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Telemedicine usage increasing rapidly for many service lines

Aug. 18, 2016, 10:08 AM

Vanderbilt Heart and Vascular Institute cardiologist Allen Naftilan, M.D., Ph.D., puts a stethoscope to his ears and listens to the heartbeats of patients more than 90 miles away.

Allen Naftilan, M.D., Ph.D.
Allen Naftilan, M.D., Ph.D.

Telemedicine makes it possible for him to identify a heart’s galloping rhythm or a whooshing murmur even though he’s in Nashville and the patients on this day are in Winchester, Tenn.

Cardiology is one of 17 service lines now participating in telemedicine initiatives at Vanderbilt University Medical Center (VUMC), a 240 percent rise from the prior fiscal year. Patient encounters using telemedicine have grown 261 percent over the same time frame.

Telemedicine is helping VUMC condense time to operate more efficiently and bridge distances to better collaborate with partner providers. It has proven to be a key connector within the Vanderbilt Health Affiliated Network, a collaboration of 56 hospitals, 12 health systems and more than 4,000 physicians aimed at improving the delivery of health care in a five-state region.

“Now that we have one of the nation’s largest affiliate groups, telemedicine is an essential element of that being successful,” said Amber Humphrey, MBA, assistant director of Telemedicine. “It is a key element in being able to elevate the level of specialty care in community settings.”

Amber Humphrey, MBA
Amber Humphrey, MBA

Telemedicine has also helped VUMC improve efficiencies.

Now, outpatient pharmacists are speeding up the discharge process by using iPads to do consultations with patients — instead of bedside visits — allowing patients to leave the hospital more quickly with their medicines.

Telemedicine technology can vary according to the medical application. Naftilan utilizes a Littmann TeleSteth System stethoscope, HIPAA-compliant video conferencing and a high definition camera.

“Patients love it,” Naftilan said. “They can see me. They can talk to me. They can ask questions.”

His patients, many of whom are elderly, prefer video conferencing to driving in Nashville traffic or relying on family members to get them to his office, he said.

So far, Naftilan has limited telemedicine to follow-up consultations, but said he would consider it if a patient needed to be seen quickly for an initial consultation.

Liza Weavind, MBBCh, MMHC
Liza Weavind, MBBCh, MMHC

Telemedicine can also help hospital staff make decisions quickly in intensive care units.

Liza Weavind, MBBCh, MMHC, professor of Anesthesiology and Surgery, is working with partner hospitals to set up a teleICU system. Her experience in the Memorial Hermann Healthcare System in Houston as the fourth teleICU medical director in North America in 2003 was the impetus for her recruitment to VUMC in 2007 to initiate a similar care paradigm. She is focused on setting up a nights and weekends model.

“Our affiliated hospitals have reached out to request help with patient care overnight and on the weekends when their physicians are not in the hospital,” Weavind said. “This will provide a dual benefit of monitoring patients to improve patient safety and outcomes, but also to give physicians down time and decrease burnout.”

One scenario: a VUMC physician via teleICU could monitor a patient who might have worsening sepsis with low blood pressure and oxygenation and order a timely intervention (supplemental oxygen, fluid resuscitation and antibiotics), which prevents further clinical deterioration and escalation of care through a transfer to VUMC. The virtual intensivist would use a VGo, a small mobile robot that provides two-way audiovisual communication at the patients bedside to discuss care plans with the nurse and family, while placing orders into the partner hospital’s electronic medical records to facilitate immediate care.

“VUMC is providing a real service to its network of hospitals and clinicians, but mostly it is a service to the patients in our community who need real time assessment and intervention to have the best chance of timely recovery,” Weavind said. “This tool will also help VUMC to appropriately help community hospitals care for their patients in the community and identify patients who need a higher level of care and facilitate timely transfers to Vanderbilt as needed for patients to get these services — both surgical and medical.”

David Charles, M.D.
David Charles, M.D.

VUMC leadership recognized that telemedicine would be integral to the affiliate network, helping doctors and hospitals provide timely expert care to patients in a more efficient manner, said David Charles, M.D., professor of Neurology and medical director for Telemedicine.

“The promise for telemedicine is it can elevate the level of specialty care in community settings, keeping the patients closest to their homes and families and also in the most cost-efficient environment,” Charles said.

“It is one of the key elements for how the network will be successful. As we increasingly project our specialists into community settings through the Vanderbilt Health Affiliated Network, we will broaden the scope of patient access to specialty services in community settings and also better identify patients needing transfer to a higher level of care.”

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