Telehealth Applications at a Burn Center

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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, BSN, PHN
• Nina Ames, BA
• Regions Hospital
• The Burn Center
• St. Paul, MN

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History

• Originally a Minnesota corrections system
• Corrections contract lost in 98
• Now a parasitic system

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Burn Centers

• 120 in United States
• Serve large geographic areas
• Long term follow-up essential
• 12-24 months

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Long Term Sequelae

• Hypertrophic scarring
• Dryness
• Itch
• Decreased skin durability
• Chemical and petroleum sensitivity
• Susceptibility to sunburn
• Cold and heat intolerance
• Psychosocial issues

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The Burn Center at Regions Hospital

• 18 bed facility
• Established in 1963
• Serves
• Iowa
• Minnesota
• Wisconsin
• Montana
• North Dakota
• South Dakota

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Telemedicine Burn Consults
Dec 1, 1997 thru Oct 4, 2000 - 142 patients ( 3
visits / pt) - 473 visits

• Range
• Age 1 - 92 years
• Burn size 1 - 95

• Mean
• Age 32 years
• Burn size 15

Includes one TENs patient and one frostbite
patient.
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Facility Types

• Hospitals
• Clinic rooms
• Conference rooms
• ER
• Clinics
• Schools
• Technical colleges
• High schools

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Specialist Participation

• 142 patients
• 473 visits
• Physician 464 consults
• Burn therapist 345 consults
• Clinical psychologist 22 consults

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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

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Telemedicine Burn Consults

• Patients 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

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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 _at_
  .325/mile)

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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 _at_
  .325/mile)

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Telemedicine Burn Consults

• Mean round trip savings per patient visit
• Miles 464
• Cost Savings 151

Does not include meals and lodging
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Financial Implications

• Lost charges
• Line charges
• Professional charges
• 210 / patient visit
• Patient travel savings
• 151 / patient visit

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Travel Savings(473 patients)

• Travel (miles) savings 464
• TOTAL 219,472
• Cost savings 151
• TOTAL 71,423

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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

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Lost Burn Center Charges ()

• Per patient charges

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Limitations

• Referring physician awareness
• Difficult to assess scar thickness
• Cannot modify splints or garments

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Limitations

• Reimbursement
• Preparing to bill
• Unknown collection rate
• Will require several months

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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

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Limitations

• Inefficient use of time
• Therapist
• Physician
• Psychologist

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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

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Is Burn Telemedicine Sustainable?

• Requires a 3 pronged approach
• Patient care
• Administration
• Education

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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

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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

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Regions Burn Center St. Paul, MN