The doctor will see you now…

from approximately 350 miles away.

I practice a fairly uncommon specialty within general surgery (Burns) in the midst of a vast rural and frontier region (the Intermountain West).  Our patients come from a huge catchment area, one that covers about 1/11 of the land mass of the U.S.  My now-retired practice partner was visionary in his recognition of telemedicine as a potential component of our practice and got our burn center involved with Telemedicine a decade ago.  At that time, we were simply using telemedicine for acute burn consultations in the emergency departments of three different hospitals.  Our initial experience allowed us to show that we could use telemedicine to accurately evaluate patients at remote facilities, something that improved resource utilization and increased appropriate referral and transfer of patients from remote locations.

Fast-foward to now, when I have lost track of the number of facilities that are part of our telemedicine network.  In 2005, the first active year of our teleburn consult practice, we saw 12 patients.  In 2012 we had 321 teleburn patient consults.  In 2013, we broke the 500 visit mark.  We still see patients as emergency consultations, but we’ve added a Wednesday “teleburn clinic” to our schedule every week.  This allows us to continue to see our patients in Idaho, Montana, and Wyoming without the inconvenience of travel for them and their families.

Many potential limitations have been raised about the practice of telemedicine, some of which continue to be slow to resolve.  If a physician or APC is going to have a telemedicine practice, they want to be certain that their technology is HIPPA-compliant (sorry, folks, FaceTime doesn’t make the cut).    While licensing continues to provide a challenge for those of us who practice telemedicine- I now carry licenses in 4 states besides Utah strictly for our telemedicine practices- rules for delegated credentialing in telemedicine established by CMS have made that particular administrative hurdle less.  Arguments have been made that that telemedicine practices aren’t sustainable financially, and our experience indicates that simply isn’t true.  For the last 5 years, cumulative data from our center indicate that physician reimbursement occurs at similar rates for telemedicine and in-person outpatient visits.  There is also a profitability benefit to the originating site system; a sampling of 1/4 of our teleburn visits in 2010-2011 demonstrated that those visits directly resulted in $4.2 million in revenue to our institution.  An important aspect of that profitability is that our hospital absorbs all operating costs of our teleburn practice, including equipment upgrades.

Is telemedicine perfect?  Decidedly no.  I’m a tactile person, and sometimes I want to feel and manipulate an area of scar on a patient and simply can’t do that through our system.  Sometimes there are technology issues that mean I’m not able to “perfectly” visualize someone’s injury or scar.  Because of the nature and location of our practice, however, I simply can’t imagine NOT having telemedicine as a service for our patients and families.  Besides, there are a few patients in Idaho who can honestly say that they have had a middle-of-the-night telemedicine visit with a specialist in Salt Lake who was “assisted” by her cat.

6 thoughts on “The doctor will see you now…

  1. Thank you Dr. Cochran for the tour of your state of the art burn unit. Your burn unit in Salt Lake covers a large geographic area and with that you are faced with unique challenges, but it was obvious to me that you are overcoming these obstacles with the resources you have available. I look forward to your upcoming publications that will continue to help advance burn care around the world. 😉

    Thank you for all that you do and I look forward to seeing you soon.

    All the best!

    Dustin Crumby

  2. Burn telemedicine could have saved my husband a few hours of anxiety and a life flight transport from Moab a few years ago. Instead he got to fly up and get a first-hand experience with the U burn center for a few toes with frost nip! So glad that telemedicine is growing in its application. It is such a valuable resource for rural areas.

    1. I didn’t take care of him, did I? I am always so grateful when telemedicine- either live or with photos- can save a patient a long trip at an inconvenient time.

      1. It was a colleague of yours. And we were SO grateful to have such a wonderful burn center to come to. The on-call doc in Moab was not too familiar with cold injuries, and had a fair number of horrible outcomes he was preparing us for. I’m sure we still would have ended up getting it evaluated at the Burn Center, just on a less frantic time schedule.

  3. Dear Dr. Cochran,
    Your center has traditionally been one of the leaders in Burn Telemedicine and I thank you for allowing us to continue to learn from you!

    1. Thanks, Michael. I think necessity has been the driving force behind our innovation in this area, but it’s been a fun thing to be on the leading edge.