The patient was short of breath, pale and his echocardiography results spelled trouble. He clearly failed the eyeball test, even if the eyeball making that assessment was 95 miles away and looking at a computer monitor. One angiogram, two stents and a short time later, he received care that might have been delayed by as much a month had he not enrolled in a pilot telecardiology program.
“We have had many examples of patients who otherwise would have waited two to four weeks to see someone in person who were seen the next day or week,” says Marc C. Newell, MD, a cardiologist and director of the telecardiology program at the Minneapolis Heart Institute. The program, launched under the Allina Health system in 2014, complements a cardiac outreach program that encompasses more than 40 communities, some 100 miles or more from Minneapolis. About 100 patients, including the one Newell referred for PCI, received telecardiology services within the first six months of the program.
Providing better, less costly, patient-focused care drives many telemedicine initiatives. Timing is in their favor. The confluence of technical advancements, patient buy-in and the shift in reimbursement models has helped these programs take off. They might not be profitable for hospitals and health systems—yet—but they offer potential efficiencies, cost savings and patient benefits that become increasingly relevant under healthcare reform.
“We are still in a fee-for-service world but we know we are shifting to a value-based world,” observes Christine Bent, MHA, senior vice president of clinical service lines at Allina. “We are trying to look for some bridging strategies. This appeared to be one where we potentially could have a win-win.”
The telecardiology program builds off long-standing relationships between Minneapolis Heart and the many small and rural practices and hospitals in Minnesota and Wisconsin that its general cardiologists assist with periodic on-site visits. It is the institute’s second attempt. The first, piloted about 15 years ago, met with an early demise.
“The feeling was that the relationships were strong enough now and the technology was good enough,” Newell says. Their partners in the towns and smaller cities needed to be reassured that cardiology services would be maintained with telemedicine. The program hired a nurse practitioner to drive to sites that didn’t have one present to conduct ultrasound exams and be with the patients during virtual visits. The telecardiology team also made sure the visual and audio components of the program were high quality with high fidelity. When they rolled out the program in June, a member of their IT staff stayed with them to ensure the patients and outreach partners had a positive experience.
“Part of it, too, was patient perception,” Newell says, noting that in today’s digital world even grandparents Skype, so seeing and talking with someone through computer screens and speakers is familiar for the older population commonly in need of cardiac care. “Patients were ready.”
Telemedicine also saves patients time and the expense of traveling to Minneapolis. For some patients, that required a full day’s commitment, possible lost wages for them or family members and a long drive to or fro. “A lot of the places we go to are two hours or more from Minneapolis,” Newell says. “They are towns of several hundred to a few thousand people. They know and love their hometown clinic and they don’t like leaving it.”
Costs & efficiencies
Compared with Minneapolis Heart’s fledgling cardiology program, the heart failure telemonitoring initiative at Geisinger Health System in Danville, Penn., is long in the tooth—Bluetooth, to be exact. Geisinger implemented a Bluetooth-enabled system in 2008 as a way to serve its members in rural regions, replacing outreach efforts that dated back to 1998. Telemonitoring not only helps the system reduce heart failure readmissions, it also improves efficiencies and saves money.
“This program helped us sunset a very manual program,” explains Doreen Salek, RN, director of Population Management Partners at Geisinger. Previously, case managers had to telephone heart failure patients, ask for weights, calculate the algorithm and enter it into records. The process limited the number of patients they could accommodate and overburdened the staff. Geisinger replaced that labor-intensive process with tools that included Bluetooth scales with interactive voice response.
“The nurses have