Telehealth Applications at a Burn Center Lynn D. Solem, MD, FACS W. Nicholas Sorensen, OTR Nancy Massman, MHHSA, MA Kathleen Schwartz, OTR Jody Rood, RN,

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