Small Oregon hospital rides robotic telehealth to ECRI device award

With the right technology deployed in the right way, such that the combo demonstrably improves care across a patient population, even a small hospital can bring about big change—including convincing a state medical board to revise a once-unbendable rule.

That was one of the lessons brought to light by Douglas Romer, RN, executive director of patient care services at 25-bed, critical-access Grande Ronde Hospital in isolated La Grande, Ore., at an April 19 ECRI Institute web conference. The care-improvement organization held the event to present the winner of its 2011 Health Devices Achievement Award, along with two runners-up. Grande Ronde earned the top honors for its bold telemedicine initiative.

The program uses mobile RP-7 robots (InTouch Health, Santa Barbara, Calif.), to connect Grande Ronde with specialists stationed hundreds of miles away, saving hundreds of thousands of dollars in transfer costs and allowing patients to stay close to their families while receiving care.

“Oregon had an administrative rule that we didn’t know about. It said you cannot practice medicine across state lines,” explained Romer at the web session, describing the hospital’s initial move to tap into the expertise of 18 intensive-care physicians in St. Louis. “We went to the Oregon board of medical examiners and did a live beam-in, where the medical examiners beamed in from their boardroom to our robot and interviewed patients, doctors and nurses. Immediately after that session, they changed the law.”

ECRI pointed out in a member publication that the new rule has opened up the possibility for rural communities across Oregon to follow in Grande Ronde’s footsteps.

Romer said the “remote presence” program traces to 2007, when the hospital received a grant from a large tertiary hospital, St. Alphonsus Regional Medical Center in Boise, Idaho. “They wanted to test the concept that you could have a perioperative nurse instructor remotely training nurses in the operating room at a distant site—our site—and we started doing that as soon as we saw how well the technology worked,” he said. “We decided that we wanted to roll it out to as many different programs [as it took] to make it cost-effective to afford those devices. We own four of them now in different clinics and in the hospital.”

The telemedicine network comprises numerous clinical, educational and support services, such as translation for non-English speakers. The robots, which remote users drive around the hospital via joystick, facilitate patient consultations in cardiology, intensive care, dermatology, neurology and neonatology, among others. They also enable remote reviews of prescriptions, radiology images and lab results.

Grande Ronde is working to integrate the telemedicine program with its EMR system, said Romer.

Session moderator James P. Keller, Jr., ECRI’s vice president for health technology evaluation and safety, asked Romer about the involvement of the nursing staff while the remote consultations are underway, particularly in the ICU.

“It’s just as if the doctor were making rounds,” Romer replied. “The nurse conferences with the physician and the physician drives the robot into the patient room, assists with listening to vital signs with the electronic stethoscope, makes ventilator adjustments with the respiratory therapist as needed and does a physical exam as directed by the physician afar. Our docs, even though there are 18 of them, do this frequently enough in our hospital that our nurses know their peculiarities and their likes and dislikes. It’s just as if those docs are on staff.”

The remote physicians make morning rounds and extend their bedside visit as needed. “Sometimes we’ve had an intensivist sit by the patient’s bedside for over an hour during a weaning of a ventilator,” said Romer.

Is there a threshold where the intensivist determines a patient needs to be transferred? “That’s happened probably a dozen times over the past four years, but way more times the patient is able to stay in our local community,” said Romer. “And if a patient is here locally, they can visit their physician, their family, their kids can come and see them—all these things that couldn’t happen if they were 300 miles away. And there’s a lot of healing that goes on when you’re in your own home.”

Also presenting at the conference were runner-up representatives Kathryn Clark, RN, nurse manager of intermediate cardiac care stepdown at Indian River Medical Center in Vero Beach, Fla., and James Piepenbrink, director of clinical engineering at Boston Medical Center. ECRI recognized Indian River for its remote telemetry monitoring program for stable cardiac patients on medical-surgical units, which has yielded a significant decrease in patient transfers to critical care, according to ECRI. For its part, Boston Medical Center developed a novel, cart-mounted point-of-care training system used both to validate alarm policy changes on telemetry monitors and train clinicians on those changes—a project that has become an integral part of the hospital’s alarm management program.