Telemedicine’s interactive video capabilities allow remote specialists to examine patients to offer second opinions or counsel local doctors unsure of how to proceed.Telemedicine is playing an ever-increasing role in the health care industry as health professionals struggle to meet the rising demand for medical care with resources that aren’t increasing at as rapid a pace. Among the biggest beneficiaries of telemedicine’s expansion will be children, who make up one of the more vulnerable segments of the health care market.
The American Telemedicine Association (ATA) defines telemedicine as ¨the remote delivery of health care services and clinical information using telecommunications technology.¨ And as the practice of telemedicine evolves and the technology it uses improves, the possibilities of telemedicine keep expanding.
Telemedicine Networks Proliferate
ATA estimates that more than 200 telemedicine networks are up and running across the country. These networks link together roughly 3,500 service sites with more being added all the time. In 2011, the Veterans Health Administration performed more than 300,000 remote consultations that were facilitated by telemedicine, according to the ATA, which also reports that well over half of all U.S. hospitals use some form of telemedicine.
Meanwhile, younger patients have some additional reasons to like certain telemedicine features, which help set it apart from normal clinical care.
Among the most vulnerable of patients are children, many of whom are fearful of visits to the doctor or hospital.
A case study from a pediatrics clinic in Coos Bay, Oregon, points out some of the more obvious benefits of telemedicine, benefits that for the most part would be enjoyed by patients of any age who are suffering from a serious illness and live far from big-city hospitals and specialists.
In a March 2014 blog posting on the website of Bay Clinic Pediatrics, Jon Yost, M.D., recounts the story of an 8-year-old patient named Ryan. The boy was seriously ill with pneumonia ¨that was robbing his bloodstream of oxygen,¨ and Dr. Yost felt sure he would have to send the boy to a hospital in Portland — roughly 250 miles away — for specialized care.
As it turned out, the family disruption and expense of an emergency trip to Portland wasn’t necessary, thanks to interactive video technology that allowed specialists from Oregon Health & Science University’s Doernbecher Children’s Hospital to consult on Ryan’s case remotely.
Admitted to Local Hospital
Admitted to Bay Area Hospital in Coos Bay after pneumonia was detected in both of his lungs, Ryan rapidly deteriorated. Desperately in need of more oxygen, the boy’s breathing became more labored and rapid. In his blog, Dr. Yost tells what happened next:
“We decided to obtain a telemedicine consultation with Doernbecher’s pediatric intensive care specialists. Like Skype on steroids, telemedicine offers ultra-high definition video and audio conferencing. An OHSU Pediatric Intensive Care Unit doctor can position the robotic camera as needed, zooming in and out to examine a patient in Coos Bay.¨
The first OHSU pediatric intensivist to examine Ryan remotely was Lauren Ibsen, M.D. Using the flexible features of interactive live video, Dr. Ibsen was able to remotely study Ryan’s vitals and lab results in real time and to direct questions to Ryan’s parents, who were at the boy’s hospital bedside. The whole process fascinated Ryan’s mother, Michelle, who marveled at the ease with which ¨she (Dr. Ibsen) could zoom in on his chest.¨ Dr. Ibsen told Ryan’s local doctors that she felt confident the patient could remain in Coos Bay and offered a couple of suggestions for improving his care.
In this example of telemedicine at work, a Mexican cardiologist checks out an echocardiogram of a patient in a rural or remote location and is able to discuss recommendations for care.
A lung x-ray taken the following day made it clear than Ryan was not yet out of the woods, prompting Ryan’s doctors in Coos Bay to call upon yet another Doernbecher specialist, Miles Ellenby, M.D., to get his views on the boy’s treatment. Dr. Ellenby approved of the therapies already being used in Ryan’s case and saw no need for further changes to be implemented. As the day progressed, Dr. Ellenby continued to check in on Ryan via the video conferencing tool.
Of the remote input from Doernbecher’s pediatric intensive care specialists, Ryan’s mother said ¨it was reassuring to know that there was not another [treatment] option¨ available, and that ¨everything was being done appropriately.¨
With the remote guidance from Portland, Ryan’s condition soon began to improve. Before long, the boy no longer needed to be on intravenous medication or supplemental oxygen, and he was released from the hospital and allowed to return home. Ryan’s case, as well as others Dr. Yost has seen, illustrates several ways in which telemedicine can benefit young patients:
- Improves Patient Care: Overall patient care is improved when specialists can consult on difficult cases remotely. As Dr. Yost points out, Coos Bay has eight well-trained pediatricians, all of whom spend the bulk of their time seeing patients with mild illness in the doctors’ respective offices. Thanks to modern vaccines, these pediatricians are rarely called upon to utilize their hospital skills. Dr. Yost observes, ¨Having a specialist co-manage our patients keeps us up to date.¨
- Bolsters Patient Safety: Telemedicine improves patients’ well-being by providing an extra safety net for patients who are critically ill. Dr. Yost says that in consulting with specialists remotely on care for specific patients, the specialists not only provide extra know-how but also help local doctors focus on some of the basics, such as cardiopulmonary resuscitation and proper placement of endotracheal tubes.
- Increases Local Staff Confidence: Backup from remote specialists improves the confidence of medical personnel at the local level. When specialists endorse treatment methods proposed locally, nurses and others dealing with patient care feel much more confident that the proper method of treatment is being followed.
- Helps Keep Families Together: For many parents, having a child sent off to a big-city hospital hundreds of miles from home creates extreme hardship. Dr. Yost notes that in Ryan’s case, his sister was also sick but not sick enough to be hospitalized. If it had been necessary to send Ryan 250 miles away to Portland, the parents would have been faced with the need to attend to both children’s needs even though they were hours apart. This might well have forced one parent to accompany Ryan to Portland while the other remained at home to care for his sibling. Thanks to telemedicine-enabled remote consultations, the whole family was able to remain in Coos Bay.
- Helps Keep Health Care Costs Down: Although the equipment and technology necessary to facilitate telemedicine are not without their costs, such expenses are usually far less than the costs of transporting patients to hospitals great distances from their homes. Dr. Yost said transporting a critically ill patient from Coos Bay to Portland could cost as much as $30,000. On top of that, big-city hospital stays are usually more expensive than care at local facilities. In Ryan’s case, for example, dealing with his treatment remotely allowed highly trained respiratory therapists and pediatric ICU nurses to stay in Portland where they could also attend to the needs of other critically ill patients.
- Eases Fears of Doctor-Shy Children: For most children, the idea of a trip to the doctor’s office is frightening, and the need to be hospitalized can be terrifying. Telemedicine is not just for such dire medical emergencies as experienced in Ryan’s case. It also can allow doctors to remotely monitor patient recovery after an illness or even provide the means for a doctor’s consultation with a child who lives in a rural area far from the doctor’s office.
- Expands Access to Medical Expertise: Only a very limited number of medical professionals have the expertise to deal with certain rare illnesses. In the event a child is stricken with such an uncommon illness at a location far from doctors who are experienced in its treatment, telemedicine offers local doctors an opportunity to tap into that expertise remotely. In the past, getting treatment for rare medical conditions necessitated transferring the patient from his home area to a hospital at which expert specialists are accredited.
Photo credits: Cisco Pics, Dorothy Northcutt Gray, Intel Free Press
Don Amerman is a freelance author who writes extensively about a wide array of nutrition and health-related topics.
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