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Technology is a way to provide expanded services and reduce healthcare costs while still maintaining quality. As leaders in healthcare, physicians are prime candidates to embrace technology because they are part of an evolving multidisciplinary approach to care, which includes physician assistants, advanced practice registered nurses, registered nurses, respiratory therapists and diabetes educators.
Video conferencing is one modality enhancing healthcare, according to a presentation on connected health at the 2018 Annual ACOG Meeting in Austin. In addition, medical devices capable of collecting various physiological information on patients that can be shared with providers in real time, whenever and wherever patients and providers are geographically located, are changing the landscape.
“Algorithms have also been developed for blood pressure monitors and glucose monitors and other types of point-of-service technologies to make decisions about patient management,” said Curtis Lowery, MD, Director of the Center for Distance Health at the University of Arkansas for Medical Sciences (UAMS) in Little Rock, which last year was recognized as a Top 25 innovation program by the Harvard University John F. Kennedy School of Government.
Dr. Lowery told Contemporary OB/GYN that telemedicine is certainly a big part of the technology movement. “Telemedicine allows knowledge to not be so centralized,” he said. “Stroke management is one of the best examples. Patients come to small emergency rooms here in Arkansas, where a physician has to decide whether the patient will be treated with a tissue-type plasminogen activator (tPA) or not.”
To assist in the decision, telemedicine allows a virtual consult with a vascular neurologist who can talk with and examine the patient and evaluate x-rays.
Since 2003, UAMS has employed telemedicine in high-risk obstetrics and for the past several years has assessed cervical cancer via telecolposcopy.
“Similarly, we visit mothers before birth, where we see the fetus via ultrasound, which I can view from my office,” said Dr. Lowery. “I can then make a decision on how to manage that patient, no matter where they live.”
The closing of healthcare facilities is also driving the demand for technology. “It is a combination of a shortage of physicians and a maldistribution of physicians,” said Dr. Lowery, Chair of Obstetrics and Gynecology at UAMS. “Some people in Arkansas live 2 to 3 hours away from a healthcare center, so instead of coming by Medicaid van, we can visit patients at home.”
From the patient’s own home, obstetric visits can be conducted using a remote blood pressure cuff and cell phone. “As a result, expectant mothers may not need to come to the office for prenatal care, as well as for postpartum care,” said Dr. Lowery.
The information can be reported directly by patients. Certain systems, though, allow data to be collected and sent to a data repository, then either viewed or sent to a patient’s record. Filtering the collected information is also an option, whereby an algorithm detects preset ranges and shares only elevated readings with the practitioner.
In fact, with telemedicine, some obstetric patients with blood pressure elevation might be able to avoid some hospitalization, according to Dr. Lowery. “This strategy reduces cost,” he said.
Dr. Lowery is founder of two medical device companies: “ANGLEeYe” Camera Systems LLC (webcams for babies in the hospital nursery) and AirToco LLC (a disposable external uterine monitor).
“There are also movement detection devices that can be placed on patients to assess maternal activity level,” said Dr. Lowery, who noted that such technology can be a substitute for patients who might otherwise be hospitalized instead of being kept at home.
UAMS has provided prenatal care via telemedicine in prisons for about 10 years. “Prison is an isolated place where it is difficult to receive prenatal care,” said Dr. Lowery. Prison officials are also reluctant to transport inmates to an offsite location by van because of the cost.
“The point-of-care devices have evolved now to where they are pretty simple to use,” said Dr. Lowery. “Blood pressure devices are sold in drug stores and blood glucose monitors have been around for nearly 20 years.”
There are also contact lenses with sensors in them that now can measure blood glucose, as well as tattoos containing thin chips that are slapped on the arm to measure different levels of chemicals like calcium and glucose.
“These devices are becoming less expensive, but they are not necessarily applicable to everyone,” said Dr. Lowery. “There still needs to be research to show safety and effectiveness when used in pregnancy. ACOG is supporting the development of standards and approaches for their use in pregnancy. If the patient is unstable or you can keep them out of the hospital by remote monitoring, this represents value for both the patient and for the healthcare system.”
In the near future, UAMS plans on using telemedicine to support a statewide safety bundles implementation in smaller hospitals. “We believe that technology can be used safely and effectively to improve the care of women throughout the state of Arkansas,” said Dr. Lowery. “Where you live does not have to determine whether you live or die.”
Dr. Lowery is founder of Angel Eye Camera Systems LLC and AirToco LLC.