Telemedicine – - what is it?
(And why should we care?)
By: Dr. Jonathan Wood
Telemedicine means different things to different people. We now share x-ray pictures and EEG tracings over long distances, lab values can routinely be reviewed from afar, and for many of us, our patients entire medical record is now “in the cloud”, securely available digitally to caretakers who need to see it. From anywhere! For some people, this is telemedicine. But for me, telemedicine is something much more than that.
Telemedicine is more than simply viewing data. It is harnessing our increased capacity to share digital information so we can see patients in real time through a video connection and participate in their management in real time. When I started using telemedicine at EMMC 8 years ago, patients were a little confused and amazed. Now, with the advent of services like Facebook and Skype available and familiar to the public, it is pretty “ho hum.” In fact, before long, I think it will be expected.
We have been using video connections in Maine for years to see patients for scheduled health-related visits. EMMC has added to this by developing an “E-ICU” program to support rural ICUs in the care of their patients through video connections. And now, with the public internet as ubiquitous and robust as it has become, we can use telemedicine to quickly address urgent unscheduled medical needs.
Over the past 8 years, through an internal commitment to this process and with much support from external grant funding, , Eastern Maine Medical Center has put together a program that allows virtually immediate access to specialty care by Emergency Departments on a moment’s notice. Almost every rural ED in central, eastern, and northern Maine has at least one telemedicine camera+screen that will allow an immediate connection with pediatric intensive care doctors, trauma surgeons, and stroke neurologists at EMMC. These machines are easy to use and we have multiple ways to see the patients from this end. The pediatric intensive care physicians even have telemedicine units in their homes that allow them to use high definition video 24/7 to see these patients and providers.
So when is an urgent unscheduled telemedicine encounter the most useful?
· Infrequent patient types (e.g. children)
· Infrequent diseases (e.g. pediatric critical illness; severe trauma)
· Need for immediate and accurate intervention (e.g. stroke)
· Need to identify the most suitable mode of transport? (e.g. ambulance vs. helicopter; regular ambulance crew vs. critical care team)
Rural emergency departments are essential to their communities. But it is impractical and impossible to maintain a staff with vast experience in all sorts of patients and illnesses. Regional tertiary care hospitals (e.g. EMMC) exist in part to provide this support to the surrounding communities and telemedicine has the capacity to facilitate this support dramatically. Invariably, geographical areas like ours (e.g. western Canadian provinces; large western states) are the places where this is pioneered and Maine is no exception. We should be proud!
It is fortunate we have this capability for our region. Visit your local emergency departments and congratulate them on participating in such a vital endeavor. The more we use it, the better we will become at it. And in the end, our communities will be better for it.