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Telemedicine is saving lives in rural America and around the world

In the Intensive Care Unit of Duke University Hospital, a pager goes off. The neurointensivist on-call excuses herself from rounds. Her clicking heels move rapidly across the tiled hospital floor, increasing in tempo with each step as she makes her way to a quiet room in the corner of the unit.

“Hello ma’am,” the doctor says calmly. “I heard you are experiencing some new symptoms. What seems to be the problem?”

{mosads}There was no one else in the small, plain room. She spoke directly into a microphone on a computer’s webcam. On the screen, in amazingly clear detail, is a patient lying in a hospital bed. She is wearing a faded hospital gown and through an oversized sleeve her arm hangs at her side like a dead weight. Her face seems stuck in a twisted, sad expression. It’s hard to say if it is from anxiety or the stroke.

The neurointensivist proceeds to gather details about the onset of her symptoms and past medical problems. She looks intently at the pixelated, almost otherworldly images pouring in through her computer screen and has the patient run through a variety of physical exam maneuvers. The patient lifts her arms up, raises her eyebrows, and names objects. After just five minutes, the doctor has all the information she needs to diagnose the stroke and advise the medical team hundreds of miles away to administer life-saving medication.

Virtual care such as this is becoming increasingly common. Glowing computer screens replace cold, sterile clinic rooms. The traditional patient-doctor encounter is gone. Vital information about a patient’s clinical history, presentation, and physical exam can be transmitted with lightning speed through cyberspace. In telemedicine, distance is trivial.

With just a click of a button, a doctor may conference in with a patient and provide rapid triage and medical decision-making that can save hours in a world where minutes make all the difference. The moment an artery in the brain gets clogged and a patient develops symptoms, a metaphorical hourglass is turned, and every minute that passes means increased risk for permanent damage. Medical providers have a window of only a few hours to deliver life-saving medications that bust through a clot and restore blood flow, giving true value to the old adage repeated throughout the medical world, “Time is tissue.”

In the United States, 22 states and Washington, DC require physicians to receive reimbursements from private insurance companies for remote care for some or all telemedicine services, and more than 40 state Medicaid programs offer reimbursements, to varying degrees, to doctors who practice telemedicine. According to VSee, a project created by a team of Stanford University scientists, at least 11 other states have considered legislation that would impose similar regulations. As U.S. medical costs continue to outpace inflation, medical professionals and insurance companies will increasingly rely on telemedicine services to provide a growing demographic of Americans with this cost-effective technology.

While the growth of telemedicine in the United States will almost certainly play a significant role over the coming decades, the greatest use of telemedicine may actually occur in other countries, including many on other continents.

Telemedicine has been part of Doctors Without Borders’ (DWB) arsenal since 2010 as a way to get consultation from specialists in developed regions to teams often operating under exceptionally difficult circumstances in the field. As of 2015, DWB has logged over 1,300 telemedicine cases from more than 240 referral sites all over the world. The top referring countries using DWB’s portal are the Central African Republic, South Sudan, and Malawi, some of the most impoverished nations in the world.

Some of the greatest challenges in global health are directly related to the implementation of expensive and complex health systems infrastructure in underserved regions. The cost of telecommunication installments pales in comparison, and while it will never be able to replace an in-person physician consultation, it is a much more affordable alternative. The potential is endless, and the use of telemedicine may extend from seeing patients for rapid evaluations, which is how telestroke works, to presenting educational seminars for other health care providers or even creating an intraoperative presence to aid foreign surgeons through unfamiliar procedures.

Corley (Jacquelyn.corley@duke.eduis a neurological surgery resident at Duke University Medical Center, a member of the Duke Division of Global Neurosurgery and Neuroscience, and a human rights journalist focusing on health-care-related topics.


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