The Michigan Stroke Network is using telemedicine to facilitate rapid stroke treatment in emergency departments and improve patient transfers to stroke centers where they get comprehensive treatment.
Problem: Stroke is the 3rd leading cause of death and a leading cause of long-term disability, and recovery depends on prompt response with the appropriate treatment. However many hospitals do not have access to stroke specialists to make live-saving and function-saving decisions when seconds count.
Innovative Program: In 2006, The Michigan Stroke Network started using robotic technology to provide 24-hour access to stroke specialists for 31 participating hospital emergency departments. Specialists can guide the treatment as thought they were present at the patient's bedside.
How it Works: When a patient with signs of stroke arrives at a participating hospital ER, the hospital calls a toll-free number that pages the oncall stroke specialist who logs onto a laptop using a wireless Internet connection. The specialist "virtually arrives" within 9 to 12 minutes and uses a joystick to move the 5-ft robot and it's camera to observe the patient, view and assess lab results, CT scans and other diagnostic tests conducted by the ER, and make treatment recommendations. If the patient requires transfer to a stroke center, a helicopter crew (that was also alerted with the initial page) is onsite within minutes.
Ongoing Stroke Education: Ongoing education for medical professionals allows review of protocols and assessment processes to improve response time. Robots are also used to educate the public about stroke symptoms and prevention via virtual health fairs.
Results: In the first 17 months, the on-demand remote consultations have enhanced care for 173 patients at 31 participating hospitals. Patients received life-saving therapies (such as rt-PA) in more than 70% of cases.
Additional Observations: Access to stroke specialists is a significant challenge for many hospitals. The decision to start certain therapies that can save lives and restore function is dependent on specialized expertise -- if the therapy is given under the appropriate circumstances, patients have a much better recovery record. But if given in the wrong circumstances, the therapy can cause death or futher damage. These decisions are not usually made by the ER physician, but depend on highly specialized expert consultation that is most often not immediately available.
This robotic technology that allows two-way audio and visual communication between the specialist and the patient results in dramatic improvement in assuring that patients who meet the right criteria get life-saving treatment when it's needed.
For more information, see
http://www.innovations.ahrq.gov/content.aspx?id=1789
Sunday, March 15, 2009
Thursday, March 12, 2009
3-D Virtual and Simulation Technology in Medical Education and Training
Use of 3-D virtual world technology and simulation training is adding an exciting dimension to medical training. Could you attend medical school in a virtual world?
In my previous post about the debate around online medical degrees, it was noted that continuing education courses have become popular in distance education. Another aspect of technology innovations and distance learning is the emergence of 3-D and simulation training, and Duke University has a robust program called the "Center for Nursing Discovery" described below.
Using a student-centered approach, the Center for Nursing Discovery provides a variety of avenues of instructional methodology, including
simulation using high fidelity (or "lifelike") adult and pediatric mannequins,
role-playing,
self-instructions
faculty-assisted instruction
procedural task trainers to develop specific hands-on skills
standardized patients (trained actors), and
the use of innovative, state-of-the art multimedia.
Students can select various methods based on their learning styles to broaden assessment, communication, psychomotor, and cognitive skills within a safe environment.
Practice in the CND, along with their clinical experiences, will help students move towards development of their own evidence-based nursing practice, achieving the ultimate goal of becoming clinical leaders in providing excellent patient care.
Is there any reason why this technology couldn't be opened to an online learning experience, allowing student nurses to train in Pennsylvania
For more information, see http://nursing.duke.edu/modules/son_currentstudents/index.php?id=20
In my previous post about the debate around online medical degrees, it was noted that continuing education courses have become popular in distance education. Another aspect of technology innovations and distance learning is the emergence of 3-D and simulation training, and Duke University has a robust program called the "Center for Nursing Discovery" described below.
Using a student-centered approach, the Center for Nursing Discovery provides a variety of avenues of instructional methodology, including
simulation using high fidelity (or "lifelike") adult and pediatric mannequins,
role-playing,
self-instructions
faculty-assisted instruction
procedural task trainers to develop specific hands-on skills
standardized patients (trained actors), and
the use of innovative, state-of-the art multimedia.
Students can select various methods based on their learning styles to broaden assessment, communication, psychomotor, and cognitive skills within a safe environment.
Practice in the CND, along with their clinical experiences, will help students move towards development of their own evidence-based nursing practice, achieving the ultimate goal of becoming clinical leaders in providing excellent patient care.
Is there any reason why this technology couldn't be opened to an online learning experience, allowing student nurses to train in Pennsylvania
For more information, see http://nursing.duke.edu/modules/son_currentstudents/index.php?id=20
Tele-Ethics Consultations
With increased availability of advanced clinical technology, medical ethics dilemnas become more frequent. More and more, families and healthcare professionals have differing views on whether aggressive treatment should be insituted (or continued). Nursing homes are often faced with the dilemna of a non-responsive patient who doesn't have immediate family or caretakers to make end-of-life decisions.
