Fri. Nov 27th, 2020

When Sonya Shakir’s 12-year-old son Charles developed a raging scream just before bedtime last winter, he decided to bypass the emergency room and head to a community center on Cleveland’s East Side. Within 15 minutes of arrival, Charles was lying in a high-tech pod equipped with a wireless stethoscope, blood pressure cuffs, thermometers and other medical devices, watching his mother video-chat with a doctor several miles away at the hospital. Was.

“So you don’t feel well today? What’s wrong?” Asked the pediatrician at the University Hospital Rainbow Children’s and Children’s Hospital from a screen in the kiosk. A clinical assistant pressed the tip of a video-equipped otoscope into Charles’s ear, projecting images of the canal and earrings onto the second screen. “See that redness and swelling?” The doctor asked, indicating signs of an ear infection. With a few taps on his keyboard, he sent a prescription for an antibiotic to a pharmacy for the family on the way home.

Shakir says, “It originated from ‘The Jetson’ a few years ago. Her two young children” ran after the kiosk in search of a doctor, “she says.” They couldn’t figure out where he was. ”

Thanks for the fast progress in Health care technology, Medical expertise is increasingly being given to the patient from elsewhere. Telehealth kiosks are cropping up across the country, and speeds will pick up as they begin testing them in pharmacy cities such as Walgreens, Rite Aid and CVS. Thousands of Americans have already mastered the art of video chat with a virtual therapist by laptop, iPad, or cellphone, to discuss a new symptom or medication adjustment. “We are on the verge of major changes,” says Jonathan Linus, chief executive officer of the American Telemedicine Association, a nonprofit business group of health care providers, hospital executives and telemedicine vendors. “Consumers stepped in and said this is what they want.”

More than convenience, telemedicine offers hospitals and physicians to enter new ways of population health management to better care for their communities. For example, in the neighborhood of Shakir, there were no walk-in urgent care centers other than hospital emergency rooms, which is why Rainbow chose that location for one of its first testing sites. “Our goal is to improve the quality of outpatient care for children, increase their outreach to pediatricians and reduce unnecessary emergency visits,” says Andrew Hertz, medical director of Rainbow Care Connections, pediatric accountable for UH Care organization.

“I looked into a machine, and it took some pictures,” says Sheila McKeon, a 60-year-old diabetes patient from Philadelphia, who was recently examined by remote specialists at the city’s Wills Eye Hospital during dialysis . ” Appointed to her local clinic. Wills has recently expanded its public health programs by deploying mobile vans equipped with ophthalmology cameras to test for glaucoma and damage the retina caused by diabetes. “We’ve taken them to doctor’s offices, pharmacies, community centers and churches,” says Julia Holler, an ophthalmologist at Wills. In McKinley’s case, the photographs revealed a cataract, which he has since removed.

Glaucoma surgeon and head of the Cataract Service of Wills Eye Hospital, Drs. L. J. Katz evaluates a patient’s eye images through telemedicine.(Will figure for USN and WR)

Specialists at major medical centers, in fields ranging from oncology and cardiology to neurology, can now be asked to “see” patients living hundreds of miles away. Wills’ ophthalmologists, at the top of their field, help diagnose hundreds of complex eye conditions each month from digital photos and medical records sent by doctors around the country. Nationwide, approximately 125,000 ER patients receive rapid virtual assessment of symptoms such as facial paralysis and numbness on the one hand by distant stroke specialists each year. As a result, many obtain significant clotbuster drugs that are sufficient to reverse permanent damage.

At the Levine Cancer Institute in Charlotte, North Carolina, oncologists provide state-of-the-art cancer treatments and clinical trials for other cancer patients thanks to a telemedicine network that connects all hospitals and medical offices within the Carolinas Healthcare System is. Oncologists at 25 participating hospitals across the region attend joint tumor board meetings each week to discuss individual cases and develop treatment plans. “Genetic counselors have remote video sessions to discuss breast cancer gene mutations with a patient,” says Levin Cancer Institute President Derek Raghavan. “A palliative care physician at one location can meet remotely with doctors and patients at another to help alleviate chronic pain.”

(For now, doctors are not legally allowed to practice telemedicine beyond the state where they are licensed. Congress has allowed states to allow active-duty soldiers to take care of military doctors along the lines of the state Has changed the law and may soon allow veterans to have a single take. The state medical boards are also working on a plan to establish the compact, which would recognize such medical licenses between different states Join in. “We don’t think it’s right but a step in the right direction,” says Linkus.)

