- The Houston Fire Department is using a telemedicine platform to screen 911 calls before they become unnecessary ER visits.
Called Project Ethan (Emergency TeleHealth And Navigation), the platform links the city’s fire and rescue first-responders with a call center manned by physicians from 8 a.m.-10 p.m. weekdays and 10 a.m.-6 p.m. weekends. When dispatched on a 911 call, an EMT can use a Panasonic G1 tablet to open a video chat with an emergency physician, who can speak to the patient, access medical records and advise whether the patient needs to be transported.
Roughly 80 percent of those 911 calls can be resolved without a costly trip to the hospital.
“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.”
The video consult can do wonders, Gonzalez says. Talking to a doctor can put a patient and family members at ease, enabling the doctor to get a better idea of why the 911 call was made. The doctor can then suggest that the patient visit a nearby clinic – even looking up directions to the nearest clinics, making an appointment and calling a cab if needed – or make an appointment with the patient’s PCP.
Launched in December 2014 after a three-month pilot, Project Ethan has been activated for some 6,300 patient encounters so far. While the exact numbers won’t be released until a case study is published in the Annals of Emergency Medicine, Gonzalez says the service has cut in half the average time spent per 911 encounter, from 16 minutes to 8 minutes.
Roughly 30 percent of the patients end up visiting their PCP instead of the ER, he says, while perhaps 50 percent of the 911 calls that end up as ER transports are done solely because the patient has the final say on where he/she wants to go.
The project has an annual budget of about $1 million, partially offset by grants and a Medicaid waiver. Its ROI, meanwhile, is a tantalizing mixture of clear and complicated.
The city’s 35 hospitals haven’t seen a dramatic reduction in 911 transports to the ER because the sheer number of ERs and stand-alone emergency clinics (around 85) dilutes the impact of the service. But the savings can definitely be traced back to the patient and the payer. A typical emergency transport to a hospital costs $800 to $1,000, says Gonzalez, and the average hospital bill attached to that visit ranges from $1,000 to $1,200. Compare that to a visit to a doctor’s office – maybe $300 – and bus fare or a $20 cab ride.
Consider, also, that the service frees up the city’s 90+ ambulances, 300+ fire vehicles (they’re initially dispatched to 911 calls as well) and 3,000+ paramedics and firefighters from spending extra time and making unnecessary trips to the hospital, especially when they might be needed at a fire, accident or other serious call at the same time. Gonzalez calls that “saved opportunity costs,” and notes that could translate to reduced overtime and stress, less wear and tear on vehicle – perhaps even lives saved or hospitalizations avoided.
Project Ethan is one of the first of its kind in the country, though fire and rescue departments in other cities have been experimenting with mHealth and telemedicine platforms to improve access to healthcare in an emergency. Gonzalez gets six to 10 enquiries a week about the program, and they’re not just limited to the U.S.
“Ethan really was sort of a cautious first step into telemedicine,” says Gonzalez, who wants to someday add remote medical devices and directed examinations to the 911 toolkit. “It was designed as a simple video visit for our lowest acuity patients. … And the response has been overwhelming.”