Telemedicine has hit the road and it’s solving real problems at every turn. It’s breaking the physical constraints of aging healthcare facilities and expanding the reach of shrinking, and retiring, staff. It’s spreading the arms of healthcare delivery into rural areas and into the homes of patients previously isolated. Telemedicine is the 21st-century solution to healthcare obstacles that stymie delivery. It has been a long time coming and too-long-delayed. Across the country, healthcare systems are turning to telemedicine to solve issues they have been wrangling with for years and they are experiencing serious success.
Perhaps the most obvious application of telemedicine is the way it can expand care already available in ambulances. Now they are becoming mobile stroke units that can span the countryside and deliver care better, faster, cheaper care while improving quality. Immediate care can mean better outcomes. Healthcare systems who are jumping in feet first are experiencing the benefits of telemedicine on the road.
Stroke care in transit
Mayo Clinic in Jacksonville, Florida has added video conferencing technology to its ambulances to provide rapid stroke care while patients are being transported to the hospital. While first responders are rushing the patient to the emergency room, neurologists can be present virtually in the ambulance. They conduct real-time assessments of the patient when time is of the essence. In a situation that is literally life or death, every minute saved is a minute in the patient’s favor. As a study in Stroke said, “Time is brain”. Every minute that a stroke is left untreated, the patient loses 1.9 million neurons”.The video conferencing system in the Mayo Clinic mobile units is secure and HIPAA compliant. It allows neurologists, first responders and patients to see and talk to one another. Using the National Institutes of Health Stroke Scale to gauge the severity of a stroke, neurologists can determine the best treatments for the patient even before he or she arrives at the door of the ED.
When asked about the benefits of the service, William David Freeman, MD, a neurologist at Mayo Clinic’s Jacksonville campus said, “We’re saving at least 15 million neurons, on average, by doing that examination in transit before the patient physically comes to the hospital.”
Other hospitals agree, among them Cleveland Clinic, New York Presbyterian and UC Health in Colorado.
Unlike the ambulances that Mayo Clinic outfitted, Cleveland Clinic launched specialized, mobile stroke units in Cuyahoga County, Ohio, where more than 5600 stroke patients are hospitalized each year. It was one of the first mobile stroke units in the country. Each stroke unit has a paramedic, critical care nurse, CT technologist, and EMS driver. The unit contains a portable CT unit, and is connected directly to the 911 system. If the 911 dispatcher believes the caller is suffering a stroke, both an ambulance and the mobile stroke unit are dispatched to the patient. After receiving initial treatment, the patient is transported to the nearest Primary Stroke Center.
The goal of the unit is to save precious minutes in the treatment of stroke. According to the director of the cerebrovascular center at the Clinic, Peter Rasmussen, MD, only 15 percent of patients make it to the hospital in time to be administered tPA. The drug dissolves blood clots and improves recovery from the impact of strike by 50 percent. The delay in arrival is what the Clinic calls “the most common reason patients are ineligible to receive the life-saving treatment”.
On the East Coast, NewYork-Presbyterian was the first healthcare system to launch a mobile stroke treatment unit (MSTU). It is staffed with two specially trained paramedics, a CT technologist, and an RN with specialty training in stroke care. The unit is also outfitted with a telemedicine connection to a neurologist. The mobile team and the neurologist can see, hear and talk with one another through onboard microphones and cameras. A portable CT scanner is on board to conduct brain scans and transmit them to the neurologist at the hospital while the patient is in transit. The unit has tPA on board, along with other medications for treating stroke, and can administer it at the direction of the neurologist. As a result, critical seconds and minutes are shaved off treatment times – the time that may make the difference between debilitating effects of stroke and better outcomes.
If the CT scan indicates an intracranial hemorrhage, advanced intravenous blood pressure medications can be administered while in transit to try to stop the bleeding. The information is used to triage the patient and transport them to the nearest, most appropriate hospital for treatment.