Telemedicine is also becoming routine as a way of keeping a close watch on the intensive care unit. Some community or rural hospitals do not provide critical care of physicians or nurses at night. About 11 percent of ICU patients across the country are now cared for by specialists working in surveillance centers connected to hospitals by wireless technology.

a Harvard Medical School The study published this year found that hospitals using tele-ICUs are able to reduce mortality by preventing infections and other complications. At the University of Massachusetts Memorial Medical Center in Worcester, for example, the ICU mortality rate fell from 10.7 percent in 2005 after an off-site team of critical care nurses and ICU specialists began monitoring patients at two of the hospital’s locations. The team looked at electronic alerts for the response to the in-room alarm, and for whether patients were receiving care at the bedside that followed best practice guidelines.

The latest telemedicine is marginal mental health. From military veterans battling post-traumatic stress disorder to children with mental issues, technology is now connecting people who otherwise do not have access to the services of psychologists and psychiatrists who can really make a difference. A recent study published in JAMA Psychiatry showed that results dramatically improved when therapy was offered via videoconferencing by a trained specialist. Researchers randomly assigned 265 veterans with PTSD who have remote cognitive processing therapy (including, say, challenging their beliefs that they could have done something different to protect their friends) or their normal Care, usually involves mood-lifting medication. Those who had an average of 12 sessions of telemedicine CPT saw a six-point drop in their PTSD scores, compared to two points for other vets.

“It’s very personal, and he really helps me,” says Calvin Goforth, 32, of Mena, Arkansas, an Iraq veteran from Arkansas who videos for a decade of flashbacks, horrifying guilt, and other PTSD symptoms Are receiving CPT through, resulting from 87. combat missions and the loss of four close friends. Psychologists at Goforth practice at the VA Hospital in North Little Rock on a three-hour drive.

At Carolinas Healthcare, thousands of patients in nearly two dozen primary care medical practices can now consult mental health experts over video links. “We plan to expand this to all 200 of our primary care centers over the next five years,” says John Santopitro, chief clinical officer for behavioral health.

Such services are changing the care available to children in 70 rural school districts in Georgia. Two boys of Jennifer Jilcott, who live in Nashville, have complained of pain in their ears, abdominal pain, and a sore throat with a virtual pediatrician by a school nurse, who is transmitted with a wireless otoscope, stethoscope and penlight Checks images and data. . From the nurse’s office, Jillcott and her 14-year-old son, who have autism, speak monthly to a psychiatrist at the Marcus Autism Center in Atlanta to discuss her anxiety symptoms and strategies on medications so that she can Could help him do it. Work and housework.

The state’s Medicaid program and other managed care companies recently began reimbursing providers for these programs that have “cut health care costs by keeping sick children out of the emergency room,” the nonprofit for Tellhelter, Georgia Says Paula Guy, CEO of Global Partnership. Which has a school program in its hands.

Typically, however, reimbursement policies have been a barrier to more widespread implementation of telehealth services. In a 2014 survey conducted by 57 hospital and health care executives, the law firm Foley & Lardner found that 90 percent had started adding services, with nearly 40 percent not always being paid by insurers or in-person care Were collecting much less than.

However, this can change rapidly Managed care runs from paying fees for every service Paying lump sums per patient or per medical condition with the idea of ​​keeping patients healthy and reducing the number of admissions and tests and procedures. By 2018, Medicare plans to provide half the quality of its payment or the value of care rather than the quantity of tests and treatments. This year Medicare has established specific billing codes that allow providers to pay for “remote patient monitoring” for chronic conditions such as diabetes and heart failure, and for annual wellness visits and psychotherapy.

For simple cases, insurers are starting to give green light. United Healthcare announced earlier this year that it would offer a Doctor on Demand service to its customers, and other insurers could soon follow suit. With this service or many other virtual doctor websites with it, consumers consult a general practitioner via a secure video link; Such interactions can lead to strep throat, pink or urinary tract infection. “About 6 percent of our virtual seizures need to be resolved with a real doctor visit,” says Adam Jackson, CEO and co-founder of Doctor on Demand. “Our virtual doctors also follow up with patients within a few days after the initial visit, especially if a medication has been prescribed.”

What is the approach to distance surgery? A decade and a half after the first remote operation, in which two doctors in New York manipulated a laparoscope using high-speed fiber optics and surgical robots to remove a woman’s gallbladder in France, undermining that revolution yet is. A major blockage: a computer connection is needed to ensure that instructions sent from the surgeon to the robot can be received immediately and there is no risk of tampering. “We already have robotic surgery that is done remotely,” says Thomas Landway, Associate Professor of Pediatric Urology University of Washington And co-director of the Seattle Children’s Hospital Robotic Surgery Center. “But the surgeon is in another room, not hundreds of miles away.”

Landway and his colleagues at 11 sites around the world have now tested the tele-operation system to learn how robotic equipment can be used rapidly and flawlessly. Others are working to overcome delays in dispatching instructions to surgical robots and developing cyber security systems. Within the next five to seven years, Landway’s prediction, telesurgery, too, will become more general.
Excerpt from US News’ “Best Hospitals 2016”, the definitive consumer guidebook for American hospitals. Order your copy now.

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