Getting Great Care Via Video

 Mary Brophy Marcus
  24th-Sep-2018

WHILE TELEMEDICINE MAY sound 21st century-esque, it's actually been around for decades. From radio consultations between land-based doctors and seafarers in the early 1900s to NASA medical teams tracking the health of astronauts in space starting in the 1960s, doctors and patients have long been exploring new ways to connect when an office visit simply isn't possible.

Now, digital natives are expecting their health care to be served up more conveniently than the in-person scenarios their parents and grandparents accepted without question. As telemedicine continues to evolve, thanks to technological advances, consider these ways it could serve you or a loved one:

Avoid an avalanche – literally. For years, Cindy Kahler, mother of five, regularly drove hours through mountain passes to take her daughter to see specialists at Seattle Children's Hospital. In mild weather, the six-hour round-trip journey is long and exhausting, but in winter it can be downright treacherous. Once she turned back because of an avalanche risk.

But for the past year and a half, Kahler has been able to skip the long trips. Instead, 10-year-old Hadassah – who has special feeding needs due to cerebral palsy – has been seen via video either at one of the medical center's satellite offices about 17 miles from home, or, thanks to a new pilot program, in their home. During appointments, child psychologist Danielle Dolezal, head of Seattle Children's pediatric feeding program, beams in from Seattle. When they connect remotely, Dolezal can observe Hadassah sitting in a highchair as Kahler feeds her. A pediatric speech pathologist and a nutrition expert join in sometimes, too. "I'm watching, coaching – I'm a bug in their ear. It's like we're FaceTiming," Dolezal says. "There's a camera on their end that I can manipulate and zoom in to see what she's doing with her mouth."

Seattle Children's serves a five-state region – Washington, Alaska, Montana, Wyoming and Idaho – that spans a huge landmass, much of it remote, says pediatric emergency physician Mark Lo, its medical director of telehealth and digital health. Nationwide, various telemedicine programs are helping people access expert specialty care that once may have seemed out of reach.

See a doc on demand by kiosk. Hit with a sinus infection or sore throat? Self-service kiosks are appearing in pharmacies, office buildings and even YMCAs around the country, enabling quick video consults with doctors. In partnership with New York-Presbyterian Hospital, for instance, some Duane Reade drugstores in the Empire State offer private kiosks outfitted with medical devices that can give emergency medicine physicians live details on a patient's health status. Think: Thermometers that measure temperature with the swipe of the forehead; a blood pressure cuff; a pulse oximeter that gauges blood oxygen levels. The $99 exams are conducted via high-definition video. Prescriptions, if written, can be sent instantly to the patient's preferred pharmacy. Other telemedicine-kiosk initiatives operate similarly. Florida's BayCare Health System, for example, has partnered with Publix to offer patients remote care via video at their neighborhood grocery store.

Get after-hours care for a sick child. Nemours Children's Health System – which serves pediatric patients in Delaware, Florida, Georgia, New Jersey and Pennsylvania – provides a 24/7 tele-urgent care service, CareConnect. It entails a live video visit ($0 to $59 depending on a patient's insurance) accessible on a desktop computer or via a free mobile app. A pediatrician conducts a video exam and can electronically prescribe medication. Users needn't be Nemours patients to be seen, but must be in one of the above states or Maryland to use the service – popular during flu season and for rashes, fevers, vomiting and more. "A lot of times parents are trying to figure out, 'Do I really need to go to the ER or not?' " says Carey Officer, operational vice president of Nemours CareConnect. Surveys show the program has kept 25 percent of patients from ER care and 34 percent from urgent care visits. When a child's condition is more serious, CareConnect guides parents to in-person emergency care.

