By Laurie Burstein
August 2007
Thanks to new technology, doctors now have remote access to their patients. From monitoring heart patients, to reading x-rays, to coordinating care for patients in critical condition—today’s telemedicine uses technology to help deliver healthcare by letting doctors and nurses monitor patients from hundreds of miles away—ultimately improving quality of care and safety.
Remote critical care is one key area where telemedicine technology is having a big impact. With a growing shortage of critical care physicians, called intensivists, at small-to-mid-size hospitals, technology now allows for ICU patients in Wisconsin, for example, to be monitored by doctors in St. Louis.
Dr. Mary Jo Gorman has practiced medicine as an intensivist for 17 years and is the CEO of Advanced ICU Care, a medical services company in St. Louis providing remote critical care to patients in hospital intensive care units in several states. Advanced ICU Care uses a telemedicine technology platform, which combines clinical management software with patient data (like vital signs, medications, etc.) and live video feeds to enable critical care physicians and nurses to remotely care for patients.
Advanced ICU Care has 18 board certified critical care physicians and 18 ICU nurses, who care for and continually monitor ICU patients from the company’s operations center in St. Louis. Studies show that this level of care significantly improves patient care and safety.
“We believe that every patient in ICU should have an intensivist coordinating their care,” Dr. Gorman says. “Our goal is to bring intensivists to as many patients as possible using telemedicine.”
Dr. Gorman says her company currently works with seven hospitals including St. Clair’s Hospital in Wassau, Wis., where Advanced ICU Care monitors ICU patient’s 24-hours a day with audio and video equipment in every room. Images and all information are sent back to their operations center in St. Louis.
“We act as partners with on-site physicians,” Dr. Gorman explains. “We can provide both reactive and proactive care through our technology. For mid-size hospitals that don’t have the staff, we are a supplement to the bedside doctor.”
Dr. Gorman says this method saves lives while making it economical for the hospital. “One hospital using the Advanced ICU Care’s eICU program has seen a 69 percent plunge in cardiac arrests and a 24 percent reduction in ICU patient mortality,” Dr. Gorman says. “These outcomes lead to lower costs for hospitals and patients, while providing better care.”
Radiology is another important area where advances in technology are improving the way patient care is delivered. In fact, x-rays can be read from anywhere in the world using new digital technology.
Quick Study Radiology (QSR) is a St. Louis company working with community hospitals in outlying areas where there is often a shortage of radiologists. QSR is one of the first to use PACS technology to read x-rays from remote locations.
Quick Study Radiology (QSR) was founded by radiologist Dr. D. Skip Sallee seven years ago and today provides imaging services to 32 community hospitals, mainly in Missouri and Georgia. QSR installs a network in each hospital with monitoring done from a remote location. The company’s data center in St. Louis provides storage of digital images and all IT support. This is much more economical for small hospitals that would have to invest $3 to 4 million dollars to install this type of technology.
Russ Fortune, chief operating officer of QSR says, “New digital technology is making radiology very sophisticated today.” He continues, “We can take an image from a rural community and send it to any radiologist in the world. We can push images anywhere someone has access to the Internet.”
At SSM Health Care in St. Louis, technology is also playing an important role in improving remote patient care. Under Project Beacon, all of SSM’s hospitals are phasing in the use of digital PACS technology for MRI’s, x-rays and some cardiology procedures.
The second phase of Project Beacon is the implementation of electronic health records (EHR) and is expected to be in SSM’s St. Louis hospitals in 2008. With this new system, doctors and nurses will spend less time getting medical histories and searching for notes from previous visits. All this means less waiting and more convenience for patients.
Dr. Richard Vaughn, the medical director for Project Beacon, says, “The new EHR system will make each patient’s chart electronic and will be immediately available from any location in our system. We don’t have to fax, call or use paper and patients no longer have to carry records from one doctor to another. The electronic records follow the patients,” he says.
Dr. Vaughn says another important feature of electronic health records is the new system will automatically cross check medications against other prescribed drugs. Since drug orders will be done by computer through an online pharmacy, the new system will eliminate hand-written prescriptions that were often illegible he says.
“Project Beacon is having a big impact on improving patient care at SSM,” Dr. Vaughn says. “Doctors in different parts of our hospital system can get an image in minutes and make decisions earlier. Electronic records will be easily accessible to ER doctor’s who need to make fast decisions. All this leads to a decrease in errors and more efficiency to get patients out faster.”
Heart patients are certainly benefiting from the remote technology program at Barnes-Jewish Hospital. New technology allows cardiologists to remotely monitor heart failure patients with implanted devices who require frequent monitoring for weight, blood pressure and other vital signs. Other systems allow patients to “key in” information using a telephone that is made available to the managing physician.
For example, Gregory Ewald, MD, Washington University cardiologist at Barnes-Jewish Hospital, uses a program called “Latitude” to monitor some of his heart failure patients.
Many implantable cardioverter defibrillators (ICDs), used to shock a patient’s heart back into rhythm, also include a remote monitoring system that wirelessly sends a patient’s information to their cardiologist securely over the Internet. The physician is alerted if there is a significant change in a patient’s status.
“This clinical information is important for us because it allows us to focus on those patients who need additional attention,” says Dr. Ewald. “If the patient’s weight goes up over a couple of days, it represents water retention and a medication adjustment or office visit may be beneficial.”
Every time a patient stands on the scale and records their blood pressure, that information is beamed back to a website where Dr. Ewald and his team can access that information daily. The system also monitors the status of the device to make sure it is functioning properly. “It allows patients who live far away from the medical center to travel less frequently and it allows us to closely monitor their health,” says Dr. Ewald.
With new remote patient care technology, medical decisions now don’t have to be made in one place. By eliminating film and paper, and moving to digital and electronic formats, telemedicine saves time and lives.
