While Congress now wrestles with Health Care Reform approaches and the political battles connected with this, there is growing evidence that telemedicine could revolutionize the medical care available in rural America, at least for some ailments.
One innovative telemedicine project, for example, is providing distant nursing home patients with Parkinson's disease access to neurologists at the University of Rochester Medical Center (URMC).A pilot study of the project - the results of which were released this month at the International Congress of Parkinson's Disease and Movement Disorders in Paris - demonstrates that the system can improve the quality of life and motor function of patients.
"This study shows that we can effectively deliver care for Parkinson's patients via telemedicine," said URMC neurologist Ray Dorsey, M.D."This system enables us to reach and provide a high level of care to patients who might otherwise not have access to a specialist."
Dorsey and his colleague Kevin Biglan, M.D. oversee the project and divide patient responsibilities between them.The effort is a joint initiative between URMC and the Presbyterian Home for Central New York in New Harford, a 250 bed nursing home near Utica and about 150 miles from Rochester.
When the nursing home opened in 2001, it was the first in the nation to offer specialized care to people with Parkinson's and other movement disorders in a nursing home setting.For years, the Parkinson's patients at the home would typically make 10 trips a year to Syracuse, Albany or Rochester to see a movement disorders specialist.Tony Joseph, the administrator of the Presbyterian Home says that these trips were exhausting for the home's elderly patients. "I knew there had to be a better way," said Joseph in a news release.
Joseph knew of Dorsey and Biglan through their work with the Parkinson Support Group of Upstate New York and approached them to seek their help in devising a solution.They struck an approach that utilized telemedicine to conduct patient visits that otherwise would have been burdensome or not possible for patients.
The expertise for such a project already existed in the Medical Center. URMC has one of the largest Movement and Inherited Neurological Disorders programs in the nation with more than 10 physicians and has been designated a Center of Excellence by the National Parkinson Foundation and the Huntington's Disease Society of America.
The Medical Center has also been an innovator in the field of telemedicine.The system employed for the project was built on a technological backbone developed at URMC and is used to conduct remote pediatric and dental evaluations on patients in schools, day care centers, and other locations.The system is essentially low tech, low cost solution and consists of a laptop, software, and a web camera that allows the physicians to interact with and visually assess patients.
While such remote evaluations have their limitations, Parkinson's disease was an ideal candidate for such a system. "Parkinson's is a very visual disease," said Biglan."You don't necessarily have to
physically touch patients to understand how they are doing."
Patients are brought to a room in the nursing home with a flat screen television so they can see the physicians.All the doctors in Rochester require on their end is a computer equipped with a web camera.Telemedicine "visits" are just like regular office visits and consist of an update on the patient's health, a review of medications, any potential complications, and a standardized motor skills evaluation (balance, gait, coordination, and stiffness) conducted by the physician with the assistance of a trained nurse at the Presbyterian Home.At the end of the visit, recommendations are discussed with the patient and faxed to the nursing home.
If broadly adopted, say the doctors, telemedicine has the potential to reshape the way individuals with Parkinson's disease think about their care and, ultimately, where to live. Currently, people often have to live near medical centers to receive the specialty care they need.Telemedicine has the potential to change that.
"The number of people with Parkinson's will double over the next 25 years," added Biglan."This should be a wake up call to the medical community and government to invest in innovative ways to bring care to this population.Telemedicine represents a tremendous opportunity to expand access to specialized care and improve the quality of life of patients regardless of where they live."
