Overcoming Telemed Challenges for Occupational Health

telemedicine workers compTelemedicine has great value when used appropriately, and its promises are attractive: immediate access and convenience (anywhere, anytime!), early intervention, lower cost than other models, and quality services.

 

However, telemedicine has potential pitfalls. At Medcor, we’ve devoted considerable time and talent to assessing these pitfalls and navigating our way to a telemed solution for occupational health that works.

 

 

Reality of Telemedicine Today

 

An honest look at the telemedicine landscape today shows us that telemedicine adoption in occupational health is slower than the hype may lead us to believe. For example, contrary to some expectations, many tech-savvy Millennials prefer an in-person provider visit rather than a virtual one for their healthcare.

 

Also, just like other medical delivery models, telemedicine can be subject to misuse as well as inconsistent results and service levels. There isn’t yet enough published data to quantify results and quality. Overprescribing, unnecessary treatments, delayed return to work, conflict around OSHA recordables, causation, denied claims, creeping catastrophic claims, opioid addiction, and litigation are problems that do not go away just because the provider is accessed by video instead of in person!

 

 

Challenges for Occupational Health and Telemedicine

 

Recognizing the challenges is key to overcoming them.

 

Technology. Using telemedicine to treat work-related injuries can present layers of technological complications at the workplace. Internet access is needed, which means that appropriate bandwidth must be available, firewalls have been anticipated and won’t be a hindrance, and patients can access the facility’s wifi. Hardware for the virtual visit is also a consideration: Can patients use their own personal smartphones, or do they need access to an employer desk­ top? Tech support is another challenge: Who will help patients troubleshoot any difficulties?

 

In terms of technology, there are also challenges of system infrastructure: Do virtual visits need to be scheduled? Does the system rely on callbacks? How are medical records, reports, billing, data security, and patient privacy handled?

 

Scope. First aid cases don’t need a provider, either in person or through tele­ medicine. Life threats and emergencies require in-person care without delay. Furthermore, telemedicine cannot meet clinical needs when hands-on assessments and treatments are required, such as imaging, labs, palpations, sutures, splints, irrigation of eyes, etc.

 

Yet many cases are appropriate for telemedicine – identifying which of these cases are eligible for care through telemedicine is another challenge.

 

Coverage. To offer promised convenience and access, a telemedicine system must have many providers avail­ able to respond to calls. In small-scale systems, a few in-house or select providers handle the coverage – but they may be spread thin and have other duties and patients. Wait times increase and service is limited after hours (e.g., nights and weekends). When alternate coverage is used, results are inconsistent. In large-scale programs, multiple providers are needed across multiple states. Multi-licensed providers are the go-to solution, but when one of those providers is in a session with a patient (or not on duty), patients in multiple states are affected.

 

Coverage challenges also include having providers who understand the ins and outs of occupational health and work-related injuries as well as having providers who are skilled at conducting virtual patient encounters.

 

User Experience. Users are affected by the challenge of technology, scope, and coverage. They also often have unrealistic expectations. User proficiencies differ, too, as do their education level, technical experience, age, personality, and willingness to try. Moreover, people who are using telemedicine are patients – they are either sick or injured. These are moments when people are not at their best. The stress they may feel from their health concern can influence their experience of telemedicine. The most common technical support issue in telemedicine is caused by people who, in the stress of the moment, have forgotten the password on their smart­ phones and therefore can’t access the telemedicine system.

 

User experience can also be influenced by how users feel throughout the process. Patients can feel alone or even overwhelmed at different stages. The level of assistance users need varies just as their proficiencies and expectations vary.

 

 

Solutions Moving Forward

 

For telemedicine to deliver beneficial outcomes for employers and patients, we’ve found an accurate assessment needs to be made first regarding the needs of the organization and its potential telemedicine users. This enables selecting the right system and setting expectations realistically and honestly, knowing that telemedicine is not a magic solution for all work-related injuries. Telemedicine will yield the best outcomes only when its use is clinically appropriate for the health concern in question. The use of telemedicine, therefore, needs to include a system to determine appropriateness on a case­ by-case basis.

 

We’re working to ensure our telemedicine adopts the best practices that have been established in our other lines of business, namely evidence-based medicine, and attentive customer service so that telemedicine is an all-around successful endeavor. By emphasizing clinical outcomes and user experience telemedicine challenges can be surmounted.

