Advances in Health Care Bring Remote Expertise Close

Telemedicine provides patients with remote dial-in diagnostic capability.

Dr. Chad M. Miller operates the RP-VITA robot at the Ohio State University Hospital in Columbus, Ohio.

Dr. Chad M. Miller operates the RP-VITA robot at the Ohio State University Hospital in Columbus, Ohio.

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The Cleveland Clinic's Heart Care at Home program discharges heart patients with a small telehealth unit that monitors vital signs such as blood pressure and weight fluctuations, which might indicate fluid buildup, and transmits the data through a phone line to a support team at the hospital – no Internet or smartphone needed. Nurses stop by as often as is necessary during the 40 days after discharge. Presbyterian Healthcare Services in Albuquerque, N.M., similarly refers patients with congestive heart failure or chronic obstructive pulmonary disease to their homes with equipment capable of video and of analyzing measurements taken by the patient. The program has a 96 percent patient satisfaction rate, and readmissions are down to 1 percent from 6 percent at the start of the program in 2001. One prevented hospital visit saves $5,500, about the cost of one patient's home equipment.

"I can manage things myself instead of every six months going to the doctor," says Heidi Dohse, 49, who suffered a dangerous heart arrhythmia at 18, underwent then-experimental ablation to effectively rewire her heart, and is on her seventh pacemaker. That's a good thing, because now that she is a program manager for Google in Somerville, N.J., her cardiologist at the University of California, San Francisco Medical Center is a continent away.

An athlete who has competed in 100-mile bicycle races and wants to continue to ride longer distances, Dohse is helping to test out a type of self-guided telemedicine called mobile health that enables patients to collect their own stats, from heart rate and blood pressure to weight and food consumed, on an ongoing basis and share it with their doctors. She wears a watch that keeps track of her ticker, letting her know whether she's cycling within a healthy heart rate range; an EKG device attaches to her smartphone when she experiences an episode of tachycardia, or quickened heart rate. Her doctors can access the EKG results, and consider them over time to make decisions about medications or pacemaker settings. Dohse can also use an app to correlate her cardiac data with her diet and see, for instance, what the effects of drinking caffeine have been on her heart rate.

The UCSF Medical Center study, launched in March, aims to collect heart data from a million people worldwide over the next 10 years and to find trends that will lead to a better understanding of heart function and ways to predict disease. The Health eHeart program, as it is called, also is already helping people like Dohse manage their conditions. What's great about it, she says, is "having trend data to make good decisions" about what to eat and how hard to train.

In the no-so-distant future, experts say, these streams of patient data that allow a minute-by-minute picture of health status will regularly help with predictions, early interventions, diagnosis and treatment planning. Imagine that your doctor, instead of viewing you just as a snapshot, can watch a feature-length film of your vitals over weeks or months. "All of these devices are making it possible for us to collect information about people's behavior that we haven't been able to see before, to look at metrics that we may not have thought of before," says Satcher. Artificial intelligence programs will sift through the numbers and spot problems and suggest solutions faster, and potentially more effectively, than any single doctor could today.

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Perhaps the most exotic application of telemedicine would be to perform a surgery remotely, a long-term goal of the MD Anderson effort. The technology exists: A surgeon using the da Vinci surgical robot today to perform minimally invasive operations sits at a console across the room from the patient, manipulating controls that move robotic arms and the surgical instruments. Other surgeons and nurses stand by at the table. Remote robotic surgery has even happened; in 2001, surgeons in New York removed the gall bladder of a woman in France (with the assistance of a team at the patient's bedside). But Matin suspects that commonplace remote surgery is a few years away, since the necessary high-speed communication lines still aren't reliable or cost-efficient enough. Moreover, there are legal barriers. It would be illegal for a surgeon licensed in Texas, for instance, to operate on someone in California. (There is legislation in Congress currently addressing this obstacle.)


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