Telemedicine to Bring Subspecialty Care to Rural EDs in West Virginia
Rural emergency departments often lack the medical specialists who staff larger, urban hospitals. Yet rural patients have the same need for prompt care that people in cities do. With a federal grant, West Virginia University will seek to address this challenge by bringing telehealth capabilities to rural emergency departments across West Virginia.
Scott Findley, an assistant professor in the School of Medicine and director of the Rural Emergency Medical Institute, has received a $1.2 million grant from the U.S. Health Resources and Services Administration to help close this rural care gap. “Telemedicine offers the opportunity to provide acute, emergent subspecialty care in rural emergency departments,” said Findley in a statement. “While rural communities can access subspecialty care through outreach clinics and scheduled appointments, this does not solve the problem of the lack of specialty care in the acute setting.”
Over the next four years, Findley will work with Amelia Adcock, M.D., who directs WVU’s Center for Teleneurology and Telestroke, and other team members to establish channels of communication between WVU Medicine’s specialists in Morgantown (population: 30,955) and emergency room physicians in Buckhannon, Gassaway, Ripley and Summersville (with populations that range from 859 to 5,493). The specialists will include neurologists, psychiatrists and case managers.
Linking neurologists with emergency room physicians can be especially beneficial when a patient shows up at the ER with signs of a stroke. Neurologists can quickly evaluate the patient’s symptoms, determine if a stroke has occurred and suggest the best treatment. They can also help to decide whether the patient should be transported to a comprehensive stroke center—which offers endovascular procedures around the clock—or can be cared for effectively where they are.
“By linking rural emergency medicine providers with specialists in real time, we can create care plans to keep emergency department patients in their home communities when able and more efficiently identify and treat patients whose needs require transfer for a higher level of care,” Findley said.
The researchers will partner with Allm USA Inc., a technology company that makes medical communications platforms, to customize an app that makes triaging patients easier. The app also makes it possible for emergency room physicians to share their patients’ medical records—including MRIs and CT scans—with specialists over the phone. Physicians can text or video chat securely without leaving the app.
The researchers will also study incorporating behavioral medicine and substance use disorder treatment into the telehealth services. According to the Centers for Disease Control and Prevention, West Virginia had the seventh-highest prevalence of opioid prescriptions in the United States in 2018. The National Institutes of Health reported that the state leads the nation in opioid-involved overdose deaths per capita. Substance-related overdoses have been rising since the COVID-19 pandemic began, with one study citing a 42 percent increase in May 2020 compared to May 2019.
Also part of the research team is Kari Law, M.D., an associate professor in the Department of Behavioral Medicine and Psychiatry, and medical director of WVU Telepsychiatry, who said the funding allows for the implementation of an innovative healthcare delivery model while minimizing stigma surrounding treatment. Patients should be able to access treatment without driving four hours to do so, she said.
To gauge the telehealth program’s success, the research team will consider several outcomes, such as the frequency of patient transfers between hospitals, the length of hospital stays and the number of times patients are readmitted to the hospital within 30 days of being discharged. They hypothesize that the telehealth program will make hospital transfers less likely, reduce the number of readmissions and shorten hospital stays.
