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July 2014

A ‘Smart’ Treatment Option
By Maura Keller
For The Record
Vol. 26 No. 7 P. 6

With a limited number of specialists available in rural areas, leveraging mobile technology through smartphones can help bridge the gap and provide timelier and less expensive access to medical care. For example, an innovative Arizona program is simplifying telemedicine by incorporating smartphone technology to improve rural trauma care.

Telemedicine technology often targets rural areas where individuals may be without transportation or lack the resources to purchase prescription medication. The long-term goal is to limit the population’s chances of hospital readmissions. Traditional telecare equipment such as remote monitoring devices, digital scopes, and examination cameras has allowed patients in remote locations greater access to quality health care, but it can be a clumsy setup.

This was the case at the University of Arizona Medical Center’s rural hospitals. “[The equipment was] stationary and took time to switch on, as it required a microphone, headphones, and camera,” says Bellal Joseph, MD, medical director of the Southern Arizona Telemedicine and Telepresence program. “Additionally, these devices were located in a remote room away from the emergency department, so in the middle of the night when trauma usually comes, it was difficult for personnel to use these devices. As a result, despite an established telemedicine program, it was not implemented due to logistic difficulties.”

However, a phone call from one of the rural medical centers changed the program’s outlook. “I told them to click a picture of a CT scan and forward it to me,” Joseph recalls. “The physician sent me an image on my iPhone, and I made the decision to transfer the patient to our center. This is when I realized the importance of smartphone technology.”

How It Works
Spurred by that conversation, the University of Arizona Medical Center now has fully embraced the use of smartphone technology within its environs. The results have been eye opening. In a recent survey of hospital employees, more than 95% of respondents believed smartphones were easy to use, boosted patient care, and improved communication among team members.

Besides being a hit within hospital walls, the technology also has made a difference throughout the area. “We have a well-established working relationship with the community and rural hospitals in this region of southern Arizona,” Joseph says. “We have also defined guidelines for transferring patients to our level 1 trauma center using smartphone technology.”

In the program’s initial phase, smartphones were given to a rural hospital’s emergency department and on-call trauma surgeons at the University of Arizona facility. The password-protected devices, whose data can be erased in case they’re lost or stolen, were issued to only trained, authorized personnel.

“Physicians in the remote facility sent patient photographs and even performed real-time video conferences to discuss the management of the patients,” Joseph says. “It took us almost one year to establish and get this program running to its potential.”

In essence, the smartphones took the place of the more expensive traditional telemedicine equipment, a huge consideration for cash-strapped rural facilities. Embracing the frequent improvements being made to smartphone technology has opened new care avenues for rural providers that appreciate the device’s impressive adoption rates and ease of use.

In addition to those benefits, smartphones can elevate patient care in a rural setting by making it more convenient and readily available to those who may live many miles from a major medical center, says Darrell West, PhD, vice president and director of governance studies at The Brookings Institution. “Video conferences allow patients to talk to high-quality physicians and get advice on their treatment,” he says. “Nurses can check on their progress following hospital stays and work to prevent the need for readmission. Patients like this kind of technology because it brings the personal touch to people who often do not have health care providers in their own area.”

Smartphones also can be deployed to take photos of a patient’s condition for inclusion in their charts. At the University of Arizona Medical Center, these snapshots serve as visual aids when discussing the severity of injuries with patients and their families. In addition, staff members reference the photos during subsequent treatment to ascertain whether there has been any progress. “The photographs add a visual component to the communication with the patient and help in better care and doctor-patient relationship,” Joseph says. “We also routinely receive photographs from rural facilities requesting advice regarding patient management.”

The photos also help educate residents and students and expedite care transfers.

Smartphone technology’s functionality works well on the road, too, says David Collins, MHA, CPHQ, CPHIMS, FHIMSS, senior director of mHIMSS, who points out that the devices are invaluable tools during emergencies. “With the advent of 4G technology, the ability for emergency medical services to interact with the emergency department doctor from a distance and provide optimal care is now an available option, which was not actually an option five to six years ago,” he says.

A Collaborative Effort
When the idea of implementing smartphone technology initially was proposed, hospital administration and lawyers concerned with potential patient safety issues and HIPAA violations weren’t sold on the concept. Trauma team members who doubted the technology’s capabilities also were hesitant to climb on board. “However, after establishing security protocols, including dedicated work phones, secure e-mail addresses, and two patient identifiers with each photograph, we were able to work cordially with both the hospital administration and staff to implement this program,” Joseph says.

On the other side of the equation, smartphone use has been well received by patients, who must sign a consent form acknowledging that they agree to have their photos taken for educational and care purposes. The introduction of Epic’s MyChart, many of whose functions translate to a smartphone, has streamlined the image-capturing process. “With the introduction of Epic software, it has become simpler, as these photographs are not directly recorded into patients’ EMRs,” Joseph says. “All trauma patients have embraced this program and given us positive feedback. Patients routinely e-mail or message us the photographs for their follow-up in order to prevent traveling long distances just for a clinic visit.”

The project has been a team effort featuring involvement and coordination at multiple levels, from administration and nursing to clinicians and residents. “It is important to understand how this system has been developed,” Joseph says. “We have presented our model at multiple national institutions to help them replicate our system and embrace smartphone technology for improving patient care.”

The Brookings Institution believes telemedicine, including the use of smartphone technology, will continue to thrive as more health care organizations become aware of its ability to deliver quality care in a relatively inexpensive manner. “If we can treat people without having to admit them into hospitals, that will save a huge amount of money,” West says. “The only challenge at this point is that we are early in the mobile revolution and don’t have detailed data on mHealth. But as more and more people avail themselves of smartphone technology, it will be easier to document its expected benefits.”

Collins says the success of smartphones in the health care industry hinges on several factors, including the technology’s availability, bandwidth, state policies, and reimbursement issues. “In general, I think that mobile technology will continue to be leveraged to bridge the gap in access to care for those in remote areas,” he says. “In fact, by doing so, this will help providers practice wellness and help to keep chronically ill patients from presenting with multiple comorbid conditions requiring long lengths of stay and potentially readmissions. The drive to value of care as opposed to volume of care due to the Affordable Care Act will certainly make mHealth technology of greater and greater necessity.”

— Maura Keller is a Minneapolis-based writer and editor.