Reducing Emergency Room queue time using telemedicine

An article in the Wall Street Journal (March 27, 2017) titled “Can Tech Speed up Emergency Room Care?” describes the increased use of remote care by emergency room doctors at New-York Presbyterian/Weill Cornell Medicine.  The Express care program offers emergency room patients the option to be connected to a doctor via teleconference, overseen on site by a nurse or physician’s assistant. The impact is to decreased wait time from 2 to 2.5 hours down to 35 to 40 minutes.  The article claims that around 30% of the emergency room visits involve suture removals, wound checks, rashes, eye pain etc, which are good candidates for telemedicine. In addition, doctors can remotely provide services to many hospitals, thus improving efficiency. If telemedicine can provide efficient, high quality service, should it be made a choice for the customer or chosen for the customer by the hospital ? Since telemedicine decreases costs, should patients be charged lower fees for such service or will the reduced queue time compensate ?

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28 Responses to Reducing Emergency Room queue time using telemedicine

  1. Jennifer Cline says:

    The telemedicine approach looks to be a digital extension of urgent care centers. Personally, I have gone to a local urgent care center many times for myself and my son rather than deal with long lines at the ER (for minor issues). I would be on board with the described telemedicine program as it still includes real time medical personnel with a nurse or P.A. in the room, which is often who you see at an urgent care center as well. I do believe it should be a customer choice, as medical care is personal and everyone has a varying comfort level with the type of care received; in particular those who are less tech savvy may not be comfortable if this option were selected for them. Given the current state of healthcare costs, I would like to think in general that if healthcare costs are reduced, this savings would be passed along to the individuals; however, this is not how firms necessarily work – cost reductions help improve and/or maintain profitability and are not always passed on to the end user of the product. From a pricing perspective, this could be looked at as a strategy of value-based pricing; when a product or service offers a differentiated, high value to the customer, there is often a willingness to pay a premium.

  2. Sean Michael says:

    I would argue that telemedicine, if implemented, should be chosen by the hospital after the initial triage with the patient has been completed (vitals, etc.). Reason being is that patients have varying symptoms and react differently to issues than another patient may. With my experience in healthcare, there are times where simple cases turnout to be more complex after an initial examination and vice versa. Because of that, a patient may not know the severity of their issues. Or their perceived severity may be significantly less that what may actually be going on. Allowing the admissions staff to initially evaluate the patient, they can make the decision to refer them to telemedicine at that point or process the patient for admittance into the ER. Obviously, flow rates and staffing needs would need to be evaluated to fit the new process.

    Decreasing costs to patients I think would be challenging. Mainly because when it comes to healthcare, services are not typically based on time. Services rendered along with a recommended treatment plan doesn’t change regardless of how long they are in the ER. Now if patients get admitted and have hospital stays, then time is definitely a factor. If the telemedicine initiative can somehow enable more precision in diagnosis and treatment plans, then patients should definitely expect to see the reduction of costs. But healthcare in this sense is conventional when it comes to billing. And that is because two patients with the exact same diagnosis won’t render the same costs because one may weigh more requiring larger dosages, etc.

  3. bernardinm says:

    I personally think the same than Sean: it would become in a certain way left to the patient or the on site nurse responsability to give the first correct diagnosis. Unless for minor case (but then what is minor?), not even the nurse should be left to decide what is it exactly that the doctor must do subsequently. From helping friends, that are doctors and nurses doing their statistical exams, we already have diagnosis that are uncorrect because the observed symptoms can be common to multiple diseases. Then the patient may give what he/she thinks be correct but can truly be a distorted picture of the reality. I don’t dispute that for issues not categorized urgent and/or important, where the patient solely wants to get rid of a temporary discomfort. Coming to the pricing, it should be in proportion to the amount of time spent with the patient on one part and then the degree of seriousness of the problem

  4. bernardinm says:

    My comment was very clear, due to computer issues. I only meant to say that physical attention of a doctor is invaluable. Cases, where the degree of seriousness can be downplayed to minor, could be treated this way, assuming that only such cases will arrive in a telemedicine program. Price should be a function of the time spent treating the patient and the degree of difficulty or seriousness of the case.

