Telespecialty consults: Connecting patients and their PCPs to specialists

December 16, 2019  //  FOUND IN: Updates & Resources

There are times when a patient receives health care from a provider outside of Michigan Medicine, but the treating physician is in need of an expert consult.

Take for example the story of Sarah Phelps, a registered nurse at MidMichigan Medical Center, one of Michigan Medicine’s strategic partners in Midland. Sarah woke up with a headache she couldn’t shake and said the pain grew worse as she sat down for an early afternoon work meeting. As she got up from the meeting, weakness on her left side made it difficult to walk, and a coworker saw the symptoms and realized a trip to the emergency room (ER) was necessary — Sarah was having a stroke.

The care team in MidMichigan’s ER performed a CT scan on Sarah and consulted with Michigan Medicine neurologists via a high-definition video camera, enabling an up-close view of her, as well as real-time communication between physicians. This virtual consultation became especially critical when the CT scan revealed that Sarah had suffered a stroke as a result of a vertebral artery dissection, which only accounts for 10 to 25 percent of strokes in patients 45 or younger. 

Sarah’s case shows how valuable Telespecialty consults can be. A Michigan Medicine stroke specialist was able to provide critical advice to the MidMichigan physician utilizing Virtual Care, and it made all the difference in Sarah’s outcome.

“Michigan Medicine’s telespecialty consults provide the very best in specialty care for patients and families within our affiliate and strategic partner clinics and hospitals,” said Lori Day, M.D., assistant professor of obstetrics and gynecology. “They afford these patients the opportunity to obtain expert care in their home communities, saving them time and money. And in the case of Sarah, the consults can be life-saving.”

Established programs: Telestoke and teleneurology

The institution’s telestroke and teleneurology programs as described above are Michigan Medicine’s most robust telespecialty programs. These two programs average more than 100 monthly consults each and continue to steadily grow. Consults include an interview with the attending physician and result in the specialist completing an exam, reviewing the patient’s records and providing a written consultation to the treating physician.

Neurointensive care tele-rounding is another way Michigan Medicine experts work with Metro Health, on the west side of the state, in utilizing telespecialty consults. Michigan Medicine physicians connect remotely to their Metro Health colleagues via video and round while remaining at Michigan Medicine. A Metro Health physician or advanced practice provider presents the patient to Michigan Medicine specialists and together, they complete a two-way consultation with the patient on screen and actively participating.

Pediatric and perinatal psychiatry, pediatric epilepsy

Michigan Medicine aligns with MidMichigan Health in Midland and Alpena to provide pediatric and perinatal psychiatry telespecialty consults as part of a program called Michigan Child Care Collaborative (MC3).

MC3 is a care model created through the Michigan Department of Health & Human Services meant to help increase access to mental health services for underserved children and adolescents and high risk perinatal women. Patients and families are connected to Michigan Medicine specialists from its pediatric and perinatal psychiatry programs through MidMichigan and receive clinic-to-clinic telespecialty consults from psychiatrists and/or local behavioral health consultants. These scheduled clinic appointments allow patients and families to receive monthly care while remaining in their own community. 

“Telepsychiatry is one in a menu of treatment options that is essential for children and perinatal women in Michigan,” said Sheila Marcus, M.D., professor of psychiatry. “There are too many children who are underserved and telepsychiatric outreach is one way to bring child psychiatry expertise to Michigan youth.”

The future of telespecialty consults

Michigan Medicine also has a Virtual Care presence within Marquette, Alpena, Harbor Springs, Saginaw and other areas in the Upper Peninsula. In those locations, the organization serves as a partner to provide pediatric epilepsy telespecialty consults through Upper Peninsula Health System. Michigan Medicine’s expert faculty connect with a Marquette-based neurologist at Upper Peninsula Health System to provide patient consults, filling the need for expert care for epilepsy, one of the most common pediatric neurology conditions. 

Future undertakings in telespecialty consults include partnerships with Munson Health in Traverse City (Child Protection Team program), McLaren Petoskey and Metro Health (pediatric cardiology), MidMichigan Health (advanced heart failure) and Upper Peninsula Health System (Maternal Fetal Medicine).

These projects prove it’s an exciting time for telemedicine, according to Mollie McDermott, M.D., assistant professor of vascular neurology: “The dedication and commitment of our physicians involved in these programs are crucial to the success of improving access to quality care across the state.”

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