Telemedicine can be defined as “the remote delivery of health care services and clinical information using telecommunications technology.”1 While telemedicine has been gaining traction in other medical specialties, namely stroke care and psychiatry, several emergency departments have developed tele-emergency medicine programs and several more have been exploring telemedicine options. A systematic review of the tele-emergency medicine literature in 2015 demonstrated three main categories of applied tele-emergency medicine: telemedicine for general emergency medicine care (eg, a rural hospital would use a tele-emergency medicine program for consultations on their patients), direct-to-patient urgent care offerings, and telemedicine for special patient populations (eg, stroke or trauma care).2 While many in emergency medicine are familiar with telemedicine use with stroke care, this article highlights three current tele-emergency medicine offerings in the United States that focus on direct-to-patient care or direct-to-provider consultation.
Direct to Patient
New York-Presbyterian/Weill Cornell Medicine in New York City has implemented the Emergency Department Telehealth Express Care Service, a direct-to-patient care telemedicine offering. This program aims to quickly see emergency department patients who would typically be seen in low-acuity areas, thus reducing wait times for all ED patients. The length of stay for patients treated via the Express Care offering is 35–40 minutes as opposed 2.5 hours in the emergency department. The program is currently offered at two emergency departments, Weill Cornell Medical Center and Lower Manhattan Hospital.
The encounter starts with an in-person triage by an ED nurse, followed by a medical screening examination performed by an ED physician assistant or nurse practitioner. The patient is then brought into an examination room with a telehealth video cart that is linked to an attending ED physician in an office geographically remote from the emergency department. The patient’s visit finishes with a video consultation and discharge by the attending. The Express Care program is staffed by emergency physicians and is available 16 hours per day, seven days a week. These patients are billed as ED visits because they receive a full triage and an in-person medical screening examination. Since July 2016, the program has had more than 2,000 visits. Patient experience-of-care scores have been in the 99th percentile, and the patients’ ages have ranged from 18 to 99 years old, with approximately 20 percent of these visits from patients older than 60.