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Medical Consultations With Webcams Extremely Successful
AgaveNectar writes "Doctors are far from being early adopters, so they have just gotten around to publishing a report that webcams help immensely with making the right decision when someone shows up to a rural emergency room suffering from a stroke. Using clot-destroying medications like Alteplase is really risky, and it should only be given in acute cases. In a study of 222 patients, rural ER doctors consulted with faraway stroke specialists. They made the right decision 98 percent of the time when the expert examined the patient with a webcam, and only 82 percent of the time when they just talked to each other on the phone. Perhaps this report will finally convince the medical community that telemedicine is important."
Now, at last, medical care can be outsourced to low-wage countries.
Will my privacy be protected, as per HIPAA, when then they stream video of me lying in a hospital bed, being less than articulate, across the interwebs?
But not because of this.
The problem is that this is not really a good demonstration of the efficacy of telemedicine, because they picked a treatment for which there is a marginal benefit for a very small proportion of people. In order to get thrombolytics for stroke, you have to meet a certain set of criteria that in my experience few meet: no recent trauma or surgery, normal blood pressure, no history of stroke in the past 3 months (or hemorrhagic stroke ever), no current ulcer disease, no diabetic retinopathy, no seizures, deficit is more than minor but not too major, certain onset of symptoms in under 3 hours (and it will take an hour to get you imaged and blood tests done after you get to the ER), and a lot more.
In addition, if we give you thrombolytics for your stroke (and you are an ideal candidate) you get a 13% greater chance to recover with minimal or no deficit, but you have a 7% greater chance of your stroke getting phenomenally worse by becoming a hemorrhagic stroke which more often than not leave you dead or in a permanent vegetative state (in addition to all the other problems you can get from being completely incapable of clotting for a good 24 hours.)
What they should do is demonstrate this where it could be really useful: with a NP or PA way off in the hinterlands or in underdeveloped countries. But that isn't snazzy, doesn't pay well, and drug companies that sell gazillion dollars a pop medicines don't sponsor it.
Google Stroke View
rewriting history since 2109
...Pay-per-view gynecology.
Could be worse though. ER tech, "This guy says he slipped and fell on a fusili statue. Here: take a look."
__ Someday, but not this morning, I'll finally learn to use the preview button.
my dream of a gynecology practice will become a reality...
Except the ones who are dead.
The only thing worse than webcamming is webcamming by yourself.
I would like to see a study comparing patient's success rates at self-diagnosis with google vs. a doctor's diagnosis success rate. Every time I've had to go to the doctor lately I've successfully diagnosed myself with the internet and known the treatment before I went, only to pay $120 for a doctor to look at me for 5 minutes and say what I had already guessed.
We didn't have a medical consultation, but yo mama gave me one hell of an anatomy lesson!
Yeah my whole family got hooping cough during a vacation out west and the doctor thought it was a regular cold... during the summer though. Anyway if it weren't for google we wouldn't have known and they still wouldn't give us medicine until they were able to take blood samples from the unvaccinated infant to confirm it.
Medtronic, Boston Scientific and St. Jude Medical have systems that monitor patient's implantable cardiac defibrillators and cardiac resynchronizers. I work for one of these companies and let me tell you, the data that's gathered and the way it's helping patients is amazing.
"There are no facts, only interpretations." --Friedrich Nietzsche.
They made the right decision 98 percent of the time when the expert examined the patient with a webcam, and only 82 percent of the time when they just talked to each other on the phone. Perhaps this report will finally convince the medical community that telemedicine is important.
82% ought to be good enough for everyone.
Fact: Everything I say is fiction.
Then above you said :I'm not sure that I call transmission of digital information 'telemedicine' but we use remote radiology all the time since we are too rural to afford a full time radiologist.
I'll call them up and tell them that Portland, Oregon is officially considered a "low wage country". I bet they will be surprised!
It has been reported in the Economist and in other business magazines that there's a trend in electronically sending X-rays and other data via the internet to docs in India for review and diagnosis. They then just email back there answers.
For one; it's much much cheaper. Two, there's time difference. So, when or if you do a night shift in the ER, where do you send those X-Rays? Is that Portland radiologist or another still working at 2:00AM?
I've worked on the technology at McKesson/HBOC - 8 years ago.
