Telemedicine

April 7, 2011 at 12:00a.m.

Specialists beam advice to far-flung patients

McClatchy Newspapers

ST. LOUIS

On the top floor of St. John’s Mercy Medical Center, doctors and nurses watch banks of video feeds, peering in on intensive-care patients at rural hospitals across the Midwest.

Two critical-care doctors and nine nurses in the St. Louis area oversee more than 400 patients at St. John’s Mercy and a dozen other hospitals in four states.

In round-the-clock shifts, they scan patients’ vital signs and review their medications, lab work, X-rays and medical records. They conduct real-time quality-control audits to ensure best practices are being followed.

From this control room, they can operate high-resolution cameras mounted in doorways of patients’ rooms — and even zoom in to examine a patient’s eyes or wounds. With two-way cameras, they talk directly with rookie nurses at the bedside of patients — or consult with patients themselves — at far-flung hospitals in places such as Independence, Kan.

“We help save lives,” said Lisa Manion, who worked as an intensive-care unit nurse for more than a dozen years before joining the Mercy SafeWatch Center, one of the nation’s largest teleICU units. “We do catch some things that the [bedside] staff, who are overworked, may not catch in time.”

Hospitals and health-care systems are increasingly taking advantage of “telemedicine” — the use of computers and telecommunications to connect big-city hospitals to often underserved rural areas, where specialty doctors are scarce.

Besides electronically monitoring the intensive-care units of remote hospitals, such technologies are also being used to link specialists with patients, including stroke victims and women with high-risk pregnancies.

At Parkland Health Center in Farmington, Mo., a robotic device on wheels helps on-call specialists in St. Louis quickly interview patients who have suffered a stroke.

The stroke specialist uses a computer with a joystick to drive the robotic two-way video system down the hallway to the patient’s room in the emergency department. Talking directly with the patient through the video monitor, the specialist performs a neurological exam to determine whether blood-clot-busting drugs need to be administered and whether the patient should be transferred to Barnes-Jewish Hospital, which is part of the same BJC HealthCare system.

The patient is asked a series of questions to assess brain function and ability to speak and also asked to describe a series of still images on the video monitor. The patient’s physical abilities and reflexes are also assessed with a nurse’s help.

“The technology has gotten so much better and so much cheaper over time,” said Dr. Karen Edison, director of the Center for Health Policy at the University of Missouri. “We really see this as the future: taking health care to patients wherever they are.”

Edison, a dermatologist and medical-school professor, began using video teleconferencing to serve remote patients in 1995. Many of her colleagues — including specialists in cardiology, psychiatry, neurology and those who attend to children with special needs — are also using these methods to consult with patients.

In recent years, the financial barriers for telemedicine have crumbled. Medicare and Medicaid reimburse doctors the same basic rate for in-person patient care as a video conference with a remote patient. Private payers, including health-insurance companies, large employers and health- maintenance organizations, also pay for many telemedicine services.

“It’s a much more patient-centered way of bringing health care to people in rural areas, patients where they live,” Edison said. “People can’t always leave their homes. A lot of people work in low-wage jobs. ... If we can use technology to keep people in their homes and healthier longer, we should do it.”