Dr. Patrick Brophy’s young kidney patient lived eight hours away in a neighboring state. Each month her parents would dutifully pack the car and hit the road for her regular checkup at the University of Iowa Children’s Hospital — an arduous trek that required missing three days of work and school.
Then one day Brophy’s team had an idea. They received permission to conduct a study in which they would examine the patient at her home via Skype. Team members gathered monthly in the hospital’s dialysis unit to connect electronically with the family and discuss any issues the young lady might be having, recalls Brophy, director of the hospital’s pediatric nephrology, renal transplant, and dialysis center.
By Neal Learner, Contributing Writer
Telehealth is no longer just a buzzword — it is fast becoming a viable treatment option and, in some cases, a savior for the patient population that it serves.
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Dr. Patrick Brophy’s young kidney patient lived eight hours away in a neighboring state. Each month her parents would dutifully pack the car and hit the road for her regular checkup at the University of Iowa Children’s Hospital — an arduous trek that required missing three days of work and school.
Then one day Brophy’s team had an idea. They received permission to conduct a study in which they would examine the patient at her home via Skype. Team members gathered monthly in the hospital’s dialysis unit to connect electronically with the family and discuss any issues the young lady might be having, recalls Brophy, director of the hospital’s pediatric nephrology, renal transplant, and dialysis center.
“Our dialysis technicians were there, along with our dietitians, nurses, and so forth,” he says. “We could actually watch the family set up their dialysis equipment. It dawned on us afterwards that we were not able to get this kind of information when they came here to our hospital. They might be able to demonstrate how they set it up, but it’s not the same as when they’re doing it at home.”
The study’s outcome? In one year, the family saved more than $5,000 in travel expenses alone, Brophy says. “That doesn’t take into account missed school, missed work, and all of those other things. And the best part was that she never got admitted to the hospital the entire time. She’s gone on subsequently to have a successful transplant, and we’re very pleased it worked out.”
Telemedicine Has A Long History, But Still Has A Long Way To Go
Remote healthcare, of course, is nothing new, but the advent of advanced wireless technology networks has pushed the concept to new levels. Recognizing the market potential of this innovation are many large technology companies, including Apple, AT&T, and Honeywell. Other new players dedicated solely to providing remote care include Teladocs and TapCloud.
All these companies are attracted to the technology’s promise of greater convenience for patients and better management of resources for providers. But despite the near ubiquity of connected technologies — and the ease with which consumers already engage with online professional services that previously required face-to-face meetings (e.g., banking) — the use of telemedicine in healthcare still lags far behind traditional doctor’s office visits. Several factors appear to be holding back market penetration including federal and state regulations prohibiting reimbursements for remote visits, a reluctance on the part of physicians who are invested in traditional methods of practice, and patients themselves who haven’t fully embraced the idea of self-care.
Kidney Transplant Centers Can Serve As Telemedicine Model
But that’s not to say pressure for telemedicine isn’t mounting. The model may be particularly well-suited for transplant patients, who receive ongoing care from specialized providers often located far from the patients’ homes.
Transplantation is a chronic condition, notes Kenneth A. Newell, M.D., Ph.D., professor of surgery and vice chair for faculty affairs at Atlanta’s Emory University School of Medicine. “The graft is always there, the immunosuppressant is always there,” he says.
“We do see our patients frequently; there are changes that can occur quite rapidly. If we were seeing people once or twice a year, it wouldn’t be as big a deal. It’s the more often you see people the more disruptive it becomes to life.”
Such life disruptions are particularly evident in rural states such as Georgia, which has only three transplant programs with two of them in Atlanta, Newell explains. Emory draws patients from southern Tennessee, South Carolina, parts of North Carolina, as well as downstate parts of Georgia. Patients sometimes come from five or six hours away.
“I remember one woman who lived in Savannah — that’s about a four-hour drive — she had an appointment at 8 a.m. Monday morning,” he recalls. “So her daughter took the day off Monday, and they came up Sunday night. They got a hotel room to see me at 8 a.m. Monday morning. That’s difficult for both the daughter and the patient.”
Sudha Tata, M.D., a transplant nephrologist at the Emory Transplant Center, says many patients she sees don’t want to come all the way to Atlanta for the visit, especially posttransplant patients who are doing well, she says. “The drive to Atlanta is long with delays in traffic,” she admits of driving into the city.
Aiming to address the concern, Emory adopted a telehealth program in 2008 that allows Tata and her colleagues to visit patients at partnering health facilities throughout the state and region.
The telehealth site at Emory is set up with a camera and a monitor, along with a mobile stethoscope at the participating facility, Tata explains. “Everything can be done like a typical visit, except we are not doing a complete physical exam (palpation) for the patient,” she says. “We can see patients and family members very well with the current technology. In fact, to examine the skin or oral cavity, the camera can focus very well. The auscultation is set up well with the telestethoscope.”
Tata says she uses the telehealth program for routine annual posttransplant visits. She also finds it very useful for pretransplant visits. Such consultations, which include Tata, a pretransplant coordinator, social worker, and dietitian, can last up to three hours and include intensive discussions with the patient. Sometimes the meeting ends with the patient realizing that they are not interested in a transplant or they are not the right candidate.
Either way, it saves an extra visit to come all the way to Emory, Tata says. “Once we find out they are interested and they meet the criteria for transplant, we then bring them over to Emory where they visit the center and meet the other team members.”
Growing Patient Population, Growing Costs
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While convenience is a huge factor, so too is the ability to manage a growing number of kidney patients and potentially lower costs. Roughly 26 million adults in the U.S. have kidney disease, and most don’t know it, according to the National Kidney Foundation. Roughly 450,000 Americans are on dialysis, and another 185,000 live with a functioning kidney transplant. Of more than 123,000 Americans currently on the waiting list for a lifesaving organ transplant, over 101,000 need a kidney, the Foundation notes, but fewer than 17,000 people receive one each year. Furthermore, Medicare alone spends roughly $30 billion a year on dialysis.
Allowing transplant recipients to communicate their health status directly to the care teams via mobile technology allows providers to shift always scarce resources away from patients who are doing well and devote more time on patients in greater need. Brophy sees firsthand how telemedicine technology can refocus valuable resources in the pediatric kidney transplant patient population. One coordinator alone may oversee 100 transplant patients, he explains. “They’re checking on those patients pretty regularly — checking on labs, etc. — and most of those folks are actually doing fine,” he says. “You may have 10 who are really at risk.”
With a mobile testing or home-based monitoring system in place, along with the ability to do a rapid virtual visit with those patients just to see how they’re doing, the coordinator can spend more time on high-risk patients to help keep them out of the hospital and as healthy as possible. This approach has been validated by the University of Iowa’s telemedicine program that targeted high-risk diabetes patients.
Dr. Patrick Brophy’s young kidney patient lived eight hours away in a neighboring state. Each month her parents would dutifully pack the car and hit the road for her regular checkup at the University of Iowa Children’s Hospital — an arduous trek that required missing three days of work and school.
While convenience is a huge factor, so too is the ability to manage a growing number of kidney patients and potentially lower costs. Roughly 26 million adults in the U.S. have kidney disease, and most don’t know it, according to the National Kidney Foundation. Roughly 450,000 Americans are on dialysis, and another 185,000 live with a functioning kidney transplant. Of more than 123,000 Americans currently on the waiting list for a lifesaving organ transplant, over 101,000 need a kidney, the Foundation notes, but fewer than 17,000 people receive one each year. Furthermore, Medicare alone spends roughly $30 billion a year on dialysis.
