One of the common medications given to stroke patients is tPA (tissue plasminogen activator), which works to break down blood clots that cause stroke. This medicine is most effective if given as soon as possible, typically within four and a half hours of stroke symptoms occurring. For a patient that lives in a community that may not have a stroke center or specialist nearby, the time required to transfer to the nearest center may mean it’s already too late.
“The sooner you can be treated, the better your chances for a good outcome. Time is very important when you’re dealing with acute stroke,” says Mollie McDermott, an assistant professor of neurology and director of the telestroke program at Michigan Medicine, formerly known as the University of Michigan Health System. Dr. McDermott has been involved with a partnership between MidMichigan Health and Michigan Medicine, since its inception. June 2020 will mark the seventh year of the affiliation.
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Wood says that telemedicine helps save patients the hassle of taking time off of work, driving to the surgeon’s office and waiting, for what might only be a five-minute conversation.
The partnership brings neurologists and stroke specialists from Michigan Medicine into hospital rooms for patients in geographically isolated areas where they might not be able to access stroke care quickly and in their own community. MidMichigan Health and Michigan Medicine work together to set up virtual care services that allow patients to be seen by specialists as soon as possible and in the comfort of a facility that is familiar to them.
“What’s crazy about this is that if you are having a stroke and walk into the emergency room our Medical Center in Gladwin, you can be seen by the same doctor that would see you if you walked into Michigan Medicine in Ann Arbor,” says Tom Wood, the director of trauma and virtual care at MidMichigan Health.
The program first started in 2016 with a small number of patients.
“But, even then, it showed us that we could do this,” says Wood. “It opened our eyes to what we could do with this technology if we invested in it.”
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With these new programs, patients can receive quick and high-quality care without having to transfer away from the comfort of doctors they are familiar with.
Now the program facilitates thousands of virtual consults every year.
Dr. McDermott says her team receives an average of 100 telestroke consults per month from MidMichigan Health partner sites.
“The telestroke program allows patients to be treated in their local community,” says Dr. McDermott. “One of the most valuable aspects of the program is bringing timely expert stroke care to patients where they live.”
Some of the most memorable cases for her are when the teamwork between the local nurses, providers, and telestroke consulting physicians is seamless.
“It is really gratifying to see the patient discharged a couple days later, back to their pre-stroke baseline,” said McDermott.
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One of the challenges of telemedicine has been recreating the human moments that can be part of in person interactions.
After a telestroke consult, the teleneurology team at Michigan Medicine will step in to follow up with the patient in the hospital. Dr. Kurt Sieloff is the director of teleneurology at Michigan Medicine. He says that he has also seen exponential growth in the program, from 79 consults in 2017 to 1,011 in 2019.
“Our teleneurology program tries to address a very real need in Michigan – that there simply are not enough neurologists,” says Dr. Sieloff who became involved with the program when he started as an attending physician at Michigan Medicine about three years ago. “One of the main benefits is that experts from Michigan Medicine can collaborate on a patient’s treatment plan at smaller community hospitals that might have to go without.”
He says that one of the challenges of telemedicine has been recreating the human moments that can be part of in person interactions.
“There is something with medicine that is very human, to be there with that person to talk about whatever it is they are struggling with,” says Dr. Sieloff. “With teleneurology, we try to build that rapport even though we are not in the room.”
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MidMichigan Health has taken a new approach with telemedicine to see what they can do to make things like waiting times to see specialists better for patients.
This all started when a team came together at MidMichigan Health to see how telemedicine could be used to enhance their patient experience. After receiving a grant from the U.S. Department of Agriculture, they began to create the protocol and gather the equipment needed to make virtual care a reality for their patients.
“It’s something we are proud of. There were bumps in the road, but we did it because our patients, especially in rural or geographically isolated areas, didn’t have access to state-of-the-art stroke care,” says Wood. “When it’s about a patient, really good things can happen.”
Steve Blodgett, the manager of virtual care at MidMichigan Health, remembers what those early days were like.
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Steve Blodgett, manager of virtual care at MidMichigan Health.