  5. Maya Devakiamma says:

    The success of a new methodology in healthcare depends on credibility and benefits it offers to customers. Humans value “personal interaction” and their psychology is geared toward consulting with a real person consoles them more than a machine. I believe the choice of telemedicine shall be given to patients, with emergency rooms having the resources and skills to prescreen and guide the patients to make a wise choice. Charging lower fees for telemedicine would be more attractive than shorter wait time and having the prices incentivized proportional to the decreased cost would help.

    Emergency rooms shall have resources to guide and educate patients on their choices, benefits, and ramifications, such as longer wait time, the additional cost to see a doctor and why their situation could be a good fit for a telemedicine service. By establishing credibility, earning patient’s trust, and collecting data to analyze and tune the effectiveness of the new methodology are critical to customer satisfaction and the success of telemedicine service.

  6. Tyler Le Roy says:

    Nearly all industries are adding digital technologies to become more efficient and it comes as no surprise that telemedicine services are now being incorporated inside the ER. There are numerous efficiency benefits with a program like this. A doctor can see many more patients throughout the day, as they are not bouncing from one exam room to the next. Being able to connect to any doctor anywhere also allows for the pooling effect to take place, drastically reducing the waiting time. What I am particularly interested in this service, besides the obvious efficiency improvements, is that it gives you access to specialists around the world, not just in your doctors in your region. This gives you the best medical care!

    I do believe medical choices are very personal and customers should have the choice of using the service or not. I have found technology to work great in the workplace, however, sometimes you just need to meet face-to-face to reach that extra step. The medical industry may use other methods to better incentive this service, besides marketing the “queue” line reduction. I would personally believe that this service should be provided at a discounted rate get more people on board. Any time efficiency improvements are made, reducing the cost of the service, the customer should see these cost reductions in the long run equilibrium.

  7. Michael Morad says:

    As others have said medical care is a personal choice and it should be left up to the patient if they want to wait in a queue for 2-3 hours and be seen by a doctor in-person or do a telemedicine session with a doctor and be treated/supervised by a nurse or physician’s assistant and wait only 30-45 minutes. If a hospital mandates the telemedicine approach some or in fact many people may dislike the mandate and go elsewhere for treatment and that would be bad for everyone. I also agree with Sean in that telemedicine needs to be preceded by an in-person triage process to ensure the situation is not worse than it seems. This is a critical step to maintain the integrity of telemedicine safety and effectiveness.

    The decreased costs of telemedicine should not necessarily mean that a patient pays less for the doctor’s visit unless it is made mandatory to the patient. If it is an option to save time, then I think it is fair that it is billed the same because that is the end goal – to get the same level of treatment, but with a shorter waiting time. This shorter waiting time should be of some value to the patient to justify not decreasing the cost. The other thing to consider is that although the time with the physician is reduced and he/she doesn’t have to be physically present there is a need to have a nurse or assistant supervise the entire case in-person and administer the treatment. This is going to add costs back into the savings so the actual savings may not be so great after all.

  8. Jason Meridew says:

    I believe it should be choice of the individual regarding the use of telemedicine. This choice however should be influenced by reduced cost which can be passed on the users and also the triage system in an ER which may require long wait times for non critical illnesses. The cost savings for telemedicine should be passed on to the consumer for a number of reasons. Those reasons include reduction in overhead (rooms and hospital space), physicians working remotely (larger pool of physician workforce), reduction of bioburden (germs) at hospitals which will reduce infection rates. With my health care insurance, we are already being encouraged to use telemedicine due to the factors listed above. The use of telemedicine is one of the few factors that may help drive down the cost of healthcare which has been increasing consistently every year. We as a country should embrace it.

  9. Nathan Pennington says:

    I think the idea of telemedicine is unique and should be considered dependent upon the severity of the situation. There are already enormous strains on hospital staffing. I worked at Ireland Community Hospital at Fort Knox in charge of our call center and routinely saw both our civilian and military members experiencing bottlenecks in waiting times. We were also routinely running out of medical appointments at 0730 in the morning in our call center. Lowering wait times in hospitals is critical. Telemedicine frees up other medical professionals to get to the most severe cases first allowing other training professionals to handle lesser cases via teleconference.

