A shortage of medical specialists, combined with a glut of newly insured patients has put some rural Texas hospitals in a bind.
One solution is telemedicine. Think of it as a kind of video conferencing on steroids that links doctors to patients hundreds of miles away.
Dr. Pritam Ghosh is in Dallas, listening with a stethoscope to a patient’s lungs, in the east Texas town of Sulphur Springs. And no, this isn’t a story about a 100 mile long stethoscope…it’s about a Dallas company bringing high tech telemedicine to the masses.
Naomi Crofford, who’s 82, has been in the Intensive Care Unit (ICU) at Hopkins County Memorial Hospital for two days. She’s sedated and has wires and tubes running in all directions. Dr. Ghosh, who’s a face on a 24-inch flat screen, is trying to determine whether she’s ready to be removed from a ventilator.
“Even if the numbers looked great,” Ghosh says, “Given what we’re about to try to do, this extubation process, I would never do unless I actually laid eyes on the person.”
And while he may not be here in person, with this telemedicine setup he can control a 360 degree camera, zoom in on charts and monitors, and listen to the chest and lungs with a stethoscope plugged in to a USB port.
Bringing Critical Care Specialists To Rural Texas
Many hospitals in rural Texas have trouble recruiting critical care specialists like Dr. Ghosh. That means transferring local patients to larger hospitals in other cities — losing business and often putting an emotional and financial strain on family.
Mrs. Crofford’s daughter, Sharon says she’s relieved she won’t have to move her mom to Tyler.
“I think this is one of the greatest things they’ve got. For him to be in Dallas and still be able to check on her, this is wonderful,” she says after talking with Dr. Ghosh via video after he examined Mrs. Crofford.
This Isn’t Skype
Chris Gallagher, a physician at Hopkins County Memorial Hospital and founder Access Physicians, a telemedicine organization that delivers specialty healthcare to underserved patient populations, worked with Dallas-based US Medical IT to customize this computer on wheels.
“We wanted to try and make it as natural as we possibly could,” he says.
So the cart is the height of a human and has its “ears” – the omnidirectional microphone, next to the face, along with its “eyes” – a pan, tilt, zoom HD camera attached above the screen.
The brain is a Microsoft tablet that uses Lync online – a secure platform – to keep patient data safe and private.
Cost Of Care
Gallagher says purchasing the telemedicine cart, including delivery, monthly maintenance and 24/7 IT cost around $30,000 dollars.
That might sound expensive, but the founder of US Medical IT, Stephen Cracknell, says his company is doing everything it can to make telemedicine affordable for the masses.
“Our telemedicine solutions start at under $6,000. But, in addition to that we recognize that the cash flow challenges are very real, particularly for rural healthcare providers,” Cracknell says.
So US Medical IT is working with partners, like AP Global, to offer a bundle of technology and clinical services that allow hospitals to pay for these services either under a monthly or even hourly plan.
Return On Investment
Telemedicine has the power to transform the way we provide critical care in rural areas, says Jeremey Kahn, “but there are questions about whether the financial investment is justified.”
Kahn is associate professor of Critical Care, Medicine and Health Policy at the University of Pittsburgh. He says access to trained critical care physicians at ICUs is linked to better survival rates and faster discharges. But studies looking specifically at the impact of telemedicine in ICU’s have shown mixed results.
“Conceptually,” he says, “the argument is very strong and there are some type of hospitals where telemedicine is likely to have a very large impact. And it’s most likely to occur at these small rural hospitals where they don’t have access to the trained intensivists without this remote technology.”
Return on investment for telemedicine may be hard to calculate in part because there’s no one right dosage. It’s a medicine that has to be customized for each hospital and clinic.
Done right, Kahn says it can keep patients in their own communities, connected to health care specialists at a reduced cost and greater convenience.