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Widespread adoption of e-health records is expected to boost telehealth adoption even further. That's because in addition to videoconferencing capabilities that let clinicians remotely communicate with each other and patients, digitized health records will provide remote specialists with more complete information about those patients.
Meanwhile, the use of digital medical images from picture-archiving systems and even digital cameras are making a wide range of information available to doctors about patients from afar.
Healthcare organizations are deploying telehealth to patients where there are shortages of specialists such as dermatologists, neurologists, radiologists, critical care doctors, and mental health specialists. Telehealth is also helping to close the care gap for patients who live in rural areas, as well as patients with debilitating illnesses for whom travel is difficult or impossible. In some instances, telehealth is helping to link patients with medical expertise even while the patient is in transit.
For example, Cincinnati Children's Hospital Medical Center is linking patients in ambulances with remote medical specialists. "This is telemedicine on the go," said Dr. Hamilton Schwartz, who came up with an idea for using high-resolution video and other telemedicine gear, such as digital stethoscopes, for pediatric patients--including sick premature infants--while these children are in transit to Cincinnati Children's Hospital Medical Center from other area hospitals.
In pediatrics, especially cases involving critically ill children, care often needs to be delivered while the patient is being moved from one facility to another. But emergency or intensive care specialists at the destination hospital can get a head start in delivering care if they can remotely examine and observe patients before and during transit, said Schwartz.
"A picture is worth a thousand words. There's no substitute for seeing a patient with your own eyes," he said.
Schwartz and his clinical team worked with telehealth products vendor GlobalMedia to design the TransportAV mobile telemedicine device. It mounts on a stretcher and supports 3G, 4G, and 802.11 networks. It includes GlobalMedia's TotalExam high-resolution camera, which can be used for video or freeze-frame pictures if there isn't enough network bandwidth in the area for clear images in motion. TotalExam is the size of a dry-erase marker and can be used for examination of patients' throats, eyes, and skin from an Internet-connected remote PC or videoconferencing system.
At Massachusetts General Hospital in Boston, doctors and IT staff have created a telemedicine program also aimed at helping critically ill children. The Connected Pediatric Critical Care program lets on-call attending physicians examine patients from their homes and communicate with on-site pediatric ICU staff using real-time videoconferencing and robotic gear.
The program, launched last May, involves six pediatric critical-care attending physicians equipped with videoconferencing units in their homes, letting them connect to a portable robotic telemedicine station, nicknamed "PICU Bot," or "Bot," for short. Bot units can be rolled to the patient's bedside. The physician can remotely control digital cameras and medical scopes attached to the unit to examine the patient. Videoconferencing capabilities let the doctor talk with on-site hospital clinicians, respiratory therapists, and other specialists, as well the patient and the child's parents.
Mass General IT and clinical staff assembled PICU Bot using off-the-shelf technology, including Polycom videoconferencing products, said Dr. Joseph Kvedar, director of the Center for Connected Health, a division of Partners Healthcare, which owns Mass General.
The use of PICU Bot is being studied by Mass General to see how improved communication between attending physicians and ICU staff impacts critical care, said Dr. Natan Noviski, chief of the hospital's pediatric ICU. The study will help Partners Healthcare decide whether to roll out Bots and videoconferencing capabilities in its other hospital ICUs for adult patients.
The Bot is used during nights and weekends when on-call attending ICU pediatricians are at home. On average, it's been used two or three times a week, said Dr. Phoebe Yager, a Mass General pediatric ICU physician and director of pediatric telemedicine.
Videoconferencing gear from Polycom and other vendors let remote doctors control examination cameras and medical gear to observe patients miles and hours away, helping to save lives in emergency situations.
Another leading telehealth application is called telestroke. When a patient suffers a stroke, there's a critical three-hour window for appropriate intervention to be provided to prevent serious complications, such as permanent brain damage and paralysis. But there are two general kinds of strokes--blood clots, which make up the majority of strokes and prevent blood flow in the brain, and hemorrhagic strokes, which are caused by bleeding in the brain.
