Electronic Health Reporter

By Dr. Talbot “Mac” McCormick, president and CEO, Eagle Telemedicine.

Telemedicine has already proven its effectiveness in traditional acute care hospitals, providing consistent coverage in areas where physicians are hard to come by, guiding clinical teams and leading specialty programs. Now telemedicine is making inroads into a new model of care—micro-hospitals. The growth of micro-hospitals, where small neighborhood hospitals offer care tailored to the specific needs of a community, is dramatic—and telemedicine is helping drive it.

Communities in 19 states have micro-hospitals today, and the numbers are climbing. Cited as a new trend in healthcare by U.S. News & World Report, micro-hospitals typically have eight to 10 short-stay beds and a small ED. They can provide the imaging and lab services performed in larger hospitals, but they are geared toward moderately ill patients who don’t require the intensive care and longer stays required by patients in traditional hospitals.

Because of this patient profile, micro-hospitals can hire fewer physicians—a plus given today’s physician shortage—and can rely more heavily on nurse practitioners (NPs) and physician assistants (PAs)—whose numbers are growing—to assume key leadership roles, make daily rounds and provide hands-on coverage.

A Perfect Environment for Telemedicine

Telemedicine teams offer a cost-effective way to provide on-the-spot, expert guidance to NPs and PAs via web videoconferencing, telephone and secure texting. One could argue that the emergence and growing public acceptance of telemedicine has made the physician-lean, micro-hospital model possible, helping bring cheaper, faster care to moderately ill patients. To illustrate, one company we are working with plans to place 70 micro-hospitals across the country over the next four to five years, and telemedicine will play a key role in all of them.

A Range of Specialized Care

In micro-hospitals, telemedicine serves a function that is similar to the model for many critical access hospitals, where NPs manage hands-on coverage of patients with guidance from telemedicine teams. A videoconferencing cart or “robot” delivers expert physicians to patient bedsides, where the physicians can converse with staff and patients. With the help of the onsite nursing team, they can access diagnostic equipment on the cart to examine patients and make a diagnosis. The telemedicine physicians also work with ED physicians to admit patients, examine them once they have a bed, and develop a plan of care to be carried out by NPs and nursing staff.

The telemedicine physicians might be in the same state and time zone; they might be across the country or, in some instances, halfway around the world, but they must be licensed in the state and credentialed by the hospital in which they are practicing. If they see that a specialist’s care is called for, they can contact a team of specialists—cardiologists or neurologists, for example—who are under contract to examine the patient via telemedicine and provide a diagnosis and treatment.

Given the growing shortage of specialists in the United States—the Association of American Medical Colleges (AAMC) projects a deficit of up to 61,800 specialist physicians by 2030—being able to contact a remote team immediately via telemedicine is another plus for micro-hospitals. For example, teleneurology specialists typically achieve an average response time of 3.5 minutes (a fraction of the time it typically takes for a local neurologist to get in the car and drive to the hospital), and an average diagnosis and treatment time of 21.8 minutes.

For the past decade, telemedicine companies have provided teleneurology services and other individual specialties to traditional acute-care hospitals. But micro-hospitals are looking for a different approach. They may choose to have a range of specialties available whenever they need them. Telemedicine makes it possible.

A Practicing Telehospitalist’s Perspective

Brian Hunt, MD, has been a physician for 26 years, and has spent the last four of them practicing in telemedicine. “I started my health career without a computer,” he said. “I was very resistant to the Electronic Medical Record (EMR) movement when it began. But gradually, I saw what a great benefit it is to the care and management of patients.”

That recognition opened the door to his acceptance of telemedicine. Based in Kansas, he has been part of telemedicine teams for critical access and larger community hospitals, and now is working with teams in micro-hospitals in Indianapolis and Kansas City. Those teams helped persuade micro-hospital executives to expand their initial staffing models and include Advanced Practice Providers (APPs)—an NP or PA—as part of the onsite clinical team, along with the ED physician and nurses. “Telemedicine is a great platform to provide healthcare, but you still need someone onsite to provide hands-on coverage,” he said. That model is currently working well in the micro-hospitals where telemedicine is deployed.

In many cases, telemedicine is a step ahead of the things onsite physicians are able to do. “Tele-stethoscopes are so accurate you can hear better than onsite,” he said. But the main benefit he sees, especially for micro-hospitals, is the flexibility telemedicine provides. “Depending on where micro-hospitals are located, their needs will vary, and we can design a comprehensive program to meet them.”