Guss doesn't say ED telemedicine is ready for prime time yet. "I can't prove this yet, and I don't know whether we'll ever prove it," he says, "but I have a strong bias that that's going to be at least as reliable" as the way ED care is delivered now. "The question is, what about other parts of a physical exam, and what [are] the limitations?"
As far as he knows, Guss says, UCSD is the only hospital system experimenting with the concept. And since the project began in November, 120 patients who came to the ED during periods of overcrowding have given their consent to be examined by an ED doctor who wasn't physically present in the room, although Guss hopes to recruit a total of 400 by next year.
After patients are given a preliminary assessment by a triage nurse to ascertain that they are well enough to wait—not critically ill and in need of immediate care—they were examined by a series of cameras and microphones connected to a real ED physician, remotely located. .
"One was in the office during administrative time. One was at home during what would otherwise be a day off. And one… was in Chicago visiting his folks, in a private area of the home," Guss says.
At UCSD, six ED bays are equipped with high resolution video equipment capable of seeing a patient's skin lesions with enough detail, and high quality audio. The peripheral devices include a stethoscope "so I can hear breath sounds and another camera that enables me to look inside ears and a patient's throat," Guss says.