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How virtual hospitals may change EMS

As virtual hospitals spring up in care facilities or patients’ homes, EMS will essentially take on the role of out-of-hospital nursing staff

With predictions that one in six doctor visits in the U.S. and Canada will be virtual in 2014, telemedicine has the potential to greatly influence how EMS operates.

Glenn Leland, chief strategy officer at ProTransport-1, a San Francisco-based ambulance transport company, said it also has the potential to offer a foundation for new models of care collaboration and continuity of care between EMS and other health-care providers, hospitals, urgent care centers, and primary care doctors.

Not to mention, telemedicine could save U.S. employers as much as $6 billion every year, and  some predict telemedicine revenues will top $13 billion in the next four years.

We sat down with Leland to see what someone at the forefront of new EMS models thought of telemedicine.

Paramedics as hospital consultants

“Increasingly, the EMS team in the ambulance is connected,” Leland said. “They have a computer. They have a camera. They have the ability to gather information about the patient ─ images and biometric measurements.

"More and more, we’re going to want to make that available in a network-like environment where various providers, who will be involved in the patient’s care, can collaborate in real-time.”

With technology enabling better collaboration, paramedics may have an expanded role in directing patient care as an integral part of a health-care team and a connected health-care system.

“You could think of the paramedic as a consultant with the hospital, helping to decide whether this patient needs to go to the emergency department, directly to surgery, or whether they need to be admitted and to what floor and what hospital,” Leland said.

In some cases, paramedics may initiate the decision to bypass the emergency department altogether in favor of taking the patient to an urgent care center, referring them back to primary care, or scheduling follow-up care through home visits or community paramedicine. In some many places, this is already happening.

In the future, paramedics may also have the option to admit a patient into a virtual hospital by setting up a patient’s bed in the home for on-going telemedicine monitoring and treatment.

How EMS will respond to virtual hospital emergencies

Today, hospitals are defined by physical structures that house patients and health-care professionals who provide medical care. Yet telemedicine, better patient monitoring and data collection systems open the door to caring for some patients in virtual hospitals.

Virtual hospitals are not contained within one physical structure, but instead refer to collections of patients who are being monitored or treated from different physical locations.

“You will still be treating patients in beds, but it might not be a patient in the fourth floor, room 417. It’s no longer traditional hospital bed structure,” Leland said. “It might be a bed in a skilled nursing facility or a bed in the patient’s home. It might be a bed in the back of an ambulance.”

The challenge, of course, is when something goes unexpectedly wrong. Leland sees responding to these emergencies in virtual hospitals as another role for EMS in the future.

“EMS is essentially going to need to have the ability to be that out-of-hospital nursing staff,” he said.

Leland also pointed to how virtual hospitals could also make hospitals visits completely unnecessary for some patients, or shorten hospital stays for others.

“If you go back a few years the average hospital stay was seven or eight days,” he said. “With remote monitoring technology such as wearables, mobile technology, and video conferencing, we could discharge some patients much earlier in their treatment and still care for them at home.”

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