COVID-19 makes telemedicine more valuable; hub at Dartmouth-Hitchcock is ramping up

  • From left: Dr. Alison Kapadia and Daryl Holthoff, RN, in the TeleEmergency center at Dartmouth-Hitchcock Medical Center. Courtesy Dartmouth-Hitchcock Medical Center

  • From left, Mariel Day, RN’ TeleICU Nurse Manager; Dr. Steve Surgenor, TeleICU Medical Director Dartmouth-Hitchcock Medical Center—Courtesy

  • . Keith McAvoy, Medical Director TeleNeurology, is shown on the screen of a mobile telehealth cart interacting with a nurse and patient at another hospital (names not available). Dartmouth-Hitchcock Medical Center—Courtesy

  • -TeleMed- Dr. Corey Siegel- Section Chief, Gastroenterology - Outpatient Virtual Visit Dartmouth-Hitchcock Medical Center—Courtesy

Monitor staff
Published: 3/21/2020 4:26:13 PM

The state’s hub of telemedicine is ramping up as the COVID outbreak spreads and its leader says that there’s no almost no limit to how much it should expand.

“Growing tenfold, at minimum. … I definitely want 10 times. I’m okay with 20 times, or more,” said Dr. Kevin Curtis, medical director of Dartmouth-Hitchcock Connected Care.

“We don’t know the demand. If almost every office visit becomes unavailable within our country, then you’re talking about hundreds of thousands of appointments a day that are canceled. We want to be ready to scale up to what the need is. That’s one of the advantages of having a system in place – we know the system,” he said.

Telemedicine or telehealth is a general term for doctors, nurses, therapists and other health care workers giving advice or making diagnoses over the internet. They use video or audio to talk with patients or with caregivers on site, as well as to gather information from connected medical devices like EKGs or pulseometers.

Long touted as a way to cut health care costs or expand medical expertise to rural areas, telemedicine has assumed greater importance in the current pandemic. It not only allows medical expertise to be widely shared but cuts down on the use of masks, gowns, gloves, cleanser and other personal protection equipment, or PPE, du ing patient visits. Such material is in short supply, to the point that hospitals are begging for donations.

Concord Hospital Medical Group, for example, has ramped up telephone visits since suspending regular office visits. As of March 20, the group said, there had been nearly 1,100 telephone visits completed and an additional 1,200 scheduled.

The federal government on Thursday loosened long-established rules to increase use of telemedicine, allowing doctors licensed in one state to treat patients in different state as long as that state agrees, and also requiring health insurance to cover telemedicine visits.

That last rule change also allows telemedicine to take place over public video channels like Skype instead of being confined to dedicated channels like Vidyo, used by Dartmouth-Hitchcock, which are designed to protect medical privacy under HIPAA rules. That will make it easier to include new patients and connect with new clinics or offices, Curtis said.

Three tech buckets

Dartmouth-Hitchcock Medical Center, the state’s largest hospital, opened its Connected Care unit in 2012 and now has seven specialty units, from TeleEmergency and TeleICU to TelePsychiatry and TeleNeurology. Other hospitals and medical facilities contract with Dartmouth-Hitchcock to use some portion of the services.

The telemedicine operates in three ways, which Curtis characterized as “three tech buckets.”

The technically simplest is video and audio consult with patients, sometimes in their homes using cell phones or tablets or laptop computers, and sometimes at doctor’s offices or clinics.

“Pre-COVID-19, about half of outpatient visits were in a clinic, half in their own home,” said Curtis.

A second “bucket” is hardwired hospital or emergency rooms, where the local medical staff can quickly get a consultation from specialists at the Connected Care center, which is staffed 24/7, all year round, for emergency and intensive care.

“The hardware never leaves patient rooms, and connects with a remote doctor or nurse in teleEmergency and teleICU,” said Curtis.

As an example, he pointed to Cheshire Medical Center in Keene. “We work with Cheshire’s 10-bed ICU. All 10, all the time, have a monitor, camera and mic in that room, directly connected by dedicated circuit to our hub. There’s a button on the wall. The bedside team pushes that button, they are directly connected in.”

“With TeleICU we’ve done almost 5,000 admissions. We’re covering around 70 beds at four institutions, including our own,” said Curtis.

Similar hardwired rooms with instant-connection buttons exist in 11 emergency departments in New Hampshire, Vermont and Maine.

Telepresence robots

The third “tech bucket” is the most futuristic. It uses what are called carts but are more like remote-controlled robots.

These are self-propelled units that are steered from afar and carry connected video and audio. They give the nurse or doctor a virtual presence in a patient’s room, creating what is sometimes called “telepresence.”

These are often used at hospitals that don’t have enough intensive-care patients for a full ICU or the need for a hardwired system, providing intensive-care expertise to staff on hand for less cost and more flexibility.

These telemedicine carts have limits – they can’t palpate an abdomen or check reflexes – but still allow the doctor who is not on the scene to participate to a surprising degree, Curtis said.

“You can move the camera to look at patient monitors, see oxygenation, cardiac rhythm. You can drive to the patient and focus the camera on the ventilator setting. You can talk directly to the nurse if necessary,” said Curtis.

The carts have some equipment, such as stethoscopes and devices for examining eyes and ears, that if applied by the local staff can provide information for the staff at the Connected Care facility. In hard-wired rooms, test results such as EKGs can be sent via the carts.

About 30 carts, made by a company called Abyssia, are deployed in the region, Curtis said.

(David Brooks can be reached at 369-3313 or or on Twitter @GraniteGeek.)

David Brooks bio photo

David Brooks is a reporter and the writer of the sci/tech column Granite Geek and blog, as well as moderator of Science Cafe Concord events. After obtaining a bachelor’s degree in mathematics he became a newspaperman, working in Virginia and Tennessee before spending 28 years at the Nashua Telegraph . He joined the Monitor in 2015.

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