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Physicians Update


Physicians Update

Winter 2013

Remote Access Extends Specialty Care to More Patients

Telemedicine at UCLA Health Nearly 56 million Americans - more than 5 million in California alone - live in areas where distance or other barriers impede their access to needed medical services. Advances in telemedicine now make it possible for these previously underserved populations to receive life-saving treatment within minutes, even when medical subspecialists are in short supply.

"There aren't enough pediatric cardiologists in every hospital and every community across the country to provide timely diagnosis to patients with congenital heart defects," explains Gary M. Satou, MD, director of pediatric echocardiography at Mattel Children's Hospital UCLA and codirector of the UCLA Fetal Cardiology Program.

Patients with congenital cardiac malformations, the most common birth defect, can have low oxygen levels and die within hours of birth if they are not diagnosed quickly and accurately, according to Dr. Satou. "If we know the diagnosis prenatally or at birth, we can stabilize the newborn with continuously infused medication until we can transfer the patient to an appropriate pediatric heart center," he says.

The diagnostic process is facilitated by a trained technician at the treating hospital, who takes and uploads digital ultrasound images to a secure server. Dr. Satou reviews the images remotely from a desktop or laptop computer with highspeed Internet access and data encryption and then discusses his recommendations with the attending physician.

Similar technology is used in the treatment of stroke. "Telestroke facilitates remote cerebrovascular specialty assessment from any location within minutes of consultation, adding greater expertise to the care of stroke patients," says Latisha Ali, MD, director of UCLA's TeleStroke Network Partner Program. "We can examine someone interactively, review brain images and provide treatment recommendations in real time."

If given within three hours of the first symptom, the clot-busting drug tissue plasminogen activator (t-PA) may reduce long-term disability from stroke. The American Heart Association estimates that only 3 percent to 5 percent of ischemic stroke patients are treated with thrombolysis. "Using this technology allows us to improve patient access to recommended stroke treatments," says Dr. Ali. UCLA provides round-the-clock support to 18 hospitals in California that do not have the resources and personnel to provide stroke patients with timely assessments and emergency stroke treatments. Initially launched in 2009, the program now provides more than 150 neurology consults each month.

UCLA TeleStroke Network "The key is having everyone know what needs to be done during a stroke code," Dr. Ali explains. "We typically have a program leader at each hospital to help us champion the program and train staff on how to triage potential stroke patients."

Telemedicine is not limited to remote locations. Virtual robot technology is also used to improve efficiency within UCLA Health.

"Our intensive-care specialists often have to manage crises 24/7," says Neil A. Martin, MD, chair of the Department of Neurosurgery. "Using virtual-presence robots, they can examine and manage patients remotely, which eliminates delays in delivering care associated with traveling to the hospital."

Ronald Reagan UCLA Medical Center was the first hospital in the world to introduce remote-presence robots. The robot is approximately 5½ feet tall with a flat-panel computer screen and camera at its head. Physicians can remotely control the robot using a joystick to make rounds at the intensive care unit and have face-to-face discussions with nurses at the bedside. The technology also extends the capability of UCLA specialists to provide consultation and training around the world.

"This technology eliminates geography as a barrier to anyone, anywhere in the world," Dr. Martin says.

For some patients, even short distances represent insurmountable barriers to care. UCLA pediatrician Wendy Slusser, MD, uses telemedicine to provide monthly, multidisciplinary childhood-obesity management for low-income patients at the Venice Family Clinic in Los Angeles. She is working to expand the program to include the Los Angeles Unified School District.

Dr. Neil Martin checks on a patient remotely Dr. Neil Martin, chair of the UCLA Department of Neurosurgery, checks on a patient remotely via an RP-6 mobile robot.


"Some patients are more comfortable staying in their own primary-care setting versus going somewhere they don't know much about," Dr. Slusser says. "Obesity management is amenable to delivery via telemedicine because it is primarily a counseling intervention." Each visit involves a physical examination and presentation by the patient's primary-care physician, followed by consultation with Dr. Slusser, a dietician and psychologist. Patients are referred for physical therapy based on their symptoms and physical exam.

"Many co-morbid conditions can get overlooked in obese children, such as poor sleep hygiene and obstructive sleep apnea, that may cause kids to be hyperactive or overly sleepy during the day," Dr. Slusser says. "Telemedicine allows us to bring our knowledge and expertise as a multidisciplinary team to more patients and then work collaboratively with their primary-care physicians to unveil and address major challenges."

Despite its promise, telemedicine still faces implementation challenges. Some hospitals require consulting physicians to be credentialed in the facility where the patient is being treated. Additionally, some insurance payers cover telemedicine services only in rural areas
where there are limited facilities available to patients.


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