Virtual House Calls for Parkinson's Disease
Date: January 1, 2013
The grainy YouTube video shows two panels. On the left, an elderly man in a wheelchair alternates between touching an assistant’s hand and his own nose. On the right, a doctor watches the patient from his own computer, nearly 150 miles away. “Good,” says the physician. ”Now try the right hand.”
The doctor is Ray Dorsey, the new director for the Johns Hopkins Movement Disorders Center. And the video? That’s Dorsey showing what telemedicine can do for patients with Parkinson’s disease.
The patient in the video is one of between 400,000 and 500,000 people in the United States who have this condition—a number that’s expected to grow by about 80 percent by 2030 as the population ages. Though most doctors see patients like this one in person in clinics across the country, Dorsey says, the tremors and difficulty in walking that characterize Parkinson’s disease can make such visits inconvenient at best and harrowing at worst.
Before he joined the Johns Hopkins neurology team in August, Dorsey saw patients at the University of Rochester Medical Center. There, he treated patients from a nursing home located about 150 miles away. For these patients, coming into the clinic could be an all-day adventure, requiring loading their wheelchairs into a van and driving for hours, sometimes in the snow. Dorsey and his colleague Kevin Biglan decided that there must be a better way.
In a pilot study, the doctors sent inexpensive webcams and video conferencing software—similar to Skype, but encrypted for patients’ privacy—to the nursing home. On a regular basis, they would fire up their laptops, connecting virtually to their patients in the nursing home. The visits happened whenever it was convenient for their patients—even when Dorsey was thousands of miles and several time zones away at a meeting in California.
From the comfort of his office, home or hotel room, and with patients in the familiar surroundings of the nursing home, Dorsey would guide them through the simple movement tests involved in physical exams for Parkinson’s disease patients: touching their noses, tapping their thumbs and middle fingers together, stomping their feet. Based on what he saw on his computer screen, Dorsey could evaluate each patient’s condition and decide whether he or she needed an adjustment in the dosage of levodopa, the medication used most often to treat Parkinson’s.
“Rather than making patients spend the majority of their time just trying to come to an appointment,” Dorsey says, “we could devote that time to actually delivering care.”
The telemedicine model that he conceived is much more patient-centered than the current, in-person method for treating Parkinson’s patients, Dorsey says: There’s no waiting, no checking in or checking out. This method is also extremely cost-effective. The webcam that he used in the nursing home study costs just $25, and the videoconferencing software costs about $150.
“People are spending more than that just on transportation costs on a single visit,” Dorsey explains. “This is the same technology that grandma is using to communicate with her grandchildren. Why not use it to deliver care?”
Now that Dorsey is at Johns Hopkins, he’s working to bring telemedicine here as well and to eventually expand its reach to other conditions and other states. He recently began offering free consultations to patients in every state he’s licensed to practice in—Maryland, California, Delaware, Florida, and New York—an effort partially funded by a grant from the Verizon Foundation. Patients in these states can request a free one-time evaluation simply by calling 855-237-7446.
Dorsey says he’d like to expand these services even farther. However, several kinks still need to be worked out. Most insurance plans don’t cover telemedicine visits, and physicians must be licensed in every state where they see patients—even if “seeing” means through remote video.
Those hurdles are surmountable, Dorsey says. States and private insurers are increasingly reimbursing for different forms of telemedicine, and federal legislation has been proposed that would address many of the licensure issues.
“I’m doing house calls like doctors would have a generation or two ago—just in a different way,” Dorsey says. “Although I don’t physically touch patients, this kind of care really touches their lives.”
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