For those of you who think the Emergency Room is a hospital's loss leader, Neal Sikka would beg to differ.

Sikka, an associate professor at the George Washington University Department of Emergency Medicine and the brainchild behind the hospital's Connect-ER telemedicine platform, says the ED "really is the gateway to the hospital." It's the point of entry for many patients, especially those in need of immediate care, and as such can define the hospital, enhance the brand and draw and sustain new business.

Speaking at a Tuesday afternoon session at the HIMSS Connected Health Conference's Population Health Summit, Sikka – who's been practicing telemedicine for more than two decades – said a phone- and video-based platform can help the ED handle only the cases it needs to handle, while referring low-risk admissions, scheduled and unscheduled follow-ups and other non-emergency cases to a phone- and video-based platform manned around the clock by trained EMTs.

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Over the past decade, Sikka said, "the ER has become the rapid diagnostic unit for the community," handling emergency cases of all types that can't wait for a doctor's normal office hours. Attaching a telemedicine platform to the ED, he said, allows a hospital to sift through and categorize the patients, assigning them to the best and fastest avenue of care and keeping that ED waiting room from becoming crowded and ineffective.

Connect-ER was launched this past July and is slowly gaining traction, averaging about 100 referrals from every 6,000 to 7,000 ED visits, Sikka added. That number of referrals could easily jump up to 2,000 or 3,000, he said, once ED staff become comfortable with identifying and referring those patients best served via telemedicine.

"It's a new paradigm," he said. "We need to broaden people's minds. We're still begging for visits right now."

Patients coming into the ED are screened and referred to Connect-ER if their needs would best be served by a video visit. Sikka said he and his staff originally developed 20 use cases of appropriate telemedicine concerns, then realized they were inadvertently "closing people's minds" to cases that might fall outside those examples but still be appropriate.

Those referred to Connect-ER are sent a PDF of a consent form, along with a short video explaining the process. Once the form is signed and sent back, the patient is connected to a communications specialist at the call center, who then sets up the telemedicine consult with a doctor.

The program has been challenging to implement, particularly because most clinicians either aren't comfortable or aren't suited to delivering care by telemedicine, and have to be trained, Sikka said, and because EMTs are more suited to emergency care, they're better prepared to man the Connect-ER call center.

Likewise, Sikka said he's still trying to figure out the financials. The service currently charges a flat rate of $35 per visit, which may or may not be enough. Part of the problem is that ED care is still fee-for-service-driven, so it's difficult to plug in a value-based model. He expects to see the value – eventually – in reduced readmissions, improved outcomes in follow-up care and better patient satisfaction scores.

"It's going to take a while," he said. "I'm changing the brand of our ED. We're giving our patients new options that they never thought existed."