Doc in the machine

Paul Robie described a recent incident at the Oroville Hospital emergency room. A woman came in, having had a stroke. But the hospital’s neurologist was not on duty. So, as ER employees do in these situations, they summoned RED (short for Remote Examination Device), a computer on wheels, and synched up with a specialist on call in Sacramento.

“He was in his car. He pulled over and, through an app on his phone, basically FaceTime’d in,” said Robie, director of physician assistants at Oroville Hospital who also oversees the telemedicine program. The doctor, whose face appeared on RED’s monitor in the exam room, ordered a CT scan on the patient and was able to view the results in real time. RED is also equipped with a stethoscope and blood pressure cuff—when hooked up to the patient, the results are relayed directly to the doctor, as if he were in the room. Based on his exam, he ordered a clot buster. When the patient was stable, she was transported to Mercy General Hospital in Sacramento.

RED is among the newest technology available to rural hospitals, enabling them to act quickly in an emergency despite having fewer resources—including staff—than are found at urban centers. Before RED, for example, Robie said the ER staff would have immediately sent the patient to a Sacramento-area hospital, meaning it could be hours between having a stroke and being seen by a specialist.

“They say, ‘Time is brain,’” Robie said during a recent visit to the hospital ER. “Every minute saved increases your survival rate and increases long-term brain functioning.”

Since getting RED six months ago, he said the ER staff uses it five to seven times a week. Currently, its focus is on neurological emergencies—stroke, traumatic brain injury or spinal injury—but Robie anticipates the hospital soon will begin using it in other time-sensitive situations as well.

Telemedicine is nothing new, though advances in technology have improved its function over the past several decades. The practice was first developed in the 1960s as a way for doctors to monitor the health of astronauts in space, Joyce White told a room full of people at the recent North State Economic Forecast Conference at Gold Country Casino. White, a longtime nurse at Oroville Hospital, went on to detail that facility’s history with the technology.

“In 1998, we launched one of the first pediatric telemedicine sites in the United States as part of a UC Davis grant project,” she said. The following year, Oroville Hospital successfully treated a child with uncontrolled diabetes with the help of UC Davis doctors at the other end of a 384 KB Internet connection.

“It was intolerant of movement,” White said of the early technology. “You’d see pixelation in the face of a bouncing child; there could be a speech delay.”

Broadband connectivity, introduced at OH in 2010, changed everything.

“With the T1 [broadband], we have a capacity of over 1,500 MB,” White said. “Audio and visual are crystal clear, and there’s a very rare interruption of audio—I don’t remember the last time that happened.”

Since 1998, there have been other advances as well. Telemedicine units were added to the hospital’s Berry Creek, Biggs-Gridley and Hamilton City clinics. And through additional UC Davis grants, specialties were added, including endocrinology and rheumatology. Plus, a unit was added to the OH emergency room specifically for pediatric trauma patients.

“It was really cool—you could hook up echocardiogram equipment so the specialist could see the test as it was being done,” White said. “There was no delay in trying to transmit or interpret the echocardiogram. And you could see and hear the baby. It saved a lot of time and our babies got really great care.”

In 2014, the hospital received a grant focused on newborns. “Before, when we transferred a baby, we’d call UC Davis, tell them what we had, and they’d send a transport team, get the baby stabilized and sent down,” White explained. “With telemedicine, we actually have a specialist in the room, with an over-the-shoulder view. They can suggest tests to do, and procedures, to stabilize that child. Then they organize transport.

“There’s a golden hour with newborns,” she continued. “Every minute saved is improved function. We’re planning to support life in that newborn, but we also want to save function so this baby will grow up to be a hell-on-wheels 2-year-old.”

The focus for the future of telemedicine at Oroville Hospital is on improving follow-up care, something that is proven to improve overall health but is often overlooked. White said when patients come in for post-surgery checkups, for instance, telemedicine can increase doctor availability by allowing nurses to do the in-person exam.

“The doctor has their own unit,” White explained. “So, you connect and then the nurse can place the stethoscope on the patient’s chest—and the doctor can actually hear the heartbeat, etc., just as if the doctor is at the other end of the stethoscope. The hand-held cameras are fantastic at showing incision sites, wounds, bruising.”

For Robie, one of the biggest advantages he’s seen to telemedicine is the ability to treat local patients locally, which is not only helpful for family who want to visit, but also on patient cost. “Instead of transferring everybody out, we can take care of them in Oroville,” he told the conference crowd. RED alone has made a marked impact on the number of patient transfers.

“We’re using it five to seven times per week, and of those, there’s maybe one transfer,” Robie said. “Our goal is to try to take care of our patients here in our community, not transfer them elsewhere.”