It’s pretty obvious what benefits telemedicine can have for many patients, particularly the elderly and infirm, those with limited mobility or lack of access to transportation or who live in rural or other underserved communities. But how do physicians feel about this “remote doctoring?”
HealthLinks asked several local hospitals to give us a sense of how telemedicine is working from their professional perspective.
Perhaps not surprisingly, one of the most frequent and highly regarded uses of telemedicine is in diagnosing and rapidly treating cerebral stroke, an acute, sudden onset affliction with an extremely time-sensitive window for treatment.
According to Shawn Valenta, the Medical University of South Carolina’s administrator of telehealth, his hospital operates a dedicated Telestroke Network. Currently connected to 26 hospitals in South Carolina, this system handles close to 4,000 Telestroke consults annually. Valenta said that before telemedicine, less than 40 percent of the state’s population was within a one-hour drive from expert stroke care. Today, that time-sensitive care is available to over 96 percent of the state’s population.
When a patient presents with symptoms of stroke, the hospital’s first step is to order a CT scan, and a call is automatically placed to the Telestroke Network. Medical experts respond within five minutes on average from wherever they are.
Through telemedicine, these experts can see everything the attending physician can see, from monitor reading to close-ups of the patient’s facial features to help diagnose the nature of the stroke – whether it’s ischemic or hemorrhagic. This critical evaluation determines whether the patients should receive the clot-busting drug TPA, which is a potential lifesaver for ischemic stroke but potentially deadly for hemorrhagic stroke, and in what dosage.
Valenta noted that MUSC also operates a Tele-ICU network in partnership with Advanced ICU Care, which serves six South Carolina hospitals. This connects the attending physician with critical care intensivists and nurses across the network, providing a second layer of trained medical professionals who can provide initial ICU assessments, monitor vital signs utilizing intelligent software that is far faster than unaided human observation and respond to medical emergencies such as cardiac arrest.
In 2017, he said, more than 160 lives have been saved as a result of tele-medicine.
Dr. Kate Wiese, DO, a neurologist affiliated with Trident Medical Center, is another enthusiastic proponent of telemedicine for stroke. She said that when a stroke patient – determined generally by EMS personnel utilizing the Rapid Arterial Occlusion Evaluation or RACE – arrives at the hospital, he or she is met by an ER doctor and the telemedicine specialists.
A CT scan is ordered to help determine, along with clinical indications, whether TPA is appropriate and where the stroke is located. With their direct connection to the patient in the ER, remote specialists can make these critical decisions and also decide whether the patient should be taken directly to the radiological suite for a catheter procedure to remove the clot.
“Telemedicine is a work in progress,” Dr. Weise said. “But initial assessments indicate that it has played a key role in arriving at much better outcomes.”
Other than for stroke, telemedicine is an important tool for the doctors at Charleston’s Ralph H. Johnson Veterans Affairs Medical Center. According to Sheila Sullivan, facilities telehealth coordinator, “currently, our biggest utilizer of telemedicine is Telemental Health.
“Our most recent program that providers find very helpful is VA Videoconnect,” she added. “We use software through which providers can connect with patients through any smart device, anytime, anywhere that is convenient for the patient. Both patients and providers use links to connect in what is called a virtual meeting room.”
Post Traumatic Stress Disorder treatment is a priority, but the Department of Veterans Affairs’ telemedicine program also assists in providing palliative care for patients in hospice, for ALS rehabilitation programs, for diabetes education and follow up and more.
During 2017, Sullivan added, VA Videoconnect assisted with nearly 2,000 patients in Alabama, Georgia and South Carolina.
For the U.S. Department of Veterans Affairs, telehealth saves patients time and money while also saving the VA money and valuable hospital space.
“It’s a very flexible tool,” Sullivan concluded.
By Bill Farley