Tuesday, July 14, 2009

Telemedicine Helps Patients

A unique and innovative telemedicine project is providing nursing home patients that have Parkinson’s disease access to neurologists at the University of Rochester Medical Center (URMC). The effort is a joint initiative between URMC and the Presbyterian Home for Central New York in New Hartford, a 250 bed nursing home near Utica and about 150 miles from Rochester.

When the nursing home opened in 2001, it was the first in the nation to offer specialized care to people with Parkinson’s and other movement disorders in a nursing home setting. For years, the Parkinson’s patients at the home would typically make 10 trips a year to Syracuse, Albany, or Rochester to see a movement disorders specialist. The trips were exhausting for the home’s elderly patients.

Tony Joseph, the Administrator of the home approached URMC Ray Dorsey, M.D, a neurologist and his colleague Kevin Biglan, M.D, to find a solution as he was familiar with their work with the Parkinson Support Group of Upstate New York.

The solution to the problem already existed at the URMC, since the medical center has one of the largest “Movement and Inherited Neurological Disorders” program in the nation with more than 10 physicians and is designed as a Center of Excellence.

Patients are brought to a room in the nursing home with a flat screen television so they can see the physicians. All that is required by the doctors in Rochester is a computer equipped with a web camera. Telemedicine visits consist of an update on the patient’s health, a review of medications, any potential complications, and a standardized motor skills evaluation consisting of balance, gait, coordination, and stiffness. This examination is conducted by the physician with the assistance of a trained nurse at the home. At the end of the visit, recommendations are discussed with the patient.

An initial pilot project funded by the nursing home followed 14 patients for 6 months and then evaluated the outcomes of those who received telemedicine care with those that did not. The study found that telemedicine patients had significant improvements in quality of life and motor function. In addition, those receiving telemedicine were satisfied with their care.

The project was so successful that Joseph decided to continue funding the effort for another year with the help of a grant from New York State. Doctors Dorsey and Biglan also hope to expand the project to other nursing homes in upstate New York. According to Dr. Biglan, this is a serious problem as statistics show that the number of people with Parkinson’s will double over the next 25 years.

However, one of the biggest obstacles concerning the doctors involved in the program is the issue of reimbursement to pay for the telemedicine services needed. Currently, reimbursement is limited to certain areas and the town of New Hartford is not considered sufficiently rural.