Healthcare IT News: The world’s smallest and most fragile people need all the help they can get.
Two recent reports concerning the use of telemedicine in hospitals or hospital departments catering to children paints a promising picture for the technology’s deployment in NICUs and other areas. One report from Children’s Hospital Los Angeles found that a remote telemedicine hookup to specialists located off-site helped improve the quality of care given to newborns in the neonatal intensive care unit. The other report, from the University of Minnesota Amplatz Children’s Hospital, found value in video links between hospitalized children and their parents, their caregivers and other hospitalized children.
Results of the CHLA study, recently published in the Journal of Perinatology, targeted 304 patient encounters on 46 pre-term and term infants at Hollywood Presbyterian Medical Center’s NICU and compared the care given by an on-site neonatologist with that offered by off-site specialists using remote robotic medicine technology.
“Telemedicine technology can provide the off-site neonatologist with direct visual and auditory information about the patient and the clinical scenario in real-time, and may facilitate the decision-making process for the neonatologist,” said the report.
The study comes at a crucial time, with telemedicine technology becoming more sophisticated and looking to gain a foothold in critical care settings and hospitals looking to improve care while dealing with limited staff and access to specialist care. A telemedicine setup in the NICU, proponents say, could allow hospitals – especially those in remote locations or with limited budgets and resources – to link directly and immediately to better-equipped NICUs and neonatologists.
“Aside from proving that the system is safe in the NICU, for the first time ever, the visual and audio accuracy and the ease of use of the system was an interesting finding,” said Istvan Seri, head of the USC Division of Neonatal Medicine at CHLA and co-author of the report, in a news story published by InformationWeek Healthcare. “In addition, the acceptance of the robot in the unit by the faculty, trainees, nursing and respiratory staff as well as, apparently, by the parents was truly remarkable.”
The CHLA study pointed out that the telemedicine system included a control station and remote-controlled robot, linked via the Internet over a secure broadband connection. Other features included bio-directional audio and video communications with real-time video, rapid-response cameras with zoom and auto-focus, a panoramic visualization system, a digital camera, audio microphones, amplification circuitry and custom software.
Researchers cautioned that the study shouldn’t been seen as substitute for on-site care. “As a robotic telemedicine exam cannot replace a bedside exam, robotic telemedicine technology should not be conceived as a replacement for the provision of on-site intensive care, but rather a way to ensure that prompt attention and early intervention based on direct and accurate information can be provided” to infants housed in a hospital’s NICU, the report said.
At the University of Minnesota Amplatz Children’s Hospital in Minneapolis, meanwhile, officials used a video communications system developed by Bloomington, Minn.-based Video Guidance to connect the newly opened hospital’s young patients with their parents, caregivers, even other patients.
“Families of hospitalized children are not always able to be at their sides,” said Jason Albrecht, the hospital’s pediatric palliative care coordinator and a child-family life specialist, in a press release.
“Some children remain in the hospital for long periods of time and some parents live many miles away, including out of the country. The desired result of the new video conference systems is to lessen emotional suffering caused by that separation.”
The health system currently has 21 in-room systems dispersed in the children’s hospital, along with three mobile video conferencing carts that float between the NICU and pediatric intensive care unit, as well as other parts of the hospital. The system can also connect to video conferencing services outside the hospital, such as a family with a PC or Mac and a video hookup at home.
Albrecht said the system offers several uses. It can be used by hospital doctors and staff to communicate with parents or caregivers who are at home, at work or elsewhere, and it can link doctors and patients at the different facilities of Fairview Health Services scattered around Minneapolis.
“This gives us the ability to visually connect a parent admitted to University of Minnesota Medical Center to a child admitted to University of Minnesota Amplatz Children’s Hospital when both are patients,” said Albrecht. “For example, a parent donating an organ may be a patient at the medical center and a child receiving the transplanted organ is at the children’s hospital. Now they can communicate via video to see, share and support one another. This also enables a parent/family caregiver serving at one bedside to remain connected with what is happening at the other.”
“Long-term separation from school and peers adds another layer of stress to patients hospitalized for extended periods,” Albrecht added. “We will soon have the ability to loan affordable video conferencing equipment to schools that do not yet have this capability in order to connect patients with their class rooms.”
Monday, July 18, 2011
Thursday, July 7, 2011
Hospitals turn to telemedicine for remote care of patients
USA Today: Tired and lethargic, Kristopher Lee Taylor knew the moment he got out of bed one recent Monday morning that he wasn't going to work.
Taylor, 32 and a Phoenix resident, instead went to Banner Estrella Medical Center, where he was diagnosed with a potentially life-threatening diabetic reaction.
At the Phoenix hospital's intensive-care unit, Taylor was treated remotely by a doctor in Tel Aviv, Israel, via a two-way camera installed in the patient's room.
Health-care companies such as Banner have turned increasingly to remote doctors to monitor their patients because of a shortage of critical-care specialists.
Dr. Baruch Goldstein assessed Taylor, monitored his vital signs and regularly communicated with him and his nurses, who provided hands-on care. Taylor received insulin, potassium, magnesium and fluid to treat diabetic acidosis, a condition in which a lack of insulin caused his blood levels to rise. He was out of the hospital's intensive-care unit within 48 hours and returned home that Thursday.
