ONE BIG CHALLENGE in tele-hospital medicine is becoming familiar with the EHRs in separate facilities, according to Stephanie Carroll, MD, a hospitalist and telehospitalist with Gundersen Health System in La Crosse, Wis.. While all the critical access hospitals in her system share an Epic EHR with the main La Crosse campus, “each facility has its own formulary and its own kind of nuances when it comes to ordering. You do have to navigate an EHR differently with telemedicine because the patient isn’t in the building.”
And when starting up a program for rural hospitals, particularly when telehospitalists are providing primary coverage and working only with onsite nurses, people should expect a steep learning curve for the nurses at remote sites.
“They facilitate the exams for us,” Dr. Carroll points out. “The staff at each of our critical access hospitals has been really good at developing that skill set and they became comfortable quickly with using the equipment.”
Meanwhile, Northeast Georgia Health System, which is based in Gainesville, Ga., had to get its telehospitalist service up and running so quickly that “many of the hospitalists didn’t really know what it was, and they weren’t excited about it,” says Connor Cooper, MBA, the health system’s administrative director of hospital medicine. “We’ve definitely learned to have a better rollout plan. Our biggest challenge is getting more providers interested in the program.”
Right now, it’s the younger hospitalists who show the most interest. To foster more participation, she and other hospitalist leaders plan to continue discussing the telehospitalist option at group meetings.
What’s the right census for a telehospitalist service? The answer depends on the coverage that telehospitalists need to provide. Read more here.
And Ms. Cooper’s advice to hospitals or health systems just starting out with telemedicine: Get the carts you’re going to need first because many of them have to be back-ordered. “That was the biggest hurdle, making sure that all the cart technology integrates appropriately,” she says. Also, “be sure to start to work early with your IT team.”
With Avel eCare, a national telehealth company that has telehospitalists working with more than 60 partner sites across 12 states, licensing and credentialing remain time-consuming and expensive. That’s according to Kelly Rhone, MD, Avel eCare’s chief medical officer. The Interstate Medical Licensure Compact—in which 39 states currently agree to work together to streamline licensing for doctors who work in multiple states—has helped, she points out.
Still, “we have a whole department that just does licensing and credentialing because it’s complicated,” says Dr. Rhone, “especially for doctors who maintain licenses in 10 or 12 different states.”
Combining telemedicine with in-person care
Telemedicine in some ways demands even more communication skills than providing care in person, says Stephanie Carroll, MD, a telehospitalist with Gundersen Health System in La Crosse, Wis., who helped develop that system’s six-year-old program.
Out of a total hospitalist group of about 30 physicians, 10 rotate through days as telehospitalists, and most of those—including Dr. Carroll—work only part time. As she puts it, she finds an advantage to working both hands-on rotations in the hospital and telemedicine.
“I actually like building relationships virtually, and I enjoy the challenge of doing that,” she says. “It’s fun when you make those connections.” At the same time, “patients are still sicker at our tertiary center, and I like to maintain my skill set with patient acuity.”
Dr. Carroll and her colleagues have thought about whether residents should begin learning about telemedicine. Does she see telehealth as an emerging specialty? Not in the near term, she says. However, “I certainly think it’s going to become part of many practices, and I do think there are skills that are very helpful to have with this type of work.”
For more information on telehospitalist services, read our additional case studies.
CASE STUDY 1: A hub-and-spoke model
A health system in the Midwest relies on telehospitalists at its main campus to provide a suite of coverage services to five rural facilities. Read more here.
CASE STUDY 2: Growing interest in surge capacity
A national telemedicine company deploys telehospitalists in rural hospitals and in larger ones to manage surging census. Read more here.
CASE STUDY 3: Rural admissions and post-discharge visits
Telehospitalists in a Georgia health system cover not only critical access hospitals but post-discharge follow-up with patients at high readmission risk. Read more here.
CASE STUDY 4: Telenocturnist coverage
A national hospitalist company opts to outsource virtual night coverage rather than grow its now telenocturnist service. Read more here.
Phyllis Maguire has been Executive Editor of Today’s Hospitalist since 2006. Based in Bucks County, Pa., her health care interests are hospital medicine and long-term care options. She also likes zydeco, hiking, and reading memoirs and romances.
