All three Hawai‘i Pacific Health (HPH) adult hospitals now offer telestroke services, with Wilcox Medical Center successfully adding new remote capabilities in March. This is the latest in HPH’s efforts to expand telemedicine capabilities to increase access and provide more timely care.
Telemedicine provides greater access, allows physicians more flexibility and can decrease costs, says Amy Corliss, MD, a hospitalist at Wilcox Medical Center and hospital specialty chair for HHP. “We can’t tell most physicians that they must live within 30 minutes of the hospital,” she says. The use of telemedicine allows physicians to care for patients in a timely manner without losing precious time in their drive from home to the hospital, or even while traveling, as was recently the case with Surendra Rao, MD, a neurologist at Kaua‘i Medical Clinic.
“With neurology, especially with stroke, epilepsy and movement disorders, visualization and a verbal encounter with the patient can be illuminating,” says Rao. “The use of technology and telemedicine can have a huge impact on patient care.”
Along with his Straub Medical Center and Pali Momi Medical Center neurology counterparts – Beau Nakamoto, MD, and Huidy Shu, MD – Rao has been able to use technology to provide timely, and often lifesaving, care to more patients.
Along with the live audio and video, the new equipment also provides visualization of medical equipment, says Rao. “The camera turns 360 degrees. It’s almost like being there.”
The use of the technology allows the specialist to provide guidance in a much quicker fashion in collaboration with the emergency department (ED) physicians, he says.
Rao has used the new equipment to treat four patients in the last few months. One patient was hospitalized for epilepsy but was actually having nonepileptic seizures. Rao was able to diagnose remotely, stop the antiseizure medications and put the patient on antidepressants. In another case, the patient was thought to be experiencing stroke symptoms but, upon telemedicine evaluation, was found to be seizing.
“It exemplifies teamwork between the ED docs and the consultant,” he says. “Having the ED docs interested and facilitating the process makes a humongous difference.”
You can’t do it all yourself, says Rao. The ER physicians set up the equipment and know how to perform a neurologic exam. “It’s truly a partnership.”
While Wilcox Medical Center is looking to expand its telestroke efforts, Corliss and others are working to look even further. As a hospitalist at the HPH hospital with perhaps the greatest need for remote access to specialists, Corliss has taken the lead on systemwide efforts around telemedicine, teaming up with her HHP specialist colleagues.
Another area of focus has been teledialysis, which allows the patient to avoid unnecessary travel while receiving a remote nephrology consultation.
As an example, Wilcox Medical Center staff recently were able to treat two patients transferred from Kaua‘i Veterans Memorial Hospital who didn’t have access to a nephrologist and needed care and dialysis. Those patients are often transferred to Queen’s, says Corliss, but the Wilcox team was able to get two Fresenius physicians, currently credentialed at Pali Momi, credentialed at Wilcox Medical Center. The patients then went to Wilcox to receive dialysis with a remote consultation from those physicians, she says. Two additional Wilcox patients were able to remain at home on Kaua‘i to continue dialysis in the hospital.
When you’re in that situation and not able to travel, your only other options could be to go without treatment for a week and risk getting sick, or even dying, or to stop dialysis completely, says Corliss. Teledialysis offers another, more viable option, especially for patients who are bedbound.
Telepsych is another area of opportunity, allowing physicians to better handle urgent needs, like conducting a suicide risk assessment, as well as more routine consults. One recent case at Pali Momi Medical Center demonstrated teamwork across all three HPH adult hospitals, with a patient being transferred from Wilcox Medical Center to Pali Momi Medical Center for complicated hand surgery and receiving a psych consult from a psychologist at Straub.
There are also opportunities around pediatrics – with both telepsych and perioperative care. Some patients miss post-op appointments because they can’t afford to travel or have other restrictions, says Corliss. This allows them to receive that follow-up care from home, which is both easier and cheaper. Dermatology is yet another area to explore, she says.
Telehealth is positioned to be a key to success in population care by improving access and lowering cost. This is just the beginning in HPH’s efforts to use technology, and our HHP colleagues are helping to lead the way.