Does E-Health Stand a Remote Chance?
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Kathleen Webster, MD, had her keys in her hand and was on her way out the door—about to make the 30-minute commute to the Loyola University Medical Center in Maywood, IL, where she is the director for pediatric critical care and the medical director for the pediatric ICU—when a nurse called to say one of her patients had arrested. “Get the cart and bring it into the room,” Webster said. The nurse was bemused—of course the code cart was already in the patient’s room.
Instead of racing to the hospital while talking to the care team on her cell phone, Webster opened up her laptop and was at the bedside—virtually—in minutes. “I can do everything but touch the patient,” she says. “I see a lot of the studies that say telemedicine is equivalent to being there. But I actually think there is a case for saying at times telemedicine is better than being there.” It’s faster and easier (and safer than driving and talking on the phone). And a high-definition monitor and digital stethoscope allow her to see and hear better than she could if she were in the room.
Advancing technology—the availability of faster and more reliable networks, wireless devices, high-definition digital images and video, and the ubiquity of mobile devices—is creating a foundation for a system of virtual healthcare where neither patient nor caregiver need be in the same place—or even in a clinical setting at all. And the programs are rising in popularity: In the 2011 HealthLeaders Media Industry Survey of technology leaders, 46% of respondents said they have one or more telemedicine programs in place. Another 41% say they’ll have one in place in one to five years.
Call it telemedicine, telehealth, e-health, mobile health, m-health, or remote healthcare, some predict that using technology to deliver care over a distance will improve access, ease physician shortages, create new revenue streams and increase volume for healthcare organizations by expanding market reach, and improve quality of care.
That’s assuming, of course, that federal regulators, providers, insurers, and technicians can figure out a model that works and overcomes barriers that include spotty reimbursement, questions about credentialing and other legal and administrative issues, a sometimes sizeable up-front capital investment unlikely to bring an immediate return, and that they can get concrete evidence that remote care is significantly better than care delivered in person.
Webster is among those who are convinced it can—and does—work.
The 508-staffed-bed Loyola University Medical Center implemented its telehealth program about four years ago as a way to increase after-hours coverage at its 14-bed pediatric ICU to improve patient safety and quality.
The telemedicine cart is fairly simple—an encrypted computer on wheels with a webcam, a high-resolution monitor, and a digital stethoscope. It allows clinicians, including rapid response teams, to evaluate a patient and intervene in a timely manner wherever they are. About 75% of patients treated remotely are transferred to the ICU; doing so early is a best practice that lowers mortality rates among high-risk patients.
“We went an entire year with no deaths in that group—and that’s as low as I can go with the numbers,” Webster says. “That tells us that we’re doing a good job of seeing these patients early.”
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