October 21, 2016

(Article by the Martinsville Bulletin) -Thanks to technology, the doctor is once again making house calls – almost.

Remote patient monitoring, also called telehealth, is using technology for “looking at other people from a distance and providing clinical care from a distance,” said Laurie Wardle, the STAR Telehealth Program Manager at New College Institute.

Telehealth involves a patient at home or other location and a doctor or other medical professional in the clinic. The patient has the use of health-monitoring devices at home, which send information to the clinic over the internet. Both parties can see each and hear each other through video on a computer or tablet.


Wardle and Margaret Fey, a STEM team leader at AmeriCorps operating out of NCI, gave the program “How Is Telehealth Changing Health Care?” Wednesday at NCI.

Studies from the University of Virginia and the American Telehealth Association show that “it really works,” Wardle said.

The specialized equipment used at the patient’s house includes a smartphone, a monitor, a regular phone with a screen, an iPad, video, a cart with medical devices and/or a laptop computer.

“The doctor’s office or hospital is responsible to provide and maintain the equipment,” she said.

The cart is on wheels. The computer part is close to the bottom, because it is heavy. It has a keyboard, screen and camera as well as medical equipment, called “peripherals.”

Peripherals connected to it include an otoscope, which is a camera that can be inserted into the ear canal; a “total exam camera with a tongue depressor” for looking into the mouth; a dermascope, for examining the skin; and a stethoscope.

Patients who are discharged from the hospital but still need monitoring can get that done through telehealth rather than by making repeated trips back to the hospital, Fey said. Usually, medical professionals would set up the medical equipment and internet connection at the patient’s house to have it ready before he or she is back home.

That equipment can be smaller and simpler than the cart. It can fit on a table, with a scale at the floor. It would monitor weight, blood pressure, the pulse and oxygen levels.

For the transmission of information, the internet connection must be a “super deluxe high-speed, high-tech one,” Fey said, capable of sending video, audio and data. It must be secure, with no buffering.

Remote patient monitoring is “too expensive and unnecessary for everyone,” Fey said. It’s for “just those likely to have to have return visits,” such as people with pneumonia.

Also, “remote patient monitoring is not 911. You have to use good judgment” to determine what is normal monitoring and what is a crisis requiring calling emergency services.

Using new-fangled technology does not mean forgetting old-fashioned etiquette. Fey said it’s important that both the patient and the health care worker on the other side of the screen dress and act as professionally as they would in a face-to-face meeting in the clinic.

That means the patient should be dressed and coiffed normally, not sloppily. The camera should be set up in a way so that the background is clear and clean, instead of showing a cluttered and messy area.

When talking on camera, both people should be far enough back so there’s a good view of each. No one should be so close the head appears to be chopped off, for example.

“Maximize the amount of time you spend with your doctor and minimize distractions,” she said.


Insurance companies are beginning to take paying for telehealth services seriously, Fey said. “Medicare and Medicaid are paying it, and that was the first hurdle. Third-party payers are coming on board. They’re not all there yet.”

An indirect benefit of telehealth is that it reduces exposure to infectious diseases. A quarantined patient could communicate with health care providers, friends and family through voice and video on computers. Even though a doctor would have to suit up before entering the patient’s area, a video conversation without the full protective garb may be more productive and comfortable.

A person’s own device, such as a smartphone or a Fitbit fitness tracker, could send information directly to a doctor. Wardle mentioned a recent news story that told about a man whose treatment for heart attack was helped because his Fitbit had recorded important information about the heart attack.

Telehealth is particularly important in regions where there simply is not physical access to medical care, such as in many areas of the Congo. Dr. Charles Lewis of UVA and Jesse Galo of CISCO set up a telehealth program there to improve health care for mothers giving birth. It has improved the survival rate of mothers and newborns, Wardle said.

In Chantilly, Virginia, Dr. Rebecca Bates has a free clinic, Adams Compassionate Healthcare Network, which uses telehealth. Tactical units are brought into the homes of people who otherwise would not normally get care, she said.

Fey asked the audience of the program if any of them remembered seeing the children’s television cartoon “The Jetsons.”

“The Jetsons,” produced in the 1960s, imagined life in the future. In the show, “the doctor comes down on TV in the living room,” Fey said. “It’s really the wave of what’s happening” now.

Holly Kozelsky reports for the Martinsville Bulletin. She can be reached atholly.kozelsky@martinsvillebulletin.com