Telemedicine improves access for movement disorders patients
By Sarah Toomey
Patients with complex medical conditions look to major teaching hospitals for the latest and most advanced treatments, but access to that care often is a challenge for the many patients who live outside the urban centers where most teaching hospitals are located. Increasingly, technology is bridging that gap.
Rush University Medical Center has launched a new telemedicine service program for movement disorders patients, the latest example of how health care providers at Rush are using technology to improve access to care.
Implemented in May after a lengthy period of quality testing the telemedicine option is especially well suited for movement disorders patients. Many patients with movement disorders such as Parkinson’s disease are disabled and may have difficulty driving to doctors’ appointments. Equally important, diagnosis and treatment decisions are based largely on visual assessments that now can be captured when a physician sees the patient on a computer screen via the new telemedicine service.
It’s a logical next step for Rush, where movement disorders experts helped establish and test the visual criteria used to diagnose Parkinson’s disease and similar movement disorders decades ago and pioneered the use of video technology in this process. Such technology has been used for many years in an office setting, where Rush providers videotaped patients during their visits to track and compare progression of their neurological conditions over time.
Telestroke program enhances stroke care throughout Chicago area
Rush also uses telemedicine to enhance care for stroke patients throughout the greater Chicago area. The Rush Telestroke Network provides 12 community hospitals in the Chicago region with access to consultations with stroke care experts, at any time of any day, for ischemic stroke patients that present in their emergency rooms.
By using videoconferencing and sharing electronic medical records, board-certified vascular neurologists from the Rush Stroke Program assess patients and help the affiliate hospital’s emergency department physicians determine a plan of care. The physicians at Rush then turn over treatment to the emergency physician or initiate the patient’s transfer to Rush if the patient requires advanced care.
Since March 2011, Rush physicians have performed more than 3,300 telemedicine consultations, and the network projects to exceed 4,000 consultations by the end of 2017.
Bringing services to the patient
Patients come from all over the Chicago area and beyond to be treated at the Parkinson's Disease and Movement Disorders Center at Rush. Now, thanks to the telemedicine program, they won’t necessarily need to travel to receive their care from Rush.
“We care for vulnerable patients who are often compromised by gait difficulty, slowness and balance difficulties. Further, we serve a large geographical area, and many of our patients spend several hours traveling to and from Rush for their care,” says Christopher Goetz, MD, a leading expert on movement disorders and director of the center, who helped to spearhead the telemedicine pilot project. “Telemedicine offers them an at-home visit, where they have direct contact with their neurologist and yet do not have to endure the challenges of travel.”
In addition to Goetz, neurologists Katie Kompoliti, MD; Gian Pal, MD, MS; and Leo Verhagen, MD, PhD, are offering telemedicine visits to their patients. Diagnosing and monitoring the progression of Parkinson’s disease and other movement disorders is based almost entirely on visual observation, because there are no blood tests or brain scans to confirm the diagnosis.
“Because I can see the patients and their disability on the screen, I can make responsible treatment recommendations and explain them carefully to the patient and family members in attendance,” Goetz explains.
The patients and physicians who participated in the pilot program felt the visits were efficient and high quality, Goetz adds.
Telemedicine appointments are largely the same as an office visit
To qualify for a telemedicine visit, patients must confirm they have high-speed internet, a webcam, and appropriate software. They need to have a blood pressure cuff at home so that they can take their blood pressure during the visit and report the findings to their physician. Patients schedule the visit online through the Rush online health record system, called MyChart, and pay a flat fee for the visit, usually using a credit card. The cost is comparable to an office visit with a specialist provider.
When it is time for the visit, the patient logs into MyChart and opens a secure video feed using a standard webcam. The patient’s neurologist then will be seen on the home computer screen, and the physician likewise will see the patient.
The visit is conducted in the same manner as a regular office visit. The physician interviews the patient and family members in attendance, reviews the medication doses and schedule, and then asks the patient to perform a number of tasks to assess the neurological condition. Finally, a summary dialog occurs with any new recommendations, and plans for the future are outlined. The patients stay in the comfort, privacy and security of their home or office, and the neurologist has a full record of the telemedicine encounter.
Technological advances are making health care more accessible
The potential of telemedicine has been discussed for years, but improved technology, wider availability of home computers, and lower broadband costs have made the service a reality. Telemedicine is one of several high-tech methods of providing health care that are being tested or recently implemented at Rush to offer more options to patients.
In April, Rush launched another new tool allowing patients to be evaluated online, making care more convenient for patients and freeing up valuable clinic time for more complex cases. A web-based application called SmartExam allows a patient to conduct an electronic visit (or e-visit) with a primary care provider, who will determine a diagnosis and treatment plan that may include prescriptions. Rush is one of the first academic medical centers in the country using this service.
This new option is a convenient and affordable approach that improves access to care for patients suffering from mild symptoms such as cough and sinus problems, and other non-urgent illnesses and injuries. Patients will be able to get a medical evaluation electronically from the comfort of their home for non-urgent conditions commonly treated by a primary care physician or at a walk-in clinic.
“Technology is improving health care in many ways, including making care more accessible,” says Anthony Perry, MD, vice president of ambulatory transformation at Rush. “People have busy lives, and we want to create convenient and high-quality options that work.”