The world has gone digital and MUSC researchers are looking to this new normal for inspiration in solving health care problems. Thanks to grants totaling $918,068 from The Duke Endowment, two MUSC researchers are implementing programs that directly impact the quality of patient care and harness the best of what a digital world has to offer.
Providing 24/7 virtual access to expertise
The Duke Endowment has made it possible to bring the expertise of MUSC Children's Hospital specialists to outlying community hospitals. Through telemedicine carts, seriously ill or injured patients can be seen in real-time by a specialist who can help physicians at rural sites make better and more informed decisions about a patient's care.
Assistant professor of pediatric critical care and project leader David McSwain, M.D., is using The Duke Endowment funds to pilot the program at Colleton Medical Center in Walterboro, Conway Medical Center, Georgetown Memorial Hospital, and Waccamaw Hospital. These facilities will have 24/7 access to pediatric critical care and emergency medicine consultation, with the goal of eventually expanding the program to include other pediatric subspecialties. The idea is to assist outlying hospitals in the stabilization and early management of these seriously ill children so that they can get to MUSC in the safest and most efficient way.
"We get transports for kids who may not need to come here," McSwain said. "So putting that cart at the bedside and allowing one of us to evaluate a child with our own eyes can make a great impact on being able to plan certain interventions. If we can save a family an unnecessary transport to Charleston, and all the time and money that goes into that, we're creating a win-win for all involved. If a picture is worth a thousand words, then a video is worth a million."
Benefits of this effort include reducing health care costs and unnecessary tests while increasing positive pediatric outcomes. Families in outlying areas may not have to incur expensive helicopter transport, hotel or gas bills.
"Telemedicine provides patients in rural communities the access to subspecialists that they could not have had otherwise," McSwain said.
Each cart is equipped with a flat screen HDTV and a movable camera. An MUSC Children's Hospital physician can be anywhere, work or at home, and readily consult on a case. "I can listen in on a stethoscope at the same time the physician at the actual bedside is. I can look in a child's ears, throat or nose. Through telemedicine, we'll be able to look at them before they might need to come to Charleston and decide if they need to come now or if it becomes a wait and watch approach."
Making smart phones mobile health hubs
The options for mobile health care are limitless when it comes to enabling patients to better monitor and manage their health with a device they use every day, all day. Frank Treiber, Ph.D., SmartState endowed chair in technology and MUSC nursing and medicine professor, leads the Technology Center to Enhance Healthful Lifestyles, which is charged with developing and commercializing software and technological products to improve the delivery of health care.
"We wanted a means of readily connecting patients with their doctors, and have found that one thing that a lot of people have, irrespective of their income level or where they live, is a cell phone. Fifty percent are smart phones," he said.
After seeing success from a pilot study called SMASH (Smartphone Medication Adherence Stops Hypertension), The Duke Endowment has awarded MUSC the necessary funds to further study the concept. One of the problems health care providers face is getting patients with chronic diseases to take medications properly. Thirty to 50 percent of patients do not take their medications as prescribed. "It's not just people who are elderly or on a large numbers of medications, either. It turns out this problem affects a wide range of ages and patients," Treiber said.
With the study, patients were given an electronic medication tray with individualized compartments for each day's dosages. Patients received a series of alerts and a blood pressure monitor to take their pressures every three days. The readings were wirelessly sent to their smart phones and via internet to a secure computer. Based upon the degree of medication adherence and blood pressure levels, patients received reinforcement and motivational messages while doctors received summary reports of their patients' pressures every two weeks and alerts if pressures were ever in a danger zone. At the three-month evaluation, patients using the devices went from hypertensive with a systolic resting pressure of 151 to being normotensive at 122.
"Mobile health technologies allow a doctor and a patient to be interconnected with each other 24/7. The doctor can readily monitor very readily multiple vital signals — heart rate, oxygen saturation, glucose, weight with the technology we have. A doctor will be able to take better care of patients when they are home, preventing patients' health from deteriorating over time and ending up in the emergency room. In the long run, these kinds of devices will help in the delivery of more cost effective health care because we'll keep patients out of the ERs and hospitals."