The Lehigh Valley Health Network began TeleID consultative services in February 2011, with the goal of providing infectious disease services to patients at remote facilities through the use of teleconferencing equipment. The effects of this service on patient outcomes are not yet known as a result of this service being so contemporary. The literature review carried out previous to the start of the project presented extremely limited scholarly information or evidence-based research on Telehealth services for infectious disease. The study is a retrospective cohort study, reviewing the charts of patients from Blue Mountain Health Systems (BMHS), Greater Hazleton Health Alliance (GHHA), and the Lehigh Valley Health Network (LVHN), comparing patients who had a TeleID consultation to those who were transferred prior to the initiation of TeleID. Currently, data is being collected in an IRB approved database while the study awaits IRB approval; therefore, results and analysis of the data have not yet been completed.
Telehealth is a means to provide a consultation when there is a physical separation between the physician and the patient. The consultation can be completed using multiple different venues; including the telephone, store and forward technology and audio/videoconferencing. Store and forward technology uses photos, radiology images and data that are sent electronically to a provider for review. Audio/videoconferencing is a real time interaction between individuals in order to assess a patient and provide feedback in regards to their course of treatment.1-3
Lehigh Valley Health Network (LVHN) TeleID Consultative Program was initiated in February 2011 and since its initiation over 600 consultations have been completed. Prior to this, surrounding hospitals did not have Infectious Disease (ID) resources available on site; and patients needing ID services had to be transferred to LVHN. The TeleID program utilizes live audio/videoconferencing technology to provide consultation to patients at remote facilities. An LVHN ID specialist is able to assess and diagnose patients with the assistance of a nurse at the bedside, operating equipment including an exam camera and an electronic stethoscope, which enables the specialist to recommend treatment options, medications, and ancillary tests for the patient.
The goal of the program is to provide the ability to share specialty healthcare across a broad patient population. The added benefits allow patients to stay in their own community to receive expert care, lessening the cost and burden of travel for the patients and their families. It also decreases the need for patients to be transferred from a small community hospital to the larger, more costly tertiary care facility for specialty care. TeleID can also optimize the provider’s productivity by eliminating the need to travel to see patients.
A literature review was carried out to examine the benefits of Teleconsultation for the care of patients with Infectious Disease diagnoses. Medline was used to look for articles on this subject; the key phrases for the search included: Teleconsultations and Infectious Diseases in the title, from January 2000 through April 2014. There was a paucity of literature available to review in this evolving field. Out of 23 articles found, there is only one article noted looking at the use of Teleconsultation for specific infectious disease conditions seen by deployed physicians with the United States Army. As a result of their study, it is noted “Teleconsultation and telemedicine services have enabled the exchange of medical information between experts at tertiary care centers and deployed healthcare providers, enhancing and facilitating medical care.”1
The proposed study is retrospective, taking advantage of the information and data from a program being provided by Lehigh Valley Health Network (LVHN) to Blue Mountain Health System (BMHS) and Greater Hazleton Health Alliance (GHHA). The goal of the study is to determine if the inter-professional and inter-facility communication and increased collaboration improves patient outcomes. The hypothesis is that there will be a difference in the length of stay, antibiotic usage, and relapse of infection between the patients who had a TeleID consult and those who were transferred prior to the availability of TeleID. Additionally, there will be a difference in LVHN hospital charges between patients transferred before the start of TeleID consultations as compared to those transferred after TeleID consultative services began.
Currently, little is known about which diagnoses and comorbidities benefit most from ID services, and what interventions would allow for local management. The objective is to determine the potential benefits and/or deficiencies of the LVHN TeleID Consultation as a supportive specialty service for remote facilities that do not provide Infectious Diseases Services.
This project is a retrospective cohort study utilizing the electronic medical records of the Greater Hazleton Health Alliance, Blue Mountain Health Systems, and the Lehigh Valley Health Network. Ultimately, data will be collected from 1200 patient charts, 600 patients prior to initiation of TeleID services and 600 after. The exposed patients are those who had TeleID consults while at GHHA or BMHS between February 2011 and February 2014, and the unexposed patients are those who were transferred to LVHN from GHHA or BMHS for infectious disease care prior to the initiation of the TeleID program. In addition to basic information such as age and gender of patient and date and time of consult, the primary variables being investigated are the length of stay, antibiotic usage, incidence of relapse, and the cost of the visit.