    As Jason mentioned above there are a lot of positives when it comes to telemedicine. The prevention of the spread of germs along with a larger population fo physicians willing to work remotely will greatly enhance our medical healthcare system. I don’t think medical costs should be as high as they are. It would be nice to believe there was free medical care for everyone but if others are providing a service as critical and highly in demand as medical care they should be compensated as well. It should be the patients decision to either choose between telemedicine or being in front of the Physician in person. I also feel no one should be manipulated into taking vaccinations if they don’t choose too. It should be the individuals choice as much as it should be their choice for telemedicine. Nothing should be forced on anyone especially when it comes to their body and their personal choice of being seen in person or via telemedicine.

  10. Tony Merlie says:

    Under my current medical plan we have the ability to use this option. The service we used is Teledoc (https://www.teladoc.com) and this option is meant to be more cost efficient for our participants. I believe we charge $25 – $50 for a service. At this point, I believe that this would be a good consumer choice item, as opposed to mandated, as the quality of service by teledocs is demonstrated, then think that mandating it would be a good option.

    The blog explains suture removal is an option, which really grosses me out, but for things like rashes, sore throats, etc. I think that this is a great option.

    One of the difficulties is going to be getting individuals to trust speaking to a doctor over the phone. We have had two opportunities to use Teledoc personally, but my spouse has been very reluctant to use the service because she simply doesn’t “trust it”. I believe we wound up paying about 2x what Teledoc would have cost us for the urgent care visit. The cost gap or convenience gap is not quite there yet, but as prices continue to go up for visiting the ER or urgent care, then I see more and more usage of this option.

  11. Brian long says:

    Agreeing with Sean and others I believe that the initial visit would need to be in person, otherwise would it really even be justified as an Emergency? Not to mention what do you think would happen to malpractice lawsuits? With that being said if the teleconference option can provide efficient, high quality service it should be an option given to the customer, after all the patient is a customer and can take their business somewhere else if they are unhappy with how they are being treated. However the hospital should make professional recommendations that would result in a win/win. I think it will be interesting to see how new developing technologies like AI and facial recognition software could define this market and mitigate the need to talk to a person for routine follow-up visits.
    I feel like the market will determine whether or not the price is affected much. As technology evolves who is the say that there would still be a cost reduction? Perhaps new “follow-up clinics” without people are the next thing in convenience.

  12. Paul Mukherjee says:

    World is now getting driven by technology and digitalization. So medical science should not be behind. Telemedicine via teleconference with the doctor is a great idea to efficient use the technology in removing the bottlenecks in the emergency queue. Definitely this technology driven process should be used for the low-level emergencies as mentioned above. I personally seen cases where doctors provide medicines to patients during the off hours through phone. So teleconferencing is one step ahead of these services. For severe cases, I always recommend visiting the emergency in person.
    With the increasing medical prices, it is always recommended to lower down the prices of those treatments done through teleconferencing. This will give a great relief to the common people and increase the efficiency of the hospitals.

    • nehapurohit13 says:

      Currently, I don’t think there is an advanced technology platform to support telemedicine. Though telemedicine adoption has increased from 8.2% to 26.5% for a large practice, there are no nurses, labor cost (except doctor), equipment and infrastructure – make sense to reduce the fees.

  13. Jennie Killian says:

    Being in the healthcare field, I find the idea of telemedicine to be quite daunting and potentially dangerous. I have been educated to believe in the power of a thorough and interactive medical history, a complete physical examination, and well thought-out diagnostics and treatment plan. I don’t feel that this can be accomplished via a conference call or web chat. Although I acknowledge that I am naive to think this kind of care actually occurs on a regular basis in human medical care. Since vet med is not an insurance0driven and overburdened field we are at a greater luxury to treat our patients. From a medical standpoint I also have concern for inappropriate medication selections-especially in the area of antibiotics. I had a friend who was prescribed an antibiotic for a urinary tract infection via telemedicine-no urine sample or culture performed. This casual approach to antibiotic selection could be detrimental in the long run. I agree with above comments that an initial evaluation and history by a medical professional could avoid some of these issues-also a lab available to run necessary tests. Although, ultimately it is invaluable to examine a patient to get a true assessment. Due to the difference in overall care, I feel it should be the decision of the patient.

    In terms of fees-I understand the argument to charge less, but would argue that the fee should be the same. When it comes to medical care in the majority of cases, the work involved is in diagnosing and providing treatment plans. This workload does not change if it is in person or over the computer.

