The Growing Role of Telehealth

A CMS Innovation grant is letting Colorado’s Pagosa Springs Medical Center and the Upper San Juan Health Service District expand their current community paramedicine model focusing on heart attack and stroke prevention with remote diagnostics for cardiologist consultations and telemedicine for acute stroke care.

The partners announced the three-year, $1.7 million Health Care Innovation award from the U.S. Department of Health and Human Services (HHS) to the Upper San Juan Health Service District in May 2012, and Pagosa Springs Medical Center CEO Brad Cochennet spoke to EMS World about where they are a year later.

“We’re still in process with solving problems, training paramedics to the critical care level and installing telecardiology,” Cochennet says. He adds that it’s been an important process building relationships among the involved partners.

That overall goal is the creation of a robust telehealth emergency response and care program to improve cardiac and stroke care at Pagosa Springs Medical Center, the centerpiece of the Upper San Juan Health Service District. It’s the only hospital within 60 miles in a medically underserved area of southwestern Colorado, and serves as home to Pagosa Springs EMS.

Last year the health service district received one of the first awards announced by the Center for Medicaid & Medicare Innovation. The Health Care Innovation Challenge was designed by CMS to rapidly enhance programs focused on addressing the “triple aim” goals of improving health, improving healthcare quality, and reducing costs for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) enrollees.

Cochennet explained last May, “We look forward to using the funding to combine innovative technology and quality healthcare professionals to provide state-of-the-art cardiac and stroke care to our rural community.”

At this point, he tells EMS World, “We’re in the process of trying to solve the issues we need to solve to be successful. Over the next two quarters we should be able to solve most of these issues.

“There’s a lot of talk about telehealth, but to put it all together takes developing the relationships, the technology, the bandwith—it’s far more complicated than it appears on the surface.”

Cochennet notes that particular challenges here include being remote and rural. “We didn’t expect it to be easy,” he says. “It takes creativity and willing partners.”

Another challenge is that healthcare officials don’t always know what to ask about various types of technology. “Technology can provide answers to questions you didn’t even know to ask,” Cochennet says.

In addition, over a long course of time planning a solution, technology continues to change and evolve. “It doesn’t make it a very predictable path,” he adds.

Despite the challenges, Pagosa Springs Medical Center continues its aim to expand access to specialists and improve the quality of acute care. The innovative care delivery model includes cardiovascular early detection and wellness programs, implementation of a telemedicine acute-care stroke program, telemedicine and remote diagnostics utilization for cardiologist and stroke consultations, and a training component for the Emergency Medical Services Division (EMS) to manage both urgent-care emergency transports to leading hospitals around the state and in-home, follow-up patient care.

The intent of the program includes giving rural southwest Colorado real-time access to cardiologists and neurologists from the state’s populated Front Range. “This is critical for saving or prolonging lives,” Cochennet says. The new program also aims to train approximately 25 paramedics and telehealth clinicians who will make up a new type of clinical team aimed at improving care outcomes for rural cardiovascular and stroke patients.

The program was designed and estimated last year to reduce healthcare costs by more than $8 million over a three-year period. In southwestern Colorado, Cochennet explains, travel time and expense create a vast burden that isn’t usually factored in healthcare estimates, since it’s often borne by the patient. However, it makes an impact down the line when systems have to factor the cost of helicopter transports, the most common form of medical transport for acute patients.

Overall, the 26 Health Care Innovation awards distributed around the country last year totaled more than $122 million and are expected to save $254 million.

Based on his experience, Cochennet has some advice for other systems looking toward implementing telehealth solutions: “Keep an open mind to learning about technology’s evolution and the issues you’re trying to solve,” he says, “and don’t be fixed on what you think the answer’s going to be.”