— Concerned about a growth on his face, Mt. Lebanon, Pa.,
resident, Robert Johnston could have made an appointment with
the dermatologist already treating him for other reasons.
he snapped photos of himself and the affected area, uploaded
them to the doctor’s website and waited.
got feedback from him the same day. It was probably within
three, four hours," Johnston, 52, who required follow-up
care at the doctor’s office, said.
the promise of telemedicine, the use of technology to connect
patients and health care providers who may be miles or even
half a world apart. The growing trend is touted as a way to
increase access to medical care, especially among patients in
remote areas, and to bring efficiency to an overburdened
health care system.
said Robert McCaughan, vice president for pre-hospital care
services at Allegheny Health Network, one more way to improve
care. It already is being used in dozens of specialties and,
at least in the Pittsburgh area, on the front lines of
this year helped to establish what the network is billing as
the state’s first pre-hospital telemedicine initiative.
paramedics answered a June 30 diabetic emergency call in
Leechburg, Pa., they brought a doctor with them. So to speak.
assessing 59-year-old Barbara Verdu’s condition, paramedics
used an iPad to set up an on-the-spot video consultation with
an emergency department physician at Allegheny Valley
Hospital, in Natrona Heights, Pa. In the end, patient and
caregivers agreed that Verdu had no need for a hospital visit,
a decision that saved her time and money, put the paramedics
back in service for other calls and helped to prevent
overcrowding in the hospital emergency department.
an interesting experience, said Verdu, who had called 911
after waking up with low blood sugar. "I was just so
nervous because it wasn’t going up," she said.
number of telemedicine services is increasing around the
country, and research supporting the initiatives is growing,
too. In July, for example, the journal General Hospital
Psychiatry published a University of Pittsburgh School of
Medicine study showing that telephone follow-up helped
patients manage symptoms of depression — and reduce medical
costs — following coronary artery bypass graft surgery.
telemedicine market includes not only services provided by
local health care organizations such as Allegheny Health
Network and UPMC but those offered by out-of-state,
investor-backed networks, such as 12-year-old, Texas-based
Teladoc and six-year-old Florida-based MDLIVE.
the concept may sound new to patients, telemedicine originated
with doctor-to-doctor telephone consultations and has been
evolving for at least 25 years, said Natasa Sokolovich,
executive director of telemedicine for UPMC.
been around for longer than I think most people realize,"
Sokolovich said. A shortage of psychiatrists helped give
telemedicine a boost in the early 2000s, she said.
advances — some that have improved diagnostics and others
that have ensured the confidentiality of patient communication
— also have fueled the surge.
insurance hasn’t yet caught up with the technology. In some
cases, patients have to pay out of pocket for telemedicine,
though the fees may be no more than the co-pay for an office
November, UPMC established AnywhereCare, offering
around-the-clock consultation on common ailments. Patients log
on to a website, answer a series of questions and usually get
a diagnosis and treatment plan from a nurse practitioner,
physician assistant or physician within 30 minutes.
follow-up questions are necessary, Sokolovich said, patient
and practitioner may communicate by phone, email or a video
conferencing capability built into the website. So far, the
service has had more than 2,100 patient visits.
UPMC initiative connects patients and healthcare providers at
community hospitals and outpatient centers with the system’s
Pittsburgh-based specialists. In all, more than 30 specialties
and subspecialties, including endocrinology and surgical
follow-up, are included in the program.
in care, the specialist can examine the patient via cameras,
digital stethoscopes and other devices operated by
counterparts at the community hospital or outpatient center.
patient truly has a visit that is comparable to what they
would have had in person with that specialist,"
addition to the pre-hospital program, Allegheny Health Network
this year allocated funds for a "telemedicine lab"
at Tyrone Hospital to enhance access to network specialists
and partnered with DermatologistOnCall, the service started by
Johnston’s doctor, Mark Seraly.
Varghese, a network dermatologist, said DermatologistOnCall
benefits patients who may have to travel long distances for an
appointment (some of his come from Erie) or those who don’t
want to wait for an office visit.
you try to make an appointment with a dermatologist, usually,
on average, you’re talking a six-month wait," he said.
STORY CAN END HERE)
knows no borders. Last month, the journal Telemedicine and
e-Health published a Children’s Hospital of Pittsburgh of
UPMC study showing that doctors in Colombia and Mexico were
pleased with help they received via video consultations with
Children’s cardiac specialists.
July 2011 to June 2013, doctors at Children’s consulted with
counterparts in the two countries 1,040 times on 476 patients.
Nearly 25 percent of the time, the consultations took place
while the patients were undergoing procedures such as
Munoz, the study’s lead author and chief of cardiac
intensive care at Children’s, said the study and three years
of consultations had addressed important questions.
international telemedicine technically feasible? "The
answer is yes," Dr. Munoz, who is also the hospital’s
global business and telemedicine director, said. "Have we
changed the practice there? The answer is probably yes."
Munoz and Alejandro Lopez, a pediatric cardiologist in the
cardiac intensive care unit and the telemedicine program, said
they’d like to expand the program to other countries because
of the global shortage of pediatric cardiac specialists.
is actually almost like being there," Dr. Lopez said of
technology is so good, Dr. Munoz said, that thousands of miles
are reduced to "centimeters of distance."