The Future of Telemedicine is Here Now

InTouch Health

In hospital emergency rooms across America and around the world, the health and wellbeing of a person in a critical care situation is measured not in hours, but in mere minutes, which can make all the difference in a life or death circumstance. This situation can be dire in smaller, regional hospitals, when a patient in need of immediate medical attention must be assessed by a stroke neurologist – and there isn’t one on staff to make the necessary diagnosis.

Fortunately, a number of solutions have emerged over the years which benefit patients and resource-strapped hospitals alike. One is telemedicine, which enables physicians to cross physical barriers, instantly eliminate distance, and facilitate vital communication between medical staff and patients. Through secure, high-speed Internet, and the use of state-of-the-art technologies, a medical specialist can be located virtually anywhere on the planet, and can diagnose a patient in an emergency or critical care situation.

Presently serving over 1,000 hospital locations worldwide and adding on the order of one new hospital per day, InTouch Health® has emerged as the leader in Acute Care Telemedicine solutions, including high-acuity consults where immediate clinical action is required. Headquartered in Santa Barbara, California, InTouch Health is the brainchild of founder Yulun Wang, Ph.D., an innovator in the field of surgical robots who pioneered the field of surgical robots. Formed in 2002, InTouch Health is growing, serving customers in 20 countries on six continents, with an expanding customer base comprising over 15 percent of all hospitals across the United States.

“The trend lines of the challenges to the health care system were as apparent in 2002 as they are now,” says Dr. Wang. “These include disparate quality of care, many people without access to care, and the cost of healthcare going up in an unsustainable way. The new layer on top of that is the increasing complexity of medical care – as in, there are more and more subspecialties – so how do you try and drive higher quality care to everyone at a lower cost? It just made sense that the way to do that is through telemedicine.”

Prior to the creation of InTouch Health, Dr. Wang became aware of telemedicine through the now-legendary “Lindbergh operation.” The first ever telerobotic surgery, the Lindbergh operation was a laparoscopic cholecystectomy (gallbladder removal) performed remotely by surgeons located in New York City on a patient in Strasbourg, France, on September 7, 2001. Separated by almost 4,000 miles, the project was named after Charles Lindbergh, the American aviator who made the first nonstop solo flight over 33 hours across the Atlantic in 1927. Led by Prof. Jacques Marescaux, the minimally invasive surgery on the 68-year-old woman was carried out through robotic surgical instruments, with an endoscopic camera acting as the surgeon’s eyes and fiber optic lines connecting doctors and patient via videoconferencing and data exchange over personal computers. “We can now extend the reach of the surgeon so that an expert can intervene any place in the world,” said Prof. Marescaux at the time, and his words ring especially true today.

It was through this pioneering surgery – and the work of leading Canadian laparoscopic surgeon Dr. Mehran Anvari, founding Director of the Centre for Minimal Access Surgery (CMAS) in Ontario, Canada – that Dr. Wang’s appreciation of the vital need and applications for telemedicine grew. Prior to the creation of InTouch Health, Dr. Wang had another company, Computer Motion, Inc., that merged with Intuitive Surgical, Inc., makers of the renowned da Vinci Surgical System. At the time, they had a system called Zeus, which enabled the transatlantic Lindbergh surgery. “That was my foray into telemedicine, and Dr. Mehran Anvari actually conducted the first series of remote surgeries at a distance,” shares Dr. Wang. Within just a few years, Dr. Anvari was performing numerous surgeries via telemedicine between St. Joseph’s Hospital in Hamilton, Ontario, and the North Bay General Hospital, hundreds of miles away.

For doctors, the benefits of telemedicine are tremendous when it comes to performing surgeries. And for patients and hospitals lacking certain critical specialized disciplines, having access to doctors immediately can mean the difference between life and death. Dr. Wang – who received his Ph.D. in Electrical Engineering specializing in Robotics from the University of California, Santa Barbara – speaks proudly of the benefits of telemedicine in many areas, not the least of which is dealing with patients who have suffered a stroke.

The InTouch® TeleStroke Solution

There are two key types of strokes, Ischemic and Hemorrhagic. Ischemic strokes – which account for 87 percent of all stroke cases – occur when there is an obstruction or a blockage of a vessel supplying blood to the brain. Hemorrhagic strokes happen when a weakened blood vessel ruptures, often due to uncontrolled high blood pressure. It is critical that when someone enters the emergency room and a physician suspects a stroke has occurred, that the person be diagnosed quickly and receive the proper care. There is a widely accepted (FDA) three-hour limit within which there are pros and cons to administering drugs to stroke patients. “The three-hour window is a short enough time in which the drugs can really benefit the patient and the benefits outweigh the risks of giving the drugs,” says Dr. Wang. With brain cells dying by the minute, a stroke specialist needs to determine treatment: if the stroke is Ischemic, clot-busting drugs need to be administered; if it is Hemorrhagic, giving patients the wrong medication could make them bleed out.

Thankfully, there is a way to improve these situations. The InTouch® TeleStroke Solution allows specialty centers to provide acute care on a timely basis for patients at outlying hospitals during the critical period following onset of stroke symptoms by establishing regional TeleStroke networks. By combining clinical patient documentation with immediate access to medical imaging and state-of-the-art, two-way audiovisual capabilities, The InTouch® TeleStroke Solution remains the only complete tool set for enabling remote acute stroke consultations anywhere, anytime, day or night.

