EMHS Telehealth

Improving Access to Healthcare in Maine’s Rural Communities

It is EMHS’ commitment to the people of Maine that all areas of the state receive the same access to high-quality healthcare. However, the shortages of medical staff professionals in rural areas present challenges to appropriately deliver a full range of primary and specialty care services. In a Community Health Needs Assessment of the nine counties that EMHS serves, it was found that throughout central, eastern, and northern Maine, hospitalizations for people with chronic cardiovascular conditions, as well as many other chronic conditions, is atypically high. In an effort to provide rural Maine with the specialty services that are needed, EMHS and its members have looked toward the capabilities of telehealth to bring specialty care close to home to our patients in rural areas. Below is one example of how EMHS is providing telemedicine services to the people of rural Maine through funding provided by the United States Department of Health and Human Service (DHHS) Health Resources and Services Administration’s (HRSA) Office of the Advancement of Technology.

Goal: Improving Rural Maine’s Critical Access to Emergency, Chronic Disease Care, Psychiatry and Diabetes Management through Telemedicine and Telehealth Monitoring.

Network Partners:

EMHS (serves nine counties in Maine); Eastern Maine Medical Center; The Acadia Hospital (Bangor); Eastern Maine HomeCare (Penobscot, Hancock, Aroostook and Washington Counties); Emergency Medical Services; The Aroostook Medical Center (Presque Isle); Inland Hospital (Waterville); Blue Hill Memorial Hospital (Blue Hill); Sebasticook Valley Hospital; Mayo Regional Hospital (Dover Foxcroft); Redington-Fairview (Skowhegan), Penobscot Bay Medical Center (Rockport), C.A. Dean Memorial Hospital (Greenville), Houlton Regional Hospital (Houlton), Mount Desert Island Hospital (Bar Harbor) and Millinocket Regional Hospital (Millinocket)

Medical Purpose:

To provide patient-centered care to rural residents in northern, central & eastern Maine.
- Telehealth technology, linking care between providers from the Clinical Access Hospitals and the Trauma Center, will assist stabilizing and improving patient care, as well as managing healthcare resources more effectively by reducing transfers, emergency department visits and re-hospitalizations;
To improve emergency access to Trauma, Pediatric Critical Care, and Psychiatry specialists.
- Having specilized service available will improve patient’s outcomes
To improve Diabetes Mellitus Care Management
- By incorporating self-management of glucose control and providers data using telehomecare monitoring.

Technology Used:
Tandberg videoconferencing units; Polycom videoconferencing units; Home Monitoring equipment: ATI units and AMD units; Tandberg MPS800 Bridge

Communication:
Full T1 lines, ISDN, IP (internet protocol) to hospitals, Internet, POTS to homes. These components make it possible to connect with our regional health programs and other health programs across the state. We are able to connect outside of our state and country as well using our Tandberg multipoint bridge.

Capacity:
Our hub site at Eastern Maine Medical Center currently has one endpoint in its trauma room and a second one has been ordered for the emergency department. Our Pediatric department has an endpoint in their Pediatric Intensive Care Unit (PICU) and each of our pediatric intensivists has one in their homes. Our 100-bed psychiatric hospital, The Acadia Hospital, has two endpoints and one of the psychiatrists has one in his home. Teletrauma, Tele-PICU and Telepsychiatry services are available 24/7 and provide support to multiple regional hospitals in the state of Maine.

Home monitors are maintained by Eastern Maine HomeCare. Patients with diabetes are referred by the EMMC Diabetes, Endocrine, and Nutrition center and monitored by Eastern Maine HomeCare.

Evaluation:
The project evaluation intends to analyze the impact of telemedicine in the following areas: 1) Adult emergency trauma services, 2) Adult trauma outpatient consultation, 3) Pediatric emergency critical care, and 4) Home health care to improve self-management of diabetes. Each of these project areas will involve an independent research study.

I. Services/Specialties: Adult Emergency Access to Trauma Services

Goal No. 1: To demonstrate that trauma telemedicine improves rural trauma care by reducing the number of unnecessary transfers, the overall mortality rate, complications and the incidence of medical errors.
Goal No. 2: To demonstrate that telemedicine will improve the trauma system efficiency by better assigning the trauma care to the level of the trauma care provider, and facilitating the communication necessary to increase compliance related to trauma triage criteria.
Goal No. 3: To access referring medical provider’s satisfaction after utilizing telemedicine services for emergency trauma and orthopedic consultation.

II. Services/Specialties: Adult trauma outpatient consultation

Goal No.1: To demonstrate the benefit of telemedicine use for outpatients follow up trauma and orthopedic consultation by assessing miles saved, and patient satisfaction.

III. Services/Specialties: Pediatric Emergency Critical Care

Goal No. 1: To demonstrate that telemedicine will optimize utilization of air pediatric transport by better distinguishing between conditions that demand rapid transport and those that can safely transported by ground ambulance.

Goal No. 2: To access referring medical provider’s satisfaction after utilizing telemedicine services for emergency pediatric critical care consultation.

IV. Services/Specialties: Home Healthcare to Improve Self Management of Diabetes

Goal No. 1: To demonstrate that telemedicine monitoring will improve the self-management of the glucose control diabetic patients for those patients with an Hb A1C over 9.
Goal No. 2: To access and compare healthcare utilization between patients receiving telemedicine monitoring, and those receiving same standard of care without telehomecare monitoring.