In 1968, a 26-year-old medical student named Michael Crichton, who would go on to write Jurassic Park, published a book called Five Patients. In it, he told the true stories of how patients interact with the then modern American health system. His last chapter outlined the story of a 56-year-old mother of three who experienced chest pain on a flight from Los Angeles to Boston. She walked off the plane and directly to the Logan Airport Medical Station where, through a black and white video feed, she was “examined” by a physician two and a half miles away at Massachusetts General Hospital. With a nurse on-site conducting lab tests and palpitating the patient, the physician diagnosed her condition and signed a prescription with something called a “telewriter.”
That book introduced America to telemedicine, creating the popular image of a video link between a physician and patient. Skip ahead five decades, and in 2016, the capabilities of providing healthcare at a distance is vast, and we are now capitalizing on these technologically advanced opportunities.
Over the past 15 years, a number of health systems have moved into digital health by creating telestroke programs. A person having a stroke loses approximately two million brain cells per minute when a blood blockage or rupture deprives the brain of oxygen. Unfortunately, it is difficult to know without a CT scan whether the patient has a block or a bleed, and giving the wrong treatment can be fatal. A coagulant to address a bleed would compound the harm if the patient actually has a blockage. Similarly, a clot-busting blood thinner could cause a ruptured vessel to become a catastrophic blood loss.
Telestroke programs connect regional hospitals with a neurologist who can rapidly evaluate a CT image and consult with the physician on-site on the best course of action. Nationally, telestroke programs cut anywhere from five to 30 minutes off the door-to-treatment time, which has been shown to improve patient outcomes. NewYork-Presbyterian took this care one step further by creating a Mobile Stroke Treatment Unit (MSTU). This specialized emergency vehicle is complete with CT imaging capability and will be dispatched by the New York City 911 System via the FDNY directly to a patient showing signs of a stroke. By wirelessly transmitting the CT scan to a NewYork-Presbyterian neuroradiologist, this significantly reduces the amount of time lapsed from the onset of symptoms to the delivery of care. Additionally, the MSTU contains medications specific to diagnosing and treating strokes, allowing the team to deliver the right drug immediately upon diagnosis, thereby saving even more precious time.
Saving time is also key for patients in emergency rooms, and NewYork-Presbyterian is using digital health to bolster these efforts as well. When an emergency room patient is in need of a specialty consult, it may take hours to bring a specialist to the emergency room or to transport the patient to another location for the consult. By making video connections between patients and specialists, we are now delivering care more quickly and efficiently, improving ED patient throughput.
With the creation of digital emergency room capability, NewYork-Presbyterian is constantly innovating. One such example is through the NYP OnDemand Digital Emergency Express Care service. Patients arriving at NewYork-Presbyterian/Weill Cornell Medical Center are given the option of a virtual visit through real-time video interactions with a clinician, after having an initial triage and medical screening exam. This is done in a private room with a webcam/monitor, providing patients unmatched convenience and reduced time spent in the Emergency Department. More importantly, in the past five months, more than 700 patients have moved through this process in an average of 35 minutes from arrival to discharge.
The convenience of digital health visits will inevitably increase as more services are offered remotely. Primary care visits will become more data-rich as patients gain access to innovative tools like Tyto and MedWand, which allow patients to provide a remote physician with ear and throat images, breath sound, heart rate, blood pressure, and blood oxygen levels. NewYork-Presbyterian is also beginning to make pre-surgical visits with anesthesiologists and post-surgical checkups with physicians more convenient by scheduling these appointments as virtual video visits. In addition to being more efficient for the physician, they can turn a patient’s four-hour experience of traveling and waiting for a physician into a 10-minute video appointment.
A recent Wall Street Journal article reported that telemedicine visits are offered by 70 percent of large US employers, while only about 3 percent of eligible employees have used the services. Part of the limited uptake may be due to a perception of telemedicine that has not changed in 50 years. This perception is changing in a big way.
Unlike the physician in Crichton’s 1968 book, today’s physician works with high resolution video, direct access to a patient’s medical history via an electronic medical record, and the ability to remotely print discharge instructions. As more digital health services are offered, as they become more than simply a video interaction, and as they become so routine that they are easy for both patients and physicians, use will increase, driving much-needed efficiency into the US healthcare system.