Obtaining Study Approval
Upon our arrival in Telehealth Services, the literature review had been conducted and the protocol for this study had been written. A final meeting with the statistician was held to make final corrections to the protocol before submission to the Department of Medicine (DOM). Departmental Scientific Review is the first step in the LVHN Three Step Research Approval Process. Documents required for this step include the research proposal/protocol and data collection sheets. Informed consent and a budget were not needed for this project as a result of it being a retrospective study.
We attended the DOM Review Committee meeting in which our project was being discussed to observe the discussion and learn about the approval process. The committee members made many suggestions as to how the protocol should be clarified before it could be approved and they suggested that we request to create a registered database with the IRB. This enabled us to start collecting data while we continued to move forward with the study approval process.
After meeting with the Infectious disease doctors and statisticians once more, the protocol was refined and resubmitted to the DOM. Shortly thereafter, we received notice that the study was approved and we were sent the Scientific Review Attestation. The second step of the process is the Network of Research Innovation (NORI) Feasibility. This step requires a NORI checklist, conflict of interest disclosure form (COI) for all study personnel, the study protocol, the Scientific Review Attestation, and the Abbreviated Feasibility review form. The committee gives their suggestion as to whether the study is appropriate to carry out at LVHN and Senior Management makes the final decision.
Currently, our documents have been submitted and we are awaiting approval from NORI. The final step will be to obtain IRB approval after completing an online application through the eIRB. This will enable the data from the registered database to be analyzed and conclusions made in regards to our hypotheses.
Progress and Future
After obtaining IRB approval to create a registered database, data collection began with patients at the Greater Hazleton Health Alliance who had a TeleID consult. To date, over 100 charts have been reviewed via Hazleton’s EMR, covering about half of Hazleton’s TeleID consults that have been conducted since the initiation of the program. As the project has not yet received IRB approval, no preliminary analysis of the data could be carried out.
In the upcoming months, data collection will continue in order to obtain data for all patients who have received a TeleID consult at GHHA or BMHS between February 2011 and February 2014. Data will then be collected from an equivalent number of patients who were transferred to Lehigh Valley Health Network for Infectious Disease care before the initiation of the TeleID program. When all necessary data has been collected and IRB approval has been received, statistical analysis will be carried out to test the hypotheses and make conclusions about patient outcomes as a result of the TeleID program.
- Morgan AE, Lappen CM, Fraser SL, Hospenthal DR, Murray CK. Infectious Disease Teleconsultative Support of Deployed Healthcare Providers. Military Medicine 2009 October; 174(10): 1055-1060.
- Lamel S, Chambers CJ, Ratnarathorn M, Armstrong AW. Impact of Live Interactive Teledermatology on Diagnosis, Disease Management, and Clinical Outcomes. Archives of Dermatology 2012 Jan; 148(1): 61-65.
- Jaatinen PT, Forsström L, Loula P. Teleconsultations: who uses them and how? Journal of Telemed icine and Telecare 2002; 8(6): 319-324.
- Sequist TD. Ensuring equal access to specialty care. The New England Journal Of Medicine 2011 Jun 9; 364(23), 2258- 2259.
- Forsblom E, Ruotsalainen E, Ollgren J, Jarvinen A. Telephone Consultation Cannot Replace Bedside Infectious Disease Consultation in the Management of Staphylococcus aureus Bacteremia Clinical Infectious Diseases 2013 Feb 15 (56), 527 – 535.
- Mandell, etal. Principles and Practice of Infectious Diseases. 7th ed. Volume 2. Chapters 132- 177.
Published In/Presented At
Pianucci, K., Hartner, J., Kromer, S.,(2014, July, 25) Improving Patient Outcomes by Using TeleID Consultation Services. Poster presented at LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.
Research Scholars, Research Scholars - Posters