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Telehealth: A Snapshot of County Practices

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In an 1879 Lancet article, the author discussed the use of the telephone to reduce the number of unnecessary doctor visits. In the 1950s the use of closed-circuit televisions was envisioned by many as the way that Americans would conduct psychiatric consultations in the not-too-distant future. These examples, among others, highlight that the idea of telehealth is not new one but, as we know today, has yet to meet its fullest potential. Today, telehealth is used in almost every aspect of the healthcare system. From the moment an appointment is booked online, to procedure results being saved digitally and accessible via an app, to physicians sending prescription orders to pharmacies, to appointments and consultations being held remotely, telehealth has changed the landscape and potential reach of health care services and systems integration. While those examples assist providers and patients, NACo asks whether a more systematic approach in the use of telehealth would benefit county schools, county jails, video recorded directly observed therapy (VrDOT), and first responders. Below are highlights of recent efforts that attempt to maximize the benefits of telehealth for county systems and the residents that utilize them.

County Schools

In Coffee County, Ga. telehealth is being used as a cost saving measure in the county’s school district. The program offers a comprehensive Adult & Pediatric Primary Care site located on all Coffee County School campuses. The site provides medical care services to students during the academic day. For example, a Bluetooth stethoscope is used on site to hear heart and lung sounds. The procedures are performed with the help of the school nurse and are analyzed by a remote physician, connected via web camera. The program also offers management and ongoing care of existing medical conditions, monthly medication management/medication maintenance, mental health, substance abuse and family centered case management.

County Jails

In 2007 the Los Angeles County Sheriff’s Department (LASD) Medical Services Bureau implemented a telehealth program that offers cost savings to the county and addresses security concerns associated with moving patients to and from jails. According to LASD Chief David Fender, “Now in full operation with the latest AMD technology, we use telemedicine to deliver healthcare inside the jail walls for 20,000-plus patient consults a year.” The program provides prescription drugs, daily nursing evaluations and treatments to inmates. The program uses technology provided by AMD Global Telemedicine which has been operating in the space of clinical telemedicine since 1991. 

VrDOT

El Pasco County, Colo., Dakota County, Minn. and Coconino County, Ariz. have developed programs that address the challenges associated with treating tuberculosis (TB). The programs utilize a smartphone telemedicine platform to deliver video for directly observed therapy (DOT) to patients who, due to physical or financial constraints or a lack of reliable transportation, are unable to come in for an in-person evaluation. Successful treatment of TB involves 6-12 months of daily medication and, in some cases, must be directly observed by trained nurses in order to lessen the risk of nonadherence and the development of medication resistant TB. In the case of Dakota County, there has been a significant cost savings of $7,000 for the first year of the program. In all three programs patients and nurses have expressed satisfaction and gratitude for this more convenient, less invasive treatment option.

First responders

The Lake-Sumter Emergency Medical Service Agency (LSEMS) implemented a lifesaving telemetry program designed to transmit heart monitor data to attending physicians prior to patient hospital arrival. The goal of the EMS Telemetry Program is to reduce the “door-to-balloon” time once a heart attack victim arrives at the receiving facility. As a result of this program, hospital administrators have reported door-to-balloon times of less than nine minutes, a duration 90% shorter than guideline standards. Additionally, LSEMS provides EMS coverage for Sumter County, Fla. in a cooperative agreement that benefits residents of both counties.

Telehealth is becoming a key strategy for county governments seeking to expand the avenues for their residents in accessing healthcare. In addition to saving lives, telehealth also presents unique cost-saving opportunities for counties. When reviewing your county’s programming, be it in county schools, jails, health or EMS services, consider ways your county can incorporate telehealth. If you would like to share innovative approaches being implemented in your county, please contact us.

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