Telemedicine Links Remote Docs With Ill KidsTelemedicine Links Remote Docs With Ill Kids

A new telemedicine program at Massachusetts General Hospital is helping doctors manage the care of critically ill children around the clock. The new Connected Pediatric Critical Care program enables on-call attending physicians from their homes examine patient and communicate with on-site pediatric ICU staff using real-time video conferencing and robotic gear.

The program, launched last May, involves six pediatric critical-care attending physicians equipped with videoconferencing computer units in their homes, allowing them to connect to a portable robotic telemedicine station -- nicknamed "PICU Bot", or "Bot" for short -- that can be rolled to the patient's bedside.

Digital cameras and medical scopes are attached to the bedside unit allowing the physician to remotely control robotics that move devices for examining the patient. Meanwhile, videoconferencing capabilities allow the doctor to talk with on-site hospital clinicians, respiratory therapists, and other specialists, as well the patient and child's parents.

The PICU Bot was assembled by Mass General IT and clinical staff using "off-the-shelf" components, said Dr. Joseph Kvedar, director of the Center for Connected Health, a division of Partners Healthcare, which owns Massachusetts General Hospital.

The PICU Bot telemedicine videoconference infrastructure consists of six small videoconference units -- Polycom V700s -- which are located in the attending doctors' homes, said Michael Carter, a Mass General project leader. In addition, there is a mobile high definition videoconference unit -- Tandberg Edge 95 -- located in the pediatric ICU at Mass General.

The at-home doctors control the robotic cameras and medical scopes via the Polycom system, said Carter.

The system is designed to be user-friendly where dialing a single number allows authorized users access to the system, yet secure enough, so that no one outside of the authorized users can call into the PICU or physician's homes, Carter said.

"Our group maintains the system and supports the doctors when issues arise," he said.

"The system is scalable, where we can add more physicians down the line, or offer similar services to partnering hospitals," he said.

The use of PICU Bot is being studied by Mass General to see how improved communication between attending physicians and ICU staff impacts critical care, said Dr. Natan Noviski, chief of Mass General's pediatric ICU. The study will also help Partners Healthcare decide whether to roll out telemedicine "Bots" and videoconferencing capabilities for use in its other hospital ICUs for adult patients.

The Bot is used during nights and weekends when on-call attending ICU pediatricians are at home. On average, it's been used two or three times a week, said Dr. Phoebe Yager, a Mass General pediatric ICU physician and director of pediatric telemedicine.

Those situations usually occur when on-call attending ICU doctors are at home and fellows--or doctors in training-- are on duty at the pediatric ICU and encounter situations that require immediate input from critical care experts.

In the past, those communications took place by phone, with the fellow calling the attending doctor at home and describing to the physician the patient's situation. Sometimes in urgent situations, other hospital staff such as respiratory specialists might be on another patient floor when the fellow seeks out guidance. So in those cases, input via phone from other on-site ICU clinicians isn't immediately available to the doctor at home.

In the past, "the fellow called the attending [doctor] concerned by a patient, describing to the doctor what he sees, such as the patient being pale or blue," said Noviski. But now, using the video conferencing and PICU Bot unit, the remote doctor has a much more information about the patient's situation available than what a fellow can usually describe via phone.

From the doctor's home, the physician can control the Bot's camera and attached scopes to view the medical monitoring equipment in the patient's ICU room and examine the patient. That includes the ability to zoom in and look at the pupils of the eyes, which often offer important medical clues. The remote doctor via the home-based computer can also view the patient's radiology studies, lab results, and other pertinent information.

The videoconferencing capabilities also allow the remote doctor to speak to the patient's parents while they're with their child to gain pertinent medical information and for the doctor to explain what's going on.

Yager said the ability to communicate remotely with ICU staff and patients' parents is invaluable. In one situation when she was on call, she was summoned at home at midnight by a fellow caring for a patient who was just admitted to the hospital with respiratory trouble, wondering whether the patient should be intubated -- a procedure in which a tube is inserted into airways for assisted breathing by a respirator.

Via the telemedicine gear, Yager was able to examine the patient and talk to the parent, who explained the child had a history of chronic lung disease. Yager decided that the child needed immediate intubation -- and then used the telemedicine gear to oversee the procedure remotely.

The ability to examine the child and assist in the procedure from afar saved time that would've been wasted had Yager jumped in her car and driven to the hospital to examine the child in person before making the treatment decision, she said.

"A look is worth a thousand words," she said.

The telemedicine capabilities of PICU Bot not only help raise quality of patient care through the improved communication between attending physicians and ICU staff, but also provide extra guidance and education to in-training physicians, Kvedar said.

In the healthcare industry, "there's been a growing drum beat over the last 10 to 20 years that trainees need more supervision," he said. "This addresses that issue as well," he said.