Cleveland Clinic Brings the Doctor's Office to Your Home via Telemedicine

MD Magazine Neurology, September 2017, Volume 7, Issue 6

Cleveland Clinic’s first reach into telemedicine extended as far as possible—into space.

In 1997, Cleveland Clinic cardiologist James D. Thomas, MD, and his team received a National Aeronautics and Space Administration (NASA) grant to develop interpretable digital echocardiology on the International Space Station (ISS).

Though their work was successful, expansion of telemedicine in the following years was delayed by a lack of technological progression. But 20 years later, the wait is over—technology has caught up to the need of remote patient access.

“That’s where a lot of the impetus for telemedicine got started, was care needs to be delivered at a distance, like the space station or to rural environment,” said Peter Rasmussen, MD. “But the reality is it really addresses access issues.”

Rasmussen, the medical director of Cleveland Clinic’s Distance Health team, said there’s been an uptick in telemedicine opportunities in the past 3 years, reaching an “inflection point” in the past year, as a majority of providers and patients of the Cleveland, Ohio-based academic clinic began adopting the technological services.

The result is about 1500 patients each month using synchronous video technology to interact with Cleveland Clinic caregivers, and another 5000 forms of distance health telemedicine interactions each month, Rasmussen said.

“Distance Health has really made for the democratization of care,” Rasmussen said. “Many patients around the globe or in the United States may find it difficult to access us, or perhaps feel intimidated accessing us for our opinion or care. And by using these technologies, we can bring Cleveland Clinic experts to anyone’s home in the [United States] or around the globe.”

The clinic’s efforts to close the gap between doctors and patients goes beyond the occasional Skype session, though. Patients can electronically send x-rays or imaging information to specialists from their primary care physicians, and expect a returned opinion via email. Patients with diabetes or with hypertension can have their daily status monitored from home and receive assistance in managing their condition.

Even health devices can be gauged remotely, such as pacemakers. Lars Svensson, MD, PhD, chairman of the clinic’s Miller Family Heart & Vascular Institute, said about 60,000 patients’ pacemakers or implantable cardioverter defibrillator devices transmit data to cardiologists, allowing them to track electrocardiograms not just in real-time, but in a trend format as well.

Svensson anticipates treatment will continue to evolve this way, molding health care into a safer, more remote field.

“The 2 things you’ll see is patients being monitored and calling in, getting their care that way,” Svensson said. “And then we’re going to see less and less invasive procedures, with greater accuracy and fidelity.”

Rasmussen, a surgeon in the clinic’s Cerebrovascular Center, sees similar writing on the wall. Cleveland Clinic was one of the first healthcare systems to provide a broad Telestroke Network, which treats about 1500 acute stroke patients annually. The network is crucial to patients in rural settings, or even areas of Cleveland with “highly specialized provider shortages,” Rasmussen said.

The network is coupled with a Mobile Stroke Treatment Program to provide comprehensive remote care. The program provides an ambulance equipped with a computerized tomography (CT) scanner and laboratory equipment that allows Emergency Department-quality evaluations of a possible stroke patient on the spot, while keeping the option of triaging the patient open.

“This really allows for the most rapid delivery of care you possibly can to a time-sensitive disease like acute stroke,” Rasmussen said. “We can shave 40 minutes off from the 911 call to the time of definitive treatment.”

But Rasmussen hopes the next evolution of emergency management transcends the use of CT scans. According to Rasmussen, the average scanner generally costs the hospital “roughly half a million dollars,” and noninvasive assessments of a stroke patients’ brain could come with the next wave of technology.

“If there can be a reduced footprint technology or a lower cost solution that will yield the same type of information in the acute setting, that’s probably the next advance we’ll see,” Rasmussen said.

Though technology has progressed to address the equally changing issues in healthcare, patients’ needs have remained stagnant, Adrienne Boissy, MD, MA, said.

“Patients still want access, they still want timely communication,” Boissy said. “They want to feel known and seen by us as an organization. How we do that has changed over the years, but our commitment to it hasn’t.”

Boissy, Cleveland Clinic’s first chief experience officer. said she knows the future of health care access does not include walls. Rather, it’s about “meeting the patient where they are.”

Boissy gave the example of a wife struggling as the primary breadwinner of a family with a husband who has multiple sclerosis.

“What I can be most empathic to is you don’t want to drive 3 hours to the Cleveland Clinic to wait for me for 30 minutes, pay $20 for parking, then be seen,” Boissy said. “The most empathic thing I can do for you is to keep me out of my office.”

The future of Cleveland Clinic patient care entails progression in the era of real-time updates and constant mobile notifications, Boissy said. It likely includes digital valet ticket service for on-site patients, geolocation services, and access to medical information and history on mobile devices. But the clinic should keep in mind that patients are different, in that they’re not consumers, Boissy said Patients don’t want the clinic’s services, they need them.

“Technology will be able to help us the most when it enables and extends that relationship, but it will never be the warmth of a human hand,” Boissy said.

Vermussen still believes there’s more merit in the “mammalian experience of eye contact ” in remote video appointments, versus the traditional physician phone call checkups.

Such improvements, however minute, contribute to the clinic’s designation as the best Heart Care Hospital in the United States by US News & World Report for the 23rd time in 2017 and drive all staff to seek improvements to patient care, from downtown Cleveland to outer space.

“The central theme of what we do is high-quality care,” Svensson said.