Dr. Chester Hedgepeth is the executive chief of cardiology at Kent Hospital. The hospital recently started a telemedicine service in partnership with Brigham and Women’s Hospital in Boston to help treat patients with complex cardiac issues close to home.
PBN: What is a telemedicine service?
HEDGEPETH: It is a way for physicians to communicate about patients when they are not at the same location or hospital. Our system, which was started six months ago, connects our local cardiologists with experts at Brigham and Women’s Hospital in Boston. It uses a web-based secure and HIPA compliant interface, or program, which can be used on desktops, iPads or iPhones. It’s a video conferencing technology so you can actually see what’s on the other side. We can talk about the patient’s data and imaging in real-time. It’s used in hospitals around the U.S., but I’m not aware of any other programs in Rhode Island.
PBN: What was the impetus for starting the program?
HEDGEPETH: There are a significant number of patients who leave the state for advanced cardiac service, though they desire to stay close to home. Our hope was that we could provide consultation regarding those services close to home. We could prepare the patient for the procedure locally and follow them after it was done.
In our cardiology program, we’ve been using the telemedicine service to discuss very complex or very ill patients who may require transfer to higher level of care hospitals where they can offer complex services like cardiac surgery, heart transplants or ventricular assist devices.
Having the advice of world experts in the area helps use to do more here at Kent. We’re able to manage the patients here in Rhode Island much more safely and for a longer period of time before pulling the trigger to transfer them. In some cases, we no longer need to transfer them.
PBN: What are the benefits to patients?
HEDGEPETH: Recently, in the case of a patient with severe heart failure symptoms and poor cardiac function, we used the telemedicine service to connect our local team of cardiac nurses and physicians with the advanced heart failure team at Brigham and Women’s Hospital. Daily, we reviewed the patient’s progress and discussed diagnostic images from his cardiac ultrasound, chest X-rays and electrocardiograms using a shared Web-based virtual desktop. Using this collaborative system, both teams gained greater insight into the patient’s condition, allowing us to manage the patient locally for a longer period of time. After several days of aggressive therapy, however, the patient’s condition began to deteriorate. The decision was made to arrange for transfer to Brigham and Women’s Hospital for ventricular assist device and work-up for heart transplantation with transfer to a team of doctors that already knew him well.
Throughout the admission at Kent, we kept the family informed of the ongoing consultations with the advanced heart failure team in Boston. At the time of transfer, there was already a strong connection between the family and the entire team of physicians at both Kent and BWH who would be managing their family member on arrival in Boston.
PBN: What are the benefits to doctors?
HEDGEPETH: If I was in the same hospital as these doctors that are providing these advances surgeries, I could walk down the hall and talk to them about the patient, ad they could see the patient. But when I'm in a community hospital 70 or 80 miles away, I can't just walk down the hall. With this technology you can have a virtual rounds where we can discuss the patient, review the data in real time, and form a plan for the patient as one team.
When the patient goes to Boston, the doctors there already know them.
PBN: Are there cost savings, limitations?
HEDGEPETH: There is a significant cost savings because in the virtual rounds we review the patient’s laboratory data, EKGs and imaging data. Much of that does not have to be recreated if and when the patient goes to Boston. Many times when a large hospital receives a patient from an outside hospital they might not have all the records and the imaging available, so they will redo a lot of it. That has costs to the medical system.
[But there are limits.] In our current version, physicians are not able to examine the patient. The patients themselves can’t communicate with the physicians on the other side of the virtual desktop.
We're talking about writing some grants to get funding to build the technology infrastructure, to allow us to put video cameras and microphones in the patients’ rooms so they and their families can communicate with the outside hospital. It’s a significant investment.