TELEMEDICINE: 83% OF PATIENTS WILL USE IT, WITH PRESCRIPTIONS & MOBILE PHONES HIGHEST RATED
Category Archives: Technology
INFOGRAPHIC: “PHYSICIANS ADOPTING TELEMEDICINE”
Diagnostics World (June 30, 2020): The shift from face-to-face patient visits to remote medical appointments is a worldwide phenomenon, but most especially in the U.S., finds a recent global survey conducted by the doctors-only social networking platform Sermo. Unsurprisingly, Zoom tops the list of most-mentioned technologies. About one-fifth of surveyed doctors say they expect to be using telehealth tools “significantly” more post-pandemic than before COVID-19 upended business as usual.
TELEMEDICINE: SENTARA HEALTHCARE IN VIRGINIA OVERSEES 132 CRITICAL PATIENTS WITH ITS “E-ICU”
From ‘Government Technology’ (June 29, 2020):
The hospital system — the first in the country — wired bedside video cameras and microphones on a secure network in 2000 so a medical team could monitor patients at multiple hospitals’ intensive care units from one command center around the clock.
When Sentara Healthcare first launched its “eICU,” the plan was to provide an extra set of eyes on critical patients, especially overnight when staffing was down to a skeleton crew.
Before the coronavirus arrived in Virginia, the average number of telemedicine visits within Sentara Medical Group was about 20 a day. Now, it is more than 2,000 a day, according to the company. Between March and June 21, its clinicians had 314,000 total patient visits, with about 51 percent of them happening virtually.
COMMENTARY
Telemedicine has been slowly developing for 10 or 20 years. The models have been developing according to the requirements of their local areas.
Dartmouth deals with a rural area and has sophisticated aid to it’s associated hospitals and transportation systems to bring Stabilized patients to the main hospital.
Sentara deals with a more urban area and has a central brain aiding the peripheral hospitals in the delivery of treatment locally.
The Tele intensive care unit system of Santara features a central ” Mission Control” With patients in multiple peripheral Intensive care units connected by telemetry. This efficient system allows the peripheral ICUs to operate at a higher level with less staff.
Such telemetry could allow convalescent hospitals and even nursing homes to improve medical care.
With such excellent models one can hope that American medicine will rapidly improve in the post Covid era, riding the wave of telehealth advances.
—Dr. C.
NEW TECHNOLOGY: SMART BANDAGES – “A HEALING REVOLUTION” (TUFTS VIDEO)
On the 100th anniversary of the Band-Aid, Tufts engineer Sameer Sonkusale is working to make “smart” bandages.
COMMENTARY
The Tuft’s video talks about transforming the Band-Aid into a detector that can warn of infection, or even exude the proper antibiotic. This would certainly be Applicable to Convalescent homes where people can’t monitor their own healing.
I am Looking forward to the time when the bandage will provide a matrix for the body’s regenerative cells to spread out and cover the wound more rapidly. Possibly someday the regenerative cells themselves can be applied.
—Dr. C.
TECHNOLOGY: “TELESTROKE” NETWORKS ARE SAVING LIVES
From Fast Company article (June 26, 2020):
An increasing number of hospitals are now equipping emergency vehicles to treat stroke patients while en route to the ER. UCHealth is a health system in Colorado that has a tricked-out ambulance, the Mobile Stroke Treatment Unit. A neurologist at the hospital is connected wirelessly through telehealth to the vehicle. First responders’ gear includes portable CT scanners and tPA.
Currently, there are also more than two dozen telestroke networks in the United States. At the hub of each is a large hospital with on-call neurologists, and broadband that connects the hospital directly to satellite hospitals and clinics. There’s always a neurologist on call to guide the smaller hospital staffs’ treatment of a stroke patient.
When I had a stroke five years ago at 10:20 on a Saturday night, telehealth saved my life. At the time, only 3% to 5% of people in the United States were able to get the “clot-busting” drug called tPA in time to avoid brain damage.
In addition to offering telestroke capabilities, healthcare providers should equip emergency vehicles with portable ultrasound devices and defibrillators. Rural communities can consider strategically deploying high-powered wired and wireless hotspots in case patients need immediate medical attention while still en route to the hospital. Following natural disasters such as earthquakes or floods, mobile hotspots configured for telehealth could be helicoptered into isolated communities.
COMMENTARY
SPEED is especially important when a blood clot blocks an artery servicing an important organ. Our Heart and BRAIN top the list of vital organs. TELESTROKE showcases Telemedicine at its best.
RECOGNITION of a stroke is a weak link in the chain of prompt Brainsaving treatment, and a Mnemonic helps.
