July 15, 2009

By Dave Trowbridge

For many people, gaining access to healthcare has become a serious challenge. Those who live in under-served rural areas may have to travel many miles to see a physician. Even in well-served areas, lack of transportation and working-family schedules can make access to medical services difficult. For elderly or chronically ill people, physically traveling to a clinic may be a hindrance. And in the U.S., the rising cost of medical services has left millions without health insurance and unable to afford routine doctor visits.

Because of these obstacles, many patients may delay seeking medical care until their situation becomes serious - and their treatment correspondingly more resource-intensive and expensive. Both governments and private care systems are grappling with ways to distribute increasingly scarce and expensive healthcare resources to a growing and aging population.

Cisco HealthPresence is a new concept in healthcare delivery that helps overcome these challenges by providing care at-a-distance over the network. Thanks to Cisco's TelePresence teleconferencing technology, the patient and physician see near life-size images of one another, similar to a face-to-face visit. .

With the help of an attendant, the physician can get the patient's vital signs and perform an exam from a distance using networked medical devices such a stethoscope, a thermometer, a scale, blood pressure cuff, glucose meter, and other types of scopes that gather images and physiological information for the benefit of diagnosing and treating a patient remotely. Using HealthPresence, physicians can deliver services anywhere there is broadband connectivity.

Better Care at a Lower Cost

This innovative approach to providing healthcare had its genesis in a Cisco solution delivering video translation services over the network. "Expanding the concept of connecting a caregiver with an interpreter got us thinking about delivering actual care at a distance," recalls Nick Augustinos, Global Healthcare Solutions Senior Director for the Cisco Internet Business Solutions Group.

At the same time, healthcare customers reported that their hospitals were seeing an influx of patients from underserved areas who were quite sick by the time they presented themselves in the emergency room - the most expensive care environment.

"It was only natural to think about how we could expand services into communities to offer more convenient and less costly care delivery. Hospitals needed a less expensive way to reach these people before the crisis stage and reduce the number of emergency room visits," Augustinos says. "Cisco HealthPresence was born as a cost-effective way to more widely distribute physical and mental health services through easier access."

HealthPresence Study in Scotland

The National Health Service (NHS) in Scotland struggles daily with the problem of providing urgent care to rural populations, especially in the rugged Scottish Highlands.

"Many of these areas no longer have overnight access to a GP who can triage that rather large 'gray area' between conditions that can be diagnosed over the phone and obviously acute problems," says Dr. James Ferguson, national clinical lead for the Scottish Centre for Telehealth. "We saw Cisco HealthPresence as a possible solution for avoiding unnecessary emergency care, which frequently requires a 20-mile dash for a paramedic over bad roads and often bad weather, or an even longer drive to a major city."

Working with the Centre and the NHS, Cisco set up HealthPresence within the emergency room at Scotland's Aberdeen Royal Infirmary for a study that began in January 2008. Patients with non-life threatening conditions were offered the option of first seeing a doctor using HealthPresence, and then seeing the same doctor immediately afterwards.

"I had not expected patients to like it as much as they did - especially the older ones who are less familiar with technology," says Dr. Ferguson, "I was gratified by the enthusiasm they showed, and many volunteered ideas about how HealthPresence could improve medical care in their community."

Patients Pleased, Technology Accurate

Post-care patient surveys found that 99 percent were satisfied with their care, 95 percent said the visit felt confidential and 93 percent said they would recommend it.

"I really was amazed, but it was so brilliant, I mean I thought it was absolutely wonderful!" exclaimed one patient, a 79-year-old woman. (Patient names were withheld in the study.) Another patient, a 33-year-old man, said that "once the consultation started, it was just like she [the doctor] was across the table from me; it wasn't a problem at all."

Even more importantly, the study showed the effectiveness and safety of HealthPresence.

"In almost every case, we could accurately identify the degree of urgency and make a diagnosis," says Dr. Ferguson. As Dr. Ferguson continues to study the technology, he notes that in cases where patients have not been pre-selected (other than by the standard NHS phone process), there's been no statistical difference between virtual and personal exams, either for triage or diagnosis.

"I'm confident that Cisco HealthPresence can enable us to deal safely and effectively with 90 percent of the cases we see."

The Future of Healthcare

Scotland, with its mixture of major cities with first-rate healthcare and remote rural areas where trained medical personnel are few and far between, is a microcosm for the problems facing healthcare professionals in much of the world. But even in major cities, Ferguson points out, the system everywhere is under tremendous strain.

"Hospitals are overloaded, and it's too hard to connect patients with specialists - we're spread too thin and working too hard. Rather than making the hamster go faster and faster, we've got to get it off the wheel and do things differently. Concepts like HealthPresence can take the strain off the system and hugely improve the quality of care."

One way to begin relieving that strain may be to place Cisco HealthPresence Pods -completely self-contained medical stations - in malls, community centers, schools, and other public venues to bring healthcare closer to people. They can be staffed by medical assistants or similarly trained attendants at a much lower cost, and would enable physicians to serve more patients without lowering the quality of care.

This could happen very soon. Providers and insurers are eager to manage care and demand for services in the most efficient and convenient manner.. In the United States, if President Obama's healthcare initiatives are successful, providers will need a way to manage the expected spike in demand as more people become insured.

"Technology can't create non-existent capacity, but it can optimize the capacity that already exists," says Augustinos.

The Medical Home

That's only the beginning of the potential revolution that HealthPresence represents. Imagine that you are a concerned parent who comes home from work to find your child running a high fever. Instead of making a dash to an urgent care facility or emergency room, what if you could use your television or other networked appliance to connect with the regional medical center?

Or perhaps you are a diabetic with chronic health issues that need to be frequently monitored. But you are homebound, making visits to a specialist's office expensive and time-consuming. With a connected device and a home healthcare-type kit, you could transmit vital physiological data to a specialist without leaving your home.

The "medical home" is not a futuristic fantasy. In fact Cisco believes it could become reality within the next three to five years. Dr. Nathan Wilson, who participated in a recent HealthCare study in which he saw patients at Cisco's San Jose campus from his office in Los Angeles, agrees.

"HealthPresence could mean the return of the house call," says Dr. Wilson, a physician with Healthcare Partners Medical Group. "And it would give physicians something they've never had before: the ability to telecommute. I could see patients from a HealthPresence Pod in my home, extending my reach and allowing me to help more people each day."

Other Potential Applications

Dr. Wilson also notes the exciting possibilities of the technology for dealing with natural disasters. "What if FEMA had been able to drop HealthPresence Pods into New Orleans and other communities affected by Hurricane Katrina, to be staffed by National Guard paramedics or no EMTs and connected to doctors throughout the country? Think of how much suffering could have been averted."

In the end, Cisco HealthPresence is about using proven and readily available technologies to bring healthcare to people anytime, anywhere. With Cisco HealthPresence, the healthcare industry can meet the challenges of sustainability and ever-increasing demand for services and deliver higher quality care at lower cost.

Dave Trowbridge is a freelance writer based in Boulder Creek, CA