  14. Jennie Killian says:

    And one more thought-as this area emerges as a service, I will be curious to see if there is an increase in adverse reactions to treatment, incorrect diagnosis, etc that will lead to higher overall cost of liability insurance. How high would that increase have to be to cause it to be passed on to the patient? How high for the company to decide it isn’t worth it?

  15. Vinutha Ram says:

    Medicine is as personalized a service as it gets with comfort levels varying for each person and each ailment in the same person. I believe that there should be no mandates when it comes to medicine because even a minor mistake could have serious consequences. If hospitals get to mandate this choice for customers, we may see wide variations depending on whether the hospital wants to maximize profits or lower costs. However, I think that telemedicine is an attractive alternative and should definitely be offered as a choice to the customer. We’ve used technology effectively in almost every other aspect of life, so it is natural to want to use that for medicine too.

    Reducing fees for using telemedicine service could be done during the initial promotion period for the service over just reduced waiting times. Over the long term, I don’t think this is a good idea – the lower costs may lead to an abuse of the system where people push the limits of things that they can consult on using telemedicine without hands-on examination and diagnosis.

  16. Ken Kibler says:

    Telemedicine is a step towards innovation in providing a better solution for emergency room care. Given the technology available, I think it is a great idea to offer options to better serve patients. They are looking for ways to reduce wait times and maximize the efficiency of staff and resources available. With the exploration of this new view it would be imperative to give the patient the choice of treatment methods. Providing patients with a choice of telemedicine or a face to face consultation is something that really should be decided by the patient. Patients need to determine whether a doctor can give an accurate diagnosis over video conference and if their saved time is worth the potential risk of inaccuracy.
    I believe this ushers in a couple of new dynamics. The most important initially is the reduced wait time, which in turn starts to impact customer satisfaction. This could be a groundbreaking change for how people view ER visits. If they start using the service in a more preventive way, it could revolutionize healthcare. Now when talking about fees associated with the telemedicine, hopefully telemedicine will be a means to eventually lower cost in the future. The initial focus needs to be directed towards maintaining the quality of care to the patient and not as a cost saving measure.

  17. nehapurohit13 says:

    Telemedicine works for growing ageing-in-place population. Kaiser in California provides telemedicine, but it didn’t reduce queue time. In telemedicine, the doctors are available after 24 to 48 hours. The waiting period(Lq) starts from the time we have taken an appointment for telemedicine. On the contrary, the queue time has increased from 2.5 hours to 2 days. Currently, there is no advanced technology platform to support telemedicine.
    In future, if we have an efficient, high-quality service than let the hospital decide for the customer for telemedicine. Hospitals would save in overhead, infrastructure, equipment and maintenance cost. The hospital management should charge lower fees for the expected time in the queue. Patients would not get in-person care rather virtual care. Virtual care should be cheaper depending on the regulations.

  18. Allan McNear says:

    Telemedicine is a great alternative for emergency visits and should definitely reduce the queuing time for patients. I am in agreement with Sean in regards to letting the experts make the decisions. An emergency visit should have a professional do the evaluation and then the option to be referred to telemedicine can be an option for the patient.

    In addition, Telemedicine can definitely make an impact in rural areas where there are a shortage of doctors and staffing. In many instances, patients have had to wait days or weeks for a doctor to travel to a remote area. It has been well documented that rural areas struggle to employ young doctors and nurses, primarily based on the locations available and the advantages of raising a young family in a suburban community verses a rural area. Waiting for an appointment can also be costly for the patient. Telemedicine can enable remote consultations that can be much faster. It would be great if the service could prove to be cheaper for the patients and more cost effective for the hospitals. Nothing like a win win for everyone!

  19. Dan Halverstadt says:

    I am not sure this would have as much of an impact on queue time as the article predicts. First, the amount of patients isn’t going to change (arrival rate). Next, the number of doctors (servers) isn’t changed either in this equation. Without a change in either of those numbers the utilization rate would stay the same for the ER. Many of these moves to input technology into a process without addressing the underlying issue end up with the results being the same as before, now with just a complicated and expensive piece of technology added into the process making the cost go up, while not impacting the overall goal. In this scenario, I don’t see much of a change for either doctor or patient. Patients would be required to wait on hold for the availability of a doctor which moved them out of sight in the ER. Doctors would still need to prep for each call and document after each call as well, so the process for them isn’t enhanced.