Major medical centers have robust Medical Ethics Committees to advise and consult on these issues, comprised of experts in medicine, the law, religion, ethics and philosophy, etc. But the smaller hospital or nursing home (especially in remote areas)often doesn't have access to internal resources of this nature.
Telehealth is providing a valuable link to solve these problems, allowing small remote facilities to access Tele-Ethics consultations and education for professionals.
The Missouri Dept of Health developed a collaborative effort where rural nursing homes could access virtual ethics consultation via telephone, email and video conferencing. The Missouri Telehealth Network and the Long Term Care Ombudsman Office collaborated to facilitate communications between remote nursing homes an an academic medical center to provide consultations with a clinical ethicist.
Facilities without videoconferencing were given laptops with video cameras, and in 2006 the network provided 23 "portable ethics consultations". The technology was also used to conduct training for clinical personnel to increase their understand of and comfort with challenging bioethics situations.
This targeted nice of distance education is another example of telehealth as a cost-effective means of improving patient care outside of physical borders.
Source: Fleming & Reynolds (2007), "Virtual clinical ethics consultation for long term care facilities." Presented at American Society for Bioethics and Humanities 9th Annual Meeting, October 2007, Washington DC.
For more information on ethics and telehealth, see www.ecri.org
Major medical centers have robust Medical Ethics Committees to advise and consult on these issues, comprised of experts in medicine, the law, religion, ethics and philosophy, etc. But the smaller hospital or nursing home (especially in remote areas)often doesn't have access to internal resources of this nature.
Telehealth is providing a valuable link to solve these problems, allowing small remote facilities to access Tele-Ethics consultations and education for professionals.
The Missouri Dept of Health developed a collaborative effort where rural nursing homes could access virtual ethics consultation via telephone, email and video conferencing. The Missouri Telehealth Network and the Long Term Care Ombudsman Office collaborated to facilitate communications between remote nursing homes an an academic medical center to provide consultations with a clinical ethicist.
Facilities without videoconferencing were given laptops with video cameras, and in 2006 the network provided 23 "portable ethics consultations". The technology was also used to conduct training for clinical personnel to increase their understand of and comfort with challenging bioethics situations.
This targeted nice of distance education is another example of telehealth as a cost-effective means of improving patient care outside of physical borders.
Source: Fleming & Reynolds (2007), "Virtual clinical ethics consultation for long term care facilities." Presented at American Society for Bioethics and Humanities 9th Annual Meeting, October 2007, Washington DC.
For more information on ethics and telehealth, see www.ecri.org
Monday, March 9, 2009
Innovations in Distance Learning: Online Medical Degrees?
As the new Obama Administration ponders the massive reforms needed to save the struggling U.S. healthcare system, a key challenge is the predicted shortage of physicians.
When the first Baby Boomers turn 65, the age of Medicare eligibility, on 1/1/11, the system will be hard-pressed to find adequate numbers of physicians to support their needs.
Innovations in distance learning could provide an alternative to traditional medical schools in increasing the number of practicing doctors to meet the needs of medically underserved areas and the increasing number of patients who will clog an already struggling system.
Back in 2001, the late Dr Eugene Stead, Jr. proposed that it was “time for accredited medical schools to establish distance learning curricula that would allow experienced community-bound health professionals, such as physician assistants (PAs) and nurse practitioners (NPs), to take medical school courses from home or at work” (Stead, 2001).
Dr Stead is known as the founder of the Physician Assistant profession, having created the country’s first formal education program for Physician Assistants at Duke University in 1965. He suggested that providing online courses for these “non traditional but seasoned healthcare professionals” would accelerate the time to achieve a full medical degree, while allowing the practitioners to remain in active practice.
In 2001, Stead asked “Which medical school will be the first to take the lead, which has the courage to explore alternative pathways to becoming a physician?”
Eight years later, those questions remain unanswered in the U.S. Of the 130 accredited M.D.-granting medical schools in the U.S., none yet offers a full online medical degree. However, there are some international programs emerging to offer four-year online medical degrees: “The International Virtual Medical School - IVIMEDS - is a worldwide partnership of leading edge medical schools and institutions, setting new standards in medical education and blending high quality e-learning and face-to-face learning in the training of health care professionals” (IVIMEDS, 2009).
Online medical education in the U.S. has made some strides, with many offerings for Continuing Medical Education (CME) courses that physicians are required to complete to maintain their licenses and board certifications. Harvard Medical School offers a wide range of “multimedia enriched, comprehensive, and interactive” online CME courses that have been taken by students from 105 countries (Harvard, 2009). They cost about $20 for each course hour, and topics range from clinical to administrative and legal issues.
