Medical Consultations With Webcams Extremely Successful 84
AgaveNectar writes "Doctors are far from being early adopters, so they have just gotten around to publishing a report that webcams help immensely with making the right decision when someone shows up to a rural emergency room suffering from a stroke. Using clot-destroying medications like Alteplase is really risky, and it should only be given in acute cases. In a study of 222 patients, rural ER doctors consulted with faraway stroke specialists. They made the right decision 98 percent of the time when the expert examined the patient with a webcam, and only 82 percent of the time when they just talked to each other on the phone. Perhaps this report will finally convince the medical community that telemedicine is important."
Yo Mama Has a Web Cam (Score:1, Funny)
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The mods here just have a strict anti-"yo mama" jokes stance. Seriously, lighten up.
Also, declaring your post "insightful" automatically voids it as insightful. It's like a guy who goes around telling people he's cool. Don't be that guy.
Next, outsourcing to Bangalore (Score:5, Insightful)
Now, at last, medical care can be outsourced to low-wage countries.
Re:Next, outsourcing to Bangalore (Score:4, Informative)
Re:Next, outsourcing to Bangalore (Score:5, Interesting)
I'll call them up and tell them that Portland, Oregon is officially considered a "low wage country". I bet they will be surprised!
So, the radiologist is working at 2AM? (Score:4, Informative)
Then above you said :I'm not sure that I call transmission of digital information 'telemedicine' but we use remote radiology all the time since we are too rural to afford a full time radiologist.
I'll call them up and tell them that Portland, Oregon is officially considered a "low wage country". I bet they will be surprised!
It has been reported in the Economist and in other business magazines that there's a trend in electronically sending X-rays and other data via the internet to docs in India for review and diagnosis. They then just email back there answers.
For one; it's much much cheaper. Two, there's time difference. So, when or if you do a night shift in the ER, where do you send those X-Rays? Is that Portland radiologist or another still working at 2:00AM?
I've worked on the technology at McKesson/HBOC - 8 years ago.
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It has been reported in the Economist and in other business magazines that there's a trend in electronically sending X-rays and other data via the internet to docs in India for review and diagnosis. They then just email back there answers.
For one; it's much much cheaper. Two, there's time difference. So, when or if you do a night shift in the ER, where do you send those X-Rays? Is that Portland radiologist or another still working at 2:00AM?
Teleradiology has been around for quite some time (as you point ou
Re:So, the radiologist is working at 2AM? (Score:4, Informative)
I'm sure that happens. We chose to use a more local group, largely because of the issues you raised.
I think this varies from state to state. In Alaska, you do need a valid Alaska license. You also have to have privileges at the hospital which is another complex step so you would weed out anyone completely unqualified.
Well that all depends on the lawyers and the jury. But they the radiologist from Oregon (or wherever) can be a defendant in a malpractice action if it comes to that.
Not really up front - patients are rarely aware of who or what the radiologist is - they're typically hidden in dark rooms and not allowed out much (sounds like your typical Slashdotter, doesn't it). If anyone asked, we could tell them. I actually do mention it when appropriate. I will tell the patient that we're sending the data down to Oregon so somebody qualified will look at it and get back to me.
Not sure exactly how to answer that since there aren't any real "savings". The radiologists bill separately - their fees are pretty much set by the insurance companies. If you're paying cash, well, in the US you're screwed but that is another rant... The hospital pays the radiology group a set fee per study for overhead and storage costs (they have to keep the data for varying times so it's a significant issue). I think we pay about $7.00 per study which we feel is a pretty good deal because then the little rural hospital doesn't have to deal with a huge, complicated IS infrastructure.
Yep, they are very careful with data handling. Everything going out into the Evil Internet is encrypted. Everything coming back goes by secure fax, phone or hopefully sometime in the mysterious future, by secure transmission into our mythical electronic medical record.
It's actually been a significant improvement in patient care. Instead of one or two general radiologists, you can have the study read by someone, for example, that just looks at head CTs. They have a night crew. They have a big IS department that's more or less functional. There were more gliches and setup problems and costs than I had hoped for when we started, but welcome to the real world....
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They already do this - who do you think reads all those X-Rays?
Radiology is the obvious candidate for outsourcing, but there are legal issues with this. The radiologists in India that can look at films do not have an American medical license. If there is a misread, they are not legally responsible. The hospital can get sued, and they will get accused of using unlicensed radiologists.
