Physicians are increasingly finding new ways to leverage telemedicine using video conferencing. With new technologies that vendors have conceived and tailored for medical applications, current video-based telemedicine has much to offer. To demonstrate how much, three physicians take PracticeLink inside their practices.
Jill Kruse, D.O., serves Tyndall, S.D., a rural town with 1,200 residents, through St. Michael’s Hospital Avera and Bon Homme Family Practice Clinic.
St. Michael’s is 90 miles from Sioux Falls, S.D., and its larger Avera McKennan hospital. Both hospitals are part of the Avera hospital system. Avera makes its telemedicine technology available to the system and its physicians. It is also available for purchase.
Kruse and St. Michael’s use Avera eEmergency with eStroke technology.
"We were a pilot site for eEmergency, so we are very familiar with it," Kruse says.
The Avera eEmergency technology connects through a Polycom video screen that offers picture-in-picture technology. The Avera McKennan hospital in Sioux Falls, which is the hub of the eEmergency system, houses the other end of the video conferencing technology. The physicians in Sioux Falls have control of the camera at St. Michael’s so they can pan around its ER. Avera eEmergency allows the physicians at St. Michael’s to access Avera McKennan’s specialists and diagnostic tools 24/7.
St. Michael’s has two systems: one in the trauma ER and one in the minor ER. Both are hardwired and mounted to the wall. "We also have a mobile camera for close-ups for anything Avera McKennan specialists cannot see straight on, and a stethoscope so the remote specialists can hear heart and lung sounds," says Kruse.
The Avera system has many applications. Patient transfers can be difficult in South Dakota winters. With eEmergency, St. Michael’s can quickly access a neurologist to look at stroke CT scans and help with diagnosis and treatment.
"There is little we can do for stroke," says Kruse. "The eEmergency saves on transfers because we can find out first whether the transfer will help the patient or not."
Avera eEmergency is useful when patients come in with acute needs. "One of my partners lives 15 miles away. I can hit the eEmergency button, and a physician in Sioux Falls can tend to the patient until my partner gets here," says Kruse.
The technology also speeds and improves care. "I can hit the eEmergency button and dispatch a helicopter 15 minutes sooner for a patient coming in who will need it," she says.
The technology also facilitates consults with physicians in Sioux Falls. "They can direct the care, give a second opinion, and we can communicate about what the doctors in Sioux Falls will need when a patient arrives," says Kruse.
Andrew Barbash, M.D., is a Mayo Clinic-trained neurologist. He works with acute stroke patients in the Neurology-Stroke Care Program at Holy Cross Hospital in Silver Spring, Md. Barbash works with nurse practitioners and a limited number of specialists. His patients usually come in through the ER.
Barbash and his colleagues use Vidyo’s telemedicine technology as a service. Holy Cross Hospital purchases the Vidyo service from a company called IDSolutions, which hosts the Vidyo infrastructure. Holy Cross doctors and nurses communicate over VidyoMobile and VidyoDesktop software, which works on any mobile device or desktop computer, respectively. "I would describe it as Skype on steroids with a couple of twists that make it useful for medical practice," says Barbash.
Barbash introduced Vidyo by having the nursing units use the software on hardware on their mobile carts.
A small number of Holy Cross physicians engage in Vidyo communications from home, or wherever they have computer access, with a small number of nurses who have these carts. "It works with the click of a button," Barbash says, "and it gets everyone on the same page in real time."
The technology supports multiple participants. "Vidyo makes it easy to invite other people into a meeting," he says. "You can control the electronic meeting room by locking it once all the participants are in." This ensures the privacy of the meeting and of the patient’s information and condition. Physicians can record Vidyo meetings as well.
The technology is critically important because when a patient and a nurse need immediate access to a clinician with the proper expertise, that doctor is not likely to be where the nurse and patient are. Without this solution, there would be more cost and disruption involved in getting the right specialist to the right location at the right time. "With Vidyo, it is just like being in the room," says Barbash.
When a physician in the ER or near a cart has a patient who is in acute stress with stroke issues, he can connect immediately in real time to an expert clinician who can see the patient.
The specialist can use the technology to share videos, images and diagrams from his computer with the people on the other end through screen sharing. The specialist can engage the doctor, patient and family members who are present, show them what a procedure entails and how it will help, and they can make a treatment decision together.
John Schaeffer, D.O., a psychiatrist, started California Telepsychiatrists two years ago with the dream that he could offer private practice psychiatry via telemedicine to the underserved.
"Now I have 50 doctors contracted and 25 assigned seeing 4,000 patients a month," says Schaeffer, who has telepsychiatrists operating nationally. "We offer psychiatry through teleconferencing, contracting with county facilities and indigent care clinics. Most patients are on Medicaid, Medicare or are uninsured. They have to go to the clinic," Schaeffer says.
Schaeffer uses Nefsis Professional for his company’s teleconferencing system. Nefsis enables California Telepsychiatrists to bring continuity of care to rural America using the best doctors available.
Using the system, Schaeffer can offer his psychiatrists a virtual office.
"From the control panel, I can set up multiple offices, one for each clinic. Each doctor has a password and host control over the software," he says.
Likewise, each clinic has login access through a county system.
The doctor comes on screen during each appointment, and the physician and the patient see each other through picture-in-picture technology.
"So long as the doctor is licensed in the area where the patient is seated, he can see the patient," says Schaeffer. The doctor can be just about anywhere.
Nefsis Professional has capabilities and collaboration tools that enable the necessary elements of a real psychiatric appointment.
The doctor can scan and share forms, bus passes, disability paperwork or excuses from work with patients. The doctor and patient can fill them out together, and the system prints them out for the patient.
The physician can bring up videos about health topics, such as depression, and run them for the patient to see. Nefsis also has a whiteboard feature that enables the physician to draw pictures of neurons and neurotransmitters as he explains the cause of the depression and how medication helps.
The physician can then pull up special software to look up medications and dosages with the patient. "The psychiatrist can pull up pictures of the side effects to show the patient what to watch for," Schaeffer says.
By adding collaborative tools, medical devices and a doctor’s natural ingenuity, today’s telemedicine takes the specialist to the immediate need.
David Geer is a frequent contributor to PracticeLink Magazine’s Tech Notes department.