“…On a recent morning, he drove through the rain to answer a call at an apartment complex near Hobby airport. Susan Carrington, 56, sat on her couch in a red track suit, coughing and gasping. “Have you seen your doctor?” Hooper asked. Carrington shook her head. “No? OK,” Hooper said. Carrington doesn’t have a regular doctor. She called 911 because she got scared. It hurt to breathe, and the cough had been bad for four days, she said. In January, she had visited a hospital emergency room for similar symptoms and been given an antibiotic for pneumonia. “Based on your vital signs, everything looks stable to us,” Hooper said. “Your lungs are clear. Your blood pressure’s great. Your pulse is good. Everything looks good.” Previously, Hooper might have taken Carrington to the ER, just to be safe. But now he has an alternative: a computer tablet loaded with a video chat application. Hooper launched the app, and Dr. Kenneth Margolis appeared on the screen. Margolis was seated almost 20 miles away, in the city’s emergency management and 911 dispatch centre. “Can I just talk to Miss Carrington for a second?” Margolis asked. Hooper swiveled the laptop screen toward the couch, bringing doctor and patient face to face, at least virtually. “Ms. Carrington, I’m a doctor with the fire department,” Margolis began. “So you’re having a cough, and feeling weak and having some trouble breathing, is that right?”. “Yes, sir,” Carrington said. “And it hurts when you breathe and cough?” “Yes.” The questions continued, with Margolis able to watch Carrington’s face and reactions. Margolis agreed an ER visit wasn’t necessary. Instead, he scheduled an appointment for her at a nearby clinic for the next morning. He also arranged a free, round-trip cab ride. He told her the taxi would be there at 8:30 a.m. “They’ll take you to the clinic and your appointment is at 9:30. Does that sound reasonable?” he asked. “Yes, sir,” she replied. “OK, I hope you feel better,” he said. The intervention is known as Project Ethan, an acronym for Emergency TeleHealth and Navigation. It rolled out across all city firehouses in mid-December. “I think a lot of people are very surprised that they can talk to a doctor directly, and have been very happy with that,” says Dr. Michael Gonzalez, an emergency medicine professor at Baylor College of Medicine. He’s the project’s director. Gonzalez says the idea is to direct patients like Carrington to primary care clinics, instead of just automatically bringing them to the emergency room. Ambulances can be tied up for precious minutes — even an hour — as EMTs do paperwork or wait for a nurse to admit a patient to the ER…“
I’ve no idea if this Patient had a mobile but I can’t be the only one who can spot that the Patient is sat next to a potential Carer who is holding a smartphone that could’ve performed a big chunk of the Patient history/smartphone medical (see here for more) and the video consult with an accessible primary care provider sometime during the 4 days that proceeded the call to request emergency services?
Fortunately I’ve noticed that Firefighters are some of the smartest early adopters of mHealth so I think this project will evolve quickly as soon as the tech is rolled out to the frontline and the Firefighters start using their own smartphones instead of that clumsy big stylus controlled Panasonic G1 Touchpad.
Still don’t quite understand the benefits of connecting with a Doctor over a mobile video call? “for the price of a $229 iPod we were able to spread the reach of our trauma centre program by 130 million sq ft” (Feb 2012)
**** UPDATE 22 APRIL 2015 ****
A mention of this post by the IHI’s President and CEO Maureen Bisognano during the International Forum on Quality & Safety in Healthcare being held in London lead to a discussion I found interesting with Paul Wicks: