When breaking news travels via text message in real time, when Facebook status updates are instrumental in solving crimes and when knowing celebrities' whereabouts requires only that you follow them on Twitter, it's clear the information age has altered the fabric of everyday life. Whether it's improved it is debatable. Fortunately, medical practitioners across Louisiana now utilize these technologies to develop advanced telemedicine programs to provide specialized care remotely, benefiting both patients and physicians.
Telemedicine outfits satellite practitioners with remote cameras that link back to a larger hospital. This way, physicians and patients can engage in a diagnostic conversation, even when they're miles apart.
Liz Cothren, director of telemedicine for Ochsner Health Systems, charts the beginning of telemedicine programs to within the past 15 years. "When we started this, we recognized that disease-specific physicians were becoming harder to find, and it was harder to make correct diagnoses," she says. "We knew that we had to find a way to leverage the physicians that we had to help people at other hospitals."
Juzar Ali, medical director at LSU Health Sciences Center, likens it to a Skype session. "There's an audio and video feed, and an exchange of images if needed," he says. "Specific examinations, like using an electronic stethoscope, can also be done."
The medical fields utilizing the technology are vast and continue to grow: They include orthopedics, psychiatry, neurology, radiology, cardiology, endocrinology and Ochsner's "Telestroke" network of more than 15 Louisiana hospitals, to name a few. Some practitioners use telemedicine as a screening process to determine if a face-to-face appointment is necessary, while others find it an effective way to manage their patients through the primary care site.
Cothren and Ali agree that telemedicine programs are beneficial on multiple levels. For one, they improve the quality of care for patients outside of urban areas by allowing them access to specialists and by reducing the costs associated with travel and the time spent away from work and family. "If you don't live near a major hospital, you shouldn't have fewer options," Cothren says. Telemedicine also "allows clinic systems to focus on triaging their patients," Ali says.
"The referring site stays very actively engaged in the care of their patients, only now with the help of these outside consultants," he says. For example, the use of telemedicine in monitoring high-risk pregnancy can mean a mother and child remain closer together during their neonatal stay. In time-sensitive situations, such as after a stroke, telemedicine can lead to immediate treatment, less long-term damage and a shorter recovery time. It's also being utilized by companies with oil rigs in the Gulf of Mexico so their employees have better access to potentially lifesaving resources, since offshore rigs are, at best, a helicopter flight and hours away from medical help.
Cothren says there's a space-age element to the process, but he has found that a remote diagnostic session can more closely mimic a face-to-face interaction than one might think. The live audio and video feed allows for an actual conversation between the specialist and the patient, during which the latter can describe symptoms in detail, ask questions and voice concerns. There is always a licensed health care professional with the patient, and Cothren uses the analogy of an air traffic controller to describe the process: "The present physician is still technically 'flying the plane,'" she says. "The specialist is just helping them stay between the lines."
Patients' responses have been overwhelmingly positive. "They're enthusiastic about the cutting-edge stuff if it works," Cothren says. After witnessing a remote physician prove instrumental in an end-of-life decision for a patient, Cothren says she's convinced the patient-practitioner relationship transcends the technology.
Ali recommends patients uncomfortable with remote interaction consider this perspective: "It gives the option of improving timely access to health care in a system with challenges of capacity," she says. To boot, telemed frees up practitioners' time, so they can serve a wider patient base.
As local telemedicine programs and the technologies behind them evolve, both Cothren and Ali envision health care becoming increasingly and immediately available to patients everywhere. In the not-so-distant future, patients may have scales and blood pressure cuffs in their homes and physicians may be able to access their results from a different location. Merging telemedicine with remote robotic surgery also is a possibility, Ali says. Cothren believes that as corporations become aware of the benefits of telemedicine, they will incorporate equipment into their locations, giving employees on-site access to better health care.
Cothren hopes provisions in the Patient Protection and Affordable Care Act will pave for patients to have easier access to telemedicine.
"We've always been concerned first and foremost with patients' needs," she says. "What we're working toward is how we get it, so that with the push of a button, within seconds of getting on an Internet browser, you're able to interact with a provider."