I have not read the article.
That being said, a 98% accuracy sounds like it's as good as the gold standard (Gold standards are almost never 100% accurate). I find that hard to believe, and therefore find the results suspect.
Help! I'm a slashdot refugee.
The mods here just have a strict anti-"yo mama" jokes stance. Seriously, lighten up.
Also, declaring your post "insightful" automatically voids it as insightful. It's like a guy who goes around telling people he's cool. Don't be that guy.
I've used webcams for breast examinations for years.
Before I start, I'd like to say I'm a junior doctor. Secondly, nothing I write in this post constitutes medical advice. Please consult your doctor for any and all advice. Now that the disclaimer is out of the way...
These aren't general medication exams taking place over telemedicine but neuro consults where acute ischemic stroke is suspected. Generally this involves smaller community hospitals contacting regional stroke centers for advice. The local doctors have done a full exam and present their findings to other doctors. The days of dialing up a doctor from home via webcam are getting closer for simpler things but the ability to physically examine a patient using our tools, labs, and diagnostic imaging are still the centerpiece of medical practice today. One of the more difficult parts of medical practice in the early years is learning to translate patient history and examination into data we can use to give us clues to the underlying condition. I really can't imagine a time when doctors will want to stop in-person examination.
For our weekly grand rounds talk 3 months ago, one of the leading doctors from the one of the stoke centers (I believe it was the Neurovascular Disease and Stroke Center at UCSF Medical Center) spoke on this very subject. He said the technology is very promising and allows patients in areas without stroke centers to get adequate care.
The basic tenants of therapy involve answers to the following three points:
* What are the benefits/risks of giving thrombolytics in patients with AIS? When are thrombolytic agents (which increase the risk of brain hemorrhage) too dangerous?
* Which agent should be given?
* When is it too late to salvage brain tissue?
These questions are best handled by the stroke specialists. There is also some question as to the safety and effectiveness of telemedicine in acute stroke which are currently being evaluated via randomized clinical trials. The Lancent article above details one of the studies. The other is located here.
That said, there is a real limit to how effective these measures are in the real world. From what we know right now the medicine works but only if the patient makes it into hospital in time. Many caretakers of elder patients and stroke patients themselves don't realize always recognize the signs of a stroke until they're out of the therapeutic window for giving thrombolytics. In those cases the benefit/risk ratio gets skewed towards tPA treatment being either non-therapeutic or dangerous due to the possibility of hemorrhage through revascularization.
http://www.utmb.edu/archived-newsinfo/02pr/oct02/antarctica.htm
I'm amazed that nobody has noticed that this means that webcams have passed the Turing test.
as long as your doc isn't Bill Frist
and University of Arizona, it's been going strong for years.
Si vis pacem, para bellum! For evil to succeed good men need only do nothing!
Trust me, many doctors are already convinced that telemedicine is important. The problem is that very few payment models have been sorted out. Until the insurance companies and the government (Medicare, VA, etc) figure out how they are going to pay the assisting doctor/therapist/etc for their time, we're not going to see a lot of telemedicine.
Hey, I saw that episode of House too!
"Perhaps this report will finally convince the medical community that telemedicine is important."
I wouldn't count on it. Interns still work insane hours in emergency rooms, sometimes making life-and-death decisions under circumstances that would get a long-haul trucker's license yanked for failing to obey hours-of-driving laws.
Why would this be different?
I've calculated my velocity with such exquisite precision that I have no idea where I am.
Parts of it already are....like interpreting tests, reading medical imaging output, writing the reports, etc.
It's a big deal from the standpoint that the contractors that are typing in the results and interpreting your medical diagnostics are not regulated by US law nor subject to the the US HIPPA medical privacy rules -- since they don't have to have privacy safeguards, their services can be offered due to lower overhead in procedures and safeguards as well as lower labor costs. I'm sure having an 'expert on call' would be much cheaper if on call from other continents.
Taking samples is something that isn't likely to be outsourced overseas any time soon. But remote surgery? Trans-atlantic surgery was done via remote 7 years ago.....
I was involved with tele-radiology back in the mid-Ninties, when I worked for one of the small companies trying to pioneer that particular subset of this field, RADMAN/Radiology Management Systems. That company isn't even in business any longer.