With TeleHealth program, second opinions in your own back yard

Last modified: Wednesday, March 05, 2014
NORTHAMPTON — Used to be that if a Pioneer Valley resident wanted a second opinion on a health matter, it would involve taking a day off from work and planning a trip to Boston to battle traffic, and parking, and an unfamiliar medical landscape.

Those days are gone, thanks to Telehealth, a 2-year-old program that allows Cooley Dickinson Hospital physicians to work with Massachusetts General Hospital providers in Boston.

CDH officials say TeleHealth enables patients in the western part of the state to more easily and more quickly get specialized care from medical professionals over 100 miles away.

R. F. Conway, M.D., director of the Cooley Dickinson Emergency Department, says Cooley Dickinson’s involvement with TeleHealth allows specialists at Mass General to assess and treat patients without the patient having to endure a drive to Boston.

“We have in the hospital a portable cart with a high resolution monitor with camera and all of the IT attachments,” said Conway.

Cooley Dickinson officially became affiliated with Mass General in July of last year, but Conway said he’s been working with Mass General for two years on the TeleHealth program because it offers such value to CDH patients.

Specialists at Mass General can actually give an exam over the monitor. “They can move the camera around from their end, they make a decision, and they can then talk to you about it,” he said.

The high resolution visual capabilities of the monitor allow the specialists to conduct an exam almost as if they were with the patient in person. Patients with neurological disorders will be able to see their primary care physician and schedule an appointment with a Mass General specialist. “You go into the room and there’s the expert, the world’s leading expert, talking to you,” says Conway.

Conway said because Cooley Dickinson is considered a tertiary care facility, it is helpful to have access to a “world-class hospital” such as Mass General.

“They have experts in things that I can’t spell,” said Conway. “For example, they have five surgeons who just do burns. They have five neurosurgeons, all they do is brain tumors. They have a couple of neurosurgeons who only do neck tumors. They’re one of the world’s best hospitals.” Mass General’s TeleNeurology Program Manager Juan Estrada said the TeleHealth program “allows Mass General to meet its mission in many senses” by helping the hospital keep up with its goals for clinical, community and educational outreach.

“The fact that we are able to care for these patients remotely is powerful,” says Estrada.

Remote access to specialized care not only helps save the lives of stroke patients from Cooley Dickinson, it allows Mass General more time to focus on its own patients.

TeleHealth “allows Mass general to lead a regional effort to improve stroke care and make stroke expertise available,” says Estrada. “It also allows Mass General to incorporate TeleHealth and this kind of 21st century practice of medicine into its educational programs.” On the Northampton end, TeleHealth makes it possible for many patients who otherwise might have been sent to Mass General for treatment to be seen by a specialist without disrupting their lives.

“In two hours they might be able to get the whole thing done here and never leave the community.” The collaboration between the two hospitals began with TeleStroke, which focused on stroke patients, and has since been expanded to TeleNeurology to include other neurological disorders. As a part of the TeleNeurology program, patients can be given neurological exams by specialists over the video monitor which involve asking the patient to “close your eyes, smile, lift your right arm, lift your left arm,” explained Conway. Specialists can even ask some patients to walk in order to assess gait and help diagnose conditions. The specialists then outline a treatment plan which the primary care physician would implement.

Because the TeleHealth program allows stroke patients to be assessed by specialists more quickly, decisions can be made about giving a clot-dissolving medication to the patient much sooner.

The two hospitals are working on expanding TeleHealth to other areas of the hospital. In the works are the TeleBurn and TeleBrain tumor programs. The TeleBurn program is not just for burns, but all thermal injuries such as frostbite, frostnip, other cold-related injuries and non-traumatic burn related injuries, according to Conway.

“They actually just developed a cart with a very high resolution camera to evaluate burns,” said Conway. “Normally, the patients with less severe thermal injuries would be sent to Mass General, have to go all the way there and then go get seen and have to come all the way back. With the Tele-Burn program, the procedure would change.” Instead of immediate transfer to Mass General, Cooley Dickinson would see and screen the patient, call Mass General, and then wheel the TeleHealth cart into the room to allow the Mass General specialist to decide if the patient fits into their admission criteria.

“It actually keeps people in the community,” says Conway. “It’s proven that we will actually end up keeping patients in the community who might have had to get transferred out if we didn’t have this program. Costs will be kept down if patients can avoid having to go all the way to Boston for care.” The program would not treat patients with very serious burns. Patients in serious condition will continue to be sent to Baystate or Mass General. “We’d want to see the 2-year-old who got the scald burn, the guy who was lighting his propane furnace and got a flash burn, the snowmobiler who’s gotten a frostbitten foot … stuff like that,” said Conway.

“The amount of things we can do is amazing,” says Conway of TeleHealth’s potential. “It’s pretty state of the art.” In addition, Mass General is looking to get Cooley Dickinson’s nutritionists, physical therapists, occupational therapists, primary care physicians and surgeons involved in the program as well. “They want us to be able to take care of that patient here the same way that Mass General would,” he said.