A Whole New Meaning to "Face Time" with Your Doctor
All the patients in dialysis have earphones to listen to the TV. They can plug them right into the Kubi/iPad device if they want to make the conversation private.Dr. Brian Remillard
With the advent of telehealth, the delivery of health care is no longer confined to the walls of a hospital or office building. That’s certainly true at Dartmouth-Hitchcock (D-H) where a growing number of departments are utilizing new technologies to provide telehealth care to patients.
The iPad as a Telemedicine Tool
The latest generation of equipment being used for remote consults involves Apple iPads, Vidyo's encrypted software and a device that holds the iPad called, Kubi which can be operated remotely through a website. After establishing a real-time video connection, providers at D-H can tilt the iPad up and down or pan sideways to interact with patients and healthcare workers at distant community hospital partners. It’s currently being tested in the Nephrology and Hypertension department, and will enable the section to perform dialysis rounding at sites ranging from Lancaster, NH, to St. Johnsbury, VT.
“In essence, the iPad becomes the doctor’s face,” says Fred Glazer, a telehealth technology specialist who recommended and supplied the equipment through the D-H Center for Telehealth. “It sits on a small cart at the patient’s bedside and allows the doctor to look in any direction and interact with the patient and nurse as if he or she were there.”
Robots versus iPads
“We initially used a large robotic unit for nephrology consults,” says Brian Remillard, MD, section chief of Nephrology and Hypertension. “Patients, particularly older ones, were scared of it. They kept looking behind it to see if we were in it. It came equipped with big base speakers on the bottom making it sound like a voice from on high. When we started to round with the iPads, patients really liked them.”
The Kubi device allows any physician to control the iPad remotely, in three dimensions, in concert with the software “Vidyo.” This is the same software that Dr. Remillard uses to teleconference with Haiti (see related story). The software operates on a low bandwidth making it reliable in remote areas.
Ease of Use
“It’s also easy to use,” says D-H Nephrologist, Thomas Kaneko, MD. “All you have to do is log on to the Kubi website, type in the ID code and click on the grid which gives you 3D coordinates needed to operate it.”
The use of the iPads is becoming an important part of their practice. Currently, D-H nephrologists travel to the Weeks Medical Center in Lancaster, NH, for consults four days a month. Weeks is now offering dialysis six days a week, effectively doubling the travel time for D-H staff. Unable to support nephrologists out of the office for eight days out of the month, the department has agreed to do half of those rounds by iPad, allowing them to leverage their existing staff.
No More Travel in Blizzards
“It’ll be great in bad weather,” says Remillard. “Both Tom and I have crashed our cars commuting to Lancaster for consults. Now when a blizzard strikes, we’ll be much more inclined to say ‘We’re going to make rounds by iPad today.’” It may even cut down on cancellations. “We have a lot of missed appointments because patients don’t want to travel two or three hours for a 10-minute visit.”
In the future, Remillard envisions having multi-specialty consults and online referrals where patients would no longer need to travel to D-H, and would have the ability to call in remotely. Gone would be that familiar refrain: “I need to see you before I can schedule an appointment.” While it doesn’t completely replace the need for in-person visits, it is helpful for triage. Will it reduce hospitalizations—a driving force behind telehealth—maybe. “That, says Remillard,“still needs to be measured.”
To learn more about using technology to connect people and to provide medical services and expertise, visit the D-H Center for Telehealth.