Telemedicine has been used successfully with older individuals to keep them safer in their homes, prevent unnecessary hospitalizations, and monitor chronic conditions. Now telemedicine is showing its value with individuals at the very beginning of their lives.
Premature infants need specialized care, yet transferring them to specialty medical centers can be costly and stressful. Telemedicine can be used with premature infants to provide them with some of the services they need at lower cost, and with less stress on the infants and their families. One recent telemedicine study demonstrated the value of a specialized eye screening that’s done on premature infants at risk for a condition called retinopathy of prematurity (ROP)
Retinopathy of Prematurity (ROP)
Retinopathy of prematurity (ROP) is an eye disease that affects premature babies, especially those who require intensive neonatal care involving oxygen therapy. The condition is believed to be caused by unusual growth of blood vessels in the retina of the eye, which can cause scarring of the retina, or retinal detachment. ROP is sometimes mild and self-resolving, but in serious cases, blindness can result. All premature babies are considered to be at risk for ROP. The standard treatment for ROP is peripheral retinal ablation, a procedure that uses lasers. The earlier the condition is addressed, the better the outcome, in general.
Study of ROP Screening Using Telemedicine
A study funded by the National Eye Institute (NEI) found that telemedicine can be an effective screening strategy for infants at risk for ROP. The telemedicine approach to screening in the study involved electronic transmission of photos of the babies’ eyes to a professional image reading center for evaluation. The staff at the image reading center were trained to recognize the signs of ROP and were tasked with identifying whether infants should be referred to an ophthalmologist for further evaluation.
The study compared how accurate the telemedicine approach was compared to the conclusions of ophthalmologists who examined the babies in person. The babies in the study were screened both with the telemedicine protocol and by ophthalmologists.
Results: Telemedicine Valuable in Screening for ROP
The non-physician image readers who examined the images transmitted by the telemedicine protocol correctly identified 90% of infants who were found to have ROP by ophthalmologists. They were correct 87% of the time in identifying images from infants who did not have ROP. Of the 162 infants who were diagnosed with and treated for ROP by ophthalmologists, the image readers correctly identified all but three, for an accuracy rate of 98%. Eleanor Schron, PhD, the group leader of NEI Clinical Applications, stated, “The results suggest that telemedicine could improve detection and treatment of ROP for millions of at-risk babies worldwide who lack immediate in-person access to an ophthalmologist.”
Telemedicine Robots in the NICU
Screening for ROP isn’t the only way telemedicine is being used with premature infants. Today there are actual telemedicine robots used in neonatal intensive care units (NICUs) that allow infants to be screened and monitored with minimal upheaval. In 2011, a project at the Children’s Hospital of Los Angeles was published in the Journal of Perinatology concerning use of a telemedicine robot in the facility’s NICU. The robot was remotely controlled by an off-site neonatologist equipped with a joystick, microphone, and earphones. Babies were examined by both on-site physicians and off-site specialists in 304 instances.
The off-site neonatologists performed nearly as well as bedside physicians. When evaluating heart, bowel, and breathing sounds, the on-site physicians and off-site physicians arrived at different findings, but the study attributed these differences to subjective opinions of the physicians rather than performance of the equipment. The researchers involved in the study believe that with further refinement and research, NICU telemedicine robots could be used routinely by small or remote hospitals that lack neonatal specialty care.
Telemedicine for Mothers Confined to their Rooms
In cases where mothers as well as infants must be closely monitored after birth, telemedicine can be used to help mothers bond with their infants. Back in 2001, the East Carolina University Telemedicine Center in Greenville, NC deployed a system that allowed mothers confined to their rooms for medical reasons to virtually visit their babies, who were being cared for in the NICU. Using equipment the Center already had, including videoconferencing technology, mothers could view their newborns and speak with NICU nurses about their babies. The tele-visitation was found to be helpful in relieving anxiety in mothers who could not physically be with their babies and promote bonding between mothers and infants.
Telemedicine and Newborns in Rural Hospitals
Last year, The Denver Post published an article about the special challenges facing premature babies born in rural hospitals or at high altitude facilities. Dr. Jeff Brown, pediatric hospitalist at Vail Valley Medical center said, “There’s a lot of things that can happen at 8,300 feet in terms of newborns … that don’t happen in Denver.” That’s because telemedicine is allowing neonatal specialists to teleconference into 33 facilities in Colorado, Kansas, and Wyoming during critical care situations.
In 2013, Rocky Mountain Hospital for Children developed a control center in its NICU that is now a hub for neonatal telemedicine. On-call neonatologists can sign in and use a robotic device called a Remote Presence Lite, a portable device with a built-in camera and stethoscope that allows remote doctors to see patients and listen to their hearts. Doctors can control what they see, and where the camera is aimed, zooming in on monitors, or watching how breathing tubes are administered, for example. They can supervise on-site physicians giving medicine, or can help interpret x-rays.
A mobile version of the Remote Presence Lite can be airlifted to hospitals that don’t have one, allowing neonatologists to assess babies and help administer care. This allows for better decision-making about issues such as whether an infant should be transported to another facility by helicopter. Nearly 60% of patients are able to remain in their hospitals, relieving the challenges of transporting babies in an area where inclement weather can be a real problem. And when infants are transported, parents can use the Remote Presence Lite to virtually meet the doctor caring for their infant.
Telemedicine is demonstrating that it can be used to help the tiniest and most vulnerable patients, providing more of them with specialist care, and preventing the stress of unnecessary transfers. AccessRx.com is excited to learn about the ways telemedicine is bringing better care to more people at lower cost. For over 15 years, AccessRx.com has worked with US-licensed pharmacists to bring people prescription lifestyle medications with unmatched convenience, competitive pricing, and a strong commitment to the best possible customer experience.