The recent crisis in Haiti and the preceding swine flu pandemic have highlighted the importance of reducing any time delays in emergency and critical care to mitigate disaster. It is therefore little surprise that many of the techniques used to increase efficiency in emergency care today rely on web and audio-visual technology.
A key advantage of audio-visual technologies is the ability to treat patients remotely without having to lose time in actually bringing clinician and patient physically together. Nowhere is this need more vital than in the treatment of ischaemic strokes, an area that is growing as a result of an increasingly ageing population. According to statistics, each minute an ischaemic stroke goes untreated 1.9 million neurons die.
For treatment to have the most effect it must be delivered within three hours.
Vascular neurologists, however, are few and far between. In New York hospitals, ischaemic stroke patients are undergoing a remote stroke assessment by means of various audio-visual techniques packaged under the title of telemedicine.
Under the system the vascular neurologist remotely interacts with patients and staff to observe diagnostic head imaging, cardiac monitors and a patient's performance on structured neurological examination.
Tests have shown this approach is more effective than simple telephoning. A recent randomised study in California shows that the correct decision in administering thrombolytic therapy was made 16% more often with patients in telemedicine than with a more conventional telephone group.
The key to the success of stroke telemedicine is the creation of a network of hospitals that can intercommunicate freely. Following from New York's example, such networks have been established in France, Canada, the US and Germany.
Accessing all areas with video
The approach has proved so successful that the same technology is being used in other emergency applications and critical care situations. Video linking, for example, is now being used by the paediatric intensive care unit at Massachusetts General Hospital for Children in Boston, US to provide continual patient monitoring.
Six paediatric intensive care unit (PICU) physicians use videoconferencing units installed in their homes. When they are needed for a consultation they videoconference in to a portable telemedicine station positioned at the patient's bedside.
The attending doctor can then see the patient communicate with on-site clinicians, who evaluate the child's condition and make treatment decisions. Special cameras and scopes can also be attached to the hospital-based unit to allow even closer evaluation of the patient.
In one case highlighted recently, a young patient was admitted to the PICU in the early hours of the morning with respiratory distress. From home, the on-call attending physician was able to evaluate the patient on video, identify the respiratory problem and discuss treatment with the nurse, PICU fellow and respiratory therapist at the patient's bedside. The on-call attending paediatrician was also able to address family concerns and supervise treatment without having to waste time travelling to the hospital.
Videoconferencing technology is hardly new but the application of this technology – connecting at-home physicians with their patients and the hospital-based medical team – is novel. Joseph C Kvedar, director, Center for Connected Health recently anticipated that other intensive care units for adult and paediatric patients could also benefit from the technology.
From treatment to tracking
Treatment is obviously an area where IT can make a difference, but tracking patients and equipment in critical care can also be vital to improving outcomes.
Here radio-frequency identification (RFID) technology plays a major role. RFID systems can track patients, staff and hospital equipment. RFID patient tags can register the time the patient goes into the hospital, the time it takes for a physician to attend to the patient, relay the information to the software system for review and analysis and provide insight into patient movements. Tags can also be embedded in hospital equipment such as portable X-ray machines, scopes, lights, surgical tools and so on, to keep track of equipment use and guarantee proper monitoring and retrieval of important equipment in a timely fashion.
California Hoag Memorial Hospital works with Patient Care Technology Systems (PCTS) to automatically track emergency patients. The application uses PCTS' Amelior EDTracker and an ultrasound-based indoor positioning system (IPS) from Sonitor Technologies.
The IPS utilises battery-powered tags that transmit 20–40kHz acoustic signals to receivers. Frequency modulation through each tag communicates a unique signal to the receivers, which use algorithms to analyse the signals then forward their IDs to PCTS' software via an existing wired or wireless network.
The web-based Amelior EDTracker software processes the tag data to automatically identify the location and status of patients and equipment. Workflow algorithms within the Amelior EDTracker software interpret the meaning of location, movement and interactions between patients, staff members and equipment, to automatically communicate patient care milestones when they occur.
Interfaces to lab, radiology and other systems integrate additional patient and order status information, creating a centralised workflow communication and management portal for the emergency department.
This technology does take some adapting, however. RFID has been shown to interfere with other hospital equipment, therefore there are limitations to its effectiveness. However, no one has suggested a plausible alternative as yet, and the benefits still clearly outweigh any drawbacks.
That caveat aside, this area seems assured to continual growth. A recent report on the state of this market has revealed that major companies such as Siemens, Community Health Systems, AGFA-Gevaert and Fresenius have shifted their attention to the telemedicine market as they believe that there is huge untapped potential in this area.