New telehealth initiatives across the country are starting to address critical shortages of many medical specialists, helping provide care to patients who previously didn't have access.
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.
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