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James Langabeer, PhD Michael Gonzalez, MD Andrew Winburn, MS Tiffany Champagne-Langabeer, PhD

Designing a Telehealth-Guided Alternative Delivery Model for Emergency Medical Services American Medical Informatics Association Nov 6, 2018. James Langabeer, PhD Michael Gonzalez, MD Andrew Winburn, MS Tiffany Champagne-Langabeer, PhD. Disclosures.

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James Langabeer, PhD Michael Gonzalez, MD Andrew Winburn, MS Tiffany Champagne-Langabeer, PhD

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  1. Designing a Telehealth-Guided Alternative Delivery Model for Emergency Medical ServicesAmerican Medical Informatics AssociationNov 6, 2018 James Langabeer, PhD Michael Gonzalez, MD Andrew Winburn, MS Tiffany Champagne-Langabeer, PhD

  2. Disclosures • Nothing to disclose and no conflicts of interest

  3. Background • Estimated 30-40% of EMS calls are non-urgent, primary care related • Ambulance and paramedic crews are limited • Telehealth offers a potential solution

  4. Objective • Assess the feasibility and cost-effectiveness of a tele-EMS program integrating video conferencing

  5. Study Setting • Study Setting: Houston Texas (4th largest metropolitan area in US) • One of the largest fire-based EMS crews in the nation (3700 EMS responders/firefighters) • Division of the Houston Fire Department (85% of all incidents involved EMS; 15% fire) • 300,000+ annual medical incidents • 63 Ambulances + 175 engines/ladder trucks/ squad vehicles for response

  6. Study Design • Case control study design • Inclusion criteria: adult patients with non-acute symptoms • Intervention involved an alternative to ‘treat & transport to ED’ model: • Telehealth-guided triage and disposition • Alternative transportation • Network of community-based health centers • Mobile health solutions involving telehealth, clinic scheduling, taxis, and HIE access • Primary outcomes: cost and reduction in ED ambulance transports

  7. Technology • Commercially available telehealth app on all paramedic tablets • Video transmitted (and stored) to EMS base station physicians • Dialogue between patients, medics, and doctors (average of 3 minutes)

  8. The Process Time, Costs

  9. Process Flow Diagram

  10. Patient Navigation

  11. Outcomes

  12. Results • 14,760 patients in 3 full years • Significant reduction in ambulance transports (74% to 12%) • Faster unit turnaround times (44 minutes) • $103 average reduction in cost effectiveness • $1.52 million total benefit over three years

  13. Barriers • Patient education and resistance (shared decision making) • Technology and systems development (costs, interoperability) • Financing and reimbursement (policy issues)

  14. Conclusions • Telehealth can improve prehospital triage and patient navigation • Telehealth offers an alternative to the traditional EMS ‘treat and transport’ model • Telehealth should be explored and adopted in other geographies and municipalities • Barriers exist for widespread adoption

  15. References • Winburn A, Brixey J, Langabeer J, and Champagne-Langabeer T. (2017). A Systematic Review of Prehospital Telehealth Utilization. J Telemedicine Telecare, https://doi.org/10.1177/1357633X17713140.

  16. Thank You James.R.Langabeer@uth.tmc.edu

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