The Evolution Of Telemedicine

By Laura Guy, OhmniLabs

Early into the pandemic, Dr. Jonathan Wirjo became the only psychiatrist to conduct in-person rounds with known COVID-19 patients at his Las Vegas facilities. But the steadily increasing patient load soon made it difficult for him to service all sites without support. While his clinics had already switched to 100% telemedicine, hospitals within his practice posed a different challenge. 

When one of his colleagues contracted COVID-19, resulting in a 15% decrease in manpower for his team, Dr. Wirjo started to prepare for the worst. What if one-third of his doctors fell ill? How could Dr. Wirjo provide the highest level of psychiatric care with a dwindling team while avoiding increased reliance on the overworked nursing staff? 

Psychiatry Expert Focused On Process Improvement

Dr. Wirjo is unlike many physicians. Before medical school, he worked as a healthcare consultant for Kaiser Permanente, one of the country’s largest integrated health systems. Dr. Wirjo’s experience enables him to easily identify and develop solutions to improve the quality and accessibility of health care services within his own practice. 

A founding member of Focus Mental Health Solutions, the largest physician-based psychiatric medical group in Southern Nevada, Dr. Wirjo’s 23-member group provides psychiatric care in a variety of settings including acute medical hospitals such as Mountain View Hospital, Southern Hills Hospital and Medical Center, and Sunrise Hospital. Services include outpatient mental health, inpatient hospital services, and emergency room evaluations.

Seeking Solutions

Dr. Wirjo had no previous experience with telepresence. But he knew he needed to find a novel solution quickly. While telepsychiatry is nothing new, many of his patients now lacked the ability to hold an iPad for an extended time and the additional burden it would place on an already busy hospital staff wasn't practical. Plus, he had experimented with Zoom and was “underwhelmed” by the experience.

Luckily, his online search introduced him to Ohmni. The pricing was “refreshingly reasonable” and it looked like the least burdensome option for the nursing staff. They wouldn’t have to hold it in place like an iPad or wheel it into and out of each room. That mobility sets Ohmni apart. 

Dr. Wirjo can sit at the nursing station of each floor, visit patients on the entire floor if needed, disinfecting the robot himself between each room. Currently, he sends Ohmni into the room for any patient with respiratory symptoms in addition to those already diagnosed with COVID-19. “I tell every patient if they don’t like the robot, they can just kick it out.” To his delight, patient reactions to the robot, named “Obi”, have been overwhelmingly positive. For most, even seeing someone through the Ohmni Robot maintains a sense of connection with the world outside of the hospital room.  

Skilled Nursing With Ohmni

At a local skilled nursing facility – a “COVID-19 hotspot” – Ohmni helped keep Dr. Wirjo’s colleagues and medical students safe from patients with psychiatric and behavioral issues. Patients with dementia or schizophrenia may not understand the importance of COVID preventative measures such as keeping a 6-foot distance. They tend to wander around, touch others, and can easily spit or cough on others. 

Upon an initial coronavirus outbreak, Dr. Wirjo assigned one of his residents to sit in the facility’s administrative office and provide consultations using Ohmni. 

“You can’t really know who has COVID because everyone is mingling so much,” Dr. Wirjo says. 

Typically, in a skilled nursing facility, about one-third of the patients have ongoing psychiatric management. With Ohmni, the resident can minimize his exposure by seeing all patients using the robot. 

Medical Education And Other Healthcare Uses

From the standpoint of graduate medical education (GME), resident physicians can log into Ohmni first thing in the morning, or after overnight call at a hospital across town. When the attending arrives at the hospital, they can lay eyes on the patient and verify any resident physician findings. This is another way the practice can improve their coverage and response time -- by having a presence in a remote location where physicians may not be present.

Other potential uses for Ohmni include case management services, social services, and disposition planning. Because none of these services require touching a patient, providers can do everything remotely. 

Translation services is another field. Some patients can’t physically hold a phone or manipulate an iPad. These are the patients that need interaction the most because they are at the most vulnerable stage of their treatment.

Piloting Virtual Visits

Dr. Wirjo hopes to launch a program at Southern Hills Hospital where families can virtually visit their critically ill loved ones through Ohmni. 

Because Ohmni can maneuver itself, the hospital does not need to rely on staff to facilitate these visits. Severely debilitated or incapacitated patients who cannot hold an iPhone and FaceTime with their loved ones -- or who are delirious and can’t maintain concentration on a screen -- will be able to interact with their families via Ohmni. 

Dr. Wirjo observed that when many of his intubated or completely incapacitated patients wake up, they recall words of encouragement from a nurse or other caregiver that may have made a difference in their recovery. 

Imagine if that were your loved one. Even if you weren’t sure they could hear you, you’d still want to see them and send loving words of encouragement just in case it might make a difference. 

Beyond COVID-19

Although psychiatry seems to be one of the most underserved specialties, there’s significant use for the Ohmni far beyond that niche field. Dr. Wirjo’s team is trying to improve its efficiency, coverage, and response time. 

With Ohmni, even after Dr. Wirjo leaves a facility, he can consult acute or extremely agitated patients via Ohmni resulting in a drastic improvement in response time and efficiency of rounding patterns. 

Having seen Dr. Wirjo use Ohmni, other specialists are interested in using it as well. Ideally, he would have a robot stationed at each facility for his own group’s use and then lend it out to colleagues in other specialties to see their patients because a COVID-positive psychiatric patient usually has 2-3 other doctors providing treatment as well.

Conclusion

Medical care through telepresence robots already achieves multiple beneficial outcomes. It allows doctors to optimize the psychiatric management of patients by maintaining and potentially expanding coverage. It reduces the amount of PPE required and reduces strain on the nursing staff. Most importantly, it reduces the risk of infection for patients, doctors, and residents. 

If Dr. Wirjo had his way, he would have a telepresence robot (or an Ohmni) available across all of his facilities to provide the best, and most timely, possible care to patients during this pandemic, and in the years and decades to come.