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."

Comments

Re:Next, outsourcing to Bangalore

[ffejie]

They already do this - who do you think reads all those X-Rays?

Yay telemedicine

[Sebilrazen]

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.

Re:A more interesting study

[ColdWetDog]

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.

That's a pretty broad brush, but overall my guess is that patients who do a fairly decent search on the Internet AND have some sort of defineable symptom or problem (rather than "I don't feel so good") is about 50-75%.

Most of the time, they end up thinking about the things that have already been dropped from the doc's differential because of previous questioning, testing or just natural history (males typically don't get pregnant). The really useful part that I have found is while wandering around looking for answers, they run into questions that a) I should have asked but didn't b) I asked but they gave an incorrect / noncommittal answer or c) I asked the wrong way. Looking at the problem from several different viewpoints in the (?)privacy of your home can often be useful.

But people come to doctors for a bit more than just to answer the question of "what do I have". There might be a useful conversation about what to do about it. And I have a very hungry Labrador Retriever puppy to feed. Have you seen the price of Purina Dog chow recently?

Re:A more interesting study

[Anonymous Coward]

There lies a slight danger in that analysis. I am not a doctor but...

A vast majority of people go into doctor's offices with 'normal symptoms' such as a fever, cough, sore throat, etc. which would in most cases be caused by 'normal conditions' such as a simple virus or bacterial infection. Obviously, you could self-diagnose a fever as being caused by a virus from google.

The reason you go to the doctor is to ensure that fever you are experience isn't caused by something more drastic such as a hard to detect cancer or life-threatening disease. When the doctor gives you a work-up he or she knows to examine places where you, the patient, would most likely miss.

Thus, say a study is performed where a patient first diagnoses himself or herself. It then turns out the patient was correct 75% of the time and the doctor was then correct 95% of the time. The real concern is what would have happened in that 20% of the cases where a patient mis-diagnoses himself or herself.

Also, from another view, doctors are trained to be knowledgeable about medicines and their inter-actions. If you goto a drugstore for an OTC antibiotic for your self-diagnosed bacterial infection, how are you going to know what to pick. Acknowledging that doctors still are 'persuaded' by pharmaceutical companies, they still are educated and continuously trained in new treatment methods in order to determine when to use what drug.

So, the radiologist is working at 2AM?

[BitterOldGUy]

Below you said: If you're an ER doc (and I am one) you should really be able to describe the neurologic exam of someone having a fairly large, well defined stoke to a neurologist on the other side of the phone.

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.

Re:So, the radiologist is working at 2AM?

[ColdWetDog]

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.

I'm sure that happens. We chose to use a more local group, largely because of the issues you raised.

- Is this practicing medicine without a license in the host jurisdiction?

I think this varies from state to state. In Alaska, you do need a valid Alaska license. You also have to have privileges at the hospital which is another complex step so you would weed out anyone completely unqualified.

- Who is liable for errors?

Well that all depends on the lawyers and the jury. But they the radiologist from Oregon (or wherever) can be a defendant in a malpractice action if it comes to that.

- Is the patient aware their care is outsourced?

Not really up front - patients are rarely aware of who or what the radiologist is - they're typically hidden in dark rooms and not allowed out much (sounds like your typical Slashdotter, doesn't it). If anyone asked, we could tell them. I actually do mention it when appropriate. I will tell the patient that we're sending the data down to Oregon so somebody qualified will look at it and get back to me.

- Does the patient share in the savings or does the hospital bill the cost of a local radiologist?

Not sure exactly how to answer that since there aren't any real "savings". The radiologists bill separately - their fees are pretty much set by the insurance companies. If you're paying cash, well, in the US you're screwed but that is another rant... The hospital pays the radiology group a set fee per study for overhead and storage costs (they have to keep the data for varying times so it's a significant issue). I think we pay about $7.00 per study which we feel is a pretty good deal because then the little rural hospital doesn't have to deal with a huge, complicated IS infrastructure.

- Is the information transmitted securely with due regard for privacy?

Yep, they are very careful with data handling. Everything going out into the Evil Internet is encrypted. Everything coming back goes by secure fax, phone or hopefully sometime in the mysterious future, by secure transmission into our mythical electronic medical record.

It's actually been a significant improvement in patient care. Instead of one or two general radiologists, you can have the study read by someone, for example, that just looks at head CTs. They have a night crew. They have a big IS department that's more or less functional. There were more gliches and setup problems and costs than I had hoped for when we started, but welcome to the real world....