Not Just the ICU
Of course, telemedicine is not limited to the ICU. It is being used for virtually every medical specialty to help provide greater access to care.
Take the University of Texas Medical Branch at Galveston (UTMB), which has used telemedicine technologies since 1994. Its Electronic Health Network (EHN) utilizes telemedicine to help care for the state’s indigent and rural populations, as well as other groups, such as the elderly, prisoners, and even researchers in Antarctica.
One of the fastest-growing services UTMB operates is the telemedicine-based corporate healthcare programs, allowing employees to “see” a primary care physician without leaving work. Companies see this as a way to help control healthcare costs and make preventive care more accessible, notes Glenn Hammack, OD, assistant vice president and executive director of the UTMB Electronic Health Network. He also pegs the application of telemedicine to psychiatry as another growing service and one that illustrates how the technology is being used to help address a shortage of providers, especially in rural and underserved parts of Texas. Like the eICU programs designed to bring scarce intensivist care to ICU patients, UTMB’s services help distribute rare resources, such as child and adolescent psychiatrists who speak Spanish, to patients.
The telemedicine program at UMTB began in 1994 as a way to help provide cost-effective healthcare for inmates in the Texas prison system. Today, the Correctional Managed Care (CMC) department has telemedicine stations in 120 correctional units throughout Texas and accounts for about half of UTMB’s telemedicine program.
The 11 telemedicine studios at UTMB used for patients across the EHN are equipped with live interactive video links that allow the telemedicine physician to see and hear the patient, located at the remote station with a registered health professional on-site. Digital stethoscopes, hand-held cameras, and other electronic medical devices help the physician treat patients. The telemedicine program also utilizes shared electronic medical records, which are critical to its success, says Dr. Hammack.
Telemedicine can also be used between departments within the hospital. Dr. Hammack notes that hospitals have become large and complicated; the journey from one end to another for a test or procedure can be difficult on patients. “Telemedicine offers the ability for face-to-face interaction, and when used within hospital departments, it can bring some humanity of scale back to the increasingly complicated hospital environment,” he says.
Another Vision
Troy Sybert, MD, medical director for CMC Hospital Medicine and a practicing hospitalist at Texas Department of Criminal Justice (TDCJ) Hospital in Galveston, Texas, was hired a year ago to help create a hospitalist program within the prison system. His is the only health facility dedicated to prisoners and located on a medical school campus.
While his six-member team is not engaged in telemedicine, he sees a number of possibilities for CMC hospitalists to utilize telemedicine technology. For one, hospitalists could use their expertise in admissions to help triage patients via telemedicine. The CMC recently created a network of regional hubs similar to ED observation centers but without a 24/7 physician presence. Telemedicine triage could help the system offload the decision to admit and would likely reduce the number of hospital admissions, says Dr. Sybert.
Telemedicine technology could also provide other possibilities in perioperative care for surgery patients at TDCJ Hospital. In partnership with the surgery and anesthesia departments, pre- and post-operative work up and care could be done remotely with the patient back in the unit, promoting shorter lengths of stay and reducing transportation needs. The hospitalists, trained in correctional care, would provide support and coordinate with surgery—especially on the patient’s transition to and from the prison facility.