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GCN : May 2015
24 GCN MAY 2015 • GCN.COM The questions continue, with Margo- lis able to watch Carrington’s face and reactions. Margolis agrees an emergency room visit isn’t necessary. Instead, he schedules an appointment for her at a nearby clinic for the next morning. He also arranges a free, round-trip cab ride. ‘A NOVEL IDEA’ The intervention is known as Proj- ect Ethan, an acronym for Emer- gency TeleHealth and Navigation. It launched at all the city’s firehouses in December 2014. “I think a lot of people are very surprised that they can talk to a doc- tor directly and have been very happy with that,” says Dr. Michael Gonzalez, the program’s director and an assis- tant professor of emergency medicine at Baylor College of Medicine. Gonzalez says the idea is to direct patients such as Carrington to primary care clinics instead of automatically bringing them to the emergency room, where ambulances can be tied up for precious minutes — even an hour — as EMTs do paperwork or wait for a nurse to admit the patient. By diverting some patients to clin- ics, ambulances can stay in the neigh- borhoods, and overloaded emergency rooms can focus on urgent cases. Across the country, emergency medical services can’t keep up with the demand, said Dr. Richard Bradley, chief of the Division of Emergency Medical Services and Disaster Medi- cine at the University of Texas Health Science Center in Houston. “I think that the Ethan approach is really a novel idea and really quite good,” said Bradley, who is not involved in the project. “One of the ad- vantages of having an emergency phy- sician on the other end of the line is you’ve got someone who is best suited to be able to look for subtle indicators of what may be an emergency.” Other cities have experimented with programs to relieve the burden on emergency responders. Some pro- grams analyze 911 data to identify “super-utilizers” and send teams into their homes to arrange needed services such as transportation and follow- up care after hospitalization. Those home-visit programs are often called community paramedicine, especially if they use paramedics to troubleshoot the medical issues. Other cities have sought to divert 911 callers by using hotlines staffed by nurses. Houston tried that approach, but firefighters complained that it took too long, and patients never spoke directly with a nurse. AN ALTERNATIVE TO THE ER Gonzalez says a key component of the telemedicine program is that it doesn’t simply turn patients away from the emergency room. It offers an alterna- tive — a doctor’s appointment that day or the next, and transportation there and back. City health workers also fol- low up with Ethan patients to identify other issues that might be leading them to use 911 inappropriately. The program costs more than $1 million a year, but the city has secured some grants and federal funding to help cover those expenses. And Gon- zalez predicts it will eventually reap far more in savings for the region’s overburdened emergency system. A 2011 study of Houston-area emer- gency rooms revealed that 40 percent of visits were for problems related to primary care. Treating those problems in an emergency room cost, on aver- age, $600 to $1,200 per visit, com- pared to $165 to $262 if the patients had been treated in outpatient clinics. If all those emergency visits could have been diverted to clinics, the savings would have been more than $2 million. Firefighter Alberto Vela recounted the case of one woman who called 911 as many as 40 times a month, often for very simple things, such as getting a prescription refilled. On one of those calls, he tried the video chat with her. “I was so surprised by how long it took. It took maybe six to seven min- utes, tops” to deal with her issue, Vela said. “It was awesome, and then we left the scene and were making more calls after that.” Vela believes the program helped the woman find a regular clinic and transportation because he hasn’t visited her home for months. “I would ask oth- ers shifts, ‘Hey, did you meet this lady?’ The other shifts said they hadn’t heard from her either,” Vela said. “And that’s very rare. So it’s working.” • Carrie Feibel is the health and science reporter for Houston Public Media. This article originally appeared in Kai- ser Health News, a nonprofit national health policy news service. The story is the result of a reporting partnership among NPR, Houston Public Media and Kaiser Health News. MOBILE techstats PROJECT ETHAN IN BRIEF Project Ethan is a Medicaid Section 1115 demonstration project funded by the Centers for Medicare and Medicaid Services. More than 100 Houston fire stations are now using the system, which relies on Panasonic Toughpad tablets and a Verizon commercial network for in-the- field connectivity. An on-duty physician mans a base station — a standard PC desktop, coupled with a Cisco EX90 telepresence system — in the Houston Emergency Center/911 call center. Field personnel and the Ethan physician create a medical record for each visit, and the entire audio/ video encounter is stored as well. The Houston team is still refining its storage-area network solution. — GCN Staff 0515gcn_022-024.indd 24 4/30/15 2:14 PM