James Gude, a California physician who founded a telemedicine practice called OffSite Care, says that when a doctor conducts a video consultation with the assistance of an on-site nurse and with access to a patient’s records and diagnostic test results, it can be nearly as effective as seeing a patient in person. “With a nurse there to help me examine you, I can order and look at everything I need,” he says. There are also sophisticated “robots” that allow a doctor to see a patient via videoconference and even send instrument readings, allowing the doctor to listen to a patient’s heart through a stethoscope, for example. (A Canadian TV show once followed Gude around as he conducted virtual rounds via a robot he controlled remotely.)
Gude started OffSite Care in 2007 to help rural U.S. hospitals improve their quality of care by providing virtual access to specialists, who are often concentrated in bigger urban hospitals. He expanded his vision of dismantling the geographical barriers to quality care when he teamed up with members of the Rotary Club of Sebastopol Sunrise, California, to create Global OffSite Care — a nonprofit that provides educational and consultative services to hospitals around the world.
“We started by contacting Rotary clubs where Dr. Gude thought there might be an opportunity [to improve a hospital],” says Mikel Cook, a member of the Sebastopol Sunrise club. “The mission of Global OffSite Care is to promote Rotary club-sponsored telemedicine projects. We bring together Dr. Gude’s medical expertise with financing, stewardship, and advocacy among Rotarians.” Cook says Rotary clubs have sponsored the equipment needed to get a hospital started conducting telemedicine, which includes a tablet and a Kubi device that transforms the tablet into a web-controlled mini-robot that can pan and tilt, allowing the user to look around the room. Local doctors are trained on the equipment and can then participate in weekly online “Global Grand Rounds” with Gude’s team to continue their education. They can also consult with experts on difficult cases.
The Global Polio Eradication Initiative (GPEI) uses another aspect of telehealth: mobile health, or health care supported by mobile electronic devices, to make progress toward a polio-free world. Mobile phones have been used to track the number of polio vaccine doses children have received, and geographic information systems have helped health workers create detailed maps of their immunization activities.
Examples of telehealth
A two-way audiovisual link between a patient and a care provider
Store and forward
Transmission of health records to a health practitioner, usually a specialist
Remote patient monitoring
Continuous monitoring of a patient’s condition from a distance, in real time or not in real time
Mobile health (mHealth)
Health care and public health information provided through mobile devices
When the World Health Organization’s African region was certified free of wild poliovirus in August, Christopher Elias, president of the global development division at the Bill & Melinda Gates Foundation, said technology was a contributing factor. One example is how surveillance improved when community health workers were trained to use a mobile app called Avadar (Auto-Visual AFP Detection and Reporting) to report possible polio cases through their phones. Sharing this information electronically allows for quick intervention, preventing outbreaks.
Patricia Merryweather-Arges, a member of the Rotary Club of Naperville, Illinois, predicts that telehealth will continue to expand. “There are lessons we can learn from this,” says Merryweather-Arges, who runs an organization called Project Patient Care and recently secured a Rotary Foundation global grant to distribute more than 200 tablets to residents of Chicago-area nursing homes. The tablets will allow physicians to assess patients via telemedicine, and families to visit with their loved ones via videoconferencing.