What’s In Your Doctor’s Medical Bag?

Smartphones, computers, and tablets are as essential as the stethoscope for physicians delivering everyday health care as the popularity of telemedicine increases.


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Tablets, smartphones, and telemedicine let patients and physicians communicate in real time.

Photo courtesy of Kaiser Permanente

One afternoon, Robby Taunton stood in the break room at work. A colleague asked how he was doing, but when Taunton replied, his speech sounded garbled. He felt sweaty and weak. The right side of his face drooped, and soon his right side went limp. As Taunton was transported to Kaiser Permanente’s Richmond Medical Center, paramedics thought he was having a stroke.

Surrounded by a doctor and nurses in the emergency room, Taunton, 27, also could see and hear a neurologist on the screen of a telemedicine cart. The cart is a mobile medical station that enables a patient and doctor in different locations to communicate via teleconference.

“It was a little bizarre, but it was also reassuring to have the neurologist, with his expertise, dealing with me straight away,” Taunton said.

The next step was a CAT scan, a special X-ray that takes multiple images from different angles. “They wheeled the cart into the CT suite, so basically the neurologist was there with me, too,” Taunton said.

The neurologist reviewed the scan with the ER doctor, confirmed the stroke, and 15 minutes after arriving, Taunton was receiving the clot-busting drug tPA, or tissue plasminogen activator.

“Stroke treatment is very time sensitive,” said Dr. Jeffrey Klingman, chair of the neurology chiefs for The Permanente Medical Group. “The faster you break up or remove the clot and restore blood flow, the better the outcome.”

Klingman realized that the key to faster treatment was to involve a neurologist as early as possible. However, neurologists are often not on site in smaller community hospitals. In January, Kaiser launched a telestroke program including neurologists who participate remotely via the telemedicine cart.

Since the program was rolled out in 21 of Kaiser’s Northern California hospitals, 82 percent of the stroke patients indicated for tPA received the lifesaving drug within 45 minutes of arriving at the ER and a third had substantially improved outcomes, even returning to fully normal function. Taunton, who also had surgical intervention, recovered completely.

Telemedicine—in which patients and their doctors meet remotely and health care is delivered via smartphone, computer, or tablet—is increasingly common. And telemedicine is not just for emergencies. The smartphone has become as essential as the stethoscope for primary-care physicians and specialists for delivering everyday health care.

Dermatology, a very visual specialty, for instance, has been quick to embrace telemedicine. Dr. Renee Howard, director of the pediatric dermatology service on the UCSF Benioff Children’s Hospital Oakland campus, said she uses her smartphone with two-thirds of the patients she sees. The high-resolution camera provides a great way to document and track the progress of many skin problems, like how a mole changes or a rash resolves. The information can be uploaded directly into the patient’s electronic medical record.

Telemedicine can be a doctor-to-doctor conversation, too. Howard, also a professor of dermatology at UCSF School of Medicine, often gets images sent to her via email and text, up to six times a day, from primary-care physicians asking her to consult.

For the past year and half, Kaiser patients in Northern California have had the choice to visit their physician by phone, video, or in-person. In fact, over the past year at Kaiser Permanente, virtual encounters, including messaging via email and telephone and video visits, have exceeded in-person visits.

Dr. Kate Land, who has an outpatient pediatric practice in Vacaville, said her patients are increasingly choosing the video option. “Video visits work really well for conversations with parents about behavioral issues, like how to handle toilet training, picky eaters, and sleep disturbances,” Land said. Video also works well, she said, when she needs to see the patient but not necessarily touch them. Land can handle a host of problems—scrapes, bug bites, headaches, constipation, hay fever, allergies, and acne follow up—by video and phone. What Land especially likes about video visits, she said, is the chance to meet with her patients in their homes. “Recently, I did a video visit with a young teen, who I have treated since she was a baby. As the visit ended, she said, ‘Do you want to see my new puppy?’ I got to spend time chatting with my patient and her mom and watch them pet this puppy. It was a great way to end a work day.”

 

Published online on Nov. 9, 2016 at 8:00 a.m.

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