Telemedicine expands critical care on Big Island

Doctors at the Queen’s Medical Center in Honolulu have begun making virtual rounds to treat the most critical intensive care patients on Hawaii island.

North Hawaii Community Hospital in Waimea started the island’s first telemedicine intensive care unit in May, allowing Honolulu specialists to virtually examine a patient’s heart and lungs with an electronic stethoscope, as well as their ears, eyes and skin via a high-resolution camera. The system eventually will allow doctors to analyze vital signs, including heart rate and blood pressure, in real time, alerting them before a patient’s condition declines.

“We make rounds virtually twice a day and those rounds are incorporated into our routine of care right now. The biggest benefit is access to care,” said Dr. Scott Gallacher, medical director for the Queen’s ICU. “On the neighbor islands, it’s very difficult to get specialty coverage. Specialists tend to congregate within Honolulu. It’s a way to provide access to a higher level of care remotely. This way you’re always guaranteed access to a critical care specialist. These patients are critically ill and time is definitely important in delivering the best care.”

Gallacher said Queen’s doctors are able to do a “fairly complete” physical exam virtually with the latest technology.

“We are projected on their screen so patients and families can see the critical care specialist at Punchbowl and interact with them as if they’re there,” he said. “The virtual counsel seems to work very well. The only thing I can’t do is actually touch them. That’s what we depend on staff at the other location to do.”

Dr. Matthew Koenig, medical director of telehealth for The Queen’s Health Systems, said the hospital already is using telemedicine for stroke care and some outpatient services.

“We want to provide patient-centered care. Rather than bringing a patient to the doctor, we’re bringing a doctor to the bedside,” he said.

North Hawaii has a handful of ICU beds and limited specialists to treat certain cases, while Queen’s has about a dozen ICU specialists who provide a range of services, he added.

“The video teleconferencing aspect is just one part of the system,” Koenig said. “The other part is a unified electronic medical record so doctors can read notes, write orders and review cases.”

A state law that went into effect in January requires Medicaid, the government medical insurance program for low-income residents, and private health plans to cover telehealth services with reimbursements that are equal to the same services provided in person. The law opens the way for expansion of telehealth services to other specialties needed on the neighbor islands.

Nadine Reese, an ICU nurse manager at North Hawaii, said the service will provide access to quality care sooner versus patients having to wait to be transferred to Honolulu facilities, potentially reducing high-cost medevac transfers.

“Many families will be very grateful to have this,” she said.