Raza T et al. 2009 "Pulmonary telemedicine - a model to access the subspecialist services in underserved rural areas."

Reference

Raza T, Joshi M, Schapira RM, et al. Pulmonary telemedicine-a model to access the subspecialist services in underserved rural areas. Int J Med Inf 2009;78(1):53-59.

Abstract

"BACKGROUND: To describe the use of videoconference telemedicine for providing outpatient pulmonary consultation to a remote, underserved clinic site. METHODS: Analysis of data from the Milwaukee Veteran Affairs Medical Center (VAMC) pulmonary telemedicine clinic. Pulmonary physicians at the Milwaukee VAMC provide outpatient consultations with the use of videoconference technology to patients located at the Iron Mountain VAMC in Iron Mountain, MI (346 km or 215 miles from Milwaukee). Data on demographics, referral patterns, access to care, consultation process, and outcomes are presented. RESULTS: A total of 314 patients (684 visits) received telemedicine consultations between January 1, 1998 and December 31, 2004. Common reasons for referral were abnormal radiology (38%), chronic obstructive pulmonary disease (COPD) (26%), and dyspnea (13%). Physical exam was performed by the telemedicine registered nurse or respiratory therapists in 90% of visits. Common diagnoses were COPD (29%), benign pulmonary nodule (11%), bronchial asthma (6%), and lung cancer (6%). Telemedicine consultation resulted in a change in management for 41% of patients. Only 8% of patients required an in-person clinic visit at Milwaukee VAMC following a telemedicine visit. Telemedicine saved patients 473,340 km or 294,120 miles of travel over the study period. CONCLUSIONS: The provision of subspecialty services using telemedicine to a remote underserved rural population provides improved patient access to subspecialty care. Physicians are able to rely on medical history and radiology to manage patients across a broad spectrum of complex pulmonary conditions with the assistance of a non-physician health care provider at the remote site."

Objective

"(1) to evaluate the use of telemedicine technology to provide consultative outpatient care for a broad range of pulmonary conditions; and (2) to evaluate the effect of a telemedicine program in terms of (a) access to care (including reduction in both travel for patients and waiting time for appointments), (b) clinical decision making (medical interview and physical exam, medical work-up required, and outcome of telemedicine consultation), and patient disposition (need for follow-up care and need for inperson evaluation)."

Type Clinic

Primary care and specialty care

Size

Large

Geography

Urban and rural

Other Information

A small rural Veterans Administration hospital communicated with a large urban Veterans Administration medical center.

Type of Health IT

Telemedicine

Electronic health records (EHR)

Type of Health IT Functions

Medical (tele)consultation between the rural clinic and the VA main medical center was conducted via a high-speed, two-way audio, and video conferencing system.

Context or other IT in place

A computerized patient record system was already in place.

Workflow-Related Findings

Only 55 out 684 patients (8 percent) required a face-to-face consultation in the primary care center in Milwaukee. Total travel distance and time was reduced by 294,120 miles and 748 workdays.

Patients reported satisfaction and understanding of advantages and limitations of telemedicine. Patients showed interest in continuing telemedicine and expanding it to other services.

There was no statistical difference in the length of telemedicine and in-person consultations.

Study Design

Only postintervention (no control group)

Study Participants

A total of 314 patients (684 visits), six board-certified pulmonary subspecialists at a hospital, two nurses, and a respiratory technician at a rural hospital participated.