—Facial assymetry or drooping
—Arm or leg weakness on one side
—Speech disturbance
—Time is all important
FAST is a good mnemonic, and adding B for balance and E for Eye, or vision loss, for BEFAST gives 2 more parameters to think about.
Living alone adds to the challenge, so be as focused as you can. I was interested to hear that some TELESTROKE ambulances are adding mobile CT and drug (tpa) capabilities, in addition to TELECONFERENCING with a NEUROLOGIST. Treating a stroke within 15 minutes is becoming a possibility.
So particularly if you have risk factors such as hypertension, diabetes or obesity, be on the alert for symptoms of stroke.
—Dr. C.
PROVIDERS: DARTMOUTH-HITCHCOCK CENTER FOR TELEHEALTH (VIDEO TOUR)
TeleHealth Services
Our Dartmouth-Hitchcock TeleHealth Service Lines include the following:
Outpatient Virtual Visits (formerly TeleSpecialty)
Outpatient Virtual Visits connect patients and health care providers to Dartmouth-Hitchcock specialists via scheduled outpatient TeleHealth visits. Outpatient Virtual Visits increase access to specialty care services for patients located in rural or underserved areas and improves the patient experience via more convenient access to specialty care with reduced travel. D-H Outpatient Virtual Visit services currently offered including specialty clinic appointments, direct-to-patient home visits and inpatient consultations.
TeleEmergency
TeleEmergencyprovides a board-certified emergency medicine physician and an experienced emergency nurse to join the bedside team, on-demand, 24/7. Using high-quality, two-way audio-video communication, the TeleEmergency team assists by whatever means requested, including nursing documentation, direct patient care, consultation, a second set of eyes, assistance with transfer coordination, acceptance, and/or transport.
TeleICN
TeleICN allows D-H Neonatologists to join your bedside team to serve the needs of you and your patients for a wide variety of diagnoses. Some babies require a higher level of care as they adjust to life outside of the mother’s body. The 24/7 support of ICN services helps keep patients and families closer to home by supporting clinical decision making and providing expert evaluations and recommendations. If a transfer is necessary, our specialized ICN team will assist in transporting that patient.
TeleICU
TeleICU provides experienced intensive care physicians and critical care nurses to augment, not replace, the bedside team. In addition, the service provides behind-the-scenes, high-level monitoring and sophisticated analytical algorithms to identifying concerning trends prior to patient deterioration. Not only does this result in decreased mortality and length of stay; it also allows more patients to get their ICU care close to home.
TeleNeurology
TeleNeurologyprovides board-certified neurologists on-demand 24/7 for Emergency Department and inpatient consultations. This includes not only stroke (including evaluation and recommendations, and assistance with tPA administration), but also assistance with other adult neurologic emergencies. This allows a lower cost coverage option for hospitals with limited or no neurologist access, improved tPA administration rates and decreased transfers.
TelePharmacy
TelePharmacyconnects hospitals to a team of dedicated pharmacists who can provide medication order review and processing as well as clinical consultation, allowing hospitals to optimize their internal staffing while remaining compliant with order review regulations. D-H TelePharmacy improves medication efficacy, patient safety and staff satisfaction while also supporting the integration of pharmacy delivery within hospital systems and/or regions, including protocols and order sets.
TelePsychiatry
TelePsychiatryenables prompt assessment and management of patients in the Emergency Department or inpatient setting for locations that do not have around-the-clock psychiatric coverage. Board-certified psychiatrists provide 24/7, on-demand assessments including expedited admit vs. discharge decisions, early management recommendations, and assistance with medication management, while improving the ultimate patient trajectory.
TeleUrgent Care
TeleUrgent Care provides back-up, support and consultation to Urgent Care providers by emergency medicine physicians via high-definition, two-way audio-video conferencing. TeleUrgent Care physician input can include general recommendations, real-time patient assessments, second opinions, advice regarding the need and timing of additional emergent or urgent evaluations, review of radiographic images, and assistance with volume surges.
PREVENTION: “FORWARD CLINICS” ARE ALL-INCLUSIVE, FLAT-FEE PRIMARY CARE
Forward care is evidence-based, focused on prevention and improvement. Set goals and collaborate for better health.
