3 posts tagged “telemedicine”

Dr. Rick Bedlack weighs in on telemedicine

Posted July 9th, 2018 by

Do you have difficulty getting to your doctor’s appointments? Ever thought about using telemedicine? Connecting online can make it easier to get the care you need. Here, Dr. Rick Bedlack (a tenured associate professor of Medicine/Neurology at Duke University and the director of the Duke ALS Clinic that’s partnering with PatientsLikeMe in the current Lunasin study) explains the basics of telemedicine, his “Tele-ALS” program and how telemedicine could improve patient clinical trial experiences in the future.

 

Telemedicine 101: How does it work?

“Telemedicine” connects patients and their doctors through secure video conferencing programs (similar to “FaceTime”). Both parties need to have a computer, tablet or smartphone, and a video conferencing program that has been approved for use by the doctor’s institution. I have been offering this type of care to patients with ALS for several years now, through separate “Tele-ALS” programs at the Durham VA Medical Center (VAMC) and Duke University.

The pros of telemedicine
  • No travel: The main benefit of Tele-ALS is that it allows patients with ALS who live in rural areas to continue to connect with their ALS specialist throughout their disease, even when travel becomes difficult or impossible.
  • Symptoms management: This connection facilitates expert identification and management of the many modifiable symptoms patients with ALS experience throughout their illness, such as drooling, thick secretions, excessive laughing and crying, cramps, spasticity, pain, insomnia, anxiety, depression, and constipation.
  • Tech troubleshooting: It also facilitates identification and triage of equipment problems such as malfunctions in speech generating devices or power wheelchairs.
  • Keeping patients in the know: I have personally found it to be very useful in keeping patients informed about exciting research and alternative options and in this manner helping them stay hopeful throughout their illness.
  • More accessible clinical trials: In the next year, I will pilot the first ever totally virtual ALS clinical trial. Instead of making “in person” study visits, this trial will conduct all required visits via Tele-ALS. This should make participation much simpler and more attractive for patients and families.
The cons

There are some down sides to Tele-ALS…

  • From a patient’s perspective, many have told me they miss coming in and meeting in person with all the members of my team. Not all patients have a computer, tablet or smartphone, or Internet access.
  • From my perspective, I miss not being able to perform a detailed neurological exam. Given this limitation, I would not offer Tele-ALS to a patient I had never seen before —only to those whom I have already examined and confirmed the diagnosis in person.
  • From an administrator’s perspective, there currently is no way to bill for a typical Tele-ALS visit. This is the main reason that more clinics are not offering it. We are only able to offer it at Duke because of a generous grant from the North Carolina Chapter of ALSA.
  • Finally, there is a silly rule that prevents us from crossing state lines with this care model. The VAMC has found a way around this rule and VA providers can now offer telemedicine, including Tele-ALS, “anywhere to anywhere.” Hopefully non-VA hospitals will figure out how to do this soon.
Going forward

As we work out some of the problems with billing and crossing state lines, I think telemedicine and especially Tele-ALS clinics are going to become much more common. If my upcoming virtual research study shows good compliance and adherence, Tele-ALS will be increasingly used in trials to minimize participant burdens as well.

For more information:

www.telehealth.va.gov

www.dukealsclinic.com/telemedicine

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Virtual house calls? Dr. Ray Dorsey’s promising research on telemedicine for Parkinson’s disease

Posted June 2nd, 2017 by

What if your next doctor’s appointment involved just booting up your laptop rather than trekking to a clinic or office? Neurologist Ray Dorsey, M.D., M.B.A., is making virtual house calls a reality for people with Parkinson’s disease (PD) and believes “telemedicine” is on the brink of transforming healthcare. “There’s a huge demand for more convenient care,” he says.

Dr. Ray Dorsey PD Telemedicine

What’s telemedicine? Why does it work for PD?

Telemedicine, also called telehealth, is the delivery of healthcare remotely via phone, smartphone, mobile wireless device or other tools with or without a video connection.

Dr. Dorsey, a professor of neurology and the director of the Center for Health and Technology at the University of Rochester Medical Center, has been studying and providing telemedicine for more than a decade – starting with people with PD in a nursing home in a remote part of Central New York. He says virtual visits work particularly well for PD because it’s a visually-assessed condition.

Also, due to geography, physical limitations and other factors, more than 40 percent of people with PD do not see a neurologist – putting them at greater risk for falls, hip fractures and other complications – so there’s ample opportunity to improve care.

Dr. Dorsey’s research findings

In a 2013 pilot study on telemedicine for PD, Dr. Dorsey and his colleagues found that patients who received virtual house calls:

  • Spent an average of 53 minutes per call (using technology similar to Skype)
  • Saved 4+ hours – plus gas/travel money – for each appointment (compared to the 255-minute average time spent per in-person visit and travel)
  • Felt just as well about their quality of life and level of care as patients who attended in-person visits during the seven-month study

Building on the findings of the pilot involving 20 patients, Dr. Dorsey turned to PatientsLikeMe and other organizations to help recruit about 200 patients for a larger study called “Connect.Parkinson” – which resulted in similar positive findings. In fact, patients receiving virtual care rated their care more highly than those receiving in-person care, with 90 percent of patients saying they were “satisfied” or “very satisfied.”

 

“The biggest perks? Patients found care, convenience and comfort in virtual house calls.”

In patients’ own words:

“Excellent – just wish these visits could continue.”

“The regular intervals of seeing my neurologist through a virtual visit allowed my neurologist to treat more of my symptoms that emerged gradually… I do not have that kind of awareness of how my PD is gradually changing in one-a-year visits with my regular neurologist.”

“As my wife and I live a long way from the nearest neurologist, this technology is a blessing.”

“I really felt comfortable and did not feel like I was missing anything crucial by not being there in person. It’s so nice to not have to get in the car to go to an appointment!!”

Six-foot-5-inch Dr. Dorsey says meeting with him over a web cam – where he’s seated and not wearing his clinical lab coat – “levels the playing field.”

“If you come see me in a clinic, you would be clearly be on my turf. When you see me from your home, if you don’t like me, you can just close your computer,” he jokes.

The future of telemedicine

From the get-go of Dr. Dorsey’s latest study, it was clear that there’s a growing demand for telemedicine. Most clinical trials take a while to recruit for, but not “Connect.Parkinson.” The trial page received 11,000 visitors from all 50 states and more than 80 countries, and the study was quickly at capacity. 

 

“We were actually overwhelmed by the interest,” Dr. Dorsey says, “I think there’s just a huge demand in the community to receive care from home.”

 

Virtual visits aren’t for every patient – or provider, Dr. Dorsey says, noting there’s a learning curve, technical glitches, personalities and some privacy concerns to consider. Also, virtual care shouldn’t be a substitute for in-person visits but work well as a complement to them, for example, in the months between annual checkups.

While telemedicine might become a go-to for things like PD, skin conditions, and mental health issues, it probably isn’t a great fit for conditions requiring regular lab work and face-to-face evaluation, such as lupus or cardiovascular disease. But Dr. Dorsey believes it’s poised for exponential growth as more patients and politicians (who are always budgeting for Medicare) catch onto its perks.

 

“With time, I think more people are going to say, ‘I shop online, I bank online – why can’t I get healthcare online?’”

-Dr. Dorsey.

Free telehealth for New Yorkers with PD

As part of Dr. Dorsey’s work in expanding telemedicine, anyone with PD in New York State can receive care for free through a program called Parkinson’s Disease Care New York. Get the details at pdcny.org. He hopes the program can be replicated in other states – and for other conditions – in the future.

See what PatientsLikeMe members with PD are saying about telemedicine.

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