Taylor was satisfied that Goldstein, located half a world away, checked him several times during the day and night, even navigating a scare when Taylor's heart rate slowed in reaction to multiple needle injections. Not only could the doctor see the patient, but the patient could see the doctor.
"This was better because there was always a doctor on hand," said Taylor, comparing last month's hospital stay favorably to a previous trip.
"This one was a little more instantaneous. I felt he (Goldstein) could respond faster, rather than having to waiting for a doctor to come to your room or call a nurse back."
Banner Health is among more than three dozen hospital systems nationwide with "eICUs," which provide remote care for the most critically ill patients.
Banner's system, which began about five years ago, includes a command center at Banner Desert Medical Center in Mesa that links doctors and nurses to 15 hospitals and about 450 beds in Arizona, Colorado and Nebraska. Starting this year, doctors in Tel Aviv and Southern California also joined the system that remotely transmits critical patient information such as heart and breathing rates. The information allows the remote critical-care doctors to guide and work with doctors and nurses who actually provide the hands-on treatment.
The system, which Banner calls iCare, is available to every patient in intensive care, but patients are offered a chance to opt out when they are admitted.
By now, Banner doctors and nurses have become accustomed to working with virtual counterparts; Banner started iCare in early 2006. Medical specialists have said in the past, though, that while they welcome the help and ability for remote doctors to quickly detect problems, they worry about turning patients over to doctors they don't know.
The concept is that such remote telemedicine centers staffed by critical-care physicians and nurses can better handle the growing number of patients who require intense monitoring. There is a nationwide shortage of such critical-care specialists, known as "intensivists," so the idea is that these doctors can monitor more patients remotely than if they were on-site at a single hospital.
Banner Health's system is among the nation's largest remote telemedicine systems used for critical care.
Over the past four years, Banner said that patients have spent 26,000 fewer days in critical care and nearly 100,000 fewer days in hospital rooms. Last year, Banner estimates that the remote system saved more than 600 lives by providing more attentive care from critical-care specialists.
Banner's estimates are based on a hospital-industry measurement called Apache (Acute Physiology and Chronic Health Evaluation), which predicts outcomes of patients under similar circumstances.
Banner, based in Phoenix, has invested $11.3.million in equipment to establish its telemedicine system, and it is testing a plan to expand the program to areas of the hospital beyond the ICU. Banner is now conducting a pilot program at Banner Gateway Medical Center in Gilbert to assess whether it's feasible to use the telemedicine for medical and surgical units, too.
Banner Health CEO Peter Fine said the technology had proved its worth in the ICU because it had saved lives and reduced the time patients stay in the hospital.
"It's a more effective, efficient outcome for patient care," Fine said. "It is representative of the type of organization we want to be from a clinical-quality perspective."
Fewer fatalities
The idea of using telemedicine to bolster care at even established urban hospitals has gained momentum based on recent research.
In a May article published in the Journal of the American Medical Association, researchers found that patients at a Massachusetts hospital that operated an eICU system suffered fewer infections and fatalities. The death rate at UMass Memorial Medical Center in Worcester, Mass., dropped to 8.6% after the telemedicine program opened at the hospital, compared with the previous 10.7%.
Dr. Craig Lilly, who is director of the Massachusetts hospital's eICU program and the lead author of the study, said that the evidence showed that the telemedicine program saved lives.
Lilly said the biggest barrier to more widespread use of eICUs was capital costs for smaller hospital systems and convincing hospital staff that it was the best way to care for patients.
"Some people call it culture," Lilly said. "The hardest thing is routine, getting people to do things a little differently than they did before."
Robert Groves, Banner Health's director of critical care, said that establishing such a telemedicine program initially required a "leap of faith" for Banner.
Past studies of the benefits of telemedicine program for intensive-care units have produced mixed results. And hospital systems must grapple with not only the up-front equipment costs, but also the training costs associated with establishing such an intricate process and convincing hospital employees that it's the best way to deliver care.
Groves, however, said Banner's ICU units consistently have delivered better results in saving lives and reducing the length of hospital stays for patients.
"The most important outcome is, do you keep your patients alive, and do you provide quality care," Groves said.
Remote monitoring
Goldstein, the Tel Aviv-based critical-care physician, said he became interested in the concept of telemedicine while he was completing his medical training at a New York hospital.
At the time, he planned to move to Israel, but he also wanted to practice medicine in the United States. He investigated several hospitals' telemedicine systems before he landed a position at Banner Health.
Goldstein, who holds dual citizenship in the United States and Israel, works from a small office in Tel Aviv that includes all the remote-monitoring equipment he requires as a doctor. It also operates with redundant T1 data lines to ensure a reliable, high-speed connection.
In a typical day, Goldstein cares for dozens of patients in emergency rooms in Arizona, Colorado and Nebraska. He estimates that he receives 15 to 20 calls from nurses and doctors at Banner facilities during each shift. Otherwise, he keeps tabs remotely on the patients.
Goldstein, a New York City native, typically works during the day in Israel, which is the overnight shift at Arizona hospitals. Two doctors who are also board-certified in critical-care medicine work with Goldstein in Tel Aviv.
Goldstein, who works occasional shifts at hospitals in Israel to keep his bedside skills sharp, said he may add one more physician to the Tel Aviv office as Banner's eICU program grows.
"As long as Banner keeps growing, it is easy to find doctors willing to work with me," Goldstein said.
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