Tele-dermatology

By Bill Rautenstrauch, The Observer November 04, 2010 09:05 am
Grande Ronde Hospital’s Regional Medical Clinic made some history and welcomed the future recently when it started offering tele-dermatology services to patients in the Grande Ronde Valley.

It’s history because dermatology services are available through Grande Ronde for the first time. Up to now, patients needing a skin specialist were forced to travel out of town.

And thanks to the wonders of modern telecommunications, things that used to happen only in science fiction are a reality at the RMC. People can get a face-to-face visit with doctors far away without ever leaving La Grande.

Meet RP Lite, a two-eyed robot that beams live video, audio and still images back and forth between the RMC and The Clinic in Walla Walla, setting up a dermatology consultation that’s every bit as good as the real thing and saving precious time and money in the bargain.

“Every trip a patient has to take to Walla Walla is three and a half hours and costs around $80 in travel expenses. This way, a doctor’s appointment becomes one event instead of an all-day thing,” said Doug Romer, GRH’s executive director of patient care services.

Grande Ronde Hospital has been on the cutting edge of tele-medicine since at least 2008, when it acquired a mobile, Remote Presence robot from St. Alphonsus Hospital in Boise. That event spurred changes in state medical licensing laws, and ushered in the future for many other medical facilities across Oregon.

The hospital’s robot is called EDGAR, an acronym for Educated Doctor Guided Assisting Robot. It roams the hospital and facilitates two way video and audio transmissions between medical professionals at Grande Ronde and those at hospitals and clinics hundreds and even thousands of miles away.

Last spring, the RMC became the first facility in the nation to use RP Lite, a robot that offers full capabilities of pan-tilt-zoom controls to view and speak with patients and medical staff.

For now, the unit is being used for dermatology consultations, but in the future it may be be put to work in other fields, including cardiology.

Romer said hospital officials began talking with skin specialists Drs. Jeffrey Stiles and Francesco D’Allesandro of The Walla Walla Clinic about a partnership last spring.

 After the RP Lite was up and running, a patient in La Grande interacted with Walla Walla doctors in a trial consultation. The doctors decided the system had great potential.

“They immediately saw the value and wanted to proceed,” Romer said.

A next step was to meet state-to-state licensing requirements, a complicated process that takes months to complete. Romer said D’Allesandro has the necessary credentials now, while Sties is working on his.

The RP Lite is equipped with two-way video and audio, and sports accessories including a digital stethoscope, an interface for ultra-sound, a CT monitor, even a privacy handset for off-line telephone conversations.

With funding help from the Grande Ronde Hospital Foundation, there’s also a hand-held digital camera that connects to the unit and transmits high-resolution still photos.

See ROBOT, 8BNancy Campbell, GRH’s patient services secretary who runs a photography business of her own, assisted in picking out that camera and its accessories. She said the Canon-model camera gives the specialists clear, close-up views of lesions, rashes and other skin complaints.

 “It has 18-megapixel resolution and a 100-meter macro lens that deals well with low light. It’s working great,” Campbell said.

In a demonstration at the Regional Medical Clinic last week, Nurse Supervisor Heidi Hill took on the role of patient and, via the RP Lite, showed Dr. D’Allesandro an age spot on her arm.

D'Allesandro, sitting at a specially-equipped laptop computer in Walla Walla, took a patient history, then zoomed in on the spot with the video controls, and asked for still images.

Campbell snapped them, and they instantaneously appeared on D’Alessandro’s screen.

“The ones he doesn’t want, he can delete, and the others he can put in the medical record,” Campbell said.

D’Allesandro also showed how easy it is to work with staff on the other end. During the examination he ordered a measurement of the spot. Campbell carried out the procedure, and the measurement was instantaneously transmitted.

In a real consultation, the doctor could make an on-the-spot diagnosis of a routine problem, or order follow-up. D’Allesandro said after the demonstration that he has encountered no problems in coordinating care.

“For some visits it’s necessary to just look,” he said. “Other times a visit to the clinic may be necessary, or I may have to order lab work. So far, it’s been pretty easy. If I do order lab tests, I see them almost immediately.”

Staff at the RMC hope that as word about the new service spreads, people who have been putting off care for a skin problem problem will be more likely to come in.

Campbell said most patients so far have been comfortable with this new-fangled way of seeing a doctor, once they try it and see how it works.

“Some people think at first it should have arms like something out of Star Wars, but once they start talking to the doctor their anxiety disappears,” she said.

Mardi Ford, GRH’s public affairs specialist, said the experience isn’t as impersonal as it might seem.

“You’re not really interacting with the machine, you’re interacting with a person via the machine,” she said.