What a lot of hospitals do now is that only the films done late at night are outsourced. In my hospital, there is a "night hawk" service that reads the films, and who knows where on earth t
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Can see the new spam already: "If you have a webcam, we can provide you with a free breast exam."
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They've been doing this here in the UK for several years. The NHS doesn't function so people go abroad for treatment.
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Next is the big pipe dream. With your webcam you can get Webtouch, the force feedback apparatus,
that allows a doctor or nurse to physically 'contact' you. Doc wears gloves on the other end that control the apparatus and allow for detection of pressure, heat and maybe even surface texture.
The best thing aside from being there.
Of course the pr0n applications for this would be through the roof.
P. S. to prep for this, all you medical folk better play your videogames. I don't want my spleen accidentally ripped o
Re: Outsourcing to Bangalore and Beyond! (Score:2)
Parts of it already are....like interpreting tests, reading medical imaging output, writing the reports, etc.
It's a big deal from the standpoint that the contractors that are typing in the results and interpreting your medical diagnostics are not regulated by US law nor subject to the the US HIPPA medical privacy rules -- since they don't have to have privacy safeguards, their services can be offered due to lower overhead in procedures and safeguards as well as lower labor costs. I'm sure having an 'expert
Are they using SSL? (Score:4, Interesting)
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Maybe. How does this differ from 90% of youtube?
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Even if they use SSL but if the doctor on the other end is required to keep the footage due to an agreement with the insurance company, it's possible that they may someday be able to whip out the footage as evidence of a pre-existing condition in order to deny you coverage and save costs.
That is, I don't see this headed toward something to protect your privacy, or toward all that much legality for that matter. Everyone is a potential terrist, you see, therefore no one may have privacy, and so not even laws
I'm convinced telemed is important... (Score:5, Insightful)
The problem is that this is not really a good demonstration of the efficacy of telemedicine, because they picked a treatment for which there is a marginal benefit for a very small proportion of people. In order to get thrombolytics for stroke, you have to meet a certain set of criteria that in my experience few meet: no recent trauma or surgery, normal blood pressure, no history of stroke in the past 3 months (or hemorrhagic stroke ever), no current ulcer disease, no diabetic retinopathy, no seizures, deficit is more than minor but not too major, certain onset of symptoms in under 3 hours (and it will take an hour to get you imaged and blood tests done after you get to the ER), and a lot more.
In addition, if we give you thrombolytics for your stroke (and you are an ideal candidate) you get a 13% greater chance to recover with minimal or no deficit, but you have a 7% greater chance of your stroke getting phenomenally worse by becoming a hemorrhagic stroke which more often than not leave you dead or in a permanent vegetative state (in addition to all the other problems you can get from being completely incapable of clotting for a good 24 hours.)
What they should do is demonstrate this where it could be really useful: with a NP or PA way off in the hinterlands or in underdeveloped countries. But that isn't snazzy, doesn't pay well, and drug companies that sell gazillion dollars a pop medicines don't sponsor it.
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It's a start. In medicine nowadays, the "Big Name, Big Profit" companies pay for new techniques, and those techniques--eventually--filter down to the poor.
It's not right--but it is the way of the world.
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What you are arguing against is not what I am saying, Nick.
Re:I'm convinced telemed is important... (Score:5, Insightful)
From the FA (no, not the stupid Wired blurb, the one in Lancet):
Not awfully shabby, small study though. No power analysis (how many patients would be needed to validly determine if an 18% difference in 'outcomes' was real). Note the hedging on outcomes - here is the real problem with the study.
Not all that different here. Note the lousy p-value. So, you do pretty much the same if you got it 'right' or 'wrong'. Interesting.
Blast and damn. No difference no matter what the hell you do.
Whatever that means. Again, no functional difference no matter what you do.
So yeah, not much to see here, move along. Nothing like overruning your data with conclusions. If you're an ER doc (and I am one) you should really be able to describe the neurologic exam of someone having a fairly large, well defined stoke to a neurologist on the other side of the phone. If you can't you can look it up. Not that the webcam is any great technological milestone but the article basically showed that it's use made no difference to the patient
Re:I'm convinced telemed is important... (Score:4, Insightful)
1) It is impressive that they managed to recruit so many patients for such a complicated study, and I don't think their sample size is that small in the first place.
2) If you do a power analysis, it won't tell you whether the 18% difference is "real" after you've already established statistical significance.
