A telemedicine project linking small rural hospitals to specialists on Oahu aims to improve the survival rate of stroke patients in rural communities.
The project, known as Hawaii Telestroke Network, links Queen’s Medical Center neurology experts to emergency doctors in rural communities to help make treatment decisions quickly for critical patients who typically don’t have access to specialists.
Virtual access to physicians is among the solutions being proposed for the growing lack of specialists on the neighbor islands and rural parts of Oahu. It is particularly crucial in situations such as strokes — the leading cause of chronic disability in adults — when time is of the essence and could mean life or death, according to Karen Seth, director of Queen’s Neuroscience Institute.
The Hawaii Telestroke Network won a three-year state grant last year totaling $454,212 to install and operate the video technology at seven hospitals. Molokai General Hospital began using the system in January, and Wahiawa General Hospital will implement the technology by the summer. Hilo Medical Center has used the system as a pilot project since 2008.
The two-way video technology allows a virtual doctor to pan, tilt and zoom in on a patient for a quick and efficient diagnosis.
"They’re ableto use the camera to zoom in from across the room and count a person’s eyelashes," said Daniel Davis, an internist at Queen’s and founder of Interactive Care Technologies, which developed the technology in 2005. "They can do a very detailed neurological exam through video camera to detect subtle signs of an impending stroke."
The system could be used to connect specialists on Oahu with rural emergency doctors to determine whether a patient is eligible and would likely benefit from so-called "clot-busting" medicine, which reverses the effects of a stroke but must be administered within three hours.
Only 1.3 percent of Hawaii stroke patients received the medicine in 2008 compared with the national average of 6 percent, due in part to the lack of timely access to neurologists in rural emergency departments statewide, according to the Hawaii Telestroke Network.
The technology was originally developed for medically fragile patients living at home. So far, Davis has sold the system to 45 patients who need round-the-clock care, which he said is a far cheaper alternative to being in a hospital or nursing home.
The system currently costs between $5,000 and $15,000 depending on type of camera and the wireless system purchased. In addition, the company charges a monthly fee for tech support, Davis said.
The Web-based system is far simpler than the telemedicine systems of old, which required providers to be at stationary workstations. This system has just an on-off button, can be wheeled up to a patient and automatically tracks down an on-call specialist at a hospital, home or on a Web-enabled mobile device.
Physicians have been slow to adopt the technology, which also could help reduce costly hospital transfers and significantly decrease mortality through timely treatment, in part due to the busy nature of emergency rooms.
"If setting up this videoconference will slow down this process, they may be reluctant (to use it)," Seth said. "Physicians are slow to adopt new technology. Look at how long it’s taken physicians to come onboard with electronic medical records."
Continued funding for telemedicine systems has been a barrier to providers as well.
Telemedicine in general has not been widely adopted in Hawaii, despite initial efforts to launch systems in the mid-1990s, according to Deborah Birkmire-Peters, director of the University of Hawaii’s Pacific Basin Telehealth Resource Center.
"Telehealth projects in Hawaii have largely not been continued after external or grant funding has expired. Most of these projects have not focused on coming up with a sustainable business model that would produce a revenue stream to actually pay for the services," she said.
"But telehealth is a potential solution to the health care access problems in Hawaii, and there are successful models in the rest of the country."
Health insurers reimburse doctors for certain telemedicine services; however, providers have taken issue with the amount of reimbursement.
"What happens is federal grant funding dries out, then the projects shuts down," Seth said. "A lot of projects spring up; it’s just sustaining them that’s difficult."
