First there was telestroke, which starting in July 2014 connected fellowship-trained neurologists based at UCHealth Metro Denver (University of Colorado Hospital) with emergency department physicians at UCHealth Colorado Springs (Memorial Hospital).
Eighteen months later, UCHealth’s second telehealth program is set to launch on Dec. 8. The Tele-MS program, a pilot that also involves a fellowship-trained neurologist, differs starkly from its predecessor – not only in terms of how it will help patients, but also in its potential to open the telehealth doors to other UCHealth services.
Telestroke is an emergency service – the idea being to speed stroke diagnosis and get clot-busting tPA into a patient’s bloodstream as quickly as possible. Tele-MS is an outpatient service involving a disease that creeps in for years. The goal isn’t instant access to subspecialist expertise. It’s access, period.
Up the road
Augusto Miravalle, MD, a University of Colorado School of Medicine neurologist specializing in multiple sclerosis and related neuro-immunological diseases, is at the center of UCHealth’s new Tele-MS program. While the telehealth system enabling Tele-MS would work across oceans, the Tele-MS “robot” through which Miravalle will see patients will be a five-minute drive from UCHealth’s Anschutz Medical Campus – at North Aurora Family Health Services at Peoria Street and 33rd Avenue. It’s a Metro Community Provider Network (MCPN) clinic, which serves patients in federal Medicare and Medicaid programs as well as the uninsured.
Miravalle already drives over to see MS patients there during a half-day clinic once a month. He’ll keep that schedule, as he has for five years. But he will add a second half-day clinic via Tele-MS. That’s a big deal, said Tom Stewart, PA, an MCPN physician assistant who specializes in MS patients at the Aurora clinic.
“This will effectively double the access that patients have to his expertise,” Stewart said. “Instead of waiting a month, we can get going much more quickly.”
Time is of the essence in MS, too. Often, a diagnosis doesn’t happen for a decade after the onset of symptoms. Access issues are a big part of that, Miravalle said, because the sort of subspecialist expertise it takes to diagnose and treat MS isn’t typically available at federally qualified health care clinics like MCPN.
“Hopefully, we can diagnose it earlier, treat it earlier, and have significantly better outcomes,” Miravalle said.
The extra patient consults Tele-MS enables should also give existing patients more frequent access to Miravalle, said Alexandra Hempel, RN, UCHealth’s Tele-MS liaison with MCPN.
“Our goal is to have our patients see him at least once a year, or more often if their status changes,” Hempel said.
The technology behind the Tele-MS program is straightforward, as health IT goes. Miravalle will connect via laptop using Vidyo telehealth software. At the MCPN office, there’s a cart with a computer, a monitor, a camera, a speaker phone, and a battery big enough to sustain the system for eight hours. The MCPN system will connect with Miravalle’s via standard wi-fi, said David Severenuk, the UCHealth system architect who integrated the off-the-shelf parts that comprise the Tele-MS system. The system costs about $8,000 – probably a quarter of the price of a vendor-built option, Severenuk said.
That doesn’t include a high-end digital ophthalmoscope capable of imaging a patient’s optic nerves, which a grant from the Anschutz Foundation to the Rocky Mountain MS Center at Anschutz Medical Campus paid for, Miravalle said.
But the hardware and software are only the beginning. “The technology is maybe 10 percent of the overall effort when it comes to telehealth,” Miravalle said.
The other 90 percent is people and process, said Kathy Deanda, RN, MSN, UCHealth’s Telehealth program director. The Tele-MS program, in addition to providing MS patients at MCPN better access to Miravalle’s expertise, is a pilot whose lessons will inform future UCHealth telehealth services. Tele-MS will help UCHealth understand telehealth’s impact on physician scheduling and patient preparation, and it will help Deanda and colleagues establish standards for telehealth referrals from primary care physicians and others. They’ll also be tracking patient-reported outcomes from several perspectives (ranging from fatigue to medication use to their ability to work) as well as patient and provider satisfaction, and comparing the Tele-MS results with those of standard office visits.
“We’re going to test it out to see what works and what doesn’t and create some standards and processes that we can then expand to the other subspecialties that are interested,” Deanda said.
Also, unlike telestroke, where the remote neurologist advises an emergency room physician who makes the actual care decisions, Tele-MS involves a direct patient-physician relationship (a relationship that can now commence via telehealth, according to a new policy the Colorado Medical Board set on Aug. 20). That’s a big step for advancing telehealth across Colorado, Deanda said.
It’s been a watershed year for Colorado telehealth policy. Gov. John Hickenlooper on March 20 signed legislation to end state regulations that restricted telehealth delivery to rural counties. The act also forbade insurers from requiring in-person care delivery when telemedicine is a viable alternative. The law goes into effect on Jan. 1, 2017. With the pilot, Miravalle said, “we’ll be ready to roll to larger patient volumes and different sites.”
With Tele-MS, those sites could include other MCPN clinics or ones farther afield. MCPN’s Stewart said he’d like to see the system helping MS patients in rural clinics.
“We’re a test bed for other organizations with similar patient populations,” Stewart said.
Similarly, the Tele-MS pilot is a test bed for other UCHealth subspecialties considering telehealth, Deanda said, including dermatology and rheumatology. Telehealth also shows promise in extending the reach of UCHealth expertise and keeping health care costs in check.
“I think overall it will decrease costs and increase efficiency,” Miravalle said.