January 20, 2016

Dr. Vinaya Sermadevi sits in front of six screens at a call center in St. Louis, directing a nurse through a video conferencing system. Her patient is in an intensive care unit at a hospital in Arkansas, and he's crashing.

"Do you have a liter of bicarb [sodium bicarbonate] mixed already? I would rather you bolus that and stop the saline," Sermadevi says, eyes switching between a monitor that shows the patient's vital signs, medical records and a real-time video of the patient in bed.

Sermadevi stays with the nurse until an on-site doctor can get to the patient's room. For Sermadevi, the work day has just started, and for the next 12 hours or so, she'll keep tabs on intensive care units in hospitals as close as St. Louis and as far away as Oklahoma City.

On the floor where Sermadevi works, about a hundred desks are evenly spaced, each one with a privacy screen behind it. At any one time, there are dozens of doctors, nurses and physician assistants murmuring into headsets as they check on patients in hospitals across five states. The building itself sits in the quiet suburb of Chesterfield, Missouri, between a highway and a shopping mall.

As far as anyone can tell, this four-story building is the world’s first freestanding center for telemedicine. Mercy, a St. Louis-based healthcare network with hospitals in four states, built it for a cool $54 million. They named it Mercy Virtual—their first hospital with no beds, at least according to their press releases.

In both rural and urban hospitals, these virtual programs work as a backup for doctors on site.

Sermadevi’s ICU monitoring program, or E-ICU, is just one of the programs housed here.

Another program keeps brain specialists on call, so if someone shows up in an emergency room with symptoms of a stroke, they can see a neurologist—even if the hospital they're physically inside doesn't have one on staff.

A new pilot program for home healthcare lets doctors check in with their patients after they've been discharged.

There’s been a big push for telemedicine in more rural states, where access to specialists and hospitals can be tough.

Art Caplan, a medical ethicist at New York University, says he expects healthcare to shift quickly to a more telemedicine-focused model, but that there are three main concerns that should be kept in mind:

  • Would a doctor interacting with a patient miss any signs, symptoms, or more nuanced information if they aren’t face to face with a patient? 
  • Will the quality of doctors hired by telemedicine providers suffer?
  • Do patients feel comfortable telling incredibly personal things to a doctor on a screen? One they’ve never met?

What if, Caplan says, someone really wants to tell a doctor: “My sex life is bad, I’m tired of abusing opioid drugs… I might think: gee, I wonder if I can say that on a computer. Isn’t it going to get stored some way? Does it work like Facebook – is it going to come back and haunt me?”

However, the big driver of telemedicine, Caplan believes, is access. And widespread shortages of doctors in many parts of the U.S. means that the technology is likely to spread.

A different version of this story appeared on WHYY’s The Pulse.

Body and Mind, healthcare, telemedicine, Durrie Bouscaren

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