 

 

 

Curtis Smith MedcorAuthor Curtis H. Smith, Executive Vice President, joined Medcor in 1995. He helped develop Medcor’s injury triage system and holds several US and foreign patents on injury assessments methods.  Smith has taught and practiced in EMS as paramedic and dispatcher.  He currently supports Medcor’s business development and marketing teams. http://medcor.com. Contact: csmith@medcor.com

San Diego Zoo and Medcor Set Up Telemedicine Program for Employees in Amazon

 
Johan Perez checks depth with bamboo pole in shallow part of the muddy Elto Madre river. On board in the red 55 gallon drum, is fuel — one of two such drums on the riverboat traveling roughly 20 hours each way to reach the research station at Cocha Chashu. Between the two boats on this mission, the Medcor team carries a spare outboard engine and 4 props. On this trip, both boats had had to replace propellers damaged by submerged logs and shifting shallow bottoms. Every few hours, they must stop to clean silt from the engine intake. And, in some places, when the current is too strong to manually push the boat, the team is forced to backtrack to find a deeper channel.
 
 
When the San Diego Zoological Society was chosen by the Peruvian government to manage its research station in the Amazon jungle — the trackless Manu National Park — it had the responsibility of providing emergency medical care to its staff.
 
 
The hazards: poisonous snakes and crocodiles, malaria and yellow fever, parasites and fungus, as well as normal strains, sprains and lacerations.(WCxKit)
 
 
Helicopter evacuation? Forget it. The dense jungle canopy, long distance and bad weather in the rainy season make it next to impossible – even if the nearest helicopters weren’t on the other side of a mountain range.
 
 
So, the zoological society hired Medcor, an on-site medical firm based in Illinois, to help establish a wilderness medical program to manage a research station in the jungle, at Cocha Chashu in the Amazon jungle of Peru. The zoo contracted with the Peruvian government to help manage the site. Since the zoo has worked with Medcor for years in San Diego, they already had experience working together and had proved the effectiveness of this kind of risk management in other projects.
 
 
June 8, Medcor founder and CEO, Philip Seeger, and EVP Curtis Smith traveled to the jungle with the zoo’s risk manager, David Matthias, to conduct a first-hand assessment of all the travel and evacuation logistics. Medcor needed to assess the medical needs and response options for people at the station that is so remote it requires four days travel from the United States each way, the last two by small boats, 10 hours a day.
 
 
This means the 20-year-old Cocha Chashu station, according to Medcor executive vice president, Curtis Smith, is two days to the nearest town. So telemedicine is essential, particularly when the science group is too small for an onsite medical professional. Research groups vary from two people up to 30, staying from days to months.
 
 
While navigating the rivers, they test two different satellite systems to connect to Medcor’s existing triage call center. Medcor’s telemedicine service is already used by over 80,000 worksites (and many mobile workers) in the US and is available 24/7. Connecting from the jungle involves data, audio and video links – all of it battery and solar powered.
 
 
Shortly after arriving at the station, the Medcor team had opportunity to use their triage service on a real patient. The first on-site injury? An insect bite (presumed to be a spider) that was becoming inflamed. Treatment was given immediately and the patient recovered without complication, Smith said.
 
 
Medcor is also working with locals who provided travel and support services for the station. The project includes stocking the station with essential medical supplies; protecting them from insects, heat and humidity is key to having them available when needed. Supplies in place could be used by researchers being directed by Medcor clinicians remotely, or used by Medcor staff who travel on-site to support large groups.
 
 
Wilderness medicine is not new for the company, which supports a clinic at the base camp of Mount Everest, provides on-site medical services at Yellowstone National Park, and has ranged far afield with services on Pacific islands, as well as remote areas in the US. “Of course wilderness medicine is specialized,” says CEO Philip Seeger, “but there are many similarities to our core on-site services in the US, too, Most of the injuries we deal with are still sprains and strains, and we have to train and support our staff, get reports to our clients on time, and stay in compliance with HIPAA and other regulations. Delivering our services remotely forces us to become more efficient overall – many of those improvements also benefit our patients and clients using our services here is the US.”
 

Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
 
 
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Medcor Jungle Team Cuts Down WC Costs at Peruvian Science Station by Providing On-site Remote Care

The Medcor team of (from left) Dave Matthias, risk manager for the Zoological Society of San Diego, Curtis Smith, executive vice president of Medcor, and Phillip Seeger, Medcor founder and CEO, readies for two 10-hour days of river travel to their destination in the Peruvian rainforest where they will medically support a team of research scientists.

 
It is one thing when an employee slips and sprains an ankle – but what would your company do if that employee was in the deepest part of the Amazon basin – you know, with, like, SNAKES!?
 
 
The answer is your company probably has no idea what to do – that is why smart businesses are hiring third party medical teams to manage remote location projects.
 
 
One such smart company is the Zoological Society of San Diego. It hired Medcor, an on-site medical firm, to establish a wilderness medical program to manage a research station at Cocha Cashu in the Peruvian Amazon jungle. Zoo officials asked Medcor to help assess medical needs and response options for a team of scientist and support staff at the station as it is very remote, requiring four days travel from the U.S., the last two being by small boats 10 hours a day.
 
