- Healthcare providers looking to remotely monitor chronic care patients and those recently released from the hospital are finding a mobile health resource in local EMS providers.
Dubbed community paramedicine or mobile integrated health, the concept is catching on in communities all across the country. It generally involves a contract between the health system and local EMS providers, who visit patients at home to gather vital signs, check on care management goals and address any issues the patient may have.
In Portland, Ore., a city-funded program will enable Legacy Good Samaritan Medical Center to contract city firefighters, paramedics and nurses to check in on discharged patients at risk of returning to the hospital. The six-month pilot, expected to cost about $50,000, will focus on patient with chronic conditions like COPD, diabetes and heart failure, as well as those recently discharged.
The program aims to reduce rehospitalizations and 911 calls by helping patientds better manage their care at home.
"We're excited about it," Commissioner Dan Saltzman, who is in charge of the fire bureau, told The Oregonian. "We think there is a role we can provide in addressing the community's health and well-being. We think it fits well with the skills the firefighters have."
In Manatee County, Fla., a community paramedicine program launched last August has reportedly saved more than $45,000 in healthcare costs, primarily in transport and treatment costs avoided because the patient is cared for at home.
Using grant money, the county purchased and refitted two vehicles with mHealth equipment, then assigned two paramedics and a supervisor to the program. The paramedics provide primary care to identified “high utilizers,” while also offering guidance on medication, health and wellness, even mental health and substance abuse issues.
In Montana, Glacier County Community Health Center recently launched its first-in-the-state Integrated Mobile Health Service Program.
“We are essentially the eyes and ears for their healthcare provider without patients having to leave their homes,” Amie Allison, Glacier County’s EMS Director, told the Cut Bank Pioneer Press. “We have a variety of options of care services. For example, we provide chronic illness care and training, basic wound care, new mom visits, lab draws, IV catheter change, extended hospice services or end of life care and immunizations and vaccinations, just to name a few of the services we can provide.”
The program’s goal is a “decrease in hospital readmissions, a decrease in emergency care transports, hospice revocation avoidance and savings in healthcare dollars for our patients and their families,” Allison said. “Having the opportunity to work with patients in the homes or work sites gives us the chance to be proactive instead of reactive.”
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When enhanced by mHealth and telehealth technology, remote monitoring programs like these could take a big chunk out of the nation’s healthcare expenses, including the estimated $3 billion spent each year on free or uncompensated care, much of which falls on the overworked shoulders of the EMS industry.
“You can have a very real impact” on EMS services, says Jonathan Feit, MBA, MA, co-founder and chief executive of Beyond Lucid Technologies, which develops mHealth technology for EMS providers. The California-based company’s CP/MIH program is now live in a handful of communities, including Alameda County in California and Lincoln County in North Carolina.
Feit’s business plan puts mHealth technology in the hands of EMS providers, who are then able to coordinate continuation of care with healthcare providers and arrive at a home with all the information they need about the patient.
The telehealth platform can also be customized, says Feit, to address community and public health issues, such as minority health, high disease rates, outbreaks, even drug or alcohol addiction. In that case, the platform identifies the specific population within the community to be treated, then sends that information to the paramedic or EMS provider.
“You’re talking pre-hospital care,” says Feit. “You’re addressing the patient’s needs in a way that hasn’t been done before, but is so much better” than waiting for that person to show up at a hospital.
“Consider the average 911 call takes 27 minutes,” he says. “The typical community paramedicine encounter can be an hour or longer. You’re focusing on the patient [instead of the emergency]. You’re helping patients in a way that hospitals really can’t … and you;’re keeping these people well so they don’t have to show up at the hospital.”
While most community paramedicine calls aim to treat patients before they dial 911, an innovative program underway in Houston is using telehealth to intervene after the 911 call, in hopes of avoiding a costly transport to the hospital.
Called Project Ethan (Emergency Telehealth And Navigation), the platform screens 911 calls and sends an EMT with a tablet and a video link to a physician. Armed with that technology, the EMT can often provide enough care to negate the need for transport.
“There’s really a lot of good that has come out of this,” says Dr. Michael Gonzalez, the program’s director and a professor of emergency medicine at nearby Baylor University’s College of Medicine. “The ideal outcome is that the patient avoids the ER transport and winds up with their primary care provider. That benefits everybody involved.”
Moving forward, advocates for community paramedicine and mobile integrated health programs say the service will improve as providers become more adept at using mHealth and telehealth technology. There might even be a time when the mobile health van becomes a more common sight than the ambulance.
“This may change how people see EMS services,” says Feit. “This is really the future of connected care.”