Chat with your surgeon. Chris Toggweiler, 40, of Miami, says a video visit with his Cleveland Clinic cardiac surgeon weeks before his recent septal myectomy gave him peace of mind. Toggweiler, who has hypertrophic cardiomyopathy – in which heart muscles become abnormally thick – knew time would be tight upon arrival in Cleveland, so one day on his way to work, he dropped his daughter off at school, pulled into a parking lot and dialed in for a scheduled video chat on his smartphone. "It was nice to meet the surgeon who's going to split you open. Just to ask some questions," Toggweiler says. Not only is telemedicine being used for virtual preop visits, but it's giving patients a more convenient way to have follow-up care after routine surgery as well. It is also being explored to aid patients and families throughout the entire surgery continuum, from providing nutrition counseling and helping smokers quit before surgery to training caregivers after loved ones have been discharged from the hospital, says Alex Cho, clinical lead for the Duke Telehealth Office.

Be treated at home. Technology has helped spur a "hospital at home" movement to monitor and treat patients who require care but don't necessarily need hospitalization. Duke HomeCare & Hospice is among those offering remote monitoring to patients receiving in-home skilled nursing care for several chronic conditions, Cho says. Brigham and Women's Hospital has its own Home Hospital program, giving select eligible patients admitted to the ER the option of returning home in lieu of a hospital stay to receive care. A remote wireless monitoring system is set up so doctors can constantly monitor the patient's heart rate and other key health measurements from afar. Patients can text or video chat with a doctor at any time, and, if a problem occurs, a doctor is available 24/7 for a home visit. Remote monitoring is supplemented by visits from providers who can perform bloodwork, X-rays and ultrasounds from the patient's bedside. Results of an initial small pilot study on the approach were published in early 2018 and revealed that it was more cost-effective than caring for similar patients in the hospital and that the patient experience and the quality of care were not appreciably diminished.

Access cancer expertise. Cancer patients living in more rural areas are likelier to die than those in more urban locations, data suggest. But through telemedicine and support from the National Cancer Institute, patients and their oncologists can tap into the expertise of an NCI-designated cancer center; the nation's 70 such centers are involved in hundreds of studies assessing the latest treatments.

UC Davis Health near Sacramento, for example, has formed the UC Davis Cancer Care Network, through which UC Davis cancer experts hold videoconferences with oncologists, pathologists, surgeons and other cancer experts in rural hospitals to review patient cases and, if deemed appropriate for those patients, alert them to clinical trials. Some hospitals, such as Roswell Park Comprehensive Cancer Center in Buffalo, New York, have recently created telemedicine programs in which their cancer experts can consult with both physicians and patients at partner community hospitals.

The NCI is also expanding its own telehealth initiatives. In December 2017, the NCI and the Federal Communications Commission announced a joint effort to bridge the gap in cancer care in Appalachia. They're studying how increasing broadband access in rural areas might "provide connections to cancer patients who have historically lacked them," says Bradford Hesse, chief of NCI's Health Communication and Informatics Research Branch.

Evidence suggests telemedicine can offer multiple benefits to patients. One study found that when people with cancer reported symptoms electronically to their providers, they saw greater boosts in their health-related quality of life than those in an unplugged control group, Hesse says. Another found that electronically connected patients were less likely to land in the emergency room and had greater survival rates than patients in the control group.

Getting mental health support. Telehealth is expanding counseling to more patients living with mental health issues, from depression to addiction. Psychiatrist Jay H. Shore, director of telemedicine at the University of Colorado Anschutz Medical Campus depression center, oversees a team of nurse practitioners and psychiatrists who treat patients in Colorado and Alaska – some 3,000 miles away. "We see and treat patients who would not have access to psychiatric care without telemedicine, both in the rural clinics and even in the urban clinics," Shore says. A major perk of visiting with a patient virtually? You can get more insight seeing them in their world versus your clinical setting, he explains.

Beyond counseling, the mental health field is applying telemedicine in other ways. One project involves a collaboration between providers and patients with obsessive compulsive disorder, most of whom are newly discharged from an inpatient treatment program. Each pair works together to create an app that is customized to help the patient transition back to everyday life.

"The patient and therapist figure out together what's helpful. They focus on behavior reminders; they use humor; it's interactive," says Armen Arevian, who directs the Innovation Lab at UCLA's Semel Institute and Center for Health Services and Society and is an assistant professor in the school's department of psychiatry. Researchers are studying the role of the app in improving patients' symptoms.

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Domain: Afterhours
Category: Entertainment

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