Telemedicine adds new opportunities

Remember 1984 by George Orwell? This book was so realistic to me that I dreaded the approach of 1984. Orwell had a vision of the government spying on people through cameras that were located in their homes. Information was reported back to Big Brother. (Or that is the way I remember it, years after reading the book.) Telemedicine uses cameras and expands the resources of the healthcare system by bringing expertise to isolated places.  Think of the radiologist in Australia or India who are interpreting x-rays of patients in emergency departments in the middle of our night. Think of the physician who uses a camera to observe the patient sitting in an outpatient clinic far from the doctor’s location. Now think of the critical care physician who observes a patient in an ICU far away. The use of remote technology permits the remote monitoring of critically ill patients by nurses and physicians. Intensivists- board-certified physicians with expertise in critical care- are in short supply.

For the past three or four years, hospitals have turned to their intensive care units to help save costs and improve access to resources such as the intensivist. The broader industry has come to employ more intensivist-trained doctors since studies have shown that these caregivers can improve the quality of care for critically ill patients and their survivability.  In Arkansas, telemedicine has been used to treat premature births and intensive care patients. Telemedicine has been conducted through the University of Arkansas for Medical Sciences in Little Rock, Arkansas’ only teaching hospital and it’s affiliated with a children’s hospital, as well as through Baptist Health Medical Center in Little Rock. About 35 hospitals nationwide have electronic intensive care units, according to a Baltimore based technology company called VISICU Inc. Cameras in the ceiling permit healthcare providers hundreds of miles away to observe the patient, and zoom in on the patient and the monitoring equipment.

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The idea of telemedicine applied in this manner offers the hope of better outcomes for critically ill patients by making highly trained physicians available to patients who would otherwise not benefit from such resources.
Remote monitoring of patients raises questions in my mind:

1. Does the remote physician or nurse document on the patient’s medical record- write notes, or orders? If so, how would a reviewer of the medical record know such a person was sitting in a remote location?
2. Are there nuances that are lost over the miles? For example, changes in color, behavior, or smells may be difficult or impossible to detect.
3. Is the ability of the remote physician or nurse limited by the skills of the onsite care provider? Does this person know enough to transmit the appropriate information or to seek out help when the patient’s condition changes and warrants the skills of the remote expert?

Although these limitations may exist, a patient in a rural part of the country still ends up better off with remote experts on hand.

Now go read 1984!