Telehealth Cuts Shelter’s ER Visits, 911 Calls

An Omaha, Neb., homeless shelter is using telemedicine consults for its clients to reduce emergency department visits and calls to 911.

The telehealth visits are proving popular with the Open Door Mission's guests, and also streamlining some forms of care for them, such as receiving medications in a timely manner. The consults are donated two days a week by Omaha-based telehealth provider Doc On.

"Several of our guests come with medication needs, and we were having to send them to clinics serving the homeless or nearly homeless in Omaha, and that was only if they had grants to fill the prescriptions," said Kate Fischer, director of the mission's Free Health & Healing Clinic.

"They were using ER's for primary care physicians. That's what we were trying to alleviate,” Fischer added. “With Doc On, they don't have to go to an ER because they just got out of jail and don't have their blood pressure meds and it's three weeks before they can get an appointment with their doctor. We can call Doc On, and the guests can get their meds that day. We also have pharmacies in the area that will deliver, so our guests don't have to do anything but show up to the clinic."

Doc On began operations this summer, said founder Christy Armendariz, and she approached mission executives shortly after launching about the idea of donating telehealth consultations. The service currently provides care for primary needs, which Armendariz characterized as minor, acute conditions. The service's Nebraska-licensed physicians are reimbursed for the $39 consults, but the shelter receives the service at no charge. Armendariz said she hopes to expand both the business and the donated services to organizations such as Open Door in other states.

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Fischer and Steve Frazee, Open Door's senior program director, said the ROI on the service is measured not so much in dollars saved as in the improvement in clients' health. However, the reduction in non-emergency ER visits and ambulance calls also alleviates the stress on the city's EMT and ER facilities; the shelter is not charged for either ambulance calls nor hospital visits by clients.

Fischer estimated that the clinic, which is staffed by volunteer nurses and physicians, sees about 200 patients a week. The Doc On services, which are performed Tuesdays and Thursday afternoons, receive about one consult every hour or two when an on-site exam isn't possible.

"All you need is an Internet connection and a computer," Armendariz said. The Open Door clinic has computers in all of its exam rooms, and also nurses on site to take vital signs for the consulting physicians.

Frazee said the mission's medical services serve as an important part of its "holistic" approach of short- and long-term housing, nutrition and clothing assistance, and counseling to help people return to society as contributing members.

Fischer said the clients who have used Doc On consults thus far "absolutely love" the service. "As far as I know, we are the first shelter that has this.It's still all pretty new to us, but we are getting there."