mile cost o The cost reflect one way transport only.

12. Current System Sample size 5 nursing homes 950 transfers over 5 years Cost per ED visit (transportation, hospital and physician) $1500 Five year costs 1,425,000

13. New System Capital expense (equipment) $100,000 Leasing costs: $24,000 Cost of emergency visits (665 x 1500) $997,500 Cost of physician charges: $95,000 Total cost: $1,216,500

14. Summary for Five Facilities Current system: $1,425,000 Telemedicine system: $1,216,500 Difference (amount saved): $208,5000

15. Political Barriers Attitudes of primary care docs-competition, financial concern, loss of control- Attitudes of nurses- resistance to change, reluctance to learn new tool, time factor (call pmd vs move pt to telemed suite)

16. Political Support ED docs NH nurses and patients and families