The University of Maryland Shore Regional Health System operates in a hub and spoke model, consisting of three rural hospitals and one freestanding emergency department that serves Maryland’s Eastern Shore.  

The Georgia Health Policy Center recently spoke to Anthony Roggio, M.D., director of telehealth for the University of Maryland Medical System, about the system’s participation in the Telehealth Network Grant Program and its plans to unify its tele-emergency department, tele-emergencmedical services, and tele-addiction services and expand its patient-centered emergency care across the rural health care network. 

What has been an early win in your telehealth program?   

In the last few months, we have been working on a big idea to create a single virtual emergency department out of multiple rural emergency departments and allowing them all to work cohesively together to see underserved patients across sites at multiple facilities in rural Eastern Shore.  

Our director of rural emergency departments, Walt Atha, has been instrumental in working with me on this. We are incorporating four emergency departments under the University of Maryland umbrella. With providers working at each of the sites working collaboratively, we can ensure that there will be shorter wait times, shorter door-to-doctor times, lower left without being seen rates, and decreased interfacility transfers, which all provide patients the care that they need as expediently as possible. 

This tele-emergency department initiative is our first tier of telehealth operations under the grant. The second piece is our tele-emergency medical services (EMS) service line. We are actually putting iPads in the hands of our EMS providers and connecting with an audio-video visual link to see patients in real-time instead of using the prior standard, base-station radio communication. This will provide real-time medical direction that is better tailored to the patient and will allow the opportunity to treat patients in place or refer them to a different site for care — whether a clinic, urgent care, or another emergency department with the specialty services a patient needs such as stroke care or cardiology. We hope this will also decrease interfacility transfers and divert patients away from emergency departments when appropriate.  

The final piece is our tele-addiction services, which is led by my co-investigator, Eric Weintraub. It involves getting our addiction specialists, who work primarily at the hub site, into the other satellite sites around rural Eastern Shore to connect with our patients who are opioid-addicted. This can act as a linkage to treatment and hopefully will result in saving lives. 

What is a tip or early learning that you would share with a health system launching a tele-emergency program?  

The biggest advice that I can give is to really get involvement and investment from the system you are working with — show the leaders of your organization how good the telehealth program could be for them, not only for their patients but also for their providers. Of course, it is also really important for the financial backers — to demonstrate how you plan to create sustainability of the program beyond what is being funded. Sustainability is really key to show everyone on the team that a plan is in place to help patients for the long term. 

How do you see participation in the Telehealth Network Grant Program impacting your broader telehealth and health improvement efforts?  

I think this grant serves as a stepping stone. It allows us to bring telehealth to the forefront and show that there is a vast improvement that we can make in health care delivery, specifically tele-emergency and tele-EMS. A lot of what we are creating already has been picked up by the system as an example of what should be done across the broader university community and Maryland. There is potential to build on our momentum and potentially take this statewide. This grant really allowed us to define what works and what doesn’t and collaborate with other institutions to understand how they are doing it and what works for them, and how we can adapt their plans and resources. We all improve our telehealth schemes by sharing in this way.   

How has COVID-19 impacted your plans?  

I think the pandemic allowed telehealth to blossom, and it showed that there was a real need for it that needed to be fostered. There is so much support from government organizations, as well as regulatory changes in the last year, that fast-tracked telehealth. We are now working to make these improvements sustainable and to speed up these efforts so as to make a good impact across the board. It has been kind of a silver lining of this pandemic. I am hopeful that continues and that these improvements that we already created are allowed to flourish. 

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