When a 7-month-old infant arrived at the emergency room in Astoria with a high fever and strange rash last summer, Columbia Memorial Hospital physicians used the OHSU Telemedicine Network to get immediate assistance from a pediatric intensive care doctor at Doernbecher Children's Hospital.
Telemedicine's secure two-way audio and video connection made it possible for Jennifer Needle, M.D., MPH, assistant professor of pediatrics, OHSU School of Medicine, to assess MaLea Fox's meningococcemia from a computer in the Doernbecher Pediatric Intensive Care Unit and explained to her mother that she had to be intubated. That telemedicine consultation was critical to saving MaLea's life, in part because bad weather delayed the infant's transport to Doernbecher by about four hours, according to her mother, Ashley Graber.
Similar critical care consultations are taking place throughout Oregon as hospitals use the OHSU Telemedicine Network to connect with OHSU pediatric intensivists, neonatologists, stroke neurologists, neurosurgeons, trauma surgeons and other specialists around the clock. Thanks to telemedicine, patients have faster access to specialty care not otherwise available in their community. This means stroke patients are receiving brain-saving, clot-busting medications such as tPA more quickly. Infants such as MaLea are receiving time-sensitive treatments more promptly as well.
As important: telemedicine makes it possible for more people to receive treatment in their hometown hospitals. That saves patients the cost of emergency transport to larger medical centers. It also spares their families from taking time off work and traveling to another community to support their loved ones. To date, 26 percent of the patients treated with the help of OHSU's Telemedicine Network have been able to stay at their local hospital saving families an estimated $500,000 in transports costs alone.
"A lot of these patients can be cared for safely in their community," said Miles Ellenby, M.D., associate professor of pediatrics, OHSU School of Medicine, a pediatric intensivist and medical director of the OHSU Telemedicine Network. "It's just a matter of improving the comfort level on both ends of the call."
Each hospital in OHSU's Telemedicine Network is equipped with a mobile videoconferencing unit that is moved to the patient's bedside when the doctor at the local hospital decides a consultation is needed. An OHSU physician connects to the mobile unit with a special laptop computer or one of the OHSU telemedicine workstations. The doctor in Portland can then examine the patient, monitor vital signs, read X-rays or CT scans, consult with the local physician and answer a family's questions with the secure two-way audio/video connection.
"In a time of crisis, a telephone call is helpful," Dr. Ellenby said. "A picture is worth a thousand words. And live interactive video is priceless. We can actually see what's going on."
OHSU has the oldest and most comprehensive telehealth program in the region. It offers an array of specialty and subspecialty services, from tele-psychiatry to the state's first neonatal telemedicine consultations as well as comprehensive telestroke and neurosurgery services.
"Telemedicine allows the emergency room doctor to have a backup – a second opinion," said Wayne Clark, M.D., professor of neurology, OHSU School of Medicine, and director of the OHSU Stroke Center. "We have a team of stroke physicians available 24/7/365. With telemedicine we can be there with the patient in five to 10 minutes maximum."
OHSU began using telemedicine to provide psychiatric care in late 2005. Today, OHSU faculty in the Department of Psychiatry continue to lead at OHSU and in Oregon in developing new innovative ways to deliver telemedicine by partnering with the Yellowhawk Tribal Center in Umatilla, the Oregon Department of Corrections, and others. The department also uses telemedicine to deliver immediate disaster response, such as to people affected by Hurricane Katrina.
The telemedicine program was expanded in 2007 to offer pediatric intensive care consultations to Sacred Heart Medical Center in Eugene. Stroke and other specialty services were added in 2010. Today, 10 hospitals have immediate access to the expertise of OHSU physicians. That number is expected to grow as OHSU’s telemedicine offerings continue to expand.
Future offerings may include everything from providing medical consultations to skilled nursing facility residents to performing routine post-surgical exams for patients who would otherwise have to travel back to OHSU for a relatively short and simple appointment.
Telemedicine Photos AboveTop photo: Wayne Clark, M.D., director of the OHSU Stroke Center, (screen on right), assists Mercy Medical Center's Brent Crabtree, M.D., (left) in conducting a practice stroke exam with a volunteer in the Roseburg emergency department via the OHSU Telemedicine Network. Stroke patients are receiving brain-saving treatments more quickly as a result of OHSU's telemedicine program.
Bottom photo: Miles Ellenby, M.D., Medical Director of the OHSU Telemedicine Network, helps provide specialty pediatric care to hospitals without pediatric intensivists. As a result, patients that would have been transferred to Portland can receive care in their home community.