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On some days, Dr. Robert Pratt sits in his Denver-areahome in front of a tablet as he diagnoses patients for possible strokes at up to 15 different HealthOne affiliated hospitals.Today, Pratt, a neurologist, is calling into the emergency room of Sky Ridge Medical Center in Lone Tree, where adecision on whether to administer a potentially lifesaving clotting drug to incoming patients has to be made within an hour of arrival.With the tap of a finger on the tablet screen, he zooms cameras in and out to focus on different parts of the body. He turns them right and left. He can flash images and words on the screen in the ER to gauge different neurological responses. He can order tests and prescribe medications instantly. If needed, an on-site nurse or doctor can lend a hand, but Pratt can handle nearly all of his examinations on his own.“When we first started using it people used to be like, 'Wow, I’m on TV,’” said Pratt, who added the technology allows him to be at bedside virtually. “We would get reactions like that. But now, people are perfectly comfortable.”Pratt and the team at Sky Ridge’s emergency room are part of a growing trend of doctors and medical facilities offering patients telemedicine services.With robotic cameras controlled through computer software programs and other technological tools, doctors can reach patients in remote or rural areas who otherwise wouldn’t have access to a certain specialist, like a neurologist.“The old way was, you got on the phone and talked to someone,” said Dr. Adam Barkin, medical director of the emergency department at Sky Ridge. You had to describe everything. This is a much better way because this allows the consulting physician to do their own observation ... The key is to get that neurologist on camera within that first three minutes.”Though the technology has been around in different forms for nearly a decade, in recent years, increased comfort with technology and online video chatting has opened up a new world of patients who are not only comfortable with — but would sometimes prefer — an online appointment, Pratt said.Efforts to find patients to talk to were unsuccessful because of the emergency and neurological nature of how technology is currently being used.Care and convenienceSamantha Lippolis, telehealth director of Centura hospitals, said Centura uses telehealth technology in outpatient settings as well as such emergency situations as strokes, and including pulmonary, cardiology, concussion management, sleep clinics, urology, genetic counseling and pre- and post-surgical consultations.Centura facilities also use the technology for critical care for doctors who can’t be on call 24 hours a day but can visit the hospital virtually to make rounds.Although telemedicine is largely limited to rural areas and specialist consultations and exams, Centura hopes to expand its use in coming years.“If you’re in south Denver and you wanted to see a specialist that is in Thornton, that could easily take you an hour-and-a-half in traffic,” Lippolis said. “We are giving it to patients as a choice and a convenience, and it’s up to them whether they want to see a doctor in person or if they would prefer to not have to drive. We really see it as a way to offer patients choice and convenience.”According to Lippolis, health insurance laws only allow for reimbursement of telemedicine for patients in rural areas or in situations where they otherwise wouldn’t be able to see a specialist.Passed in 2015, House Bill 1029, sponsored by Rep. Perry Buck (R-Windsor) and Joann Ginal (D-Fort Collins), requires insurers to reimburse health-care providers for telehealth services in counties of all sizes. Previously, Colorado law had required reimbursement only for counties with 150,000 residents or less.“Last year, legislation was passed (in Colorado) that all commercial payers, non-Medicare, will be required to reimburse for telehealth services in urban areas beginning in 2017,” Lippolis said. “What we all expect is that now we can offer telehealth to patients as a convenience.”Neurologists are zebrasAccording to Amy Maxe, service line director of neurosciences at Littleton Adventist Hospital, Centura has cameras at facilities throughout the state.The facilities with cameras don’t have neurology coverage in their hospitals or their communities. Littleton Adventist provides the neurologist for all of these facilities remotely.“It started as telestroke, and that’s the majority of the patients that we see,” Maxe said. "But it could be a seizure patient or something else. The other thing that we are starting to use it for is teleneuropysch evaluations.”As the technology advances, doctors treating patients not only across the state but also from across the country will become more commonplace, Pratt said.A patient in California will be able to see a specialist in New York without leaving his or her hometown.“As long as I can get a good Internet connection I can work,” Pratt said. “Medicine and treating patients is the same, regardless of what state you are in.”But doctors must be licensed in each state they practice, Pratt said.From a nursing perspective, telemedicine is helpful because it allows nurses to diagnose a patient in a more comprehensive manner, said nurse D.J. Sasso, assistant vice presidentof neurosciences and cardiovascular services at SkyRidge.“In some of the rural areas that only have nurse practitioners or PA (physician’s assisant), they utilize this technology as quick access to a physician,” Sasso said.Another benefit to telemedicine, health professionals say, is cost savings.According to Rebecca McBride, the telehealth program coordinator for Centura Health, the typical cost of a machine is between $20,000 to $30,000 — a fraction of the cost of hiring a full-time specialist.“I think telemedicine is the next frontier of where medicine is going to go, especially for the rural hospital or a critical care hospital that doesn’t have certain specialists,” Barkin said. “You’re going to see more and more about telemedicine on a regular basis with our behavioral health patients, too. We actually do remote assessments for psychiatric patients that need evaluations. Just like how neurologists are rare, like zebras, not every hospital can have psychologists or behavioral specialists."
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