3) Regarding intravenous thrombolytics: So the 28% vs 23% is "not all that different". But could it make a difference to a few patients? The "lousy p-value" (p=.043) indicates a significant difference at alpha=.05, so I have no idea why you call it lousy.
Your post basically showed that ER docs will use the year of stats classes that they took in school to interpret research any damn way they want to.
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>Your post basically showed that ER docs will use the year of stats classes that they took in school to interpret research any damn way they want to.
And your post basically showed that you fail to understand his point. There is a clear-cut litmus test for introducing new medical interventions: what is the effect on patient mortality and morbidity in the short-term and long-term? According to the data: not much. Are stroke patients dying less or otherwise getting better outcomes if you use a webcam? N
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It is impressive that they managed to recruit so many patients for such a complicated study
I see you seem to be having a stroke Mr. Jones, would you be interested in participating in a clinical research study to determine the effectiveness of telemedicine? Maybe if they used radio commercials...
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Not awfully shabby, small study though. No power analysis (how many patients would be needed to validly determine if an 18% difference in 'outcomes' was real). Note the hedging on outcomes - here is the real problem with the study.
This is statistical nonsense. Post-hoc power analyses are a one-to-one mapping to the observed p-value, and serve no real purpose. One of many references to this is found here:
http://www.childrensmercy.org/stats/weblog2005/PostHocPower.asp [childrensmercy.org]
I believe you may be confused about what
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How can a study that shows significance have too small a sample size? That makes no sense whatsoever!
If the statistically significant difference is a clinically insignificant measure.
Let me give you an example. We test two drugs for hypertension to see if we find a difference in efficacy. We find that there is a statistically significant difference in the mean systolic BP in these two groups. Drug A gives a mean SBP of 120 and Drug B gives a mean of 125. This 5mmHg difference is significantly different because we did a study with n=1000.
However, when we look at clinically significant endpoints (strok
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If the statistically significant difference is a clinically insignificant measure.
Then you were underpowered for a certain outcome, sure. But that just begs the question, and my initial claim was that post-hoc power analysis is worthless, which I stand by. Also, remember that just because a study does not show an effect, does not imply it is underpowered.
And with all due respect, I am well aware of surrogate outcome trials, and the trial in particular that you brought up, assuming you are talking about W
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The answer is (Score:1)
Google Stroke View
How long until greedy HMO's require... (Score:3, Funny)
...Pay-per-view gynecology.
Could be worse though. ER tech, "This guy says he slipped and fell on a fusili statue. Here: take a look."
For the Good of All of Us (Score:1, Funny)
Except the ones who are dead.
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A more interesting study (Score:5, Interesting)
Re:A more interesting study (Score:4, Informative)
That's a pretty broad brush, but overall my guess is that patients who do a fairly decent search on the Internet AND have some sort of defineable symptom or problem (rather than "I don't feel so good") is about 50-75%.
Most of the time, they end up thinking about the things that have already been dropped from the doc's differential because of previous questioning, testing or just natural history (males typically don't get pregnant). The really useful part that I have found is while wandering around looking for answers, they run into questions that a) I should have asked but didn't b) I asked but they gave an incorrect / noncommittal answer or c) I asked the wrong way. Looking at the problem from several different viewpoints in the (?)privacy of your home can often be useful.
But people come to doctors for a bit more than just to answer the question of "what do I have". There might be a useful conversation about what to do about it. And I have a very hungry Labrador Retriever puppy to feed. Have you seen the price of Purina Dog chow recently?
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But people come to doctors for a bit more than just to answer the question of "what do I have". There might be a useful conversation about what to do about it.
Fair enough, but I've always ALSO been able to find the usual treatment for my self-diagnosed problems online, and every time I've been to the doctor in the last 10 years or so (which is admittedly only a handful of times) the doctor's proscribed treatment was exactly what the internet suggested. Usually the "useful conversation" was only useful for me because it was impossible for me to get the necessary medication without a prescription.
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overall my guess is that patients who do a fairly decent search on the Internet AND have some sort of defineable symptom or problem (rather than "I don't feel so good") is about 50-75%.
so is that better or worse than the doctors' success rate under similar conditions?
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Oh, most docs are about 95-98% "accurate" in terms of knowing what the diagnosis is (disclaimer - I am going to arbitrarily exclude the vague but incredibly common and complex visits that include the "I don't feel well" complaint noted abo
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There lies a slight danger in that analysis. I am not a doctor but...