UC Health that serves Metro Denver, Colorado Springs, and Northern Colorado launched its mobile stroke unit in collaboration with local first responders. It has the same features as the New York Presbyterian mobile unit, and the same potential to save lives and reduce the impact of stroke.
As these units grow in number, so does their reach and their immediacy. Getting medicine to the stroke victim instead of waiting for the individual to get to care can significantly improve outcomes. It’s an example of excellence in telemedicine and the embodiment of what the technology can do.
Telemedicine to truckers
Long haul truckers have unique circumstances. They drive for many hours at a time, often alone, with a community built only through contact with other truckers on the radio and at local truck stops. They live a sedentary lifestyle and studies show that many are obese, have high blood pressure, smoke and don’t get enough sleep. These risk factors make them vulnerable to chronic diseases. Yet, healthcare can be hard to come by when you’re on the road day after day. Clinics aren’t commonly found at remote truck stops around the country. The trucking industry is using telemedicine to solve that.
Increasingly the trucking industry is encouraging long-haul truckers to sign up with mobile apps that connect them to doctors. They want them to be able to get a quick diagnosis, prescription medication and other care they may need while on the road. There are many different types of apps but they all offer one essential, life-saving service. That is the ability to check in with a doctor when the symptoms of illness present themselves, not after they cause an accident.
Long-haul truckers have two unique and potentially lethal workplace hazards. They can cause truckers to lose concentration and/or fall asleep at the wheel with potentially devastating consequences that may take many lives. The conditions are:
- Eye movement disorders
- Sleep deprivation/sleep disorders
A condition called strabismus, which is a misalignment of the eyes usually seen in childhood, can develop in adults. The problem is especially serious for truckers because it can cause blurred or double vision, eye strain, and headaches; none of which are conducive to safe driving. However, strabismus can be treated with surgery, eye patches or glasses, but they must first be diagnosed; and that means getting the long-haul trucker to health care.
Sleep deprivation and sleep disorders can be fatal for truckers. Long-haul truckers, despite new regulations limiting hours and miles driven at one time, work extremely long hours. They often work at night. Together those two factors can cause dangerous sleep issues.
Sleep deprivation can cause a condition called “micro-sleep” that is said to run rampant through the trucking industry. In micro-sleep people fall asleep without realizing it. If you observed an individual experiencing micro-sleep you would notice staring and a loss of focus. You might see the person’s head falling forward and then snapping back.
A study of sleep habits in long-haul truckers published in the New England Journal of Medicine found that “Long-haul truck drivers obtained less sleep than is required for alertness on the job. The greatest vulnerability to sleep or sleep-like states is in the late night and early morning.” While drivers reported that the optimal number of hours for sleep was seven hours; in reality, the majority slept only 4.78 hours. According to the study, 56 percent of the drivers studied had “at least one, six-minute interval of drowsiness while driving, as judged by analysis of video recordings of their faces.”
Telemedicine can screen for micro-sleep through remote monitoring. If diagnosed, the doctor can alert the trucker to the issue and work on strategies that allow more sleep and safer driving. It’s a technology that has the potential to save many lives at one time, by addressing the health needs of a single individual.
Telemedicine also solves a particularly sticky problem for truckers – health insurance. The issue is two-fold:
1: The majority of long-haul truckers are independent contractors who may find it difficult to pay the high cost of health insurance
2: If they do buy health insurance, they are most likely to be out of network if they need care while traveling across state lines
However, telemedicine crosses state lines with truckers. It’s available to them in the middle of the night and is relatively inexpensive. Telemedicine seems custom made for truckers.
All healthcare is local
With a nod to former Speaker of the United States House of Representatives Tip O’Neill, who made famous the phrase “All politics is local”, we paraphrase to say that all healthcare is local. Telemedicine can make it so.
Long distance medicine doesn’t work. Patients can’t drive hundreds of miles for care. Emergencies are nearly impossible to address if the physician can’t see the patient. However, when telemedicine goes on the road it erases those miles and makes healthcare local. The World Healthcare Organization (WHO) is proving it.
