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Telehealth Applications at a
Burn Center
Telehealth Applications at a
Burn CenterLynn D. Solem, MD, FACS
W. Nicholas Sorensen, OTR
Nancy Massman, MHHSA, MA
Kathleen Schwartz, OTR
Jody Rood, RN, BSN, PHN
Nina Ames, BA
Regions Hospital
The Burn Center
St. Paul, MN
History
Originally a Minnesota corrections system Corrections contract lost in ‘98 Now a parasitic system
~120 in United States Serve large geographic areas Long term follow-up essential
– 12-24 months
Burn Centers
Hypertrophic scarring Dryness Itch Decreased skin durability Chemical and petroleum sensitivity Susceptibility to sunburn Cold and heat intolerance Psychosocial issues
Long Term Sequelae
The Burn Center at Regions Hospital 18 bed facility
Established in 1963
Serves:– Iowa– Minnesota– Wisconsin– Montana– North Dakota– South Dakota
Telemedicine Burn Consults
Range: Age = 1 - 92 years Burn size = 1 - 95%
Dec 1, 1997 thru Oct 4, 2000- 142 patients (~ 3 visits / pt)
- 473 visits
*Includes one TEN’s patient and one frostbite patient.
Mean: Age = 32 years Burn size = 15% *
Hospitals– Clinic rooms– Conference rooms– ER
Clinics Schools
– Technical colleges– High schools
Facility Types
Specialist Participation 142 patients 473 visits
– Physician = 464 consults– Burn therapist = 345 consults– Clinical psychologist = 22 consults
Telemedicine Burn Consults
Burn Areas Assessed- Arms 78 patients- Hands 71 patients- Trunk 67 patients- Lower extremities 55 patients- Neck 39 patients- Head 37 patients- Face 34 patients- Feet 19 patients
Telemedicine Burn ConsultsPatients evaluated by burn surgeon and
burn therapist for:- Healing (open areas)
- Range-of-motion
- Therapy needs
- Home care needs
- Return to work or school
- Scar maturation
Telemedicine Burn Consults
Patients lived 54 to 680 miles from the Burn Center (one-way)
– Mean travel: 536 miles (round)
– Mean round trip cost: $174 (based on IRS @ $.325/mile)
Telemedicine Burn Consults
Patients accessed local Tele-medicine facilities from 1 to 271 miles (one-way)
– Mean travel: 72 miles (round)
– Mean round trip cost: $23 (based on IRS @ $.325/mile)
Telemedicine Burn Consults
Mean round trip savings per patient visit:– Miles = 464– *Cost Savings = $151
*Does not include meals and lodging
Financial Implications Lost charges
– Line charges– Professional charges– $210 / patient visit
Patient travel savings– $151 / patient visit
Travel Savings
(473 patients)Travel (miles) savings 464
TOTAL 219,472Cost savings $151
TOTAL $71,423
Lost Burn Center Charges ($)
Per patient visit ~$210– Line & facility charges $34,668
~$73
– Professional charges $64,674 ~$137
TOTAL $99,342
Per patient charges
Lost Burn Center Charges ($)
Per patient charges
Limitations
Referring physician awareness Difficult to assess scar thickness Cannot modify splints or garments
Reimbursement– Preparing to bill
Unknown collection rate Will require several months
Limitations
End user facilities– Conference rooms, not exam rooms
Confidentiality Privacy
– Technicians Unfamiliar with equipment Occasionally controls left with patient
– Auto-focus cameras– Patient dressings
Limitations
Inefficient use of time– Therapist– Physician– Psychologist
Limitations
Theoretical Advantages of Telemedicine
Improve access to health care Speed referral process Decrease provider isolation Involve local provider in care and follow-up Maintain the viability of rural health care facilities
Is Burn Telemedicine Sustainable?
Requires a 3 pronged approach– Patient care– Administration– Education
Conclusions
Burn follow-up can be successfully completed via telemedicine
Patients and families experience dramatic savings in travel expense
However, telemedicine visits are less time efficient for physician and therapist
And, reimbursement remains an issue Result: telemedicine remains an expensive
technology
Future of Telemedicine in Burns
Expanded follow-up visits– Clinic visits ~ 2,000 annually– Telemedicine visits ~ 200-300 annually
Digital photos / email / phone consult Consults to remote regions Acute consults 7 X 24 service
Regions Burn CenterSt. Paul, MN