Dr. Stead (who died in 2005 at the age of 97) would no doubt be pleased to learn that his long-time employer, Duke University in North Carolina has incorporated distance learning degree program technologies in traditional classroom courses. Anesthesiology students there are “using computer simulations to enhance their learning and decision-making processes before applying these to patients in the operating room” (Degree Board, 2008).
Many universities are taking advantage of Duke’s good example to offer a combination of technologies designed to help their students learn as effectively as possible.
See the next post on Duke School of Nursing’s Center for Nursing Discovery for an example of a world class institution using simulations and innovative state-of-the-art multi-media in online and classroom learning.
For more information:
Degree Board (2008). Campus-Based College Degree Programs offer Online Lessons . Retrieved online on March 9, 2009 at http://tinyurl.com/arqhbn
Duke University School of Nursing (2009). Center for Nursing Discovery. Retrieved online on March 9, 2009 at http://tinyurl.com/atxbu2
Harvard (2009) Harvard Medical School Department of Continuing Education. Retrieved from the Internet on March 9, 2009 at http://cmeonline.med.harvard.edu/
IVIMEDS (2009) International Virtual Medical School. Retrieved online on March 9, 2009 at http://www.ivimeds.org/
Stead, E. (2001). “Using Distance Learning to Provide a Medical Education to Non-traditional Students,” North Carolina Medical Journal, Vol 62, Number 6, 2001 retrieved from the Internet on March 9, 2009 at http://easteadjr.org/guest.html
When the first Baby Boomers turn 65, the age of Medicare eligibility, on 1/1/11, the system will be hard-pressed to find adequate numbers of physicians to support their needs.
Innovations in distance learning could provide an alternative to traditional medical schools in increasing the number of practicing doctors to meet the needs of medically underserved areas and the increasing number of patients who will clog an already struggling system.
Back in 2001, the late Dr Eugene Stead, Jr. proposed that it was “time for accredited medical schools to establish distance learning curricula that would allow experienced community-bound health professionals, such as physician assistants (PAs) and nurse practitioners (NPs), to take medical school courses from home or at work” (Stead, 2001).
Dr Stead is known as the founder of the Physician Assistant profession, having created the country’s first formal education program for Physician Assistants at Duke University in 1965. He suggested that providing online courses for these “non traditional but seasoned healthcare professionals” would accelerate the time to achieve a full medical degree, while allowing the practitioners to remain in active practice.
In 2001, Stead asked “Which medical school will be the first to take the lead, which has the courage to explore alternative pathways to becoming a physician?”
Eight years later, those questions remain unanswered in the U.S. Of the 130 accredited M.D.-granting medical schools in the U.S., none yet offers a full online medical degree. However, there are some international programs emerging to offer four-year online medical degrees: “The International Virtual Medical School - IVIMEDS - is a worldwide partnership of leading edge medical schools and institutions, setting new standards in medical education and blending high quality e-learning and face-to-face learning in the training of health care professionals” (IVIMEDS, 2009).
Online medical education in the U.S. has made some strides, with many offerings for Continuing Medical Education (CME) courses that physicians are required to complete to maintain their licenses and board certifications. Harvard Medical School offers a wide range of “multimedia enriched, comprehensive, and interactive” online CME courses that have been taken by students from 105 countries (Harvard, 2009). They cost about $20 for each course hour, and topics range from clinical to administrative and legal issues.
Dr. Stead (who died in 2005 at the age of 97) would no doubt be pleased to learn that his long-time employer, Duke University in North Carolina has incorporated distance learning degree program technologies in traditional classroom courses. Anesthesiology students there are “using computer simulations to enhance their learning and decision-making processes before applying these to patients in the operating room” (Degree Board, 2008).
Many universities are taking advantage of Duke’s good example to offer a combination of technologies designed to help their students learn as effectively as possible.
See the next post on Duke School of Nursing’s Center for Nursing Discovery for an example of a world class institution using simulations and innovative state-of-the-art multi-media in online and classroom learning.
For more information:
Degree Board (2008). Campus-Based College Degree Programs offer Online Lessons . Retrieved online on March 9, 2009 at http://tinyurl.com/arqhbn
Duke University School of Nursing (2009). Center for Nursing Discovery. Retrieved online on March 9, 2009 at http://tinyurl.com/atxbu2
Harvard (2009) Harvard Medical School Department of Continuing Education. Retrieved from the Internet on March 9, 2009 at http://cmeonline.med.harvard.edu/
IVIMEDS (2009) International Virtual Medical School. Retrieved online on March 9, 2009 at http://www.ivimeds.org/
Stead, E. (2001). “Using Distance Learning to Provide a Medical Education to Non-traditional Students,” North Carolina Medical Journal, Vol 62, Number 6, 2001 retrieved from the Internet on March 9, 2009 at http://easteadjr.org/guest.html
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