by: Cullen Hebert, MD
[Dr. Hebert is a critical care physician & pulmonologist in Baton Rouge, LA. We are excited to have him present his experience as a pioneer in emergency telemedicine]
In Part 1 of this article, we showed how implementing a region-wide wireless communication network was instrumental in bringing our call to balloon time (CBT) down to a remarkable 23 minutes by transmitting ECGs of patients during emergency transport.
Over the last decade software has become more mature, hardware faster, connectivity improved, and security & privacy challenges becoming increasingly met. But what has to happen for all this to work for the benefit of patients is that communication and planning must occur.
It starts with a plan of what and how. Key players, including physicians, ED nurse managers and EMS administrators are identified.
Once the planning is complete then the recommendations go to the city council, EMS administration, hospital administration and physicians. With the approved plans in hand, funding has to be identified, applications completed, and approved. After planning and funding comes the education of those who will utilize the system – the EMTs and the medical staff in all of the EDs.
Once all that is done, there is the deployment of the equipment. Finally the switch is turned on. Then come the comments like “What is this? Why are we doing this?”. This leads to the re-education phase.
Our work began in 2006 when I convened a meeting that brought together physicians, political & hospital administrators and wireless providers. Administrative and chiefs of local EMS were involved, both from the clinical and IT side. What was initially disappointing was that, of the three wireless providers invited, only one showed enough interest to participate.
We got around this by utilizing the broadband connectivity used for police and fire services. Unfortunately, this broadband connectivity was limited in coverage, as stated previously, to only eight square miles. Eventually, we were able also to utilize 3G, and later 4G, connectivity. We are now testing the AV qualities of 4G with the ambulances in motion with results pending.
The other piece of this puzzle is maintenance. Initially, our EMS IT team consisted of one person who ran the networking, did the installs, ensured encryption is active and maintained all the units in each hospital as well as all the portable laptops – quite a daunting task! EMS has since hired one other person to share these responsibilities.
The process of educating the people on the “front line” takes coordination on several levels. There are roughly three groups; people answering the calls, the nurses and the physicians. Each group has their own set of responsibilities and the education for each group has to be tailored to their respective responsibilities.
On the hospital side, the EDs and the cardiac cath labs had to readjust their process when they receive the ECGs wirelessly. There was initially resistance by the ED personnel to accepting the wireless ECGs, as the traces were not identified by name. Working through that process took time and effort but once this was overcome, the wireless ECGs were accepted by the ED staff and the cardiologist with HIPPA compliant patient identification in place.
Each portion of the process has to be scrutinized by many individuals and this takes time. Many meetings have to occur with the goal of making this a reality and not giving up on the process.
Wireless technology adds another dimension to the pre-hospital care of patients. As technology continues to advance, it is up to clinicians, IT personnel, and administrators to construct proper utilization for the benefit of our patients. After all, isn’t this why we went into medicine?
Watch the Video:
[Do you have a story to share of using mobile or telehealth in your practice ? We would love to hear it. Send us note here.]