 
According to Medcor executive vice president, Curtis Smith, the Cocha Cashu research station has been operating for about 20 years and the zoo just recently contracted with the Peruvian government to help manage it. For this Amazon project, research groups may vary from two to 30 people, staying from days to months. Hazards include a wide variety of snakes and insects, wild animals, and a risk of malaria, yellow fever, and other diseases, on top of many types of parasites and fungus — all this, along with temperature extremes and the usual work-site hazards of strains and sprains, slips and falls, and so on. Access to the park is restricted to only authorized researchers and a few indigenous people who live there without contact with the outside world.
 
 
The research station fits into the zoo’s broader mission of protecting and researching animals and plants, Smith says. The zoological society has a long history of conducting research in a wide variety of animal and plant topics, including preservation of endangered species, environmental sustainability, and wildlife education. The zoological society has conducted research throughout the world, including projects such as working with utility companies to minimize wind farms impact on migrating birds. The station at Cocha Cashu in Peru is so remote and untouched that is provides rare research opportunities, including baselines and comparisons for studies elsewhere.
 
 
Now that the zoo is assuming responsibilities for managing the station, they want to understand the risks to the participants — zoo employees or visitors — and provide for the safety of everyone there. These goals include bringing medical services to the program.
 
 
The service is based on extending Medcor’s existing telemedicine/triage services into the Manu National Park, which covers nearly 20,000 square kilometers of jungle. Medcor's triage service is already used in more than 80,000 worksites in the US, meaning Medcor is responsible for the health of workers at 80,000 locations. Additionally, Medcor provides on-site medical care at more than 170 factories, distribution centers, studios, farms, and mobile or temporary sites.
 
 
Founded in 1984 by CEO, Philip Seeger and COO Ben Petersen, the company operates with the belief that all employers want to control costs, improve outcomes, provide rapid response when it is really necessary and avoid claims when they are not necessary – and this means planning ahead even when the worksite is far from the typical office.
 
 
Privately held with 400 full-time and 400 part-time employees, Medcor does $54 million in business per year. The company boasts seasonality and flex work to meet changing client needs – for example, the retail distribution industry during the holiday season.
 
 
Through the use of telemedicine, Medcor reaches note just remote locations, but also employees working in worksites to small to support an on-site clinic, working on third shift when there are fewer clinics available, and even mobile workers. Telemedicine delivered through well-tested simple phone connections (or more complex satellite hookups) can be more practical and cost effective in many situations than providing on-site medical staff. In all cases, understanding the injury or illness and making a good decision about on-site treatment or the possibility of off-site treatment and evacuation is critical to ensuring good clinical outcomes and to avoiding unnecessary costs and claims.
 
 
To begin Medcor’s involvement with this project, Smith left for Peru with the zoo’s risk manager, David Matthias, to conduct a first-hand assessment of all the travel and evacuation logistics. They surveyed the site and tested two different satellite systems. Medcor also works with local personnel who have provided travel and support to the station in the past.
 
 
Smith says, “I’d call it more of a ‘business expedition’ than a ‘business trip.' We are bringing with us everything we need to live in the Amazon jungle for four to six days, including our tents, food, water purification systems — and our laptops!”
 
 
Matthias, a former Marine and law enforcement officer, says, as risk manager, he assesses all kinds of risks including health, safety, financial, legal, and helps create policies and protocols to address and mitigate the risks. He also helps place liability coverage/insurance for these projects and notes that safety and prevention are key components — as is working with specialized partners, such as Medcor, to address medical support.
 
 
Matthias made the trip to Cocha Cashu to understand firsthand the logistics of getting researchers, staff, students and supplies into the station. The station operates with very low environmental impact, with staff living in tents and relying on solar power. He also met local rangers from the Peruvian national park where the station is located and interviewed researchers who worked in the area before.
 
 
Medcor provides at least six support options for the station:
1.    Medical training for local staff and rangers.
2.    Stocking the station with essential medical supplies and equipment.
3.    Preventative measures, such as physical exams, fitness criteria and vaccinations prior to travel.
4.    Providing medical support for the station, based on extending Medcor’s existing telemedicine and triage services into the site via satellite phone, video and data links. (This is critical because the dense jungle canopy, distance, bad weather and lack of aircraft sources make helicopter evacuations nearly impossible.)
5.    Documentation and reporting with Medcor’s proprietary electronic medical record system, which is encrypted and HIPAA compliant.
6.    Sending qualified medical staff to work on-site supporting researchers at the station.
 
This is the first of several glimpses Medcor and the Zoological Society of San Diego we be sharing with our readers.

Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
 
 
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

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