How this system would work

1) One call from primary provider to call center triggers screening/decision process. This call states problem or concern and requests immediate interaction with specialist or advise re: mini-data sets jor clinical pathways directions.
2) Call center or specialists office responds-with progressive additional phone/fax/e-mail data exchange to prepare for efficient use of phone conference of team
3) Phone conference scheduled. Provision for continuity to deal with change is provided with same approach. When needed interaction of participants with existing grand rounds is arranged. Options for second opinion and trial scenarios discussions are included. Managed scheduling can provide 24-hour real-time (within 15 minutes) and scheduled time access/interaction between patient, local provider and expert.

Advantages of the system

One call triggers process. Lowest level available technology can be used. Prompter, more personalized access to needed information and choice of best intervention. History is the engine that drives the decision making process. Model incorporates practical ways of data input to include physical, psychological, social, work/school and random elements. Also to summarize and display data graphically - which assists in analysis and outcome assessment.

Case Examples

A woman in her 30's with recurrent abdominal cramps, vomiting over several years, had upper GI, barium enema, other test and numerous treatments by internist and psychiatrist over 10 years. Symptoms continued. With our system, an initial, brief screening history done at her doctor's office and then an examination would be followed with one call to call center-interactive FAX screening questionnaires from gastroenterologist. This would identify possible lactose intolerance promptly. She responded to dietary restrictions.

A 50-year old woman with two-year history of milk left sided weakness and chest pressure. Three hospitalizations in intensive care and coronary care units with extensive evaluations over a total of 18 days. No cardiac disease found. Symptoms of periodic dizziness, depression and passing out, persisted. MRI of the head revealed small, old stroke. Two years after onset, electroencephalogram revealed seizure activity and she improved promptly with seizure medication treatment. With our system, phone conferencing from emergency room or intensive care unit-with a neurologist, internist and patient would have led to diagnosis before or at first hospital admission.

Why the system isn't being used now - barriers

Healthcare providers lose money if they take the time to get detailed history and phone conference. The current system is fragmented and has a disjoined infrastructure.

Summary

We emphasize strengthening the weakest links. This means making available timely live communication to all -the telephone-(supplemented by other technology). Other tools in this model can help better deal with the challenges of: costs, local control, quality and continuity of care, legal issues, data input-compression, summary, and display graphically, helping achieve changes in provider behavior, and building on existing advances.