However, the urgent treatment needed for blood-clot-caused ischemic strokes is very different than that given to patients whose strokes are caused by bleeding. Ischemic strokes need to be treated within three hours of onset with blood-thinning drugs to prevent permanent damage and disability. However, giving blood thinners to patients' whose strokes were caused by bleeding can be damaging or even deadly. Plus, hemorrhagic strokes have a much higher fatality rate than ischemic strokes.
At University of Pittsburgh Medical Center, stroke specialists provide immediate guidance to ER doctors at 15 (soon to be 17) hospitals in Pennsylvania, including several non-UPMC hospitals that don't have in-house stroke specialists or neurologists always available.
Using the telemedicine gear, which includes videoconferencing capabilities provided by Polycom, remote UPMC stroke specialists can observe, talk to, and examine suspected stroke patients in the other hospitals' ERs quickly, as well as view the patients' CAT scans and electronically pull up other test data. This helps stroke patients to receive the appropriate treatment faster, saving lives and reducing permanent disability and rehab, said Dr. Lawrence Wechsler, VP for telemedicine at UPMC and director of the UPMC Stroke Institute.
UPMC has been evolving telemedicine applications over the last several years in a number of other key areas, including surgery, dermatology, pathology, and psychiatric care, said Wechsler.
One big hurdle for telemedicine is that its capabilities for improving care are advancing faster than many health insurers' willingness to cover remote services. Also while government programs like Medicare cover some telehealth services, coverage is usually tied to services provided to patients living in regions where there are shortages of primary care doctors, not specialists like stroke experts, who are even scarcer, said Wechsler.
Perhaps coverage of telemedicine services by health insurers and other payers will expand in the years to come as more is learned about how telehealth can not only improve patients' care and save lives, but also help to cut costs.
Such research is under way at Mayo Clinic, which, with Intel and GE Healthcare, recently launched a program to study how at-home health monitoring can help sick, elderly patients avoid hospitalization. During the yearlong study, 200 Mayo high-risk patients over the age of 60 who suffer chronic conditions such as heart failure, diabetes, and lung disease will use at-home medical devices to take their vital signs, such as blood pressure, peak air flow, and weight or blood sugar readings every day.
The medical devices transmit the readings to an Intel Health Guide remote patient-monitoring system located in the patient's home. Depending on the medical device, data is transmitted to the Intel system via wired or wireless connections, such as Bluetooth.
From there, data is transmitted to a Mayo database, and accessed by clinicians who watch a "dashboard" for early signs of patients who could be developing a medical problem--such as weight or blood pressure out of normal range.
Using the videoconferencing capabilities of Intel Health Guide, clinicians can observe and communicate with the patient and offer up intervention that prevents a condition from worsening to the point where the individual needs hospitalization.
In rural Louisiana, telemedicine is helping to diagnose breast cancer in patients who might otherwise not get screened. A mobile van equipped with digital mammography lets rural women quickly have their mammograms performed and read by remote radiologists. Mobile digital mammography is one of the telemedicine services offered via the Louisiana Rural Health Information Exchange, which was launched in 2007 to serve central, northern Louisiana.
A highlight of the exchange is its support of telemedicine services that help link rural patients with medical experts at LSU Medical Center in Shreveport. Without those telemedicine services, patients often would need to wait three months or more for an in-person appointment with specialists like cardiologists and pulmonologists, not to mention a long road trip requiring hours of travel, said Jamie Welch, CIO of the exchange. In fact, many of those low-income patients don't have cars and can't afford the price of a cab or other transportation to get to the medical center.
"It's very satisfying to know you've played a part when a woman in her 60s receives her first breast cancer screening," said Welch. Remote radiologists can often detect a possibly cancerous or suspicious spot immediately after the patient has her digitized mammogram, Welch said.
Finally, some U.S. employers are offering health services on-site to workers at company facilities, and Cisco is tapping its technology expertise to help make that happen in its workplaces. Cisco's use of telepresence technologies lets remote clinicians examine and communicate with Cisco workers while at company facilities.
Cisco has 67,000 employees globally, with 20,000 in San Jose, Calif., where its HealthPresence Center is located. Cisco also recently added the ability to provide remote diagnosis to its Research Triangle Park, N.C., facility. Add family members, and it services almost 45,000 people. Employees can make appointments online and just hop over to Building Q, where they wait in a lobby for no longer than three minutes before being escorted to one of 15 private care suites.