A vast majority of people go into doctor's offices with 'normal symptoms' such as a fever, cough, sore throat, etc. which would in most cases be caused by 'normal conditions' such as a simple virus or bacterial infection. Obviously, you could self-diagnose a fever as being caused by a virus from google.
The reason you go to the doctor is to ensure that fever you are experience isn't caused by something more drastic such as a hard to detect
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On the other hand, this also assumes that doctors are competent and have your best interests in mind.
First off I want to say that I have little doubt that most doctors are good.
However, my mom was having various weight issues and lack of appetite, and went to the doctor several times over a period of months. Each time the doctor just said "oh, it's probably just stress, don't worry about it! No problem at all", to the point of completely ignoring my mom's requests for a more thorough examination.
Eventually
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And every time I've ever rode in a car, I was never in a wreck, so there's obviously no reason to wear my seat belt. The doctor is there to diagnose those less-often and perhaps life-threatening things you'll diagnose wrong.
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OK, good point!
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Two good outcomes or one good outcome? Tough choice, huh?
*sarcasm*
You forgot all those precious seconds of your life wasted putting on and removing seatbelts, as well the the occasional unlucky person who can't get their seatbelt off fast enough to escape from a burning/sinking vehicle, or the dude who claims that if he hadn't been thrown out of the car, he would have plunged down the 300 ft gorge along with it.
*/sarcasm*
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My wife went to see a doctor, because she did not feel well. Headaches and pains. We had a guess based on some study on the internets, but the doctor promptly decided that she had tension neck. Now the 'tension neck' is sound asleep and three years old.
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1) almost nobody is smart enough to reliably, safely and accurately diagnose themselves using the internet
That might be true. I don't really know. Which is exactly why I said I would like to see a study on it.
2) even if you got it right, the treatment you administered to yourself could be dangerous to you for entirely different reasons which you hadn't even thought to check up on. The alternative is for people to be permitted to treat themselves. Utterly horrific things would result.
Doctors screw things up all the time. The question is how the success rate of a doctor compares to the success rate of a person trying to treat themselves. Which again, we don't really know. Doctors are very expensive. I can't rationally decide if going to a doctor is worth my money unless I have statistics on how going to a doctor improves my chances. Which, again, is why I would like to see such a study
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Every time I've had to go to the doctor lately I've successfully diagnosed myself with the internet and known the treatment before I went, only to pay $120 for a doctor to look at me for 5 minutes and say what I had already guessed.
My difficulty with a recent illness is that while I was able to self-diagnose my condition, I needed to see five physicians before I found one who was actually willing to run the tests to confirm my suspicions. It's really irritating to be told time and time again by doctors "No, you don't have that illness, and I absolutely will not run any tests" until you find one that decides to humor you, and whaddyaknow, confirm what you already knew.
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There's a web site, www.privatemdlabs.com which lets you pay online for any test you want, print the test requisition off the Internet -- approved by an actual M.D. and all -- then go to whatever testing center administers the tests and have blood or whatever else drawn. The downside is, it is 100% out of pocket costs -- several hundred for routine tests.
They send you the lab results (uninterpreted) as a PDF and then you can do whatever you want with them.
I have no relationship with this company other than
Yay telemedicine (Score:2, Informative)
Nah. (Score:1)
They made the right decision 98 percent of the time when the expert examined the patient with a webcam, and only 82 percent of the time when they just talked to each other on the phone. Perhaps this report will finally convince the medical community that telemedicine is important.
82% ought to be good enough for everyone.
The results are too good. (Score:2)
I have not read the article.
That being said, a 98% accuracy sounds like it's as good as the gold standard (Gold standards are almost never 100% accurate). I find that hard to believe, and therefore find the results suspect.
Prior Art (Score:1)
Turing Test? (Score:4, Funny)
I'm amazed that nobody has noticed that this means that webcams have passed the Turing test.
sounds great (Score:1)
Check out Tandberg (Score:2)
It's all about the money (Score:2)
Only six months late (Score:1)
Doctor knows best (Score:2)
"Perhaps this report will finally convince the medical community that telemedicine is important."
I wouldn't count on it. Interns still work insane hours in emergency rooms, sometimes making life-and-death decisions under circumstances that would get a long-haul trucker's license yanked for failing to obey hours-of-driving laws.
Why would this be different?
Tele-radiology (Score:2)
I was involved with tele-radiology back in the mid-Ninties, when I worked for one of the small companies trying to pioneer that particular subset of this field, RADMAN/Radiology Management Systems. That company isn't even in business any longer.