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Push begins for telemedicine at Mercy Fort Scott
Mercy Hospital Fort Scott kicked off a new campaign to help raise funds to join a telemedicine program with other hospitals in and outside the Mercy network. Saturday's campaign kickoff event was sponsored by the Mercy Health Foundation.
"Currently Fort Scott does not have telemedicine," Tina Rockhold, Mercy Fort Scott regional marketing, communication manager and Philanthropy director said. "Some of the other Mercy communities do have telemedicine and it has been very successful and has very significant patient outcomes."
Those successful outcomes have been seen in stroke patients who must receive treatment for their symptoms within four hours of the first sign of stroke. With the use of telemedicine, patients in a rural area have quicker access to a specialist, such as a neurologist, who can quickly evaluate the patient. By using Skype technology, a specialist located anywhere within the network, or even country, can visit with the patient.
"They would be able to evaluate that patient via computer by having specialized equipment and sophisticated cameras," Rockhold said. "It allows them to make consult and assessment of the patient. So in the case of a stroke, they would say, 'administer TPA.' So it gives rural providers and emergency department physicians the opportunity to care for that patient in the emergency room, versus that patient having to be transferred to a larger facility that does have a neurologist or specialty like that. So it brings advanced care to a rural community that otherwise would not have a neurologist on staff."
Having the technology in Fort Scott is not just around the corner. Rockhold said getting the equipment put into place and locating participating specialists "on the other end" is going to take some money and time.
"It could be six months, it could be a year, it could be longer," Rockhold said. "It just depends on how the contract works with getting the specialist in place to offer that. We have a contract agreement set in place."
Besides assisting stroke patients, telemedicine can be used in other areas. Pediatric psychology is an area that is using the technology more frequently, she said.
"We just don't have child psychologists in the area," Rockhold said. "So it opens the door for those who live in rural healthcare (areas) to have specialty care opened."
Dr. Chris Veremakis, medical director of mercy Center for Innovative Care, was the keynote speaker for Saturday's event and explained how the technology can benefit patients in rural communities.
Telemedicine can be used in hospitals, clinics, long-term acute care and Veremakis said offering telemedicine in nursing homes is in the near future and will change nursing home care.
"There are some people in nursing homes or assisted living who like the process of going to a doctor," Veremakis said. "That's an outing for them. But there are large number who it is a burden to go see their doctor. We can now move mobile carts into the nursing homes and the primary care (physician) can now see patients."
Telemonitoring is already being used in the homes of 300 patients and Veremakis said that will be more common in the future. By December, Veremakis said there will be 1,000 homes connected to telemonitoring across the Ozarks and northern Arkansas. The focus currently is on diabetic patients, but he said in the future, telemonitoring will include those with heart disease.
"As you get up in the morning and you're brushing your teeth, you're going to stand on a scale which will upload your weight to your doctor," Veremakis said. "You're going to put your finger in a little gizmo that's going to give your heart rate, pulse and oxygen saturation to a group (of medical staff monitoring information in a hub location.) You'll prick your finger and do your blood sugar. You'll put a cup on your blood pressure information will go to people who are viewing to see what's normal, what's not normal, what's deviated. And then when they find something that seems to be different, they will red flag it and that will go to the doctor."
The doctor would then place an order for an adjustment of medication. Veremakis said such communication with a physician who can quickly do an assessment and then make adjustments to treatments will lessen the likelihood that a patient will have to go to the emergency room because symptoms were not caught sooner.
Telemedicine will allow people to stay in their homes longer because they will have more support, Veremakis said.
Mercy's tele-ICU is located in one building in St. Louis. There are three physicians on duty each night, 11 nurses on duty 24 hours each day and several secretaries who are watching 500 patients in five states in Mercy and non-Mercy facilities that have contracted with the program.
The telemedicine program began in 2006 in Oklahoma City. There are nine hospitals using telestroke.
Telemedicine allows a doctor to provide service in his office, the hospital or even his home, Veremakis 'said.
"He can deliver that service to a school, a home, almost anywhere," Veremakis said. "It doesn't matter where you are. You just need your units in two different places."
The telestroke doctors have units in their homes so that when they get a call, they are able to walk into their office at home and see the patient, Veremakis said.
"In Ardmore, Okla., which had no neurologists and was delivering stroke care in a 1990s fashion six months ago, now when a patient hits their emergency room and has had a stroke, they can push a button, it calls us, we call out to our telestroke doctor and somebody in Oklahoma City or Springfield or St. Louis, that person goes on and sees the patient for 10 minutes and they read the CT scan and makes a diagnosis, they offer a treatment, (the patient) gets treated all less an hour," Veremakis said.
Six months ago, that patient would have had to have been transported to Oklahoma City, which is two hours away. That meant the patient lost "precious minutes" that makes a difference in their recovery, Veremakis said.
Besides telestroke doctors, Veremakis said Mercy also has pediatric neurologists, pediatric cardiologists
Telemedicine now allows a doctor to listen to a patient's heart and lungs and also see x-rays.
"About the only thing you can't do with this is examine the abdomen," Veremakis said. "That still requires you to touch and feel the abdomen."
However, in the "not too distant future," doctors will be able to examine the abdomen by remotely viewing ultrasounds.
A doctor is using telemedicine for pre-op and post-op visits with his Arkansas patients, eliminating the need for patients to drive to Springfield, Mo.
Telemedicine also is being used at the bedside of sepsis patients to diagnose deterioration in a sepsis patient's condition. Veremakis said sepsis has a 90 percent mortality rate, which makes an early diagnosis imperative.
"We have seen by using this technology, to identify sooner at the beside, make the call and jump on it so sooner, we catch it in the early stages, treat it sooner and we're not seeing as many deteriorating stages," Veremakis said.
While telemedicine has become acceptable with doctors, Veremakis said many were at first skeptical that patients would accept seeing a doctor through a television monitor on the wall.
"The first time I was asked about this, when Mercy came to me, I'd spent my whole career building a critical care team for bedside care at Mercy St. Louis, that's what I did for 25 years," Veremakis said. "My response was you can't take care of critically ill people 250 miles away. Case closed."
Mercy approached him again, he agreed to take a look at the program, then slowly became convinced. He said telemedicine is not a replacement for bedside care, but it improves that care.
"It's much better to have telecare looking in at 2 a.m. when things go wrong than calling a doctor up on the phone and he can't even evaluate the situation," Veremakis said. "So it's the veteran doctors and the veterans nurses that are the hardest to convince that there's a better way to do things. Patients and families love it. Patients and families know it's not the same at 2 a.m. as it is at 2 p.m. They know no matter how good their nurse is, she's only in the room half the time because she has other patients. They know no matter how much they like their doctor and how good he is, he comes by once maybe twice a day and has lots of other patients."
Telemedicine allows someone to be there watching, Veremakis said. It also allows rural patients fewer long trips to see a specialist. Veremakis said patients who drive to see a specialist five times a year can eliminate four of those trips by using the technology.
"That makes a lot of sense to them," Veremakis said.
Members of the community are invited to become Friends of Mercy. The fee to become a Friend is $25 per month or $300 annually. Proceeds from this year's Friends of Mercy campaign will go to the Mercy Health Foundation and be used to establish telemedicine at Mercy Hospital Fort Scott. Those who become Friends of Mercy will be invited to the "First to Know Event," when they will be able to view a telemedicine demonstration prior to the service's launch.