Med-RT Clinical Encounters

Many medical facilities, such as rural hospitals and outlying community clinics, are often challenged in meeting the needs of their patients due to a lack of in-house specialist physicians. Conversely, larger urban and teaching hospitals, are overloaded by potentially unnecessary transfers that result from the inability of the original attending physician to access immediately required specialist assistance.

Med-RT Telemedicine Peering™ of Specialists provides an effective solution for improved patient care by:

Enabling high-definition video communication between patient, attending physician and/or nurse, and specialist. The result is the delivery of audiovisual quality, consistent availability, patient and provider acceptance, and accuracy of data transmission to maximize equivalence to an in-person clinical encounter. Benefits include:
- Improved Emergency Department (ED) efficiency as no longer tying up resources (both beds and personnel) while waiting for a psychiatric assessment of a patient involuntarily confined as they are deemed a danger to themselves and/or others [California 5150]
- Improved ED efficiency through support of "fast tracking" in the treatment of lower acuity patients triaged to a separate area designated for the purpose.
- Improved education with the opportunity for referring physician to learn during joint consult
- Improved documentation of encounter (via recording)
- Increased revenue per patient (at rural facilities)
- Increased specialist service revenues through increased patient acquisition and efficiencies of a Telemedicine Service Exchange
- Reduced ED over-crowding as no longer having to accept transported patients requiring a specialist consult
- Reduced ED wait time and patient "left without being seen"
- Reduced travel costs through no longer having to transport patients for a specialist consult
- Reduced need for patients to transport themselves to another facility for a specialist consult
- Reduced patient by-pass at rural facilities
- Reduced cost of specialist consults through efficiencies of a Telemedicine Service Exchange

Patent-pending matching of the patient with the most appropriate specialist using intelligent, dynamic, configurable (policy-based), multi-dimensional mapping. Example dimensions include:

Patient Location (e.g. ED)		Response/Wait Time (e.g 0 mins)
Specialty (e.g. Psychiatric)		Sub-Specialty (e.g Child & Adolescent)
Special Needs (e.g. Deaf)		Gender (e.g. Male)
Language (e.g. Chinese)*		Dialect (e.g.Mandarin)*
Certification (e.g. NIC)*		Additional Skills (e.g. MD)*
Preferred (e.g. Dr. Eric Jones)		Re-Use Last If Available (e.g. Yes)
Cost Limit (e.g. $200 per hour)
		* See Telemedicine Peering: Interpreters

Using our Command and Control Pad available resources are identified, matched, and automatically connected. Configuration can be as simple or as complex as required. At its most basic the user just need select from a predetermined list, for example, "Pediatric Orthopedic Surgeon - Dr. Eric Jones".

Access to multiple resource sources - either your own internal specialists, or from other service providers in our network. In cases where you have your own internal specialists these would normally be utilized first, but when you do not have the appropriate in-house specialist or they are unavailable/busy then you can tap into the other resources available through the Med-RT network. Conversely, you could make your own specialists available to other members of our network on a chargeable basis.

In the following example flow the patient is, for example, also deaf and so an interpreter is required:

		Patient arrives at ER

		Complete any immediate required paperwork		Med-RT routes connection to appropriate interpreter
				Continued interaction with interpreter throughout encounter.
		Triage technician takes vitals and identifies chief complaint.

		Triage nurse assesses acuity, based on facility guidelines, and directs appropriately.

		Billing
		Waiting

		Medical Screen Exam (MSE) performed by physician.

		Patient is treated, with possible advice to come back for follow-up or referral to patient's own physician, and then discharged.
		Specialist consult is required, for example in the case of a pediatric bone break, or psychiatric assessment.		Med-RT routes connection to appropriate specialist

		Patient transferred to other facility via ambulance, etc. where they start the process again with another MSE.		Remote video consult that allows the specialist to lay eyes on the patient most often negates the immediate need for transfer.
		Patient is told they need to visit another facility, and must use a Privately Owned Vehicle (POV).

Once telemedicine capability is deployed within your facility its use can be expanded to support Emergency Medical Response (EMR). In the event of a natural/man-made catastrophe or Mass Casualty Incident (MCI), emergency response teams who are appropriately equipped can triage on-scene, and with the aid of remote physicians, specialists, and/or interpreters, can immediately provide critical care. Not only does it push the care out to the point of immediate need, by eliminating the necessity for some patients to go to the ER it alleviates potential extra load in an already potentially overloaded ER.

For an example of how telemedicine can successfully be utilized for EMR please visit the Loma Linda University Medical Center (LLUMC) - Center for Prehospital Care, Education and Research website. The LLUMC state-of-the-art Mobile Telemedicine Vehicle or MTV for disaster and emergency response was unveiled and put into service April 2006. It continues to be the most innovative vehicle to be used in the field of emergency medicine in the U.S. today.

LLUMC Mobile Telemedicine Vehicle