View source for IoT for Mitigation - Telemedicine

{{COVID-19

| title             = Telemedicine to Avoid Transport of 9-1-1 Requestors to the Hospital
| team              = Wireless

| leader            = Bill Schrier
<!--bill.schrier@firstnet.go-->
| image             = Cell200.png
| imagecaption      = [[Wireless]]
| municipalities    = 
| chapter           = Internet of Things
| contributors      = Bill Schrier
| website           = 
| download          =  
| description       = 
Many calls to 9-1-1 for medical assistance are not really emergencies which require diagnosis and transport to a hospital emergency room.  Such calls can be handled on a routine basis with trips to see a healthcare provider for a visit.  In most jurisdictions, firefighters and emergency medical services (EMS) agencies respond to calls to 9-1-1 for medical assistance.  (Some jurisdictions contract this to a local hospital or private EMS provider.)  Until recently, EMS and Fire-and-Rescue Agencies would not be reimbursed by the federal Centers for Medicare and Medicaid Services (CMS) for any 9-1-1 call involving a medicare or medicaid patient unless that patient was transported to a hospital. In 2019 CMS, on a pilot program, allowed pilot EMS providers to use telemedicine and receive reimbursement for transport to alternative care locations.  During the COVID crisis of 2020, this pilot program is now extended to any EMS agency using telehealth to contact healthcare professionals for alternative treatment options.  But EMS agencies need to have telehealth capabilities and arrangements with physicians or other healthcare providers to engage and triage patients.

=Challenges=
* The policy of the federal Centers for Medicare and Medicaid Services (CMS) has been to require transport of a medicare or medicaid patient to a hospital or emergency room (ERs) in order for an Emergency Medical Services (EMS) agency or fire-and-rescue agency to receive reimbursement after responding to a 9-1-1 call for medical assistance.  
* This policy resulted in many unnecessary transports, overburdening both EMS providers and hospital ERs.  
* With the COVID crisis, this situation results in unnecessary exposure of EMS medics and emergency room personnel to potential infection.

=Implementation=
* CMS has changed its policy to allow reimbursement for triage of patients via telehealth technology between an EMS provider in the field with the patient and a healthcare professional and subsequent transport to an alternative facility such as a clinic or physician’s office.
* Public safety agencies procure an application which provides the telehealth capability and trains its own emergency medical services personnel and emergency room or other involved healthcare personnel in its use.
* [https://www.iafc.org/blogs/blog/iafc/2020/04/01/new-ems-treatment-options-for-covid-19 Description of the modified policy and implementation]
* [https://www.cms.gov/files/document/covid-final-ifc.pdf Department of Health and Human Services policy document]
* [https://www.ems1.com/ems-products/communications/articles/3-potential-applications-of-ambulance-based-telemedicine-EZgjnrpb7Mmcizmq/ Potential applications of telehealth in EMS]
* The Houston Fire Department (HFD) is a leader in the use of telehealth instead of requiring transport to an ER.  HFD implemented Project ETHAN in 2014.
** [https://www.clintonfoundation.org/sites/default/files/chmi_houston_ethan.pdf Description of Project ETHAN]
** [https://www.jems.com/2019/04/09/tele-ems-improves-productivity-and-reduces-overall-costs/ Journal of Emergency Medical Services 2019 article detailing how Project ETHAN operates with results, costs and data analysis]

=Examples of Telehealth Apps= 
* [https://www.ems1.com/ems-products/communications/articles/pulsara-announces-free-covid-19-management-package-wkmaRAcUBeyFqOZk/ Pulsara - widely used by EMS agencies and hospitals to alert and assemble stroke and cardiac emergency teams]
* [https://www.pulsepoint.org/ Pulsepoint - developed by a fire chief, this app alerts CPR trained individuals (including civilians) to a nearby CPR incident to which they could respond]
* [https://www.mdally.com/how-it-works MDAlly is a relatively new company (2018) for telemedicine]


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