A telemedicine program operated by the OhioHealth hospital network and Time Warner Cable Business Class has improved health outcomes for thousands of Ohioans while saving the large health system significant amounts of money, particularly in the drastic reduction in the number of hospital transfers. OhioHealth focuses its telemedicine program primarily on stroke victims, but plans are in the works to expand to behavioral health, cardiology, and others.
By Neal Learner, Contributing Writer
Transporting patients by medevac helicopter can save lives when moments count, but it’s not always necessary. Telemedicine allows specialists to provide immediate and effective care for patients in remote locations who may otherwise have required an airlift.
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A telemedicine program operated by the OhioHealth hospital network and Time Warner Cable Business Class has improved health outcomes for thousands of Ohioans while saving the large health system significant amounts of money, particularly in the drastic reduction in the number of hospital transfers. OhioHealth focuses its telemedicine program primarily on stroke victims, but plans are in the works to expand to behavioral health, cardiology, and others.
Paula Meyers, System Director of the OhioHealth Stroke Network, recalls how stroke patients were handled before the program was implemented. “When we started, most patients were transferred to the hub hospitals. And most places tended to call the helicopter because time is crucial,” she says of patients exhibiting stroke symptoms. “Today these smaller hospitals are keeping 75 percent of the patients and transferring only about 25 percent. It varies from hospital to hospital, depending on the size, but as we’ve gone through this over the past five years, they’ve become more comfortable keeping more of those patients.”
Is It A Stroke?
The initial caution was understandable as some of the rural and community hospitals may see only one stroke victim a month. “Stroke symptoms are sometimes vague, and we sometimes see stroke mimics — for example Bell’s palsy — and the doctor might think it’s a stroke, and ![]()
they don’t have the expertise at the hospital to fully evaluate the condition. So they transfer them to the larger city hospital either by ground or air, which are both costly, only to find out they could have been taken care of on an outpatient basis or at their home hospital because it wasn’t a stroke.”
In fact, initial examinations via telemedicine often reveal that the patient is not having a stroke.
OhioHealth hasn’t quantified the savings from telemedicine over the past five years. But Meyers notes that by treating patients in their home hospitals, the system is “saving a ton of money in transportation.” The savings also accrue indirectly to the patients and their families, by not having to travel to the hub hospital and incur costs of transportation and lodging.
But it’s not just the bottom line that benefits. Patients are having better outcomes as well.
“We can treat these patients quicker and maybe reverse some of the effects and deficits of having a neurological emergency,” Meyers explains of the telemedicine approach. “Some of these patients can go straight home; they don’t have to go to rehab or lose work. They’re maintaining their quality of life, their functionality, and they can go back to their jobs and take care of families. That part is hard to quantify in dollar terms.”
System Connects 60 Facilities To Hub Hospital
Columbus-based OhioHealth has had a relationship with Time Warner for 10 years. The system now connects roughly 60 facilities throughout central Ohio with the hub hospital, explains Jim Lowder, System Vice President of Technology at OhioHealth. It features a 100-megabits-per-second private Ethernet that provides high-definition two-way video and audio transmissions. The connections are all land-lines, either buried or aerial, with point-to- point bandwidths that are not shared with other facilities.
Lowder says that when OhioHealth engages with regional or community hospitals, there is an expectation to get the system up and operating as soon as possible. This need for speed led OhioHealth to Time Warner. “We found, compared to many other vendors in the market, Time Warner was able to work much better within the timeframes we had provided. The overall reliability of the network, the uptime, the performance, the low latency … of all of those things led us to Time Warner.”
Even with Time Warner’s track record, however, OhioHealth faced some installation challenges.
“Some of these smaller hospitals didn’t have all of the technical expertise that we’re fortunate to have in the more metropolitan areas, as well as some of the staffing,” Lowder says. “We’ve had to do more handholding than we basically expected to do. But at the same time, it’s the right thing to do and we’re willing to do that, but it was probably more of a challenge.”
Additional challenges came from the state of wireless connectivity within the local facilities themselves, which weren’t as advanced as those in the metropolitan areas. OhioHealth struggled with some organizations early on, helping them get the right VPN connections needed to make this work.
Getting Accustomed To The Technology
Other challenges came from the staff. Meyers acknowledges the technology is still intimidating to a lot of tenured nurses, physicians, and other bedside providers. That was a lesson learned, she said, about the need to make the technology as easy to use as possible while also making the providers feel comfortable with technology.
“Anytime there is an upgrade or change in the technology, we need to make sure education is a key component, not just for the bedside providers but also for the leadership in the organizations,” Meyers explains.
Additional hurdles came from some local providers reluctant to engage with their remote colleagues. “Believe it or not, most of them in the community hospitals didn’t want to bother the neurologist or subspecialist in the metropolitan area,” Meyers says. “There was a handful that said, ‘I don’t need somebody telling me how to take care of my patients.’ But after they saw it function, and that it was more of an advantage for them to have that expertise, they became more comfortable with it.”
The technology is very easy to use, Meyers says. It requires setting up the camera at the bedside and making the connection to the hub. The local ER staff simply inputs the patient’s name and birthdate, and it connects. Once connected, the off site specialist has control of the camera to zoom in and zoom out. This person then relies on the bedside nurse and physician to serve as the hands to get necessary information that can only be acquired in the presence of the patient.
The local ER physicians are experts in everything, yet they can’t be experts in the details of everything, Meyers notes. When a patient comes into the ER, they know the right questions to ask. They work collaboratively with the telemedicine colleague by giving a verbal report of what’s going on, right there in front of the patient and family.
Patients and their families, naturally, are often curious about the technology. Some of the bedside providers have been reluctant to answer some of the families’ questions, Meyers acknowledges. “Patients ask about the technology, and we know there is nothing to be afraid of,” she says. “Most people ask if it is being videotaped or audiotaped as well. They ask technical questions that the bedside staff can’t answer. How does it work? The nurses sometimes don’t want to take the time to answer that, and some are afraid to answer those questions.”
Expansion Plans For The Future
OhioHealth has seen significant benefits from the program in stroke care and is now looking to achieve those successes in other areas. OhioHealth currently has a pilot program underway in cardiology, which asks the same question: “Does the patient need to be transferred to a metropolitan hospital or could he or she be transferred to a midsized hospital closer to his or her community?”
Another pilot project in the works is around behavioral health, which has a shortage of specialists and specialized treatment facilities. The pilot aims to ease caseloads on ER departments. “Some of these patients just need to have their medications readjusted,” Meyers says. “Or they can come into the ER, be seen, and go home.”
In addition, OhioHealth has expanded its telemedicine presence in labor and delivery departments to address high-risk patients who might need an additional eye and assistance to the bedside providers.
Meyers is bullish about the potential of telemedicine to address needs across the spectrum. “I’m hoping to just keep growing; the door is wide open, and I think we can get almost all of the specialties.”
A telemedicine program operated by the OhioHealth hospital network and Time Warner Cable Business Class has improved health outcomes for thousands of Ohioans while saving the large health system significant amounts of money, particularly in the drastic reduction in the number of hospital transfers. OhioHealth focuses its telemedicine program primarily on stroke victims, but plans are in the works to expand to behavioral health, cardiology, and others.
they don’t have the expertise at the hospital to fully evaluate the condition. So they transfer them to the larger city hospital either by ground or air, which are both costly, only to find out they could have been taken care of on an outpatient basis or at their home hospital because it wasn’t a stroke.”
