Financial, Philosophical Hurdles
Hospitalists like Suman Narumanchi, MD, who leads the HM team at Resurrection Medical Center in Chicago, surmise most patients and their primary-care physicians expect doctors—not a robot or telemed cart—to physically be at the bedside in the hospital. As a result, if something goes wrong, the patient and their primary-care physician might respond with lawsuits. For that reason, “there has to be consistency in telemedicine,” Dr. Narumanchi says. “I just think at this point, it is probably a different level of care based on pure luck, because you don’t know who is going to be working that particular night.”
The concept raises interesting questions, says Eric Samson, DO, HM director for IN Compass Health Inc. in Greensboro, N.C. “Such as that of accountability and ownership of outcomes. On the other hand, it seems enticing to limit the multitude of distractions that occur through nighttime floor calls by implementing a cross-cover specialist fielding floor calls from a more-humane time zone—‘Hey, I’m working night call, but during bankers’ hours.’ ”
photo courtesy of The Night Hospitalist Co.
The Night Hospitalist Co.’s mobile cart costs between $20,000 and $30,000.
Protocols vary from hospital to hospital, and it will be difficult for telehospitalists who cover multiple facilities to learn the differences, says John Nelson, MD, FACP, co-founder and past president of SHM, and principal in Nelson/Flores Associates, a national hospitalist practice management consulting firm in La Quinta, Calif. The job becomes even harder if one or more of the hospitals does not have electronic medical records (EMRs) and instead has to fax patient records to the telehospitalist, he says. Before hospitals invest in this expensive technology, a better solution might be to invent another way to address night coverage, such as allowing nonphysician providers (e.g., nurses) sign off on routine items that now require a doctor’s signature, he says.
Robert Cimasi, president of Health Capital Consultants, a St. Louis-based healthcare financial and economic consulting firm, says telemedicine’s ability to connect patients with distant specialists and allow hospitals to share doctors is tremendous, but agrees the technology is expensive and shouldn’t be entered into without a solid game plan, staff buy-in, and a long-term outlook. Although telemedicine proponents insist EMRs aren’t necessary, Cimasi advises hospitals serious about telemedicine to invest in EMRs, along with electronic order entry for their pharmacies and a secure computer network.
“A lot of hospitals aren’t going to have the capital capacity to do this without government help,” Cimasi explains. “The question is whether the political will is there to have a sustained period of investment.”
Eagle’s remote-robot program is less expensive than hiring a nocturnist or using a locum tenens physician, Dr. Young says. He predicts rural hospitals will benefit the most from his company’s program and other telemedicine services in the market because rural hospitals are most affected by the shortage of inpatient physicians. That might be the case, but if telemedicine is to ever make inroads among hospitalists, it will happen at urban hospitals first because they have the patient populations to support it, Dr. Nelson says.
“At larger hospitals where hospitalists are very busy admitting patients and busy checking patients already admitted, I could see using telemedicine to do the cross-coverage,” he says. “But in a small hospital, that wouldn’t make much sense, because there’s not enough patient volume.” TH
Lisa Ryan is a freelance writer based in New Jersey.