One-of-a-Kind Mobile Medical Unit Using HIE to Improve Care and Reduce Unnecessary Emergency Room Visits

Date: December 11th, 2013Category: CORHIO e-NewsletterTopics: HIE, Hospital Readmissions, Emergency Services

True North Health Navigation providers access CORHIO via iPads to deliver better patient care and reduce costs associated with unnecessary ambulance rides to hospital ERs.

The first mobile emergency medical unit of its kind in Colorado, True North Health Navigation, is now using data from the CORHIO health information exchange (HIE) network to research patient medical histories in route to non-life-threatening 911 calls. When the medical team arrives on-scene, they are better prepared to help patients and offer appropriate medical treatments.

True North responds to lower-acuity 911 calls with a staff of emergency medicine trained practitioners and a special truck equipped with a variety of medical supplies and medications as well as a CLIA-certified lab that can process both blood and urine samples. The practitioners have all the tools they need to diagnose and treat medical conditions that are, in some cases, more complex than what a typical urgent care facility can handle. The True North mobile medical truck currently responds to calls alongside South Metro Fire Authority paramedics.

“Our goal is to affect hospital readmissions and lower the overall cost of medical care. To do so effectively, we felt we needed to reinvent the housecall,” said Dr. Mark Prather, cofounder and CEO. “We’ve designed, in partnership with South Metro Fire Authority, what we believe is the first mobile CLIA-certified lab and vehicle capable of properly treating urgent and semi-emergent medical conditions. We’re capable of advanced treatment such as suturing, splinting, epistaxis treatment and catheter replacement. We carry medications for the treatment of common medical conditions like asthma, allergic reactions, nausea/vomiting and heart failure. In addition, we’ve partnered with Walgreens to provide IV antibiotic therapy.”

Why Mobile Medical Treatment Makes Sense

The National Academies of Emergency Dispatch estimate that about 20% of 911 calls are classified as non life-threatening. Every 911 call does not require a costly ambulance ride to be treated at a hospital. Dr. Prather explains that currently in most communities, “it’s a one-size-fits-all response – the patient has a legitimate concern, so the system gets activated, the ambulance takes them to the emergency department. The cost of that transport is around $1,000 and the average cost is $2,200 for the ER visit.” Now that many patients pay a higher percentage of their medical care costs, it's especially important if they can potentially save hundreds or even thousands of dollars by avoiding an ER visit and receiving treatment from the True North mobile medical team.

Many times, a medical situation calls for some basic labwork and medical intervention that could be done on-site, at the patient’s home or worksite for example. “We recently had a patient at her place of work who developed an allergic reaction and we treated it right there -- placed an IV, administered Benadryl and a steroid, and waited to make sure the reaction was over,” said Prather. “The patient was safely discharged and her cost of care will be a fraction of the traditional 911 response.”

“The other place where our service has obvious application is senior care, such as skilled nursing and assisted living facilities,” said Prather. “Sometimes they can’t get a physician there quickly enough to evaluate a patient or can’t get IV antibiotics expeditiously. So they call for ambulance transport because it’s the safest option they have for the patient.” True North can evaluate the patient and treat him or her on-site at the nursing facility and determine if they can safely be left at the scene to be monitored.

Health Information Exchange Vital for Care Coordination

The True North mobile provider team accesses patients’ clinical data from iPads set up to securely access CORHIO’s Web-based PatientCare 360® application, which helps them head off potential medication interactions and gain valuable insights into patients’ past medical histories. “In the field, we may not be able to get an accurate medical record,” said Prather. “CORHIO solves this issue. Patient problem lists are vital – patients do not typically remember everything about their care.”

“Our goal on the more complex patients is to get some history – it’s hard to walk into a facility, like a skilled nursing facility, blind. With CORHIO, we will be able to access accurate medical history, and that can be very significant and could affect our decision on whether to transport,” said Prather. “Before CORHIO, we were working with unconfirmed data from patients and family members.”

True North eventually wants to go beyond just accessing HIE data and be able to contribute data to the HIE. This will help with care coordination among the patient’s entire care team, including their primary care physician. “We are all headed towards more value-based care -- getting patients to the right care, at the right time, at the right price” said Prather. “Our goal, in every interaction, is to involve the primary care doctor to establish continuity, and in some cases arrange for home health or other services that the patient may require. We don’t want to create another price point in the system, we’re trying to integrate into the system.”