“Without our solutions, a certain neurologist can only take care of patients in their immediate geographic region,” says Dr. Wang, recalling a recent conversation he had with a stroke neurologist who has contracts with 100 different hospitals to provide on-call service at various different times, in five different states. As the market leader, InTouch Health is actively developing and supporting new technologies, and powers over 65 percent of all established TeleStroke networks in the United States, including 17 of the Top 50 neuroscience centers of excellence, as ranked by U.S. News & World Report. “New models are enabled through our network, so over the next few years, it’s only going to get better and more enabling,” comments Dr. Wang.

A privately held company, InTouch’s commitment to furthering the medical profession and enabling better patient care through telemedicine has earned the company numerous awards and accolades over the years. In 2014, 40 per cent of the U.S. News’ Best Hospitals that merit special acclaim utilized the InTouch Telemedicine System. Touching the lives of over 50,000 patients annually, there is one consultation every 10 minutes through InTouch. With over 2000 physician users embracing the InTouch Telemedicine System, adoption of the system is growing rapidly, as the company continues to partner with hospitals and health systems to build financially sustainable programs which deliver superior clinical outcomes.

The company’s InTouch Telemedicine System remains the only FDA cleared end-to-end solution in the industry, encompassing immersive two-way audiovisual, medical imaging, and patient care documentation — all delivered via the SureCONNECT® cloud-based infrastructure and SureSUPPORT® managed services. By removing time and distance barriers, the InTouch System effectively enables doctors to perform real-time consults through a host of FDA-cleared telemedicine devices.

Acute Care Telemedicine

Providing a range of superior Acute Care Telemedicine services, InTouch’s complete end-to-end products and service solutions encompass many areas. Designed to greatly facilitate improvements in patient care and increase hospital revenue in acute care settings, the InTouch Telemedicine System is complemented by a number of well-designed and advanced products. These include CS Interfaces, which are designed specifically for Acute Care Telemedicine consults. The CS Interface software sets the telemedicine standard for connecting doctors to the point of care through InTouch Health’s suite of FDA-cleared, remote presence devices. The CS App for the iPad enable doctors to complete remote consults with two-way audiovisual, clinical documentation and DICOM images, all from a single pane of glass.

Constantly innovating, InTouch Health is behind a number of other successful products, including MultiPRESENCE® capabilities and collaboration tools, which allow multiple remote doctors and transfer center staff to confer and coordinate care in real time (PC only). Since the pioneering Lindbergh operation in 2001, one of the challenges for telemedicine has remained the need for sufficient and affordable bandwidth. Years ahead of the competition, InTouch was one of the first to utilize Internet-based technologies even before the term “Cloud” was popularized.

“We built a Cloud structure… which makes telemedical care robust and reliable,” comments Dr. Wang, emphasizing the importance of the quality of interaction on both the patient and physician sides. “The physician has to feel good about what he or she has done, especially in the area that we are in, which is acute care telemedicine. If you are dealing with a patient with a stroke, you had better feel good about the calls you are making, because you know you’re dealing with an acute situation. From the patient side, they have to feel the engagement of the physician.”

The Future of Telemedicine Today

With practical applications in a variety of areas, telemedicine can be used across the care continuum including chronic disease management, long term care, clinics, and home care. Moreover, in the hospital environment, clinical needs are extending beyond the emergency department into other areas like the patient floors and intensive care units (ICU). In critical care, there are subspecialists called intensivists; they lead the care practices, quality measures, and care of ICU patients. Doctors cannot be at the hospital around the clock; however, they can be available on-call. If a critical care nurse sees a problem with an ICU patient during the night, the intensivist on-call is paged, and beams in through telemedicine to manage patient care.

“We think of it as two main applications: round and respond,” says Dr. Wang. Responding is what happens when something goes wrong with the patient, while rounding is a proactive effort which sees the intensivist going from one patient to the next. “If they round from bed to bed and make adjustments prior to things going south, it makes the whole nighttime and off-hour care run much more smoothly.”

In addition to AES 256 data encryption and password protection, InTouch ensures compliance with HIPAA privacy laws for patient data protection. Moreover, InTouch Health’s telemedicine solutions are FDA cleared, ensuring its safety for patients and users in applications inclusive of clinical consults requiring immediate action. “Medical care commands medical-grade solutions,” says Dr. Wang. “You wouldn’t expect an orthopedic surgeon to drill into bone using a power drill from your local hardware store.” As current President of The American Telemedicine Association, Dr. Wang envisions telemedicine as an idea whose time has truly arrived.

It has been 13 years since the first telerobotic surgery was performed with doctors and patient separated by thousands of miles, and considering how rapid rate of growth is in the field, Dr. Wang welcomes what the coming years will hold. “I think telemedicine is one of the cornerstone technologies which are going to enable the country to provide more consistent, high-quality care at a lower cost,” he says. “So I’m a big believer that telemedicine is going to give us a solution that we are all looking for. And the way it’s going to be accomplished is to be integrated systemically at the core of our entire healthcare delivery system. I can’t predict over what period of time, but the good news is that a rapidly increasing number of people are coming to that point of view, which will only accelerate its adoption.”

July 17, 2018, 7:38 AM EDT

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