Telemedicine provides a variety of services for hospitals. These services fall into two categories:
- Hospitalist Coverage. Telemedicine provides hospitalist coverage to help fill staffing gaps, cover nighttime hours and keep daytime physicians from having to take calls during the night.
- Specialty Coverage. Telemedicine can also provide specialized care such as neurology, cardiology and ICU care when a hospital wants to offer specialty care, like nephrology, to its community but doesn’t have the local resources to provide them on its own.
Relieving hospital stress in four key areas
Quality night coverage can be a headache for any hospital. In small facilities, staff physicians might have to rotate working at night or be on call to answer questions from night nurses when patients have problems. It can quickly lead to burnout, especially today when young physicians place a greater premium on work/life balance than their predecessors. Telehealth services can solve the problem.
For example, a 25-bed critical access facility in rural Oregon replaced its nocturnists with onsite nursing staff and Eagle Telemedicine. Collaborating with 24/7 ER physicians, the telenocturnists handle an average of 50 admissions a month. The admission rate remained consistent when the hospital transitioned from onsite nocturnists to telemedicine.
Despite the physician shortage, the supply of nurse practitioners (NPs) and physician assistants (PAs) is growing. Studies show there were about 155,000 practicing NPs in the U.S. in 2010. That number will grow by 57 percent to 244,000 in 2025. The PA supply will grow by about 73 percent during the same period, from 74,000 to 128,000.
Smart hospital leaders are already taking advantage of the more plentiful supply of NPs and PAs. While they still employee hospitalists to lead clinical teams, they are rounding out their staff with NPs and PAs who perform the same functions as physicians; they conduct daily rounds with patients, complete admissions from the Emergency Department (ED), diagnose patients and prescribe treatment and medication. Through telemedicine, a cadre of hospitalists are available by phone, text and two-way video conferencing to advise the local clinical team, suggest approaches to patient care and validate decisions the NPs and PAs make.
Hospitals have tried many approaches over the years to manage surges—those periods such as flu season when ED traffic and admissions spike. A “jeopardy” system that keeps an unscheduled doctor on call to handle periodic ED admissions has its drawbacks. Pay rates for jeopardy doctors are usually higher than average hospitalist compensation. Staff hospitalists often serve as the jeopardy doctor on their days off. Few doctors want to be the “weak link” who calls to interrupt those valuable days of downtime.
Telemedicine services solve the problem for both rural hospitals that have difficulty finding qualified staff and for metropolitan hospitals that are trying to keep staff on an even keel regardless of surges in patient volume.
The same telemedicine teams that provide surge protection also cover cross-cover calls. These providers give relief to night hospitalists who may already be overwhelmed with admissions. With telecross-coverage, telehospitalists can remove the burden of floor calls and consultations from onsite ED nocturnists, and are available to help with ED admissions during peak periods.
As the supply of primary care physicians continues to shrink, so will the supply of specialists. According to an Association of American Medical College’s study, specialties like emergency medicine, anesthesiology, radiology, neurology, and psychiatry, among others—will face a shortage of between 18,600 and 31,800 physicians by 2030.
Specialty services can help a hospital:
- Respond to changing healthcare needs in its community
- Offer new services to patients
- Avoid having to transfer patients to larger hospitals in metropolitan areas to get the necessary care.
Specialists might be on call with a local hospital, but without backup for nights, weekends, holidays, or vacations. Telemedicine services help fill the gaps. Telespecialists share coverage with local providers—individuals and small practices alike—to help ease the demands on them. A community hospital might have a local cardiologist on call 15 days a month. For the remainder of the month, a telecardiology team provides coverage for the hospital.
Specialty telehealth services
- Teleneurology: Rapid diagnosis of patients with symptoms of stroke or other acute neurological emergency
- Telecardiology: Diagnosis and treatment of heart disease, including the transmission of clinical data and electrocardiograms
- Telepsychiatry: Behavioral health assessment and care, which the APA recognizes as a valued component of a mental health delivery
- Tele-ICU: Remote treatment by a critical care team of intensivists in an effort to reduce a patient’s length of stay
- Tele-ID: Diagnosis and treatment of infectious diseases, manage infections and monitor administration of antibiotics
- Telenephrology: Patients needing virtual consults, inpatient dialysis, and follow-up visits
- Telepulmonology: Patients with obstructive pulmonary diseases, in which remote pulmonology specialists review spirograms and other relevant clinical information to provide accurate diagnoses and treatment
- Teleoncology: Hematology and oncology consultations, genetic counseling, palliative care and cancer treatment reviews