When Karen Giatto's mom was admitted to Thomas Jefferson University Hospital in Philadelphia last winter for the second time in three weeks, the family already knew the bad news.
Her bladder cancer had metastasized to her lungs and elsewhere.
The issue was, what were her best options? These were decisions her mother wanted Giatto and her sister involved in making. Those options needed to be discussed with members of her mother's care team during daily rounds in the hospital each morning.
For Giatto, that could have meant getting the kids off to school, and then battling morning rush-traffic for an hour or more and maybe missing the doctors if traffic snarled. Her sister faced a similar challenge commuting into the city from a different direction.
“Both my sister and I were trying to get down there for rounds in the morning. We wanted to start our morning each day knowing what we were dealing with,” Giatto said, but “getting stuck in traffic happened to me a couple of times.”
Instead, the two daughters stayed home and still made five of their mom's visits with her care team, thanks to a pilot telehealth program called “virtual rounds” that Jefferson initiated last October. Patients and doctors connect with family members using an iPad computer equipped with a video camera and telehealth software.
“My mom had her questions,” Giatto said. “We could start each day knowing what we were dealing with medically. The second week she was in there we were doing this every day. It made my mom feel so much better knowing we were with her there.”
Dr. Judd Hollander, associate dean for strategic health initiatives at Jefferson, said about two or three patients a day use the service, which is an adaptation of teleconferencing technology by Blue Jeans Network, Mountain View, Calif. The Philadelphia hospital has used the system to link as many as four family members at a session, with one as far away as California, Hollander said.
“We're trying to figure out where the best places to scale up are first,” Hollander said.
Jefferson started with cancer patients, because their stays are typically longer, so the service would be of most use to them and their families. But the hospital is expanding virtual rounds to other departments and should be available on demand to all patients in the hospital by the end of this summer, Hollander said.
Privacy issues using the service are no different those that might occur with a phone call, he said. The videoconference is initiated by the patient, who can end the call at any point. Videoconferences do not have a higher risk of being overheard than telephone calls or in-person discussions, Hollander said.
In a study published in the Journal of American Medical Informatics Association, authors noted that Jefferson “benefits by gaining access to a larger pool of patients for clinical research studies.”
Virtual rounds is part of a broader telehealth strategy in which “Jefferson is no longer going to be defined by its geography,” said Dr. Stephen Klasko, president and CEO of Thomas Jefferson University and Hospital System. The hospital also plans to use telehealth for post-discharge home-monitoring and for a “tele-triage” service for patients who might otherwise head to the emergency room but don't really need that level of care.
“The entire strategy is to move care as close as we can to the patients,” Klasko said. “The only reason not to do it is you continue to believe with the Medicaid expansion that people are going to continue to show up at the most expensive place to receive care,” that is, the emergency room.
Jefferson is not alone in the basic approach, according to Dr. Joseph Smith, chief medical and science officer at the not-for-profit West Health, La Jolla, Calif., which studies and promotes the use of information technology in healthcare.
“Technology is appropriately being used to connect people across distances in a lot of different formats,” Smith said. “I think telemedicine is a poly-headed Hydra.”
Last week, Smith said, he attended a demonstration of similar technology connecting patients, family members and clinicians at the University of California San Diego Medical Center, only that the inpatient monitor wasn't an iPad, but a big flat screen TV on the wall in the patient's room.
“I've seen technology where they want to put this into senior living facilities to allow the aging to stay more in tune with their families and their care givers,” Smith said. To Klasko's point, Smith said, “Healthcare should no longer be held to the tyranny of geography. Why should we ask the sickest and weakest among us to be the body in motion?”
After her weeklong second hospital stay, Giatto's mother was discharged to a rehab center, then to her home where she died under hospice care.
“It did progress faster than we had thought, moving from hospital to rehab to home,” she said. “We knew that her condition was grave,” she said. That was why “every piece of information was vital to us.”