On the Case . . . Professors Ryan Baxter, Monica Garfield (c.) and Janis Gogan are studying the technical, organizational and emotional challenges of telemedicine.
A pediatric intensivist would know. But keeping that kind of critical-care specialist on staff is not practical for community hospitals, which typically see only one or two critically ill children each year.
But the approach comes with complications: issues related to technology, virtual team building and business processes, to name a few.
Three Bentley colleagues have marshaled their complementary areas of expertise to study challenges and best practices in using telemedicine under time pressure. The team is Janis Gogan, professor of information and process management; Monica Garfield, associate professor of computer information systems; and Ryan Baxter, assistant professor of accountancy.
Brian Smith
So far, the researchers have examined telemedicine services in critical-care pediatrics, trauma care, acute stroke care, geriatric psychiatry, and dermatology. And they are looking at both sides of the arrangement, that is, efforts at several prominent teaching hospitals that serve as telemedicine “hubs” and at community-based “spoke” hospitals, which receive the consultation services.
Pediatric cases pose special challenges. Baxter cites the panic and fear that often accompany a child’s arrival at the emergency room.
For youngsters like the hypothetical Joey, such care is available through telemedicine.
Local doctors whisk the boy into a room outfitted for videoconferencing. The system provides a connection to the Boston-based MGH Hospital for Children, where an on-call pediatric intensivist can consult from afar. The specialist can see the room from four camera angles, monitor readouts from medical equipment, and talk to doctors and nurses.
The recommended course of action — inserting a breathing tube — is a tricky procedure to perform on a small child. Coaching the emergency team, the off-site doctor notices they are pushing the tube down a bit too far. They make the adjustment; Joey starts breathing and his vital signs begin to stabilize.
Fast and expert care, better outcomes, and reduced costs are the promise of telemedicine.
“Under stress, people tend to tunnel in on one thing and fail to see the big picture,” he says. “In these cases, the off-site specialist can serve as the ‘eyes above the room,’ noticing things that the on-site team might miss: an intubation tube at the wrong angle, for example, or EKG readings that are becoming unstable.”
The long-distance consultation serves other purposes, too. “Doctors at the community hospital sometimes just need reassurance that they’re doing the right thing,” explains Gogan. “Other times, the specialist helps to stabilize the child for a safe transfer to the teaching hospital.”
Telemedicine has been around since the 1960s, but its use lagged before the rise of the Internet. Today’s initiatives, says Gogan, allow for providing “better care, faster, by experts at a lower cost.”
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