Mom is watching her son Johnny play soccer. Johnny is hit in the head from a kicked soccer ball. Johnny appears woozy and somewhat disoriented, a condition that lasts for a while. Mom does not know whether to take Johnny immediately to the Emergency Room (ER). Mom's healthcare plan includes access to a medical call center.
She calls the telephone number for the medical call center and is connected to a triage nurse. The nurse asks Mom a series of questions based upon a triage protocol. Because Mom's cell phone has been registered with the medical call center, the nurse knows that Mom's cell phone has the telmedx telemedicine application installed. The nurse asks Mom if she can start a video session so she can see Johnny's face. Shortly a message box appears on the face of Mom's cell phone requesting permission to remotely turn on the camera in the phone. Mom says or taps "yes" and the camera in her cell phone is remotely turned on by the nurse.
The nurse also remotely turns on the speakerphone and asks Mom to point her phone's camera towards Johnny's face. Mom can see Johnny's face on her cell phone at the same time that the nurse is seeing it. The nurse observes Johnny's face and asks him through the speakerphone to look to the left and then to the right. Seeing that Johnny's eyes are equal in size and react normally and that he answers questions coherently, the nurse tells Johnny's Mom that she can take Johnny to see the doctor tomorrow; there is no need to go to the ER.
Stella lives in an assisted living facility and underwent minor surgery on her elbow. For follow-up care, once a week she and others living in the same assisted living facility board a bus that takes them to the medical center for their appointments, a forty-five minute ride. In Stella's case she waits in the doctor's office for a nurse to undo the bandage on her elbow to observe that it is healing properly and that her range of motion is unrestricted, perhaps a five minute interaction.
Her appointment completed, Stella has to sit and wait until all of the other people's appointments are done before the bus takes all of them back to their assisted living facility, another forty-five minute ride.
Alternatively, the surgeon's nurse calls the cell phone of one of the caregivers at the assisted living facility and says that she needs to check Stella's elbow. The caregiver goes to Stella's apartment and tells her that the nurse wants to check the healing of her elbow. The nurse remotely turns on the cell phone speakerphone so that Stella can hear her. The nurse tells Stella that she wants to check the healing of her elbow and wants to start a video session.
A message box appears on the face of the caregiver's cell phone requesting permission to remotely turn on the camera in the phone. The caregiver taps "yes" and the camera in her cell phone is remotely turned on by the nurse. The nurse asks the caregiver to unwrap the bandage on Stella's elbow and to point the cell phone camera towards the wound. The caregiver can see Stella's wound on the face of her cell phone. The nurse asks the caregiver to move the camera around to give her various perspectives on the wound.
At one point the cell phone's flash goes off and Stella and the caregiver hear the shutter on the cell phone camera click as the nurse remotely takes one or more high resolution images of the wound for Stella's Electronic Medical Record (EMR). Seeing that Stella's wound is healing normally, the nurse directs the caregiver to replace the bandages on Stella's elbow and tells them she will be calling again in a week or ten days.
A few weeks ago a baseball player was struck on the end of his finger, partially detaching his fingernail. I received a call from an athletic trainer who laboriously described the extent to which the player's fingernail had been detached. I was faced with a decision of whether to send the player directly to the ER or to the University Health Center. Such a decision is largely based upon the degree of detachment. Because I could not observe the detachment, I sent the player to the ER; the conservative decision. Had I had the live medical grade video available, I would have been better able to in situ assess the injury and its medical determination.
Brad P. Buchman, M.D.
Medical Director, Cal Sports Medicine
University of California Berkeley
The Department of Surgery and the Department of Emergency Medicine in a health center can give surgical patients upon discharge a cell phone with the telmedx application installed or install the telmedx application on the patient's or caregiver's cell phone. Rather than have the patient return to the hospital, a clinician could telephone the patient regularly for follow-up care. Additionally, if the patient encounters post-surgical difficulties, they can contact the Department of Surgery or the Department of Emergency Medicine immediately without having to wait for a scheduled return visit. The patient would return the cell phone upon final discharge. This procedure enables more frequent patient follow-up and increases the efficiency of scarce clinician resources.
