Within a hospital setting, doctors are working together using bedside videoconferencing on a variety of devices to make diagnoses without actually having to be in the room. Nationally, there are more than 200 telehealth networks and more than 3,500 service sites in which hospitals and other providers use telehealth services, according to the American Telemedicine Association.
The Michigan Stroke Network (MSN) is one such collaborative network of hospitals, providing innovative stroke care across the state. Through the use of remote presence robots, the network ensures hospitals across Michigan and the surrounding region, regardless of their size, location, or resources, can offer every patient the most advanced stroke care available. MSN utilizes telepresence robots to provide stroke patients 24-hour access for consultations from neuroendovascular specialists.
Compiled by Amanda Griffith, Contributing Writer
Telemedicine is being leveraged to improve treatment times for stroke patients, and one network is taking it to the next level with remote presence robots.
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Within a hospital setting, doctors are working together using bedside videoconferencing on a variety of devices to make diagnoses without actually having to be in the room. Nationally, there are more than 200 telehealth networks and more than 3,500 service sites in which hospitals and other providers use telehealth services, according to the American Telemedicine Association.
The Michigan Stroke Network (MSN) is one such collaborative network of hospitals, providing innovative stroke care across the state. Through the use of remote presence robots, the network ensures hospitals across Michigan and the surrounding region, regardless of their size, location, or resources, can offer every patient the most advanced stroke care available. MSN utilizes telepresence robots to provide stroke patients 24-hour access for consultations from neuroendovascular specialists.
These robots reduce healthcare costs and save precious seconds in emergency situations by eliminating the time and distance barriers that have traditionally cut off hospital patients from proper care, all by combining cloud-based technology and robotics. Jack Weiner, president and CEO of St. Joseph Mercy Oakland Hospital in Pontiac, MI, discusses how his organization designed a telehealth program that reduces unnecessary admissions while ensuring patients get the care they need.
Q: Why did MSN choose to implement remote presence robots, and what have the results been?
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A: St. Joseph Mercy Oakland has had a telemedicine strategy in place since October 2006, when the hospital became a hub for the Michigan Stroke Network. Through the program, doctors in as many as 25 hospitals throughout Michigan have real-time access to stroke specialists through remote robots.
By placing the robots in rural hospitals — or those without major stroke programs — local providers have access to specialists who can provide evaluations on a real-time basis, taking hours off treatment times. Through video interface capabilities, the remote location dials a special number that is manned by an operator, who then connects a stroke specialist to the remote unit.
Stroke is the third-leading cause of death and it leads to the most disabilities, but only 2 to 8 percent of patients receive proper treatment. The technology has had a major impact on the treatment of stroke victims, who can lose countless brain cells every minute care is delayed. With an average response time of 6 minutes, our program is often faster than that of a major medical system, which may have an oncall physician in a different part of the hospital.
Q: Why did you select InTouch Health as your robotics partner, and do the robots integrate at all with your EHR and HIS platforms?
A: When we began this initiative, InTouch Health was one of the few vendors with a HIPAA-compatible communications platform that was stable in all locations, a critical factor because the last thing we wanted was the network to go down during an intervention.
The InTouch Robots (RP-7i and RP-Lite) use infrared cameras and receivers and are equipped with a camera, phone medicaldevice ports, and a stethoscope. A robot can also project the physician’s face or beam test results through its LCD screen.
Data collected gets fed right into the EMR, and we even have special research protocols running so we can contribute to worldwide literature in stroke intervention. The national average is single-digit in terms of response time compliance for intervention. Ours runs at 75 percent within prescribed time frames, far exceeding national and international standards.
Q: How does a specialist examine and diagnose a potential stroke patient using the robot?
A: A stroke specialist controls the robot and drives it right up to the patient. It can ask the attending physician to perform certain diagnostic tests on strength, mobility, and agility that the attending physician reports back. The specialist can also see the patient’s weaknesses, view facial movements, and even ask the patient to respond directly through two-way communication on the screen.