- Connect Your Biometrics Sensors
- Receive your Sensor Kit
- Record measurements in the app
- Review insights together with your doctor
- Complete Your Labs at Home
- Schedule your at-home blood draw with a lab specialist
- Receive comprehensive results
- Create a Personalized Plan During Your Baseline Visit
- Discuss your health goals and concerns
- Review your biometrics and lab results
- Develop a personalized, preventive plan
- Answer Questions In-App for Insights on Your Mental Health
- Answer a short series of questions in-app
- Receive a measure for anxiety and depression
- Partner with your doctor on your results
- Customize Your Plan Based on Your Genetics
- Receive your Genetics Kit
- Review the results with your doctor
- Update your plan to address your risks
- See Your Doctor In Person for a Custom Follow Up Visit
- Request an in-person visit in the app
- Review your progress with your doctor
- Complete a physical exam and diagnostics
- Assess Your Skin Cancer Risk
- Complete a physical exam of your skin
- Capture high-definition images of any moles or blemishes
- Discuss your skin health and cancer risks with your doctor
- Receive a Message From Your Doctor to Update Your Plan
- Your doctor will check-in regularly
- Update your doctor on progress and goals
- Ask questions, anytime from anywhere
- Develop Nutrition Goals Based on Recurring Labs
- Review your latest labs with your doctor
- Develop a nutrition plan for targeted results
- Measure progress with future labs
COMMENTARY
Forward Healthcare differs from a conventional primary care clinic in several, generally good ways.
Most importantly, they stress PREVENTATIVE care. Blood tests that monitor diabetes, metabolic syndrome, and anemia are done regularly, since they have a laboratory on premises. They have their own EMR (electronic medical record) platform, and their own telemedicine platform, which are downloaded on the initial visit.
They give out a “sensor kit” consisting of temperature monitor, Pulse-oximetry, and a BP monitor, which wirelessly sends information to medical records.
Telemedicine is available through their own Downloaded platform. Although I get the impression that Telehealth isn’t as central as I would have expected in a technology oriented operation, it is increasingly important.
The monthly membership fee of $149 pays for the above and unlimited Doctor Availability 24/7 without copay.
Concierge Medicine has the monthly/yearly fee and unlimited access, but has a copay. Both will utilize your insurance, and neither treats patients in the hospital or provides referral care.
Government Health care is coming, and with it longer waiting times, shorter Doctor interaction times, and probably less time for Preventative Health Care.
Systems like Forward Health and Concierge Medicine will be the upper tier of a 2-tier system.
Proactive attention to Health in my opinion is essential in the future if we are to have a healthy nation, and not “bankrupt the system”. Telehealth is growing in importance, and offers help in making medical expertise more convenient, widely available and for less cost.
I am happy to see progressive Systems like Forward Health offer a preventative option to the present, broken, reverse-incentivized, fee-for-service System.
—Dr. C.
HEALTHCARE: TOP DIGITAL TECHNOLOGY TRENDS (2020)
From MD+DI (June 17, 2020):
Remote-care solutions like telehealth and wearable devices are included in the new approach that healthcare professionals will be embracing as they position their businesses to best serve patients in a COVID-19 world. Digital healthcare product solutions address critical issues for the remote delivery of care or the “hospital at home” that have been resonating long before we began looking at all our interactions through a social-distancing lens.
Wearables and On-Body Devices – Real-time data collection and communication are critical to digital health initiatives. More than half of survey respondents—52%—said they are currently developing or planning to develop wearable or on-body devices as part of their strategy. Another 33% said the same for patient-monitoring solutions.
Miniaturization, flexible circuitry, and biometric capturing sensors are leading to exciting new devices that will help patients in recovery or with chronic issues. The data communicated from these solutions will equip healthcare providers and patients with the data that can transform healthcare.
Seamless technology integration – A range of emerging technologies, including artificial intelligence (AI), 5G, cloud-based applications, and a growing roster of IoMT devices.
More than nine in 10 healthcare solution providers agree that the collection and purposing of data should be standardized to enable interoperability between devices and within product platforms, according to the survey.
TECHNOLOGY: H4D “CONSULT STATION” – 1ST CONNECTED LOCAL TELEMEDICINE BOOTH
H4D facilitates access to healthcare by allowing patients to consult a doctor remotely in the Consult Station®, the first connected local telemedicine booth. This medical device allows quality healthcare to be delivered for primary care, occupational health, and general health promotion.
COMMENTARY
CONVENIENCE, SIMPLICITY, and SAFETY area all goals of TECHNOLOGY going forward.
The “hands-free” check-in for hospitals and hotels are convenient and safety, but require a certain level of familiarity with technology, and may be Hard for the elderly to use. I think about the airport check-in kiosks, and store check-out points. The solution is to have “helpers” stationed by to assist.
The Telemedicine booth, with devices for examination of the ears, nose, and throat, a stethoscope probe for the lungs, payment port, video camera, etc certainly offers convenience, but may need helpers for guidance, and to clean after every use.
I’m betting on a super I Phone in all areas, although cost and band width improvement will be needed.
Doctors Without Waiting Rooms 