In 2003, two-hospital Georgia Regents Health System in Augusta began offering remote stroke teleconsultations with mid-sized and smaller hospitals in the region. Today, it serves 29 hospitals and has conducted nearly 4,000 examinations.

The delivery system now is expanding to offer a range of other teleconsultations that include other neurological conditions, as well as pulmonary, psychiatry and pediatric care. Lessons learned from stroke consultations often apply to other remote examinations, say Steve McGraw, CEO at telemedicine vendor REACH Health and Jeffrey Switzer, D.O., a Georgia Regents neurologist who has conducted teleconsultations since 2006.

Hospitals offering telemedicine services should have a dedicated service line coordinator that can work with other facilities to ensure staff are in place to facilitate examinations and to also recruit other providers to participate, McGraw explains. The coordinator also should educate hospitals being served on how telemedicine works and how these hospitals can leverage the technology to better serve patients who need to be immediately transferred to another hospital, while retaining patients who can be treated in the community.

The goal is to make telemedicine sustainable in the hospitals being served. While Arkansas has invested in a statewide telemedicine network, Georgia doesn’t have such a commitment, Switzer notes. Consequently, Georgia Regents Health System invests in the smallest hospitals it serves and the larger ones fund--to some extent--the telemedicine technology and fees to their clinicians who participate.

The telemedicine technology used at Georgia Regents and partner hospitals includes a point-and-zoom camera that enables a neurologist to closely examine eyes and extremities while also viewing local brain scans and getting a medical history from the patient and attending nurse or physician, Switzer says. The telemedicine platform creates an electronic health record of the session that can be placed in hospitals’ EHR systems.

Remote consultation programs can produce millions of dollars in revenue for hospitals, Switzer says, “but you have to adequately compensate participating physicians, who are on call from 11 p.m. to 7 a.m.” These physicians, he notes, still have their regular daily schedules and never know when they will be called upon for a remote consultation, so they have to be dedicated to the program and adequate “on-call” supplemental pay certainly helps.

Physicians participating in teleconsultations should have good social skills and do their homework on the technologies of the hospitals and capabilities of the clinicians to quickly assess what can and cannot be done at the local facilities. Stroke treatment requires fast decision making, particularly with the administration of certain time-sensitive medications.

Working out standard workflows with hospitals being served is another lesson. Assessment of acute stroke cases is pretty standardized with few variables, Switzer says. But other neurological conditions are not; it can get pretty complicated when assessing why a patient is suffering from falls, or other conditions. Standardizing processes and workflows to the greatest possible extent enables creating a situation of the consulting physician being at the bedside, even though he or she actually is not.

Local nurses and physicians also have to learn how to make sure the consulting physician has necessary information, as the consultant doesn’t have access to the local EHR. “If they don’t tell me something, I won’t know about it,” Switzer says.

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