WHO deploys mobile clinics and medical teams to people around the world who are cut off from health services. In the past few years WHO has relied heavily on mobile clinics and telemedicine to serve the victims of war and civilian conflict. It deployed:
- 34 mobile clinics to Syrian health non-governmental organizations to serve populations in hard-to-reach areas
- Mobile clinics to operate in Jordan (in aid of Syrian refugees), and Syrian Arab Republic, among other countries
- In Iraq, in one of the Amriyat Al-Fallujah camps for internally displaced persons
- Mobile units in Ukraine carried out nearly 200 000 patient consultations since 2015
- In Yemen, an estimated 1,982 mobile medical teams and 5,964 health workers participated in 691 mobile teams
Providing healthcare to isolated people isn’t a problem limited to the far corners of the earth; it’s a problem right here in the United States as well. Rural hospitals are closing at rapid rates, leaving communities without access to care. In South Florida, mobile units are filling the gap. In fact, one non-profit organization has launched a fleet of mobile Health Promotion Units that are Federally Qualified Health Centers (FQHC). The mission of the Miami-based organization, Care Resource, is to “seek out areas where underserved populations are isolated and reach out to people who might otherwise to uneducated and screened.”
Each custom-made unit offers free wellness screenings, free rapid HIV testing, and condoms. If adverse results are received, the patients are referred to the organization’s medical staff. Then referrals and other appointments are made for them as needed.
The outreach to isolated populations sounds a lot like the work of WHO. That brings us back to our point – all healthcare is local.
Harvard Medical School (HMS) wants to support the effort to expand mobile care. Their program, Mobile Health Map, wants to help identify low income and minority populations. According to HMS, they “have a disproportionate burden of ill health and would benefit the most from the care provide to them by a mobile clinic”. The program offers free tools to help communities build mobile clinics. It helps them identify and validate their need, partner with community organizations, and raise money to purchase and outfit a van. In other words, it helps communities to provide telemedicine services. The program is like a mentor who will help gather the information and funding needed to deliver healthcare to the underserved.
Taking the fight to opioids
Perhaps one of the most important applications of telemedicine is in the fight against the opioid epidemic. Telemedicine clinics are going to the streets, literally, to deliver care to those in need. Access is one of the core issues in fighting opioids. It’s estimated that 3.6 million Americans miss doctor’s appointments due to lack of transportation. When those appointments interrupt work to fight addiction, the consequences can be tragic.
Now a non-profit in western New York state has put six mobile health units on the road to fight the opioid epidemic face-to-face. The vehicles have exam rooms and telemedicine capabilities to provide treatment and counseling for addicts. The non-profit that funded the vans, BestSelf Behavioral Health, calls it a “street outreach program”.
The United States Department of Agriculture is contributing money toward the telemedicine fight against the opioid epidemic. It recently announced the availability of $1.4 million in grants to expand care to fight the opioid epidemic in rural Appalachia.
The power of telemedicine to improve healthcare delivery is documented by Harvard Medical School’s Mobile Health Map Impact Report. It says that mobile clinics are providing up to 6.5 million clinical visits each year. Sixty percent of the patients they serve are uninsured and most live in low-income cities and towns.
Expanding access, lowering costs
Telemedicine and mobile clinics are making a real impact in lowering healthcare costs as well. Mobile health map reports “the average return on investment for mobile health is 12 to 1. That means for every $1 spent, $12 are saved.” In addition, it’s estimated that each mobile clinic results in 600 fewer emergency department visits each year.
Telemedicine is delivering huge benefits:
- Improved access to health care for those with obstacles like lack of transportation
- Delivery of healthcare directly to underserved and isolated populations
- Lives saved
- Healthcare costs reduced
It’s hard to argue with those benefits. It’s time to ramp up the adoption of telemedicine across the country. Healthcare organizations need to increase the number of mobile health vans that can reach the underserved. Our people need the care and they deserve to receive it.