4 cases of telemedicine from the United States, which is worth a closer look

From January 1, the law on telemedicine began to operate in Russia. It’s still far from widespread - first you need to prepare the infrastructure. Yes, and the population is still suspicious of innovation. But the experience of other countries shows that in some cases telemedicine is very useful. I propose to study several specific cases of its use in the United States. Telemedicine has been developed and practiced there since at least 1967, when the first American telemedicine clinic in Massachusetts was established.

Alabama and Georgia veterans with type 1 diabetes

Veterans of the US armed forces with type 1 diabetes, living in rural Alabama and Georgia, face a lack of specialized medical care. There are not many doctors in rural areas, and there are no endocrinologists at all. Therefore, telemedicine was the solution.

The Federal Agency of the US Department of Health CDC conducted a study of personal cards of veterans who received telemedicine care from June 2014 to October 2016. Patients were enrolled at the Endocrinological Telemedicine Clinic for Veterans in Atlanta. The researchers were interested in the “before and after” glycemic control indicators, the level of glycated hemoglobin, saving time and money, following the appointments and patient satisfaction with telemedicine.



Results of the study: 32 patients with type 1 diabetes received qualified assistance and appropriate prescription for treatment. On average, the level of glycated hemoglobin and glucose in the blood decreased from 8.7% to 8.1% in six months. Cases of hypoglycemia increased slightly. Patients saved an average of 78 minutes on the road (one way) and $ 73 to pay for the trip. At the same time, they complied with 88% of all appointments of doctors, and 100% of respondents said they would recommend telemedicine to other veterans.

New York State Asthma Schoolchildren

Every tenth student in the US suffers from asthma. This is the most common childhood disease in America. Children from poor families do not always receive proper care, so there are frequent cases of severe asthma attacks that lead to expensive ambulance calls.

Therefore, the Medical Center at the University of Rochester conducted a study of 400 students of the school district of Rochester (New York), suffering from asthma (age from 3 to 10 years). The first half of the students received medication from school nurses and twice a year underwent telemedicine examinations. The other half of the students were simply given recommendations on how to prevent the disease and assigned visits to a local doctor.

According to the study, the first group had more asymptomatic days than the second. And only 7% of them required emergency assistance for the entire academic year, compared with 15% in the second group.

Telemedicine VS emergency room

Dr. Nicholas Mohr and his colleagues at the University of Iowa conducted a study that focused on emergency wards in rural Iowa. A group study covered 2,857 emergency room patients. Of these, telemedicine users were 2 times more than patients who did not use these services.

It turned out that patients who used telemedicine services got into the emergency room 6 minutes faster. In 41.7% of cases, an employee of the telemedicine department was the first to observe a patient. In these cases, the telemedicine service was rendered 14.7 minutes earlier than the examination by local doctors.

Successful outcome of stroke

February 15, 2013, former railroad worker Clarence Renno, who lives in retirement in the town of Dulles (not to be confused with Dallas), felt bad. At about 6.20 pm his wife Carol heard an incomprehensible sound that her husband seemed to make. She asked Clarence, but there was no answer. He tried to tell her something, but could not, because he had a stroke.

Seeing the condition of her husband, Carol called 911, and they called the nearest ambulance. She arrived 15 minutes later, and five minutes later Clarence’s right half of her body fell asleep. By 7.30pm, he was brought to the emergency room of the Columbia Medical Center.


Clarence Renno with wife Carol

The head of the department, Dr. Patrick Grimzley, appointed a brain CT scan. The pictures showed that Clarence had a blood clot in the brain that interferes with blood flow. Before the advent of telemedicine gadgets, Dr. Grimzley would have had to decide on his own whether to send the patient to a clinic in Portland, Oregon. In 2013, the doctor simply contacted specialists from this clinic through a special robot .

The robot was equipped with a stethoscope and a camera with multiple approximations for the study of pupils. After a remote examination, the neurosurgeon said that the patient must be transported to Portland. But before that, it is recommended to give blood thrombolytic drugs, to restore blood flow. Time played an important role here: thrombolytics are most effective in stroke, if you enter them within three hours from the beginning of the attack.

The preparations were injected, and Clarence was prepared for transportation to Portland. The symptoms of a stroke began to disappear as they approached their destination. There, Clarence was assisted, and after two days he was able to move independently. More about this case

A similar incident occurred in the city of Salem, Oregon, with an 84-year-old (relatively healthy) woman. She had a blood clot in the right half of the brain - the left half of the body was taken away and problems with speech began. At the local hospital, emergency doctors contacted the same clinic in Portland through a telemedicine robot. The neurosurgeon stated that it was already too late for the entry of thrombolytics - a woman must be urgently transported for surgery. Upon arrival, the doctors discovered a large blood clot in the internal carotid artery and successfully removed it. The next day, the woman recovered fully, and there were no signs of a stroke on CT.

The future of telemedicine in Russia is still uncertain . Foreign cases show that it works well in cases where people in rural and remote areas need the help of qualified specialists who are not in local medical institutions. It may not be as effective as a regular doctor's appointment, but if there are two options — either no help or telemedicine — then the choice seems obvious.