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Two studies show efficacy of telemedicine technology

For telemedicine to compete with traditional in-person health care modalities, physicians must prove its value. Two studies presented at ATA 2011 attempted that. Results varied.

TAMPA, Fla. -- While some health care providers struggle to locate funding for paying for telemedicine technology in patient care, others are going a different route -- implementing telemedicine to enhance provider-to-provider communication.

One project showcased in a session at the American Telemedicine Association's ATA 2011 conference demonstrated telemedicine's value in quality-improvement projects. In the study, Advocate Health Care, a multi-hospital system based in Oak Brook, Ill., used cameras in intensive care units to remotely monitor nurses' adherence to central-line insertion protocols designed to prevent infections.

Digital technology has the potential to increase access to cervical screening to populations disproportionately at risk for cancer.
Dr. Ronald Weinsteindirector, University of Arizona telemedicine program

Another study, spearheaded by the University of Arizona telemedicine program, aims to prove that telemedicine technology can help cancer pathologists, a sub-specialty concentrated primarily in the United States, as they help physicians in other countries diagnose cervical cancer. Telemedicine comes in through technology that concentrates 80 microscopes into the space of a quarter, scans a Pap smear sample mounted on a glass slide and sends the digital image to a remotely located pathologist.

"Digital technology has the potential to increase access to cervical screening to populations disproportionately at risk for cancer," said Dr. Ronald Weinstein, ATA president emeritus and director of the Arizona telemedicine program, who presented the telepathology study.

Telemedicine technology brings quality improvement to the e-ICU…

Central-line infections cause 14,000 to 28,000 deaths each year, depending on who's counting. They are also expensive to solve once they set in.

This prompted the Institute for Healthcare Improvement to highlight the issue in its 100,000 Lives campaign. Advocate Health Care tackled prevention of central-line infections by setting up an electronic intensive care unit, or e-ICU, in which nurses remotely monitored camera feeds from three of its hospital ICUs during central-line insertion.

"When you can [remotely] look into a patient room and see what's going on, you tend to see things that other people don't know you're able to observe," said study presenter Cindy Welsh, Advocate's vice president of adult critical care. "I don't mean that in a bad way. It just gives you the opportunity to see things people in the thick of providing care don't necessarily pay attention to."

The ICU nurses -- who willingly participated in the quality improvement initiative, even though they thought they were already doing things by the book -- were not always consistent in their techniques, the remote monitors found. When monitors gathered their data and fed findings to the ICUs on how to improve protocol adherence, central-line infections dropped.

Welsh said just a small spike in central-line infections between 2008 and 2009 cost the facility $150,000 in extra care. After e-ICU monitoring, they returned by 2010 to previous levels, which helped offset the cost of the monitoring program.

Advocate Health plans to use observations from its e-ICU project to upgrade central-line protocols to further cut infection incidence, Welsh said. Her group huddled with infection control practitioners and supply-chain management staffers, who were working on prevention-minded central line projects themselves.

Together, they revised the health system's protocol, which the chief nursing executive recently approved. It will be posted to the Advocate employee website and go into effect later this spring. IT staffers will get into the act, too, updating central-line insertion procedure checklists in the electronic health record (EHR) system to reflect the updated steps.

…but interpreting Pap smear results still evolving

The University of Arizona study, meanwhile, offered a glimpse into future uses of telemedicine technology for hospital labs.

Cervical cancer is the third largest cancer killer of women internationally, with nearly 500,000 new cases diagnosed annually, and more than 250,000 deaths, Weinstein said.

The incidence and death rates among U.S. patients are much lower, having dropped 75% between 1955 and 1992, thanks largely to the development and use of the Pap smear, which detects cervical cancer most of the time while it's still completely treatable. In 2007, U.S. physicians diagnosed 12,000 cases of cervical cancer; more than 4,000 women died from it.

Weinstein said a number of factors make cervical cancer rates higher around the world, but the primary reason is the lack of access to pathologists able to read Pap smears. The digital age hasn't yet hit this sector of medicine, either; most pathologists still read glass slides with microscopes.

The Arizona study's objective was to determine whether pathologists could effectively diagnose cervical cancer remotely, using digital telemedicine technology. Three pathologists participated. Each read the same set of 100 "digital slides," offered a diagnosis and also addressed issues such as their confidence in the diagnoses and how long it took to arrive at their conclusions.

The results were a mixed bag. The pathologists achieved slightly less accuracy with digital slides and indicated less confidence in diagnoses that involved reading computer monitors instead of microscopes. The confidence issue, as well as the time devoting to interpreting Pap smear results -- about 3 minutes 42 seconds per digital slide, which is roughly twice as long to diagnose using traditional methods -- can improve once a pathologist gets practice reading digital images, Weinstein speculated.

The pathologists also indicated a lack of satisfaction with the quality of the images, he continued. However, recent developments in microscope imaging can double the magnification of the digital slides. That, Weinstein said, would likely improve the pathologists' attitudes toward image quality if the study were repeated today.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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