The team would roll a computer on wheels — one with Internet access of course — and use a video conferencing service to speak with the patient. A staff member would have to turn on the computer and log in, and there was only a one-sided camera facing the patient. In three years, the team has acquired several pieces of equipment designed to fit different patient needs including iPads, laptops, wall-mounted television units in patient rooms, telemedicine carts, double-sided screens and the ability to navigate peripheral devices (hand-held cameras, otoscopes and digital stethoscopes).
With these new programs, patients can receive quick and high-quality care without having to transfer away from the comfort of doctors they are familiar with as well as friends and family. It also saves patients the hassle of taking a day off of work to come into the hospital for what only has to be a five minute follow up. Finally, these programs help practitioners better manage their schedules so they can serve more patients.
“When we talk about access, we think about rural care. We absolutely care about that and it is a hallmark of our program,” says Wood. “But we’re also looking at what can we do to serve patients better.”
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For it ease of use and cutting down patient waiting times, telemedicine continues to see growth.
For the past few years, Wood reiterates that MidMichigan Health has been focusing on direct to consumer care. This helps with access issues for communities in areas without a large health system nearby. But, it also addresses a more common problem that Wood has noticed.
“You’ll have patients who need to see a surgeon, but they are booking out three months,” says Wood. “We try to take a new approach and see what can we do to make that better.”
When it comes to minor surgeries — involving a gall bladder or a hernia — patients are usually back to work within a week. However, a post operation follow-up appointment may not be scheduled for 10 to 14 days later. Wood says that telemedicine helps save patients the hassle of taking time off of work, driving to the surgeon’s office and waiting, for what might only be a five-minute conversation.
“That’s not the doctor breezing you over,” says Wood. “That is all that is needed.”
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Patients can often see a specialist much faster through telemedicine.
Patients always have the option to come in person or follow up with their physician if they feel something might be wrong, but increasingly many are opting to fill out a short questionnaire via the patient portal.
Dr. Shane Martin is one of the surgeons who has been working on a virtual post-operation care program for the last six months.
“It has changed my practice drastically,” says Dr. Martin, the chair of the surgery department at MidMichigan Health. “It has freed up significant time.”
If a patient opts to do a virtual post-operative visit, they receive a questionnaire ten days after the procedure. They are also able to upload photos of their incisions, and reach out to the doctor or his or her office with any concerns.
The telemedicine team works with physicians of different specialties to craft questionnaires that are relevant to their field and the procedure they have performed.
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A patient consults with a doctor via iPad.
“It takes an organization-wide effort to get these things done,” says Wood, who has seen the program expand to different specialties. “Putting a patient in front of camera and doctor in front of camera doesn’t make telemedicine happen.”
There is an entire workflow process that has to be mapped out from checking in to patient consent, and then guiding a patient on where to go.
“We pride ourselves on it looking seamless to the doctor and patients, but some of these things take months to train and do properly,” says Wood.
At times, the team also creates technology from scratch to be able to do the procedures and consults in the way they want to. This is under the guidance of Dan Waltz, corporate vice president and chief information officer at MidMichigan Health.
“My vision for this program is to continue to grow exponentially to compete in this market. We are not only competing with other hospitals, but with the likes of Google, Walmart or CVS,” says Waltz. “We have the physicians and relationships with patients, we have to offer this convenience to patients over the coming years so they stay with us.”
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Blodgett estimates that since the virtual care program started, it has saved people over 750,000 miles in travel.
Wood knows it takes a village to make this happen. Michigan Medicine and its physicians are part of that community as both health systems work closely together to provide this care and service for their patients.
“They are the absolutely best physician partners in terms of quality of care and just working with us,” says Wood.
There are many other virtual care programs up and running at MidMichigan Health in both the inpatient and outpatient setting, nephrology, behavioral health, infectious disease, child psychiatry and post-operative follow-ups, to ensure patients receive the best care possible in their local communities,” says Blodgett.
Blodgett estimates that since the virtual care program started, it has saved people over 750,000 miles in travel.
In the end, he continues to be motivated to grow and expand these programs, because he knows it is about providing better care to patients.
“With these sorts of things, if it helps even one person, it’s so worth it,” says Wood.