“Patient outcomes improve when they can see what the physician is seeing,” Dinger says. “They can listen to their own heartbeat and see the same things that the physician does.”
Dinger says Saint Thomas chose cardiology to trial the system because it is complex and needs lots of support. The physician can perform all the tests he normally would in an office visit.
“Listening to heart sounds, the lungs; looking for leg swelling; listening and looking at neck vessels, skin lesions; looking in ears—all of that can be done,” says Chomsky, illustrating a cardiologist’s typical consultation or office visit.
The most critical concern, as always, had to do with whether the patient was satisfied with this kind of visit. Chomsky does his own informal polling, and Saint Thomas circles back with the patient later to find out whether it was as satisfying to them as seeing the doctor in person.
“We’ve satisfied ourselves and our patients that you can have a very useful clinical interaction through this system,” Chomsky says. “But I do ask the patients how this was for them, and universally, they are positive. They think it’s perfectly fine and they’re happy to do it again.”
As for scalability, Dinger has trouble containing his excitement for the variety of opportunities an effective remote system like this presents for the hospital and for Ascension. Since the cardiology program started at the beginning of the year, Saint Thomas has also added neurology and primary care, and another eight specialties were set to be added before year end.
“We have over 20 locations, just in cardiology, right now,” he says. “This could go into multiple dozens of locations in this state and neighboring states.”
And that’s the rub for a system that is looking for ways to grow its regional base and form alliances with allied providers.
“This allows you to support ongoing research and subspecialization because your catchment area is so broad and your relationships are so close,” he says. “What’s dawning on people is that this is an integral piece to our ACO strategy—it’s not just a telemedicine phenomenon.”