Telehealth tech gets smaller, cheaper; docs remain wary

The devices are getting smaller and the technology's getting cheaper--but barriers to mHealth have pretty much stayed the same.

At this week's meeting of the American Telemedicine Association in San Jose, Calif., presenters shared ways they're using smartphones and other hand-held devices to deliver remote care. One example comes out of George Washington University Hospital in Washington, D.C., which has been testing a wound triage program that uses patient-submitted cell phone pictures. Emergency physician Neal Sikka, director of innovation practice at GWU, gave the audience an update on the pilot study.

Patients took up to four photos of their wound on their cell phone cameras and emailed them to a dedicated address. A clinician reviewed the photos to determine whether or not the wound was severe enough to require stitches. Later, the study compared the in-person diagnosis to the one made from the patient-submitted photos and found 95 percent of the wounds diagnosed by photo were properly classified and those patients received appropriate triage. 

The study showed that triaging patients by phone can be useful for diagnosis and may cut down on unnecessary ED and office visits, but Sikka noted that user images (and users' cell phones, for that matter) have to be high-quality for the concept to work.

The challenges will sound familiar to anyone's whose tried to implement similar programs: protecting patient privacy, training patients and providers to use the technology, managing the data and adding photos to patients' electronic health records, Sikka said.

Then there's liability. What about the 5 percent who were not properly classified? Sikka said providers must make clear that they're giving advice, not making a diagnosis.

In Bangor, Eastern Maine Medical Center trauma surgeons are using video chat to perform consults. Trauma surgeons conducting consults via a $229 iPod Touch are using the free video chat program Skype. The surgeon makes a call, gets a report from the treating physician, conducts a visual exam of the patient and gives his or her recommendation for care.

The solution is smaller, simpler, more intuitive and less expensive than traditional telemedicine, with its expensive, large, and often stationary equipment such as wall-mounted cameras, Rafael Grossman, a trauma surgeon at Eastern Maine, said during a session on tele-trauma care.

That said, the organization is still grappling with privacy and security issues and, naturally, physician adoption.

The referring physicians love it, Grossman said. The consulting surgeons? Not so much.

Part of the problem is that Skype can be glitchy--it can sometimes take a few tries to get a connection and then connections sometimes drop out in the middle of a consult. Surgeons want technology that's as easy to use as their smartphones, Grossman told the audience. When a tele-consult is as easy as making a phone call, physicians won't think twice about conducting them.

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