Some residential care facilities for the developmentally disabled are dispersed throughout the community, while others operate a campus facility. In an example of dispersed facilities, a nurse is responsible for five to seven homes, each home having five to seven residents. The nurses are on 24/7/365 call and must physically visit a home to evaluate a patient upon the occurrence of a medical incident. Each residence has a cell phone with the telmedx application installed. With an injury or trauma, residential caregivers can call the responsible nurse who initiates a video session via a Web browser at home. They can see the patient's condition, evaluate whether they need to travel to the residence, as well as give care direction. This procedure reduces the workload burden on the nurses and resident caregivers, and shortens the time for care delivery to the residents. The procedure is similar in a campus setting where the charge caregiver contacts a responsible nurse or Medical Director. Availability of the telmedx telemedicine platform can help reduce clinician overtime as well as reduce the number of resident Emergency Room visits.
Patients in long-term care facilities, especially nursing homes, see physicians infrequently. A responsible physician is only required to review a patient's chart once every sixty days to meet legal requirements. This infrequency of contact sometimes allows conditions to exacerbate when earlier knowledge could have ameliorated the condition. Use of the telmedx telemedicine platform can increase physician patient contact and lead to a higher level of care with concomitant cost savings. In this scenario, a nurse, Physician's Assistant or medical technician may engage the patient on a regular basis.
Walk-in clinics are one response to the long time it takes to see a physician in many cases, and the medical condition is often one not requiring physician interaction. The charge for seeing a nurse, Physician's Assistant or medical technician is also less than the charge for seeing a physician. The telmedx telemedicine platform may be used to expand the geography of care by eliminating the need for a patient to travel to a brick-and-mortar medical facility, as well as creating new revenue opportunities. A live medical grade video consultation can be priced below a walk-in clinic, and the patient interaction efficiently handled in the course of normal medical workflows by lesser trained clinicians under appropriate supervision.
Drug compliance is a major factor in the treatment of some diseases such as tuberculosis. The treatment regimen for the first incidence of tuberculosis is daily medication for about six months. Patients start to feel better after the first two months and often stop taking the medication, which leads to resurgence of the disease. Unfortunately, the medicine to treat the resurgent disease is much more expensive than the original drugs, ten or more times as costly, and the duration of daily medication is typically extended to twelve to eighteen months. For this reason the local Public Health programs often employ nurses and medical technicians to drive around and watch patients take their pills, a very costly endeavor. This Direct Observation Therapy (DOT) can be accomplished using the telmedx telemedicine platform, thereby reducing costs and extending the program to more patients by increasing the efficiency of available healthcare resources.
Drug compliance is a significant issue in drug trials. The two most common procedures for assuring compliance are to have the patient come to a clinic or other medical facility to take the drug, or to send a nurse or medical technician to the patient to deliver the drug and observe them taking it. Both procedures are costly and inefficient, prohibitively so if the patients are in a foreign country. Compliance may be increased using the telmedx telemedicine platform, thereby reducing costs and increasing the level of compliance with the drug testing protocol. The telmedx telemedicine platform may be used by trial managers wherever located for drug compliance; the trial subjects need only a cell phone with telmedx application. The trial managers access the live video and high resolution images via a Web browser.
Concierge medicine programs often include house calls. House calls inevitably come at inopportune times. Instead of going to a patient's home or other location, concierge clinicians may use the telmedx telemedicine platform for the "house calls." Patients have a cell phone with the telmedx application installed and clinicians access the live video and high resolution images via a Web browser or tablet .
Some concierge medicine practices are worldwide in scope. Use of the telmedx telemedicine platform enables clinicians to treat their patients wherever and whenever they happen to be.