Telemedicine in the Wild

From the July 2000 Issue

Telemedicine in the Wild

Web-based program speeds diagnosis and treatment of spider bites.

By Gail Dearing, a free-lance health-care writer based in Los Angeles.

If a patient presented at your emergency department (ED) with a swollen, ulcerating spider bite, how would your staff proceed? Does the treatment depend on the species of spider? Is the course likely to be painful but benign, or might it be one of those rare bites that progresses to neurotoxicity? Today’s technology can bring the answers right to the patient’s bedside via the patient monitor, leading your staff to the proper diagnosis and swift treatment. That is being implemented right now at the Prince of Wales Public Hospital in Randwick, New South Wales.

The 350-bed Australian teaching hospital has equipped its patient monitors—Universal Clinical Workstations (UCWs) from Spacelabs Medical—with the WinDNA application to provide Dynamic Network Access (DNA). By so doing, they created a Web-based system that provides bedside access to the protocols and guidelines on the hospital’s intranet, plus Windows-based resources such as the Physicians’ Desk Reference (PDR).

Kenneth Abraham, M.D., head of emergency medicine, developed a program to help treat patients who have suffered spider bites, a relatively common occurrence in the hospital’s location. With the Web-based decision support program, ED personnel can quickly assess the type of spider bite. They can display graphics and photographs of various types of spiders and ask the patient to identify the one that bit them. Detailed treatment methods for each type of spider bite are immediately accessible through the program.

Bedside Access to Protocols

The hospital’s 14-bed ICU is also implementing WinDNA on its UCWs. “Our main aim for WinDNA is to run ward medical and nursing protocols on the server for access at the bedside on the UCW,” said ICU specialist John Lawrence, M.D. “Bedside access to protocols will be a big improvement,” he said, noting that “now the protocols are in a book which is difficult to locate and cumbersome to update. You never know if you’re looking at the most recent version. With WinDNA, we’ll have immediate access to the latest and best information, which is sure to improve patient care.”

Abraham agrees. “Protocols highlight indicators of disease severity and then guide therapy according to hospital policy and evidence-based guidelines. Caregivers will have bedside access to management guidelines such as drug regimes or to a video illustrating how to perform a particular procedure, such as insertion of a subclavian line.”

With WinDNA, caregivers at bedside UCWs can access Windows applications running on a local server. They can also view and control information from other computer systems, allowing interaction with lab results, order entry, clinical data and other reference information that can be of clinical benefit at the point of care.

Another advantage of the WinDNA application in a busy unit such as the ED, Abraham says, is that it’s available right on the bedside monitor. “There is no need for another terminal in the patient’s room or at central station.”

Better Data Collection

Abraham also anticipates improvement in collection of patient data. A standardized “first encounter sheet” becomes the foundation for the record of the patient’s visit, eliminating the need to re-enter data later or in other locations.

“This improves accuracy in two ways,” he suggests. “First, data will only have to be entered once. Second, personnel will be guided by the online protocols, which will decrease variability in history-taking.”

Abraham said the new system “will allow us to produce public health monitoring data daily—or faster if needed. It also enables automatic collection of more detailed performance (quality) data based on outcomes.”

“Initial outputs will be the number of cases per day, variations from guidelines and response to therapy matched by time to physiological response and lab data modifiers,” he says. “Besides helping to produce a standardized and more complete discharge letter, this kind of outcomes data will facilitate teaching and help identify those who require additional teaching or training in specific areas.”

July 2000