• UMMC • The Anniversary of TelEmergency Richard L. Summers, MD; Kristi Henderson, DNP; Kristen C. Isom, RN; Robert L. Galli, MD
ississippi is a national leader in telemedicine/ telehealth, and this year marks the tenth year of using technology to improve health care in our state. The telehealth program has expanded rapidly over the last two years, but it all started in emergency medicine. The TelEmergency Program at the University of Mississippi Medical Center (UMMC) began as a pilot project with three hospitals in October 2003.1 The program was initially started with the assistance of private funding from the Bower Foundation, acquired by Dr. Richard Summers. Conceptualized and organized by Robert L. Galli, MD, and Kristi Henderson, DNP, NP-BC, the program was born from a consensus within the UMMC Department of Emergency Medicine that there was a serious need to improve emergency care in our state. A strategy which uses a telemedicine connection to provide some emergency medicine expertise to these struggling medical communities is one possible solution. Our TelEmergency system operates like an ED on a 24/7 basis with a board certified emergency physician in our telemedicine console room ready to answer all calls. Emergency consultations are available for any patient that arrives to one of our distant-sites as determined by the provider at that location. We encourage engagement with the service for all higher acuity patients but welcome any teleconsult. An example is with acute stroke care and the use of thrombolytics. Most emergency physicians prefer to manage these cases in consultation with a stroke neurologist. Telestroke can be considered a variation of emergency telemedicine in which a stroke specialist is engaged from a remote location to advise about management decisions during an acute presentation.2 We have used facilitated consultations in our TelEmergency system with a number of specialties inAuthor Information: Professor and Chairman, Department of Emergency Medicine, University of Mississippi Medical Center (Dr. Summers); Director, Center for Telehealth, University of Mississippi Medical Center (Henderson); Stroke & STEMI Coordinator, Telemedicine Liaison, Anderson Regional Hospital (Ms. Isom); Professor and Director of TelEmergency, Department of Emergency Medicine, University of Mississippi Medical Center (Dr. Galli). Correspondance: UMMC Center for TeleHealth, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216. www.umc.edu/telehealth, Telephone: 601-815-2020 (firstname.lastname@example.org).
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cluding neurologists, psychiatrists, and obstetricians, to bring the expertise of those specialties to the small community hospital emergency department in a way that was never before possible. Whether you need an emergency infectious disease consultation in remote Rwanda or a stroke neurologist’s advice in the rural Delta of Mississippi, it is now all possible. Telemedicine equipment mounted on a mobile cart allows for two-way audio and visual communication between the patient or distant provider and the physician at our console. The technology allows for a thorough exam remotely to include the ability to auscultate the heart and lungs, examine the inner ear, nose, and skin. Technology can be utilized to complete any portion of the exams as if in-person except for those involving smell and touch. There are also mechanisms in place for the electronic downloading and surveillance of images, laboratory data, and electrocardiograms from the distant site. With this system we have assisted in running codes, delivering babies, and many other forms of acute care management in real time. If necessary, we can easily launch the helicopter from the telemedicine room for quick transports, and in the past we have sent a doctor to the distant site in a time of disaster. We also have some telemedicine sites on oil rigs in the Gulf of Mexico. Preventing the unnecessary transport of patients can save thousands of dollars. The current TelEmergency program now serves nineteen rural hospital emergency departments in Mississippi at multiple geographically distant sites through interactions with nurse practitioners, family medicine physicians, and emergency physicians. Nine more hospitals are slated to join the program over the next six months.3 The vast majority of these small EDs are covered by nurse practitioners who see approximately 2,000 patients per month as a part of the Telemergency Program. To qualify for our program, these nurse practitioners undergo an initial rigorous course of special training beyond their traditional license and then have required ongoing continuing educational requirements to remain in the program. Our 10 year volume of patients served by our program is estimated at 422,000. TelEmergency consultation is requested for 40.5% of the patients seen, and they are evaluated collaboratively by the nurse practitioner and our TelEmergency physician via an audiovisual connection. Audiovisual teleconsultations between the University ED physician and the nurse practitioner at the rural site occur at the rate of about 50 per month.