Innovations in Emergency Medicine: Emergency Triage, Treatment, and Transport by Amanda Trubey https://padlet.com/amandatrubey/opzqx389gbs40y0l Utilizing telehealth in emergency response services en-us 2022-06-12 23:51:57 UTC 2026-03-02 19:19:57 UTC hello@padlet.com The advancement of telehealth: How can it be used in EMS today? amandatrubey https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2218876088 Telemedicine has been around for decades, but it has become more vital to the medical community during the recent pandemic.   The potential uses of telemedicine extend beyond scheduled appointments with providers. In 2019, CMS announced the development of the ET3 model, intended to increase value and reduce costs associated with emergency ambulance services, and provided the most appropriate care to beneficiaries.  
The ET3 model allows EMS to work with health care providers via telehealth to order and deliver on-site care when appropriate, along with other services.  Utilizing this communication technology, providers can determine if patients require treatment in an ED, can direct EMS to transport to an urgent care or PCP office if more appropriate, or treat at home. This is a new application of telehealth technology that has potential to improve ED efficiency, reduce health care costs, and deliver care to patients when and where they need it most. ]]> 2022-06-13 01:04:12 UTC https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2218876088 CMS announced ET3 initiative February 14, 2019 amandatrubey https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2219640550 CMS announced the ET3 initiative in 2019, and began accepting applications for the new program.  The first performance period for participating services began January 1, 2021 (Centers for Medicare and Medicaid Services, 2021). ]]> 2022-06-13 14:42:08 UTC https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2219640550 Rolling out the ET3 Model amandatrubey https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2219642517 A vital component of the ET3 model allows EMS to partner with providers and deliver healthcare via telemedicine on scene when appropriate.  With this innovative use of current technology, providers can lay eyes and communicate with patients and EMS at the scene, begin the decision making process, ordering care at the moment and potentially reducing transport needs (Fisher Titus, 2020). ]]> 2022-06-13 14:43:33 UTC https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2219642517 Using telehealth in EMS: PROS amandatrubey https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2219672183 Increased patient satisfaction- patients who receive care on site and avoid transport to the ED, therefore avoiding ED wait times, invasive labs/monitoring, and possible admission to the hospital may report increased patient satisfaction. 

Reduction in health care costs- the use of telemedicine on site will result in  saved health care dollars.  CMS payouts for transports may decrease, along with costs associated with ED and inpatient hospital stays (Centers for Medicare and Medicaid Services, 2021). 

Appropriate use of the ED-  by redirecting care with telehealth, EDs may experience an improvement in congestion caused by unnecessary visits (Colombia Southern University, 2019). ]]> 2022-06-13 15:10:22 UTC https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2219672183 Using telehealth in EMS: CONS amandatrubey https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2219696162 Missed diagnoses- even in the ED, the potential for missed diagnoses and unfavorable outcomes exists, but the risk may increase when using telehealth in the field, given the lack of resources (radiology, lab, etc).  The solution for this lies with extensive training and experienced providers. 

Risk of patients bypassing EMS- if the community has a misunderstanding of how ET3 and telehealth in EMS works, there may be an increase of patients choosing to drive directly to the ED in order to avoid being redirected.   In some cases, this may create a danger or delay in care for patients.   This problem could be mitigated by extensive community education.  

Cost of implementation- In order to implement telehealth in EMS, initial outlay of costs would include equipment- iPads or smartphones enabled with software that can protect patient information while allowing for real time transmission of data, training for staff, and the costs associated with partnering with physicians or practitioners who provide the telehealth services.

Reduced income for EMS,  EDs and hospitals- EMS collects a fee for each Medicare and Medicaid patient transported to the ED.   The ET3 model will pay for transporting patients to PCP and urgent cares, and will also pay for telehealth care delivered on site.  However this income stream may not equal previous payouts by CMS.  Additionally, EDs and hospitals may see drop in income due to reduced visits.  Although redirecting some patients to other sources of care is appropriate, this may result in reduced payouts to hospitals from what was previously a guaranteed payor.   ]]> 2022-06-13 15:32:09 UTC https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2219696162 Utilizing telehealth in EMS is a feasible solution to the problem of inappropriate ED visits. amandatrubey https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2219986760 It is imperative that health care resources be utilized fairly, and the ET3 program is an important part of regulating over use of the ED.  By providing care at the scene via telehealth, or diverting traffic to PCP offices or urgent care centers, EMS services can help preserve the use of EDs for true emergencies.  
The 5 year trial of ET3 has potential to make a tremendous impact on the costs associated with inappropriate ED usage. CMS payouts for ED and inpatient stays may decrease, but there is potential for revenue in payment to telehealth providers, as well as  transport to non-emergent destinations.   Furthermore, if the ET3 program is successful, private insurance companies may be incentivized to take part as well.  Hospitals and EMS companies would be well-advised to explore financial opportunities in these areas. ]]> 2022-06-13 21:45:35 UTC https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2219986760 Using Our Strengths Effectively amandatrubey https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2220004538 My own strengths of Intellection, Learner, Input, Achiever, and Strategic allow me to collect and analyze data effectively, using that knowledge to produce ideas that will lead decision making. 
The following members' strengths compliment my own and each others', creating an effective team that can lead our project to fruition. 
The Activator, Andrew- Andrew's strength of turning thought into action will spur the implementation process of any project. 
Chelsea, with the strength of Command, would make an effective leader, directing efforts and guiding decision making.  Each team needs a clear leader, preventing confusion and stagnation. 
The Maximizer- Matthew's job on the team is to direct member's strengths to creating an project that overcomes obstacles and achieves success.  Maximizers promote excellence. 
Rachel, with the strength of Restorative, works as our problem-solver.    During the process, all projects are subject to obstacles, and Rachel's job is identifying the issue and determining a resolution. 
And finally, with the strength of Communication, Carter will work on the team as the person who gets stakeholders on board, disseminating the concept of using telemedicine in EMS to the public, explaining the benefits of appropriate levels of care, cost reduction, and decreased ED congestion. ]]> 2022-06-13 22:22:08 UTC https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2220004538 References amandatrubey https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2220004984 Centers for Medicare and Medicaid Services. (2019, February 14). HHS launches innovative payment model with new treatment and transport options to more appropriately and effectively meet beneficiaries’ emergency needs. Retrieved from CMS.gov.

Centers for Medicare and Medicaid Services. (2021, September 23). Emergency triage, treat, and transport (ET3) model. Retrieved June 9, 2022, from CMS.gov: https://innovation.cms.gov/innovation-models/et3

Colombia Southern University. (2019, January 29). Retrieved June 12, 2022, from Colombia Southern University: The Link: https://columbiasouthern.edu/blog/blog-articles/2019/january/ems-telemedicine/

Fisher Titus. (2020, December 18). Fisher Titus North Central EMS ET3 Program. Retrieved June 12, 2022, from https://www.youtube.com/watch?v=4s78SOkdO5U

 

 

 

]]> 2022-06-13 22:23:11 UTC https://padlet.com/amandatrubey/opzqx389gbs40y0l/wish/2220004984