Evidence-Based Tele-emergency Network Grant Program

The movement from a traditional fee-for-service healthcare system that rewards the volume of healthcare delivered to a reformed payment system that rewards the IHI’s Triple Aim of (1) improving the patient experience, (2) improving the health of populations and (3) reducing the per capita cost of healthcare will have a significant impact on emergency medicine. Despite the lack of robust emergency medicine and specialty care resources at community-based emergency rooms, if the Triple Aim is to be achieved, telehealth technology must be deployed to “import” those needed medical resources to every medically underserved emergency room, helping keep more patients in their home community, reducing unnecessary transfers and facilitating the rapid transfer of patients that require the care only available at a large quaternary care center. Using telehealth technology to deliver the right care to the right people at the right time in the right place will improve clinical outcomes while reducing the cost of care. The University of Kentucky Department of Emergency Medicine in partnership with Kentucky Telecare, the university’s telehealth program with over 19 years of clinical telehealth services and over 65,000 clinical events provided via videoconference technology is applying for an important HRSA grant entitled, the Evidence-Based Tele-Emergency Network Grant Program to develop the UK-ATEN (UK-Appalachian Tele-Emergency Network) to support implementation and evaluation of broad telehealth networks to rural and community providers without emergency care specialists. Using existing relationships developed over many years between the UK ED and the ED’s and physicians across rural Kentucky, we have consensus that such a technology deployment can achieve the Triple Aim goals. Specifically, we hope to improve the care for two types of patients, but there will likely be additional benefits in other patient groups as well. 1. Assistance with the critical/emergent patient in which there are questions about the best ways to manage a particular patient and expedite an emergent referral. 2. The ED patient with an urgent (but non-emergent) diagnosis needing to be managed by a specialist that is not available at the rural ED. We know that traditionally, many patients in this category are sent to the Chandler ED “to be sorted out” by specialty services only to be sent home from the Chandler ED to follow-up in the outpatient clinic. We seek to improve this situation by arranging timely and reliable outpatient follow-up, using telehealth when appropriate, to improve clinical outcomes, improve patient/family/provider satisfaction, reduce costs to the healthcare system and travel costs for family/patients referred to UK from the rural ED’s. The study will include 18 rural hospital ED’s throughout eastern and southeastern KY to participate in a cluster-randomized assignment of nine hospitals to a control group using the current telephone-based system of clinical support for the rural ED physicians and nine hospitals to the intervention group which will deploy telemedicine equipment, staff training and 24 hour videoconference access to UK EM and specialty physicians. We will not know which group each hospital will be assigned to until after the randomization selection. This project will prove that deployment of telehealth technology can deliver these clinical services without adding incremental workload to rural ED physicians and staff. Experimental sites will receive funding for telehealth equipment and partial FTE support for a Medical Director and Staff Support for deployment, operation and data collection. . Control sites will receive Staff Support funding to coordinate data collection. We believe that the UK-ATEN grant will enable us to learn how to coordinate care in the most efficient, cost effective and patient centered ways possible.