HONESDALE — Seconds after he appeared on a monitor set next to the emergency room bed, Edgar Kenton III, M.D., described how neurologists stationed 100 miles from Wayne Memorial Hospital will play a critical role in diagnosing and treating the hospital’s stroke patients.
Using the same two-way videoconferencing software as Dr. Kenton, the director of Geisinger Health System’s neurology department, neurologists employed at Geisinger clinics in Danville will remotely examine the patients, analyze brain scans and recommend treatment.
“This has given us 24/7 access to a neurologist in a critical, life-threatening emergency that can coordinate care with our doctor, and visualize and interview the patient in real
time,” said registered nurse James Pettinato, director of patient care services at Wayne Memorial Hospital, regarding the service contract with Geisinger.
The telestroke program, launched at the hospital on Aug. 11, reflects the surging use of telemedicine technology at healthcare facilities worldwide, especially those in rural areas that struggle to recruit specialists.
Experts tout telemedicine as a way to reduce health care costs, improve patient safety and expand access to speciality care, especially in rural areas, where a patient otherwise could have to travel hours for the required treatment.
On average, rural residents have 54 specialists, such as cardiologists or neurologists, per 100,000 people, according to a 2011 American Hospital Association report. That number balloons to 134 in urban areas, where people, in general, are less likely to suffer from chronic illnesses and more likely to have health insurance.
“The issue in this country, or at least in Pennsylvania, isn’t a lack of specialists,” said Gus Geraci, M.D., consulting chief medical officer for the Pennsylvania Medical Society. “It’s the maldistribution of specialists. Telemedicine solves that problem. It’s like being in the same room as the patient and the bedside physician.”
Skyrocketing use
Telemedicine is comprised of three main categories: remote patient monitoring, two-way video interactive services and “store-and-forward,” the electronic transfer of medical information, such as patient data or X-ray scans.
More than half of the U.S. hospitals use some form of telemedicine, according to the American Telemedicine Association. By 2018, seven million patients worldwide will use telemedicine services, a massive jump from the less than 350,000 patients who did so in 2013 an IHS Technology report predicted.
Neither of the Community Health Systems-owned Scranton hospitals — Moses Taylor Hospital or Regional Hospital of Scranton — offer telemedicine services, Commonwealth Health spokeswoman Renita Fennick said.
Geisinger Community Medical Center in Scranton unveiled its tele-intensive care unit program in March, enabling critical care physicians and nurses in Danville to monitor GCMC’s intensive care unit patients via a live video feed.
The providers, who can zoom the camera in close enough to see a patient’s pupil, analyze patient data, such as vital signs, medications and blood results. If they identify early-warning signs or notice worsening symptoms, they will alert the critical care staff at GCMC.
Officials say the services augment care provided by onsite physicians and nurses.
“Within our system, a primary goal for telemedicine is to enable our patients to have timely access to specialty care without having to drive, if they are an outpatient, a great distance,” said Scott Davis, vice president of business development at Geisinger Health System.
Geisinger’s telestroke program targets patients who have symptoms of stroke, which normally involves the interruption of blood flow to the brain and requires physicians to quickly restore it.
Within a three-to-four hour window, the emergency physician must take a CT exam of the patient’s head and upload it for Geisinger’s on-call neurologist, who analyzes it and then performs a patient exam remotely. The neurologist and onsite staff then will determine whether the patient needs a clot-dissolving drug or should be transferred to a certified stroke center.
“Someone who only sees something like once a year can show a picture to somebody who sees it 100 times a day, and can quickly look at something and say, ‘yeah, you don’t need to worry about that,’ or ‘yeah, it’s worth getting a helicopter,’” Dr. Geraci said.
Evolution
As the technology has evolved over the last decade, it has enabled specialists to do more remotely.
A digital stethoscope allows them to listen to a patient’s heart sounds. And experts say that they eventually expect a specialist to be able to stick their hand in a glove and determine whether a patient — who could be hundreds of miles away — has a lump on their skin, and feel if it’s soft or hard.
Despite the benefits, experts say there are still problems with telemedicine, most notably reimbursement.
For example, Pennsylvania’s Medicaid program offers some form of reimbursement for live-video specialty consultations, but it is not one of the 11 states that reimburses, in some form, remote patient monitoring, a 2014 Center for Connected Health Policy report found.
Meanwhile, more than 20 states nationwide require insurance carriers to reimburse care delivered via telemedicine at the same rate as those provided in person, Mr. Davis said. Pennsylvania is not one of them.
“Like any new method of delivering care, we want to make sure that it is safe and effective for our patients, but we also want to make sure that there is an adequate system of payment for it,” said Robert Wah, M.D., president of the American Medical Association. “So, we are looking for ways to make sure the payment system accommodates this new tool in a way that we all benefit.”
Date: August 25, 2014