  20. Andrew Tigulis says:

    I do think Telemedicine should be made a choice for the customer or chosen for the customer by the hospital. Telemedicine aims to meet the needs of today’s healthcare consumers and has the capacity to revolutionize the delivery of healthcare. It supports efforts to significantly improve the quality of healthcare by increasing accessibility and efficiency through reducing the need to travel, providing clinical support, overcoming geographic barriers, offering various types of communication devices, and improving patient outcomes. The use of telemedicine has been shown to allow for better long-term care management and patient satisfaction; it also offers a new means to locate health information and communicate with practitioners, thereby increasing convenience for the patient and reducing the amount of potential travel required for both physician and patient. Some may not like the fact that there is no personal interaction, but they should be given choice. Since telemedicine decreases costs, patients should be charged lower fees for such service.

  21. Amy Phillip says:

    The health care field is always looking for ways to decrease costs and the digital arena is an area of focus. In my industry, we see the marketing aspect try and capitalize on digital pieces instead of physical collateral. Utilizing virtual physicians through Telemedicine is another way that the medical industry is trying to reduce costs and still provide relevant information and services. As with all innovations, I believe that patients and physicians alike should have the option to participate in this type of service model. However, data to support the success of this type of treatment should be analyzed and scrutinized heavily for success. How does a patient know if they have a life threatening illness or injury, even a 30 minute wait time could be too much and the patient has lost precious time by not going directly to the ER for care.

    How the cost burden is reflected in this situation actually seems alot like a branding situation. As a patient, I personally want to see and speak to a human being in a situation where I am seeking medical care. I do not think that we need to turn everything into an online interaction. When it comes to my personal health, I still feel like direct human interaction is imperative to success. I don’t want the “bargain” for the sake of time.

    I want to know that I am receiving quality care, not the sale price of the online resource. I believe patient’s have to be their own advocates in the healthcare space and cost isn’t necessarily a driver for the best care. I would not choose an online option for a diagnosis or treatment plan.

    I want the real deal. The price is worth it to me.

  22. Paresh Sharma says:

    To answer the second question, yes cost benefit have to be passed on along with reduced queue times otherwise customers will not accept such a solution

  23. Paresh Sharma says:

    On the question of effectiveness my friend actually started a telemedicine company. His target customers were people in need of psychological care. Due to social stigmas attached to psychological issues people are reluctant to go to therapists. His platform provided easy access to people and also helped people who were reluctant to go in person however the platform did not succeed to bring in intended returns as customers found the service to lack the personal touch

  24. Paresh Sharma says:

    I believe similar concerns would apply in emergency rooms where people are even more vulnerable and seeking care

    • David says:

      I mirror what a lot of the others have felt, that initial consultations on a new diagnosis should probably involve a health care professional. However, this seems like a good low cost solution for required follow ups, or quick questions about ongoing issues or symptoms. This also helps with elderly patients who cannot drive themselves, as well as families where work hours would otherwise require ER visits after the doctors offices have closed. Which only leads to higher healthcare costs, either out of pocket or through insurance, which then causes premiums to go up for everyone else.

  25. Brett Damisch says:

    Telemedicine should be a choice of the consumer. I do not care for telemedicine. I am offered this option through my health care plan and always opt out of it. I am old school and like to see a doctor in person. Hospitals will not drive telemedicine if customers pay less for the telemedicine. Hospitals need all full paying customers that they may get. I believe that telemedicine may be very beneficial for those who may not be able to afford healthcare or a ride to the hospital for such care. This will help to drive down costs and wait times exponentially in the hospital for non-emergent issues.

  26. Bryan M Corbin says:

    Theoretically implementing telemedicine should improve wait times and service levels for all hospital users, therefore I would allow the choice to be made at the hospital level. As others have indicated, there would need to be a triage process in place to separate ER visits that can be taken care of via a telemedicine service vs those that should truly be taken care of in a hospital emergency room.

    For costs we would have to understand a little more where the benefits are actually realized. It’s likely that they would be buried in layers of insuranance and administrative costs. Additionally, there seems to be an ethical issue of ‘thank you for coming in with your emergency, would you like the cheap care or the more expensive care?’ Standards will need to be established to ensure both service types maintain acceptable yields in results. I’d place the value on the improved service levels and (naively) expect the system to correct pricing over time.

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