A modern twist on a doctor’s house call

Mari Beth Senn uses her cell phone to communicate with her doctor over a telehealth network.

Although not in the traditional sense, Ronald Paapke’s doctor was with him all the way through his recent health emergency.

“It was as if the doctor was actually in the room with me,” says Paapke, 54, who suffered a stroke on Sept. 19. “As I moved, the telecom screen was following me. Where I went, the doctor went. It was pretty amazing.”

Call it telehealth, telestroke or telemedicine, the technology that connects hospital to hospital, and doctors to patients, is what helped save Paapke’s life. By the time he arrived by ambulance to Columbia Memorial, OHSU neurologist Dr. Stewart Weber was already onscreen, working alongside the Astoria man’s team of doctors.

Using a secure two-way video and audio communication, Weber was able to help evaluate Paapke and assist with treatment plans, including using a clot-busting drug. The onscreen interaction helped stabilized Paapke until he could be transferred to OHSU for further treatment.

When Paapke arrived by helicopter, Weber was actually in the operating room with fellow neurologist Hormozd Bozorgchami, who performed the surgery to remove the blood blot.

“I recognized Dr. Weber immediately since I saw him on the video linkup from Astoria,” Paapke told OHSU staff.

Following surgery, Paapke remained in the hospital a few days and then was able to go home. Today he is recuperating with no side effects. His tasks now are to change his lifestyle and to go onscreen one more time for a follow-up appointment.

“I am very grateful,” Paapke says of his ordeal. “I’m fabulous, actually.”

Dr. Miles Ellenby is the medical director of the OHSU Telemedicine Network, a pediatric intensivist at OHSU Doernbecher Children’s Hospital, and an associate professor of pediatrics in the OHSU School of Medicine.

“Patients love the increased interaction,” Ellenby says. “It is cost saving, time saving, and people are much more engaged in their care when they have a more tangible feedback mechanism. They are more accountable and timely in reporting issues.”

OSHU has three main arms to its telemedicine program: acute care medical consultations to hospitals in the network and their emergency rooms; ambulatory outpatient specialty care, especially for those with chronic diseases; and, in its infancy, remote patient monitoring. About 1,700 patients currently use the telemedicine system, Ellenby says.

“Telemedicine helps doctors make better decisions with the local team,” says Ellenby. “It’s a different way to practice medicine, but in the end, it increases efficiency.”

Most telemedicine consultations are covered by Medicare and some health insurance plans, he says.

Salem Health goes onscreen with OHSU for its youngest patients.

“The pediatric unit can receive consultations from pediatric intensivists,” says Lisa Ketchum, director of Women’s and Children’s Services. “When a consult is needed, staff will bring the device to the patient’s bedside and then place a call to OHSU to activate.”

Telemedicine started at Salem Hospital in 2011, and the pediatric unit currently uses the network for one or two patients per month.

“The amazing thing about telemedicine is that the provider who is consulting can do a physical exam on the patient,” says Andrea Bell, nurse manager of the Pediatric Unit. “They can listen to the patient’s heart and lungs, and can view imaging studies. They can move the robot around the room and zoom in to look at the patient closer. They can view the patient so closely that they can assess their pupils and look at abnormalities on their skin, such as a rash.”

Doctors can also speak directly to the patient and the family, as well as the care team, she says.

“Telemedicine is not only used in emergencies, but also to help a family feel more comfortable when transporting to OHSU,” Bell says. “The patient and family can meet the team who will be caring for them when they arrive —they can meet their nurse at OHSU before leaving Salem Health.”

Salem Health hopes to add endocrinology, gastroenterology and other sub-specialty services as resources to care for children “who would then not need to transport to Portland for short-term care,” Bell says.

“The OHSU Telemedicine Network highlights the importance of collaboration and quality care for the children of our communities,” says Dr. Jill Pearson, medical director of Pediatric Hospital Medicine. “The national trend of moving rounds from outside the patient room to the patient’s bedside allows the healthcare team to embrace the input of the family. Telemedicine takes the benefits of this practice to the next level.”

Santiam Hospital in Stayton uses the OHSU telemedicine option for neonatal, pediatrics and stroke patients.

“We are able to call OHSU and the appropriate providers on their end come across the screen,” says Erika Lentz, a registered nurse and nurse manager for the Family Birth Unit. “It’s amazing technology that has allowed us to provide a tertiary level consultation without transferring our patients unnecessarily. Specifically for our stroke patients, this is a great thing. When determining treatment for strokes, time is a major factor for certain therapies.”

“The providers at OHSU are able to view all imaging done here at Santiam Hospital, participate in the assessment, and help to guide treatment,” she says.

But telemedicine is not just for stroke patients. Meri Beth Senn, 63, is a Kaiser Permanente patient who has had multiple surgeries in the past few years. Recently, Senn logged on to the KP Telehealth Network to talk to her doctor about symptoms in her leg that made her suspect she might have a blood clot. Her doctor recommended she go for an ultrasound that ruled out a blood clot, but she was able to save herself one visit to the doctor’s office.

“By seeing your care provider virtually, you don’t have to pay for gas or public transportation to get to the doctor’s office or make arrangements for things like childcare,” says Dr. Deborah Sailler, who practices family medicine in Salem and is KP Northwest’s primary care director of operations. “One of my patients moved about 50 miles away from KP’s Keizer Station medical office, and was pleased to learn that he could meet with me in a video appointment and save himself a trip to Salem.”

Sailler’s patient, Claudio Lima, says the option of a virtual visit is “fantastic.”

Prior to his appointment, Lima, 72, talked with an IT professional from Kaiser Permanente who helped him get his home computer ready for his video visit.

“Having someone walk you through what to do and expect before your first video visit helps things go smoothly,” Sailler says. “Video visits can be done over computers, tablets and smartphones. You just need a high-speed connection and video capabilities. Think of it as the old-fashioned house call with modern technology.”

In 2016, Sailler says all primary care physicians in Kaiser’s Northwest region were trained to conduct video visits. So far, she says, 32 different departments have used video appointments.

“We’re on track to double the number of video visits over the previous year, with nearly 7,000 visits completed in the first eight months of 2017,” she says.

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