Administration and Leadership, Equipment & Gear, Mobile Integrated Healthcare, Special Topics

Connect on Scene with MIH-CP Telemedicine Technology

JEMS: Give us the basic overview of GD (formerly General Devices) and your e-Bridge Mobile Telemedicine solution.

GD: As a company, “responsive innovation” defines the culture of who we are and what we do. GD believes in challenging the status quo. We do this by responding to changing needs with innovative solutions that are well-designed and simple to use for the benefit of patients, communities and care providers alike. Our innovative spirit pushes the envelope with nextgeneration solutions and an eye to the future of connected care.

Our business has focused on EMS-hospital communications solutions since 1990, and today we’re in more than 500 hospitals with our CAREpoint workstations handling tens of thousands of EMS calls daily.

e-Bridge emerged from a series of telemedicine projects for homecare that we began in the mid-90s. Our first of many EMS telemedicine presentations was at the Gathering of Eagles conference with Ray Fowler, MD, FACEP, back in 2005. We created the first city-wide deployment in Tucson, Ariz., in 2007, and then Baton Rouge, La., joined two years later.

Although the idea was strong, this pioneering work was just a little ahead of the curve. Fastforward, and today there’s an evident convergence of telemedicine and technology through smaller and more powerful mobile devices, more reliable wireless broadband and video conferencing. This, combined with changes in healthcare emphasizing better quality and more cost-effective care, and the growth of MIH-CP, supports our belief that critical mass for mobile telemedicine has been attained.

e-Bridge Mobile Telemedicine is a responsive innovation app with the power to connect distant care providers that’s HIPAA-secure and easy to use. For example, a prehospital provider can effectively collaborate with a physician in the hospital and beyond. The exchange of text, voice, forms, 12-lead ECGs, pictures, video clips and live video facilitates better communication and collaborative patient consults by adding a new perspective to patient care. e-Bridge allows providers to use their own devices, including Windows, iOS and Android devices, therefore providing organizations with powerful capabilities and no extra hardware to buy.

JEMS: How does this functionality assist with the delivery of EMS and the latest transformation for EMS into MIH-CP?

GD: GD has been a believer in the MIH-CP concept since the late-90s after engaging with innovators like Jack Stout and Kevin McGinnis. MIH-CP adds a positive twist to mobile telemedicine now that real-time collaboration and consultation is both practical and desirable.

The nature of non-emergency care is different. A physician may wish to interact with a patient directly and can via telemedicine. This is exactly what East Baton Rouge EMS has been doing with their Community Integrated Health Program. They use our e-Bridge Mobile Telemedicine software on iPads to securely video conference with their medical director or the CAREpoint workstation at the hospital ED to make decisions to help prevent unnecessary ED transports; their data shows it’s working.

Mobile telemedicine use applications are varied; there’s no one-size-fits-all solution and need drives innovation. For day-to-day EMS, common application uses range from stroke assessment and treatment, determining trauma mechanism of injury, documenting refusals, triage, wound or burn assessment, 12-lead ECG transmission, disaster coordination and more. Simply put, telemedicine enhances clinical decision support.

The key to telemedicine utilization is appropriate use—use that provides real value, not just because it’s a cool gadget. Quality, cost-effective patient care is the primary focus. Telemedicine technology is simply a tool to assist a paramedic, physician or other MIH-CP provider in accomplishing the goal of the right care at the right place. For example: You wouldn’t benefit from having live video capabilities for a stroke assessment if the neurologist or physician weren’t available at that moment in time. Instead, the more appropriate solution would be to have the ability to send a video clip of the medic conducting the stroke assessment and sending it to the hospital while in transport. This will provide the neuro team with insight needed to be best prepared for the patient upon arrival.

Some utilization of telemedicine is purely for medical-legal documentation, such as against medical advice refusals, although live patientphysician interaction may change those dynamics. Similarly, to document a wound, burn, or mechanism of injury in a motor vehicle crash, all EMS needs to do is send a picture securely to help the hospital best prepare for patient arrival.

Real-world technology limitations will also dictate utilization. We’re talking about dataintensive features in the wireless, mobile environment, not hardwired networks between a hospital and clinic. In locations where wireless bandwidth is limited or non-existent, such as in a basement or metal-clad building, a picture clip or data form can still be obtained and sent when the connection permits. In this case, the secure multimedia features of e-Bridge offer significant advantages and solutions.

EMS is a clever bunch, and providers have already begun using e-Bridge as their go-to solution in many unique ways. One EMS service uses e-Bridge to take pictures inside homes to document for child protective services. It’s been used to record a video clip of a patient refusing care against medical advice and to share pictures of an auto accident scene with the trauma team. We’ve also seen sharing of 12-lead ECGs with a voice report attached, adding yet another unique dynamic to information sharing.

JEMS: What’s the long-term vision of GD?

GD: Henry Ford said, “If I had asked people what they wanted, they would have said faster horses.” Like the automobile, mobile telemedicine is a disruptive technology. It’s sparking a change in the way healthcare has traditionally been provided. To EMS, change is slow but not uncommon. Pulse oximetry, 12-lead ECGs and defibrillation, now mainstream, were all once disruptive technologies. To the general public, these seemingly simple telemedicine tasks are intuitively expected in the smartphone age.

As Kevin McGinnis said, “The average 13-yearold has more capability in their hand than we have on the ambulance.” However, consumer apps, such as Skype or FaceTime, aren’t permitted—or appropriate—for HIPAA-legal healthcare, and these consumer applications will put healthcare providers who use them at a risk of hefty fines.

Healthcare is changing and EMS will have to meet new challenges. Forward-looking, innovative organizations will avoid the trap of “We’ve always done it this way” and view mobile telemedicine for what it is: a technological tool that enhances the prehospital healthcare provider’s capability to improve the quality of patient care while reducing costs.

Based on the EMS, MIH-CP and hospital organizations, both big and small, that already use our latest generation of HIPAA-secure mobile telemedicine solutions, our vision is shared. That’s “Responsive Innovation.” As we say, the future of connected care is already in your hands.

Curt Bashford is the president and chief executive officer of GD (formerly General Devices). He can be reached at [email protected].