6 Doctors Share How They’re Using Telemedicine
One of our Subject Matter Experts, Marcia Headley, RN BSN CCM, recently attended the Telemedicine Leadership Forum in Washington, D.C. hosted by Telemedicine Magazine and URAC. Below is her account of the forum segmented into 6 doctors and their contributions and insights into Telemedicine.
It is truly amazing to see how far the practice of medicine has advanced with technology! One presenter described the term telemedicine (telehealth) clearly, “it’s not the medicine that has changed, only the care delivery model.”
Teaching surgeons laparoscopic skills with video games
Program: Laparoscopic surgery & telemonitoring
The forum kicked off with a presentation by Dr. James “Butch” Rosser, Jr., a pioneer in telemedicine since the early 1990s. What a diverse and exciting career in medicine he has had working with NASA and the military. He was an early adopter of laparoscopic surgery and created a program to teach surgeons laparoscopic skills using video games and simulation. He has provided care remotely by what he calls “telementoring” including surgery. This was the subject of a Discovery Channel TV program when “cyber-surgeon” Dr. Rosser directed surgery from his home office in the US to a surgical team in the Dominican Republic.
Delivering telehealth programs to the veteran population
Program: Telehealth for veteran
Dr. Kevin Galpin, Executive Director of Telehealth Services at the Veterans Administration, noted that last year they delivered over 2.18 million episodes of care – touching about 12% of the enrolled veteran population through telemedicine. One area where this is used extensively is in mental health care via live video. The VA also uses a “store-and-forward” modality for certain specialties like dermatology and a remote monitoring modality in their telehealth program. Per Dr. Galpin, telehealth matters because it enhances the accessibility, the capacity, and the quality of healthcare.
Real-time interaction between ICU staff and intensivists
Program: Electronic two-way video ICU solution
Dr. Christian Becker from Westchester Medical Center Health Network presented their electronic ICU solution to the growing issue of the shortage of intensivists. This is accomplished with a 2-way video between the ICU patient room and the command center with a button in the ICU room for emergency consults. This allows real time interaction between the ICU staff and the intensivist in the command center.
Using telemedicine to combat the opioid crisis
Program: Suboxone & Telemedicine
Dr. Mark Plaster, Chief Medical Officer of Baltimore clinic, Turning Point, provided some alarming statics regarding the skyrocketing opioid crisis. He predicted we will lose over 40,000 Americans next year to opioid overdose. His clinic treats over 3,000 Methadone patients per day! It is estimated that 2.5 million people are addicted today at an estimated cost of $250 million per day spent on just opioids. He discussed treatment with Suboxone (buprenorphine/naloxone) and telemedicine follow up benefits. Telemedicine addresses the issues of the stigma surrounding the addiction diagnosis. It also allows for direct observation of drug ingestion, frequent face-to-face counseling and provides a discrete avenue for group counseling.
Connecting stroke neurologists to stroke patients when they need it most
Program: Administration of tPA through telemedicine
Dr. Raymond Reichwein, Medical Director of Penn State Health, presented their telestroke program (LionNet) that has greatly improved rural patients’ access to IV tPA administration which can only be administered within hours of the onset of symptoms of acute ischemic stroke. The goal for treatment in the ER is tPA administration within the first 60 minutes of patient arrival. What Dr. Reichwein saw in their ER were patients that had a 1-2 hour ambulance transport time while passing hospitals much closer to the patient but not equipped to handle stroke patients. These patients arrived at their ER too late to receive the best treatment for stroke. Therefore, Penn State developed a hub and spoke network with 16 rural hospital partners whose ER providers typically did not have a high comfort level with administration of tPA. Penn State provides 8 stroke neurologists who are on call 24/7/365 for video consults for their partner hospitals to enable rural hospital ERs to deliver tPA within the timeframe required.
Using credit scores to treat heart failure
Program: Treating heart failure with credit scores through telemedicine
Dr. Judd Hollander, Telehealth Fellowship Director at Thomas Jefferson University, presented an eye-opening slide entitled “Who knows patients the best?” Certainly, the answer is not our hospital or health system and not even our primary care MD. Walgreens or CVS is the one who knows so much more… think about it… they know we have pets at home, need reading glasses, are compliant with medications, get a flu shot every year, and the list goes on. In addition to a pharmacy, it was a health payer that discovered this fact: The single biggest predicter of 30-day hospital readmission for heart failure is credit score! They moved predictability of heart failure readmissions from 30% to 75% because the credit score represents whether the patient can manage themselves. Dr. Hollander talked about their online direct to consumer app, JeffConnect, that spans the healthcare continuum – from e-visits for routine issues, to acute care through virtual ED, to post-discharge management. JeffConnect has been so successful that over 80% of the patients on a follow up survey say they have already recommended JeffConnect to someone.
As you can tell by now, there are a myriad of ways telemedicine and supporting technology improves healthcare. As I was writing this blog, 2 big news stories came out that show not only how technology can improve healthcare, but also cause catastrophic issues if unchecked. The first is an encouraging story of how an Apple Watch saved the life of Florida teen. The second is a disheartening story of up to 270 women dying because they didn’t get an automated call for a final breast cancer screening generated by a computer algorithm. As we progress forward, it’s important to remember that every technology still needs clinical expertise to monitor or augment the technology.