Telemedicine A vital link
The patient, a man in his 60s who had recently undergone knee surgery back home in Missouri, was nearing the end of a visit with family in the Sonoma area when the knee began to swell up — fast.
The man went to the nearest medical facility, Sonoma Valley Hospital, where doctors determined that he had a post-operative infection. The fix — cleaning out the wound — was pretty straightforward.
But there was a problem. The doctors, following standard procedure, wanted to hook the patient up to an IV bag to administer antibacterial medicine — a step that would keep him hospitalized and prevent him from returning home when he had planned.
A solution was soon realized thanks to a relatively new member of the Sonoma Valley Hospital family: a flat-television screen equipped with a camera that staff had affectionately dubbed "R2-D2." At a moment's notice, R2-D2 can put infectious disease specialists at UC Davis Medical Center in close, two-way communication with Sonoma Valley Hospital, a small, 56-bed facility in Northern California.
Using a secure telecommunications connection, R2-D2 immediately linked Javeed Siddiqui, an infectious disease specialist and associate director of UC Davis' internationally renowned Center for Health and Technology, with the patient and his care team in Sonoma. With the camera, Siddiqui examined the patient's knee and offered an alternative – a new oral anti-bacterial that would render an IV bag unnecessary but would still aggressively treat the infection. The patient, figuratively speaking, jumped at the option. He was discharged the next day and was able to return home as he had planned.
This episode demonstrates how telecommunications and information technology can be applied to increase the availability and efficient delivery of high quality health care, resulting in more satisfied patients with better outcomes. According to Siddiqui, the collaboration with Sonoma Valley Hospital is a first in the telemedicine field to offer inpatient infectious disease consultations via telemedicine. The Sonoma link is the latest step in an effort begun at UC Davis about three years ago to add inpatient consultations as a service provided by its pioneering telemedicine program.
Launched in the 1990s, the UC Davis telemedicine program gives more than 80 sites in Northern California, many of them in rural areas, access to approximately 30 academic medical specialists.
While most of the consultations are with outpatients, an increasing number of inpatient consultations are taking place, including in pediatric critical care, cardiology and, now, infectious disease.
Siddiqui, who is an assistant professor of clinical medicine in the Division of Infectious and Immunologic Diseases, said planning is under way to bring infectious disease telemedicine consultations to two other rural hospitals. Meantime, the folks at Sonoma Valley Hospital say they have nothing but affection for R2-D2.
"I believe the future is in telemedicine," said Victor Iacovoni, the hospital's medical director. "It allows me to bounce a case off someone that has a lot more experience and knowledge than I do."