Telemedicine Brings the House Call Back!Sep 24, 2013
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Interviewer: We're talking with Dr. Jeffrey Saffle about telemedicine. My first assumption is telemedicine, it sounds like medicine done by the telephone. Am I right or am I wrong?
Dr. Jeffrey Saffle: Well, you're certainly right, but telemedicine includes a lot more than that. Patients use Internet for a host of medical questions, and we're seeing more and more real time video using programs like Skype or FaceTime as a way for patients to communicate with their physicians without having to be inconvenienced by travel, the expenses associated with that, and the time losses that are associated with it as well.
Interviewer: It sounds like originally telemedicine was for different doctors to collaborate with each other, look at X-rays if their physical locations were completely different, but now you're seeing more applications where you could do diagnosis over video. Could you give me an example of that?
Dr. Jeffrey Saffle: Absolutely. Two examples that are very well developed here at the University of Utah are the burn program where we routinely connect to patients in a five state area both for acute evaluation of burn injuries and for follow up clinical care. We now perform about 300 telemedicine visits a year with patients all over the Intermountain West, many of whom live so far away they would never be able to come down here for clinic.
Another very successful program is our telestroke program which is now located at 16 hospitals throughout the Intermountain area. When a patient comes in with an acute stroke the length of time that it takes to arrive at a diagnosis and institute treatment is absolutely critical. The more time that is lost the more brain matter is likely destroyed by the stroke.
Our team of very specialized, very well trained vascular neurologists can evaluate a patient on video, look at appropriate CT scans, make a diagnosis, and make recommendations about the institution of treatment usually within about an hour's time. In the past a patient from a remote hospital might have to travel to Salt Lake City before they get any of this diagnostic information. That can be two or three hours of travel time. By the time we figure out that the patient has had a stroke we've lost the opportunity to institute some of this very effective treatment in an early manner.
Interviewer: Is this exciting to you?
Dr. Jeffrey Saffle: It's tremendously exciting. I believe the surface of telemedicine has barely been scratched. Because it is so cost effective, because patients seem to like it so much, and because of the shortage of physicians in almost every specialty in our region I think we're going to see telemedicine used for almost everything, and it's going to become routine, I think, for patients to expect to connect to their doctor and talk to their doctor, or a physician extender, or a nurse from the comfort of their home for most of their regular routine clinical needs.
Interviewer: Tell me about the study.
Dr. Jeffrey Saffle: I just reviewed a study from the Stanford V.A. in which over 140 patients who had had routine surgical procedures, mostly gallbladder removals or hernia operations, were sent home to their hometowns.
Instead of having to return to the V.A. medical center after two weeks for a follow-up clinic appointment, which in many cases is only a five minute appointment even though the patient might have to travel for four hours to get there, the patients were simply interviewed over the telephone by a nurse practitioner following a very carefully scripted set of questions and answers. If any problems were discovered during that interview the patient, of course, had to come to the hospital to be evaluated, but in the vast majority of cases no problems were discovered, as expected.
The patients were able to stay home. They didn't have the inconvenience and the expense associated with travel time. And, the clinic at the hospital had more time to see new patients, because the clinic wasn't filled up with these routine postoperative visits.
The patients expressed a very high degree of satisfaction, and I think it's very clear that young people today really are used to communicating both with each other and with other people by video, by telephone in a very routine way. That's one of the reasons why I think this is going to be so widely accepted by consumers and driven by patients.
Interviewer: As a consumer, is there anything I can do to speed this process up, or is it just going to organically happen?
Dr. Jeffrey Saffle: I think it will organically happen in many places. But, one of the biggest challenges we faced is trying to change the culture of medical practice and get many of our practitioners to understand that telemedicine is not second class care, it is not viewed that way by patients, and while there are obviously limits to its application we haven't even begun to scratch the surface of all of the different ways that it can be used.
As a consumer, what you can do when you have a routine follow-up appointment or a visit with a physician for a particular problem is ask if this can be done by telemedicine, if there's some way that you could connect to the physician by video or even by telephone to get some of this routine care delivered. I think some doctors haven't really thought about it, and I think if it's requested by their patients they'll be much more likely to adopt it and much quicker to adopt it.
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