Dr. David McSwain could have done it the easy way.
He could have just ordered a premade telemedicine cart and saved himself a ton of time. Instead MUSC’s assistant professor of pediatric critical care spent hours with information technologists and equipment suppliers to design just what he wanted – a cart he would use as a physician if he were treating a seriously ill child and had no time to waste.
“Dealing with a critically ill child can be an extraordinarily stressful thing for everyone involved. The last thing I want to do is to add another thing to complicate what they already are doing,” he said of the emergency health professionals at outlying rural hospitals who will be using this telemedicine technology. “In 30 seconds to a minute, they can have a pediatric critical care physician in the room with them. That’s huge. This allows us to take some of their stress away. It’s as if our physicians are there at the bedside with them.”
With initial sites going live at Georgetown Memorial Hospital and Waccamaw Hospital in September, the pediatric critical care telemedicine program will also be rolled out at Colleton Medical Center in Walterboro later this year, and at Conway Medical Center in early 2014. These facilities will have 24/7 access to pediatric critical care and emergency medicine consultation, with the goal of eventually expanding the program to include other pediatric subspecialties. The program is made possible through a $525,000 Duke Endowment grant. McSwain has spent the past three years designing the program, and personally detailing the $36,000 carts to make sure doctors will love them.
Rolling one of the carts out like his baby, McSwain beams, pointing out special features. There’s a high-definition camera mounted on top that he can control remotely, zooming in at whatever he needs to look at in an examining room, from the way a child may be breathing to their vital signs on a monitor.
| ||Dr. David McSwain, center, demonstrates the ease of the telemedicine cart to the hospital staff at Georgetown Memorial Hospital. Photo Gallery|
“If a picture is worth a thousand words, a video is priceless.”
A handheld camera operated by the health professionals in the room allows him and others to see incredibly close-up shots during the exam, images that can be frozen and examined in great detail. A laptop can transmit any X-rays and lab results, and any equipment with a video output, such as an echocardiogram, can be linked into the cart. A Bluetooth electronic stethoscope can transmit heart and lung sounds in real time.
“We hear exactly what they hear,” he said, holding up a stethoscope that is a replica of the one being used by the community providers. “It’s just like being in the room examining a patient, and that is amazing. It’s an example of something we wouldn’t have been able to do a few years ago.”
McSwain has no doubt the program will save lives and costs. He also knows he’s laying an important foundation for what will be an exponential growth of telemedicine at MUSC, especially given the $12.4 million state appropriation to the Medical University of South Carolina for the Medical University Hospital Authority to expand its telemedicine program. See the related story here.
Access to Care
Telemedicine’s main selling point is access to care, especially given the recent advancements in technology. McSwain designed the program so the equipment could be expanded and evolve with expanding technology. The goal is to bring in additional pediatric and adult subspecialties.
“What I’m doing is not only developing a program for pediatric critical care and emergency medicine, but developing a foundation for telemedicine throughout South Carolina.”
There’s a major problem with access to care and access to subspecialties in particular. Only 3 percent of pediatric critical care specialists practice in rural areas, whereas 27 percent of visits to community emergency departments are children. “There’s a major mismatch between the patients who come into the departments in the community and the specialty services available to handle those children. A critically ill child needs the help of a critical care specialist as soon as they can get it. This program provides that care within minutes instead of hours.”
Data shows that critically ill children cared for in a center without pediatric critical care have worse outcomes than centers that offer that specialty, he said. McSwain said they are there to help community physicians. “There’s a comfort level that we can provide because of the volume of these type cases that we see.”
Another benefit is MUSC physicians may no longer have to have children transferred who could safely be hospitalized closer to home where their support system is. With telemedicine, critical care specialists have the information they need to make that determination remotely and to also avoid costly treatments that may not need to be done. Data shows a successful telemedicine program can allow up to 25 percent of the patients to remain at their community hospitals.
McSwain said developing the program has been more time-consuming than he thought but well worth the technology geek label he’s gotten. “There are a lot of problems throughout the country and in South Carolina in particular with access to care, but there is technology available now to address that in a way that has never been addressed before.”
MUSC has six pediatric critical care physicians and 12 pediatric emergency medicine physicians who already are taking emergency calls by telephone. Now they will have the advantage of making better-informed judgments and be able to assist community physicians in a way that eases some of the difficulties of caring for a critically ill child. For children who will need transport to MUSC, they can begin developing that critical relationship with the family before the child even arrives.
As technology continues to improve, it will make sense to use it to reach remote areas to increase the quality of care.
“I think the future of medicine is that almost all doctors will be using telemedicine in some way or another, and what we want to do is to establish that foundation to allow for the appropriate growth of telemedicine in the future. I really do see a few years down the road having telemedicine available to community hospitals and community doctors’ offices throughout South Carolina that provides a menu of subspecialty services to communities that have never had access to these services before.”
A crucial part of the program has been exploring the community sites to make sure there is staffing and technical support. McSwain said it takes a telemedicine “champion” at the other end to make the program a success. It’s meant to be a collaborative project, he said.
And though the technology is powerful, it’s not the main selling force for MUSC or community doctors. McSwain said he was drawn to the field of pediatric critical care because of its ability to help really sick children, ones who seem to have little chance of surviving. He and other subspecialists have a chance to do that on a bigger scale with telemedicine and save precious minutes in the process.
“You have the opportunity to make a huge difference and even save their life, and they’ll go on to live a long and normal life. It’s an amazing thing to be able to have that kind of impact on these extremely sick children. The things we can do to help them are really incredible.”