Category Archives: Case Studies in Virtual Care

Using ShareFile for medical imaging collaboration

Today I had a great experience leveraging the new Medical Image Uploader plugin for ShareFile

A family member went for an MRI at the request of a consulting physician

All she had to do was get a copy of the CD before leaving the imaging center

She went home, and put the CD in her computer

Because I have remote control granted, i literally opened ShareFile from that computer (with the dual factor mobile phone authenticator code, which is very cool) and the sharefile medical image plugin recognized the format of the CD

It asked for a folder name, quickly imported the entire MRI study in easily used format for anyone else to view

Secure Link sent out to email address of the specialist

I got notified a few minutes later they had been able to access the images and report

Amazingly simple workflow

In our Virtual Clinic at http://www.nowdox.com, this is one of the tools we make accessible to our subscribed members also

So easy, and its the simple secure collaboration across practice boundaries that is so wonderful and efficient

AJBMD

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Reviewing scans with patient in the ER

An ER physician contacted me recently at 1230 AM because an aquaintance of his, who also was a patient in the ER, had some unusual visual event earlier in the day and a somewhat confusing interpretation of CT/MRI.  The ER physician was logged into Google Talk from his desktop, identified as the “ER Physicians Desktop 1” in my list.

He sent me quick text message noting that even though my “status” was “asleep-urgent only”, that in fact this was an urgent question. I texted him back to ask for the medical record number so I could take a look at the scans.  I sent the ER doc a link to my home page that directs him to click/connect into my virtual consult room. He does so, and within 30 seconds he is online.  The patient had no neurologic deficits at the time, was fully conversant, and could provide some additional details himself.

We roll the cart into the patients room to not only get added history, but to show the patient the scans, come up with a care plan, and ask about any questions or clarification. We were able to reassure all involved of the probably nature of the issue, the reason for getting some added tests, the risks of any interventions and what to expect over the next few days.

Then a brief note is entered into the hospital’s electronic online medical record (or could have been in an office based electronic record if  needed, or ones own document repository)….

Then used Snagit to grab a copy of the notes and images, delete or cover over any names or identifying info, and send a copy as a secure email attachment to the nurse practitioner who will pick up the case in the morning on daily rounds.

Daughter able to monitor father’s status in ICU

We just recently experienced a situation in which a patient arrived with a few seizures, having had a stroke in the past. There was some concern of a new stroke but the more history we got about the last few hours it became clear it was most likely this was a seizure related to the old stroke from 2 years ago and that his recovery from the acute event should be very good, as long as no new complications arose. His wife was present along with a close friend. His daughter is a social worker in another state 200 miles away. She has 2 small children and a teenager, so there would have been challenges travelling between metropolitan areas on a Friday.  We got her email address from her mother in the ER and right from the neurologists’s smartphone we sent a brief email to her, confirming she was the right person (for privacy reasons this is our general practice the FIRST time a patient or family is sent an email, to confirm their identity and that they alone check this email account).  That confirmation occurred within minutes.

Early on the following day, his daughter wanted to be able to “visit” to see how he and her mom were doing. We sent an email with a hyperlink that sent her right into the “neuro icu virtual consult room” and ran a test to make sure the webcam, sound and connection were ok on her end. All went well in 5 minutes.  We then arranged that 30 minutes later we would have her visit virtually. She “pinged” that same link and it rang and launched into a high quality video interaction on the mobile cart that we had already wheeled to the patient’s bedside. His daughter was able to see him gradually awaken from some of the sedating agents, talk to him to let him know she was “with” him, and talk with her mother to review the situation and feel that the whole family was present at the bedside. His daughter was able to meet the nurses and one of the transport assistants attending to her dad. We then rolled the cart around to show her the IV lines and monitors and the room, and then a brief “tour” of the Neuro ICU so that she could be comfortable with the nature of the facility, the staff caring for her father, and hear directly from her mom her impression of the care.   The level of confidence in the care process was brought to a level such that she did not even need to leave home but would plan to followup online each day if desired.  Even those of us who do this frequently had tears in our eyes. THIS is WHY we do virtual care. The technology is merely there to enable the process to occur seamlessly.

Please note, a copy of this image, marked up for privacy, was sent to the patient’s daughter for her approval before anything was posted online in this story.  Click the image to expand.

Also, 24 hours later, after the MRI scan was done, we were able to email to his daughter and review online an anonymized snapshot of select MRI images with a few comments of explanation and reassurance.

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