So I'm here at the Johns Hopkins capacity command center in the hospital access line which is affectionately called the how line. And behind me you see all the screens and the folks and I'm going to walk you through and introduce you to the space and how we can use telemedicine in this space. Okay, so in this area we have four distinct pods. And what we've done, what Johns Hopkins medicine has done is they have combined their transport area. So if you have an emergency or a code you would call these beautiful folks and they would send out the purple people they send out the ambos and they send out the helicopters to come get you and the triage care. And so that's coming in across the state. And then up here at the front of the room, we have all of our ORS and procedure areas. Our prep in our pack you so they know who's coming in, who's going out there also facilitating our one way trips which means folks would come to us and then they come over and stay in our ICUs. Or they could be round trip where they're just coming for their procedure. Okay, perhaps have the procedure being attacked you and then go back to their home facility. Over here we have every bed in the hospital and how it turns over and the wonderful wall of analytics that we have really be actually has some embedded logic is always learning. And so we can tell you based on how many folks on staff how many discharges they have coming up, which room is best to put the patient thing. So how can we use telemedicine in this area. >> And Rebecca, a couple of terms that I wanted to clarify for those that might not be as familiar when Rebecca referred to the purple people. That's what they're affectionately called. And the individuals who help with transport based on their purple colored scrubs. And the screens that you saw up were of the heliport at the above the hospital. Right Rebecca? >> And, yep. So there are screens for the heliport, there's also screens for the ambulance base. We can see what's coming and going and then we can also see the code team their hallway so we can see when they're deployed and when they come back. >> Great, and then with some of the screens that you were showing some of the most helpful data can be in the room turnover. And you talked about the pack, you the post anesthesia care unit and being able to track those numbers for the shift coordinators in real time really helps from an operational efficiency standpoint. >> Yeah >> And then you refer to how the Hopkins access line of course and really exciting to see some of the ways in which providers are being able to be brought in to meet with the patient virtually. And to see what's going on and assess things. So yeah, tell us a little bit about what that work is. >> Yeah, so the exciting thing is when you have a group of people like this are so used to working together. Technology is helping them on the back end predict when things will be available. We want to give them an added layer of technology. So when a provider calls the hospital access line and says I would like to speak to a hematologist. I've patient parent fervent that I'd like to start their oncology treatment but I need some advice. Typically what would happen is the that's how operator would then paid b consulting provider, wait for availability, paid back connected to and hang up the phone. But we want to give them is when are requesting provider calls for that human quality control. The health operator opens up a virtual room and sends the link to both providers via their chorus. So in their text messaging in their hand on their smart device, they would get a link, there's a constant requests click here and they would click on that length and that would open up the virtual room and they would be in that virtual space together. Now the beauty of that is that the patients would be right there. There could be some physical examination at the consulting physician wants to look in there both in the electronic medical records but they're both seeing live results and images and really being able to talk about that patient on a very deep level and come to an understanding what is the best treatment plan. Should the patient be transported or can we care for them in place? Right there with their family and community around them and can we provide a level of fan support from a academic medical center to that community hospital so that each patient that's cared for at Hopkin's receives that same exceptional care no matter what hospital they are located in the access for the special counsel. >> Yeah. Right, and Rebecca quick question. So there we were talking about synchronous form of communication and the originating site is going to be the patient with the hematologist who's calling from a separate hospital, perhaps correct? >> The patient with the oncologist? >> Yeah, the patient with the yeah, the hematologist oncologist, exactly. And then you are facilitating this. Can you talk a little bit about how reimbursement has traditionally been a barrier here and then what hot off the presses changing. I know it gets you jazzed. I mean for you this is all right. >> Yeah this is so exciting. So just last week, CMS announced six new codes for inter professional consult provider to provider consult that can be via telephone, think furnace on video. It can be now and these six codes are time based. So it goes anywhere from five minutes to an hour and now it is fully reimbursable. This is huge. So what happens is providers take care of patients to the best of their ability in their specialty and they rely on the specialty of others, right for the professional counsel. And so that was happening. Besides there we call those curbside where you get someone in the hallway and say, hey I have this patient let's talk or are they would send an email, can you review these records, let me know. This is a necessary part of taking care of our patients. And this was unpaid and not only was it not unpaid but it didn't out towards the so physicians typically our assigned effort. So they have to cover 80% of their effort would be clinical let's say. Maybe they have a grant cover the other 20% during research but that 80% clinical time when they see a patient and actually write a report that has RVU value relative values on that and that goes to their effort. Goes to the bottom line covered their salary. And so when a clinical activity such as doing a curbside consult for a professional consult does not have that RVU value, it means while it's necessary to do and we have to do, it cuts into the provider's clinical time because they have to keep up a certain level of clinical activity in order to cover their salaries. So really merging these two and making this a reimbursable activity has huge implications for provider satisfaction enjoy information are. >> Right and with CMS it was the final ruling right for the 2019 fee schedule. >> That's from the start of January 1. >> Yeah that's amazing, those six new codes and the expanded reimbursement for remote patient monitoring the RPM work. That's going to I know there have been people just waiting to come out of the woodwork or that have been setting up shop. >> Yeah, so there's three new codes for remote patient monitoring to set up the equipment to do the education to actually perform the service. There's also two really exciting code. One is called the virtual checking code and this is where a provider and a patient and have a synchronous video visit for the purpose of do I need to go to the ED. Or urgent care or can I stay home or do I need to come see you in your office? So this is a virtual second take. Are you all right? What are the next steps we need to do? This is now reimbursable in the home for medicare patients. This is groundbreaking and really exciting. The second new exciting one is actually a synchronous E visits. And so this is when a patient would send an email to the provider the picture of the rack on it and the provider would look at and say yeah that looks like it was NIV. Pick up this prescription for that this and provide care based on that image and the patient reported symptoms. This happens all the time, providers are in their investment daily taking patient requests in helping patients once again a critical component of medicine and a way to take care of people but not reimbursed. Now that is reimbursed effective January 1st. We're really excited. >> Yeah that's store and forward reimbursement. That's a huge change. >> So when you look at adding telemedicine to a transport areas such as this can really see some increased efficacy that we can find and some efficiencies and also some layers of air for so let's take burn for example. So at John Hopkins Bayview Medical Centers appreciated burn center for the state. And so if you're badly burned this is where you want to go, right, this is where you need to go. And they have a criteria. So one criteria, you have burns over 30% of your body. And so when an area hospital or emergency room falls into this how and says I have a burn patient I want to transfer. They would go through verbally enlist the criteria that the patient would have to meet and they would get confirmation. Yes 30%, yes 2nd and 3rd degree burns. Right and so on. And then when the patient was transported here we would find that perhaps they didn't meet criteria and they didn't need such an acute level of care. Now that bed is being taken up by someone who really doesn't need it and the next burn person who truly needs that bed doesn't have access. So when you add a camera to the transport nurse right, and they call we can actively eyes on the patient. And we can that transport operator would link in the burn attending who would actually examine the patients via video and talk to the remote attending and decide on the best venue of care for that. So it would really allow for that. Therefore with dark stay in their community stay at a lower cost facility, right at his savings to both the payer of the hospital and the patients themselves. And it would allow that high acuity bed to be reserved and open for that next patient that really needs it. >> Yeah, that sounds like an excellent use of the technology but lots of logistics to work through. I mean we can talk about it certainly [LAUGH]. So many [LAUGH]. Yeah, so and that's why you're busy. I know you were on a call before and you have another call to jump on now. So we do appreciate you taking the time to talk to the students Rebecca. >> Thank you so much, this was my pleasure
