Take the Long (Distance) View
Date: March 1, 2013
Johns Hopkins neurologist Ray Dorsey gained an unusual degree of insight into the life of patient Mark Matulaitis during a recent consultation. With the help of a laptop, the physician sat in a conference room in Green Spring Station while his patient, diagnosed with Parkinson’s disease in 2011, spoke into his own computer screen from his living room in Salisbury, Md.
“Can I see you walk a little bit?” asked Dorsey, who directs the Division of Movement Disorders as well as neurology telemedicine. Matulaitis paced. He also shared his concerns about depression and said he was determined to follow Dorsey’s advice to stick with yoga, even though he found it awkward. At one point, the 57-year-old patient stepped away from his computer screen to collect his bottles of pills so he could tell Dorsey the precise dosages.
The consultation between doctor and patient, conducted through a teleconferencing system from New Jersey-based Vidyo, took 20 minutes. This arrangement saves Matulaitis a five-hour round-trip drive and gives Dorsey a glimpse of his patient’s home life. The technology allows Dorsey to see five patients each Wednesday afternoon, the time he devotes to his telehealth appointments. Tele-consultations often result in better relationships, he says, because patients are more comfortable at home and better able to keep appointments.
Until recently, telehealth at Johns Hopkins Medicine developed in a piecemeal fashion through individual departments. The new Office of Telehealth and Interactive Learning (OTIL) signals a more unified approach. Its telemedicine operations group, formed last summer, includes legal and billing experts who hash out such nuts and bolts issues as liability, credentialing and billing.
“We now have a central resource that can be very helpful to physicians,” says William Baumgartner, vice dean for clinical affairs at the Johns Hopkins University School of Medicine.
Baumgartner says the rapid expansion of Johns Hopkins’ own health system makes the technology more appealing. So do federal laws that reward hospital accountability by encouraging collaboration and cost efficiencies. And in Maryland, a new law mandates private-payer coverage of telehealth services.
Telehealth at Johns Hopkins serves several purposes. Clinical programs like Dorsey’s provide direct care to patients. Distance education allows physicians at affiliated hospitals, such as Johns Hopkins Bayview Medical Center in Baltimore and All Children’s Hospital in St. Petersburg, Fla., to participate in Grand Rounds. The technology can also improve administrative communication by including groups from other hospitals in meetings.
Alex Nason, program director, estimates that a dozen telehealth projects are under way or in pilot stages. One, developed by Neeraj Naval, director of the Neurosciences Critical Care Unit at Johns Hopkins Bayview, provides crucial coverage, especially during overnight hours, when there is less staff.
The system is used for assessing new overnight Neuro-ICU patients, and when an inpatient’s condition turns for the worse. Using a two-way audio and two-way video, Naval can speak to the on-call residents and nurses and assess the patient for signs of neurological deterioration, such as seizures and changes in pupil reaction. He can also review a continuous EEG monitor and prescribe the correct level of medication for a patient in an induced coma.
Naval uses the system each night, to “go over the plan for each patient, which includes the first diagnostic and therapeutic response if the patient [crashes]. The result is optimal and expeditious remote management of critically ill patients” and fewer middle-of-the-night physician visits to Bayview.
Naval started the program in trial about 15 months ago, working with Nason to find the telesystem that best met the needs of his Neuro-ICU patients. The first system lacked a high-definition camera, so it was impossible to get a close look at the patients’ pupils. The second required camera manipulation by an on-site nurse who might also need to attend to patient problems. The chosen system, called MedVision, allows Naval to remotely move the camera.
Dorsey, who came to Johns Hopkins three years ago, became interested in telemedicine at the University of Rochester, where he developed a telehealth program to serve Parkinson’s patients in far-flung nursing homes. And, with the help of a recently awarded $50,000 Verizon Foundation grant, the neurologist is taking his Parkinson telemedicine clinic global, providing free consultations in 11 countries to patients who need only a computer and high-speed Internet. Soon, he adds, smartphones will provide even greater access.