The mountains and plains of Colorado are a magnet for skiers, bikers and extreme sports enthusiasts. Amid all that activity, accidents are bound to happen, often far from medical specialists with the expertise to treat specific injuries such as concussions.
In the face of that reality, Centura Health has added a teleconcussion program in four rural Colorado areas. Using two-way audio and visual communication, the program gives primary care physicians access to expert secondary opinions about individuals who have or may have suffered concussions. It also assists with concussion management and prevention advice for coaches of young athletes who compete in high-contact sports.
“The reality is that patients don’t have the time or resources to drive an hour or two to get that secondary type of consultation,” says Samantha Lippolis, Centura Health’s director of telehealth. “We’re hearing so much about chronic traumatic encephalopathy and the long-term implications, so focusing on this area and giving athletic coaches and primary care physicians a place to go is great.”
Rocky Khosla, M.D., a family doctor in southern Colorado’s Centura Health Physician Group, developed the program. He’s been interested in concussion treatment since the early 1980s, but has witnessed an explosion of related information and technology over the last five years.
In 2011, Khosla set up a concussion management program at St. Mary-Corwin Medical Center in Pueblo, Colo., that works with kids in sports like football and hockey, and conducts impact testing and establishes treatment protocols. A year later, Colorado passed a law that requires coaches to receive education and have a plan in place to treat concussion victims.
Khosla already was working on a teleconcussion program for rural areas when, at a conference, he met Jennifer Kagan, a trauma and emergency department nurse in Frisco, Colo., who helped Khosla to expand the program.
To illustrate how the program works, Khosla describes a hockey player in Frisco who was still exhibiting symptoms three weeks after his third concussion. The player’s primary physician had performed the initial procedure but knew he needed more advice.
Kagan gave the patient a nine-page questionnaire about his mood changes, depression and other symptoms, and shared the responses with Khosla.
During the telehealth visit, Khosla could watch Kagan and the patient from a monitor in his office. He directed Kagan to perform parts of the physical exam and was able to see the patient’s expressions and reactions.
Khosla says teleconcussion could expand beyond the medical exam room, assisting coaches during football games and in a locker room after a player suffers a concussion.
“It’s not that you get one concussion. It’s that you get repetitive concussions over and over because you weren’t properly managed after your first,” says Lippolis.
Centura Health offers telehealth in a range of areas, from pulmonology and cardiology to genetic counseling and diabetes education. In the ED, telehealth is used for stroke victims, telepsychiatry, infectious disease consultation and more.
Lippolis says other organizations considering telehealth programs should start by reviewing state regulations and medical board requirements. “Luckily, we’re not finding many places where they’re making specific telehealth regulations,” she says. “It’s important to remember that telehealth is just a tool to deliver medical care. It is not a unique and distinct medical service. We work at what’s considered standard of care, and whether we can replicate standard of care using these tools.”
Centura Health has been awarded the 2017 Patient-Centered Innovation Award from the Colorado Academy of Family Physicians for its teleconcussion program.