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In 1968, a 26 year-old medical student named Michael Crichton, who would go on to write Jurassic Park, published a book called Five Patients. In it, he told the true stories of how patients could interact with what was then the most modern parts of the American health system. His last chapter outlined the story of a 56-year-old mother of three who experienced chest pain on a flight from Los Angeles to Boston. She walked off the plane and directly to the Logan Airport Medical Station. There, through a black and white video feed, she was “examined” by a physician two and a half miles away at Massachusetts General Hospital. With a nurse on-site conducting lab tests and palpitating the patient, the physician diagnosed her condition and signed a prescription with something called a “telewriter.”
That book introduced America to telemedicine, creating the popular image of a video link between a physician and patient. At the time, such interactions were still quite rare. But skip ahead five decades, and in 2016, America’s capabilities in providing healthcare at a distance have become vast, and we are now truly capitalizing on these technologically-advanced opportunities.
Over the past 15 years, a number of health systems have moved into digital health by creating “telestroke” programs. A person having a stroke loses approximately two million brain cells per minute when a blood blockage or rupture deprives the brain of oxygen. Unfortunately, it is difficult to know without a CT scan whether the patient has a block or a bleed, and giving the wrong treatment can be fatal. A coagulant to address a bleed would compound the harm if the patient actually has a blockage. Similarly, a clot-busting blood thinner could cause a ruptured vessel to result in catastrophic blood loss.
Telestroke programs connect regional hospitals with a neurologist who can rapidly evaluate a CT image and consult with the physician on-site on the best course of action. Nationally, telestroke programs cut anywhere from five to 30 minutes off the door-to-treatment time, which has been shown to improve patient outcomes. NewYork-Presbyterian, where I serve as chief information officer, took such care one step further by creating a Mobile Stroke Treatment Unit (MSTU). This specialized emergency vehicle is complete with CT imaging capability and will be dispatched by the New York City 911 System via the FDNY directly to a patient showing signs of a stroke. By wirelessly transmitting the CT scan to a NewYork-Presbyterian neurologist, the amount of time from the onset of symptoms to the delivery of care is significantly reduced. Additionally, the MSTU carries medications specific to diagnosing and treating strokes, allowing the team to deliver the right drug immediately upon diagnosis, thereby saving even more precious time.
Saving time can also be critical for patients in emergency rooms, and NewYork-Presbyterian is using digital health to bolster efforts there as well. When an emergency room patient is in need of a specialty consultation, it may take hours to bring a specialist to the emergency room or to transport the patient to another location. By enabling video connections between patients and specialists, we are now delivering care more quickly and efficiently, improving efficiency and quality of care in the Emergency Department.
With digital emergency room capability, NewYork-Presbyterian is constantly innovating. One example is through the NYP OnDemand Digital Emergency Express Care service. Patients arriving at NewYork-Presbyterian/Weill Cornell Medical Center are given the option of a virtual visit through real-time video interactions with a clinician, after having an initial triage and medical screening exam with nurses on site. A private room with a webcam/monitor provides patients unmatched convenience and reduced time spent in the Emergency Department. More importantly, in the past six months more than 1,300 patients have moved through this process in an average of 35 minutes from arrival to discharge, which is at least two hours faster than they would have experienced in the traditional process.
The convenience of digital health visits will inevitably increase as more services are offered remotely. Primary care visits will become more data-rich as more patients gain access to innovative tools like Tyto and MedWand, which allow them to provide a remote physician with ear and throat images, breath sound, heart rate, blood pressure, and blood oxygen levels. NewYork-Presbyterian is also beginning to increase the convenience of pre-surgical visits with anesthesiologists and post-surgical checkups with physicians by scheduling these appointments as virtual video visits. In addition to being more efficient for the physician, they can turn hours of traveling and then waiting for a physician into a 10-minute video appointment for the patient.
A recent Wall Street Journal article reported that telemedicine visits are offered by 70 percent of large U.S. employers, while only about 3 percent of eligible employees have used the services. Part of the limited participation may be due to a misunderstanding of how much can now be achieved with telemedicine.
Unlike the physician in Crichton’s 1968 book, today’s physician works with high resolution video, direct access to a patient’s medical history via an electronic medical record, and the ability to remotely print discharge instructions. As more digital health services are offered, go beyond a simple video interaction, and become routine and easy for both patients and physicians, use will inevitably increase. And that will drive much-needed efficiency into the U.S. healthcare system.
Daniel Barchi is Senior Vice President and Chief Information Officer of NewYork-Presbyterian, one of the largest healthcare providers in the US, in affiliation with Columbia University Medical Center and Weill Cornell Medicine. He leads a team of 1,000 informatics and technology specialists who deliver the tools and data that physicians and nurses use to deliver acute care and manage population health.