Providers on both sides of the screen can quickly engage in a pretty sophisticated protocol to determine if a stroke has occurred and, if one has, how long it has been since onset. If it’s within the defined medication administration window, the local physician can try to assist in initiating a plasma clot-busting drug. If too much time has elapsed, the remote hospital can transport the patient for more advanced stroke intervention. We also have interventionists who are on call 24/7. We strive for a 30-minute door-to-cath-lab time so that by the time a stroke patient arrives, we can begin intervening quickly.
Our biggest fear was the acceptance of a remote physician by patients, especially the older patients. Instead, we found ourselves amazed at how well people adapted to the program. As a result, the patient community has accepted it with very little resistance. As long as there’s a human interaction and someone they can relate to, they’ve overwhelmingly accepted remote presence robots as part of telemedicine initiatives.
Q: What benefits has your hospital and its patient population realized as a result of this initiative?
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A: Earlier this year, a woman in her early 50s was saved, in part due to MSN. The woman, who was home at the time, was taken by ambulance to a Metro Detroit hospital with stroke-like symptoms. The hospital, which did not have an interventional stroke program, was a participating MSN site and had a robot in their facility. Minutes after the ER physician called into the MSN network, a St. Joseph Mercy Oakland vascular neurologist was online, examining the patient face-to-face using the robot, with the assistance of the on-site ER doctor. Soon, tissue plasminogen activator (tPA) was ordered, and the patient was airlifted to St. Joseph Mercy Oakland where she underwent surgery. Today, the patient is alive and well and recovering quickly. Had it not been for the MSN infrastructure in place, the patient’s outcome could have been far worse.
Q: What advice would you share about the implementation of remote presence robots?
A: When we first launched MSN, patients and hospitals were wary of using robots and didn’t understand telemedicine. Now that they’ve seen MSN in action and experienced its benefits firsthand, they’ve embraced it as a community benefit that helps underserved patients who otherwise wouldn’t have access to an advanced specialty.
Communities often ask about challenges surrounding licensure for the doctors who answer the phone, but it’s becoming easier and easier to have a dialogue as people become aware of the capabilities of telehealth technology and as states begin to change credentialing laws to allow multistate practices and cross traditionally historical boundaries. We now can provide high-level treatment in areas we never thought possible and believe this is one of those breakthrough technology utilizations that will not only over time enhance treatment options but will start to allow standardization of care across communities, irrespective of medical manpower pool in that community.
Q: What future plans do you have for your robots?
A: Many communities have begun to use remote presence robots in the mental health fields, because there is often a shortage of mental health providers available during emergencies or after hours. Increasingly, we’re also seeing the technology used for second opinions for cardiology, urogynecology, gynecology, and minimally invasive surgery, because it allows for an intellectual dialogue and the ability to see medical records and X-rays. Use has expanded rapidly, and programs will continue to be developed that utilize remote presence robots in innovative ways.
Within a hospital setting, doctors are working together using bedside videoconferencing on a variety of devices to make diagnoses without actually having to be in the room. Nationally, there are more than 200 telehealth networks and more than 3,500 service sites in which hospitals and other providers use telehealth services, according to the American Telemedicine Association.
A: St. Joseph Mercy Oakland has had a telemedicine strategy in place since October 2006, when the hospital became a hub for the Michigan Stroke Network. Through the program, doctors in as many as 25 hospitals throughout Michigan have real-time access to stroke specialists through remote robots.
A: Earlier this year, a woman in her early 50s was saved, in part due to MSN. The woman, who was home at the time, was taken by ambulance to a Metro Detroit hospital with stroke-like symptoms. The hospital, which did not have an interventional stroke program, was a participating MSN site and had a robot in their facility. Minutes after the ER physician called into the MSN network, a St. Joseph Mercy Oakland vascular neurologist was online, examining the patient face-to-face using the robot, with the assistance of the on-site ER doctor. Soon, tissue plasminogen activator (tPA) was ordered, and the patient was airlifted to St. Joseph Mercy Oakland where she underwent surgery. Today, the patient is alive and well and recovering quickly. Had it not been for the MSN infrastructure in place, the patient’s outcome could have been far worse.
