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Taking Johns Hopkins to the Patient

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Taking Johns Hopkins to the Patient

Taking Johns Hopkins to the Patient

Date: 04/01/2015

When she describes the benefits of telemedicine, nurse practitioner Wendy Batchelor recalls one factory worker who recently visited her office in the Nestlé Dreyer’s Ice Cream Products plant in Tulare, California. The woman was seeking advice about a blistery rash on her hands that had become increasingly bothersome, despite her primary care physician’s attempts to treat it. She faced an eight-month wait to see a local dermatologist who would take her insurance.

Thanks to the Johns Hopkins Medicine program at her workplace, however, the woman was able to obtain a dermatologist’s diagnosis—dyshidrotic eczema—and appropriate treatment quickly, via telemedicine.

“Instead of having the patient come to the medical center, we are in effect taking our medical center to patients across the U.S. with this model,” says Ed Bernacki, director of the Division of Occupational and Environmental Medicine and professor of medicine.

Increasing Access, Extending Reach

Batchelor is program coordinator in Johns Hopkins’ Division of Occupational and Environmental Medicine as well as the care provider at the Nestlé Dreyer plant, which is one of 56 workplaces ranging from multinationals to small manufacturers scattered across 23 states where Johns Hopkins offers on-site health care through nurse practitioners. In the past six months, the services have been augmented by teledermatology.

“Our NPs see a lot of skin problems. The wait for a dermatologist in a farm community such as Tulare can be very long,” Bernacki says. “When a patient presents with a skin lesion, for instance, the NP takes photos of it, transmits those photos to a Johns Hopkins Medicine dermatologist, gets the opinion and delivers timely care.” The NP then follows the patient, consulting again with the dermatologist if necessary.

Teledermatology will soon be piloted at Johns Hopkins Aramco Healthcare in Saudi
, says John Ulatowski, vice president and executive medical director for Johns Hopkins Medicine International and interim CEO of Johns Hopkins Aramco Healthcare. International patients will get second opinions and follow-up care via telemedicine as well.

“It’s an efficient, cost-effective way of doing certain parts of the medical evaluation that are amenable to interview, and saves the patient the cost and time of traveling when unnecessary,” says Ulatowski. He points out that televisits can be better for patients whose mobility is impaired by neurological conditions, such as Parkinson’s disease. The technology allows neurologists to evaluate patients in their regular environment, typically home.

Appropriate, High-Value Care

Paul Scheel, director of the Division of Nephrology, who heads up Johns Hopkins Medicine’s telemedicine efforts, is working with Ulatowski to ensure that all divisions of Johns Hopkins Medicine pursue telemedicine strategically.

“Telemedicine is the future, especially as it pertains to population health,” says Scheel. “When we are responsible for managing populations and decreasing costs, telemedicine can help us deliver effective, high-value care.”

Research is underway on the best ways to use the technology. Johns Hopkins is one of several institutions enrolling patients with Parkinson’s disease in a clinical trial about the effectiveness of treating their condition via telemedicine. Jointly sponsored by the Patient-Centered Outcomes Research Institute and the Parkinson’s Disease Foundation, the study randomizes patients into two groups. Those in the control group continue with their usual care, supplemented by educational materials about the disease. The patients in the experimental group continue with their usual care, supplemented with educational materials and virtual care from a Parkinson’s disease specialist. The four virtual care visits happen via Web-based video conferencing directly into the patient’s home.

Zoltan Mari, director of the Johns Hopkins Parkinson’s Disease and Movement Disorder Center, is enrolling patients for the trial. One is a pastor on the Eastern Shore who, like many patients with her condition, has trouble moving around and traveling. She also had encountered difficulty getting on his schedule. For those reasons, says Mari, she was pleased that she could enroll in the telemedicine trial.

“Via videoconferencing, I evaluated her, confirmed her disease status did not require an in-person visit and adjusted her medications. I also advised her on modifying her daily activities.”

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