Doctor, Can You See Me Now?
More Hospitals Are Using Video to Connect Patients With Specialists Far Away, Speeding Treatment
By BEN WORTHEN
The Wall Street Journal
In August, Tim Buirge suffered a stroke, leaving him unable to speak or move the right side of his face. That's when he went on TV.
At the local hospital in McCandless, Pa., where Mr. Buirge sought treatment, the 58-year-old lay in bed as a stroke specialist at the University of Pittsburgh Medical Center, 15 miles away,watched him on a giant TV, courtesy of a video camera in Mr. Buirge's room. The diagnosis was critical, since for most stroke patients, a clot-dissolving drug received shortly after arriving at a hospital can reduce the effects of stroke and limit permanent disabilities. But the risk is that for some patients with a certain type of stroke, such a drug can actually increase bleeding in the brain and boost the chance of death.
After reviewing Mr. Buirge's vital signs and a CT scan, the stroke specialist used the remote camera to check such things as the patient's speech and eye movements and his ability to follow commands. The Pittsburgh-based doctor then recommended that the local hospital administer the drug, called tPA.
Ms. Buirge's wife, Dianne, says the video diagnosis likely saved her husband. Within 10 minutes of receiving the drug, Mr. Buirge's symptoms began to abate, and he's now almost fully recovered, she says. "To go from just being so afraid to having a diagnosis and treatment was just so reassuring," she says.
Experiences like Mr. Buirge's may become more common as hospitals increasingly install video technology to connect local and regional hospitals to large urban medical centers where most specialists practice. The video hookups, which usually include high-definition TVs, a camera, and Internet-connected medical equipment, provide a way for smaller hospitals to tap these specialists' expertise when necessary. That boosts the chances patients will receive timely treatment and lowers transfer rates.
Video medicine is useful for diagnosing a range of ailments that rely heavily on visual inspection, advocates say. In addition to strokes, the systems can be used by faraway dermatologists to determine the severity of burns and other skin conditions, and by trauma specialists to assess the severity of a wound. Neonatal specialists are using video systems to figure out from afar whether a newborn needs intensive care. Healthcare providers also expect that videos will help them identify patients with chronic conditions like diabetes at an earlier stage by making medical advice available in traditionally underserved areas.
Currently, however, many health insurers won't reimburse hospitals for video conferencing services because the systems aren't in wide enough use. Medicare will pay for video services only when patients are in so-called provider shortage areas — mostly rural areas with a shortage of primary-care physicians.
And hospitals generally don't try to collect directly from patients, since the systems are often used in critical-care situations when it wouldn't be ethical to delay care to seek the patient's permission. As a result, local hospitals often foot the bill or doctors volunteer their time for emergency video consultations.
The technology has won fans among doctors, and earlier this year, the American Heart Association formally endorsed video-conferencing systems for diagnosing strokes. "The pictures are clear, and the audio is excellent," says Lawrence Wechsler, director of University of Pittsburgh Medical Center's Stroke Institute. "At this point it gives me an equally good evaluation" as a face-to-face consultation. Dr. Wechsler says he performs about 150 video consultations with stroke patients a year.
The video-conferencing systems, from companies like Polycom Inc., LifeSize Communications Inc. and Cisco Systems Inc., typically cost $30,000 to $50,000. About 3,500 hospitals and other medical facilities in the U.S. now have such systems, up from about 2,500 in 2007, and that's growing about 15% a year, according to the American Telemedicine Association. Still, that's just a fraction of the total number of facilities in the U.S.
Colorado recently announced plans to connect 400 state-run health facilities via video. And UnitedHealth Group Inc., one of the few insurers that does pay doctors for video-conferencing services, plans to purchase Cisco equipment to connect three rural facilities in Colorado to a major hospital in the state early next year. The telemedicine association estimates that about$400 million will be made available over the next six months from the Obama administration's stimulus package that can be used to create video links between hospitals.
Some of the bigger networks are centered in places like the Stroke Institute at University of Pittsburgh Medical Center, which maintains video links with 26 smaller hospitals in the region, including the one that treated Mr. Buirge. University of Texas Medical Branch at Galveston has video connections with about 350 facilities, including a few in Europe and South America. And the University of Arizona's Telemedicine Program links more than 150 sites around the state with hubs in Tucson, Phoenix and Flagstaff.
Patients may find the experience of talking through a television odd, but there's always a doctor or nurse present to check blood pressure or carry out the specialist's instructions. While the camera typically is stationary, like an eye, the specialist can use the device to zoom in and out,look left or right, and choose what to focus on. The patient may have to move around a little in order to give the doctor a proper view. A screen at the other end allows the patient to see the doctors doing the examination.
At Nationwide Children's hospital in Columbus, Ohio, known for its neonatal care, specialists used to consult with doctors at Adena Regional Medical Center — 50 miles away in Chillico the, Ohio — over the phone. But without a physical exam, "invariably the decision would be to transfer the baby," says Dr. John Fortney,Adena's chief medical officer. In late 2006, Nationwide set up a video connection with Adena. Since then, Adena's transfer rate to Nationwide dropped to 35 babies last year from 140 in 2006.
Nationwide says it has federal funding for equipment to hook up 10 other regional hospitals besides Adena, but it has proceeded slowly since many of its doctors' video-conferencing services go unpaid. "If you aren't getting reimbursed, that quickly becomes a real challenge," says Morna Smith, Nationwide's director of federal relations and health policy.
She says Nationwide has decided to go ahead later this year with setting up the additional video systems and hopes it can handle the increased demand for consultations. Nationwide plans to bill participating hospitals a "modest charge" for the services, Ms. Smith says, and leave it up to them to decide whether to pass it along to a patient's insurance company. "If we wait around for[insurance] reimbursement to start first, we're never going to get there," she says.
Funding Mobile Clinics
UnitedHealth Group, the big insurer, says it believes the technology can potentially reduce medical costs by, for instance, helping patients with chronic illnesses like diabetes maintain their health and avoid expensive emergency treatment. Besides its plan to connect facilities in Colorado, UnitedHealth says it will set up next year a mobile clinic to treat diabetes and cardiac patients in two New Mexico counties through a video link. Both are pilot projects that, if successful, can be expanded, the company says.
Other insurers aren't yet ready to take the plunge. A Cigna Corp. spokesman says that the company believes video systems are an important part of the future, but that they aren't 'twidespread enough for the insurance giant to cover yet. Highmark Inc., a Blue Cross Blue Shieldaffiliate in Pennsylvania, also doesn't cover services delivered by video.The systems have real promise, says Dr. Carey Vinson, a Highmark medical director, but thereisn't yet a standard definition for what constitutes a video consultation a expected outcome should be, making it hard to bill for these services.
More widespread availability of telemedicine would be welcomed by people like Stacie Traylor. Ms. Traylor's daughter Emily was treated via video at the Adena medical center in April 2008 when the newborn had trouble breathing. Before the video system was installed, Emily would have been transferred to another hospital, with Ms. Traylor staying behind as she recovered froma Caesarean-section delivery, she says. But because of the video system, the Adena center doctors were able to take care of Emily without her having any problems,” says Ms. Traylor, 31. Emily, now a year and a half old, is doing fine, she says.
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