Dana Giarrizzi, DO, FHM, MBA
National Medical Director
Question 1: What is the most important aspect of technology to you, as a hospitalist, in facilitating a patient examination via telemedicine?
Answer 1: Having a good internet connection is essential. It makes the patient encounter seamless.
Question 2: Do you have access to patient records as a telehospitalist?
Answer 2: We have the exact same access to medical records as the physicians who work on site. The PACS system allows me to review radiology. Sometimes it is very important to show the x-rays to the patient. We have the ability to obtain electronic medical records and notes as well. We can see previous hospitalization records and labs as well as the current visit. Depending on the Electronic Medical Record (EMR) system used, we can even see notes form the patient’s outpatient primary care physician or specialist.
Answer 3: We use the hospital’s EMR system for patient care just as on-site physicians do. We are able to review the current history, labs, and orders as well as the previous hospitalizations and procedures. As I previously said, sometimes we can even go further and see what has been going on with the patient in the outpatient setting. This allows for enhanced communication between the inpatient and outpatient physicians. We are also able to directly put in orders through the Computerized Physician Order Entry (CPOE). This allows for orders to be directly placed by the physician for better quality of care to the patients, as well as more meaningful use for the facilities.
Question 4: How does your service support the on-site physicians’ workflow?
Answer 4: We support the on-site physicians by being able to see patients and start the patient’s care the same night. We perform the history and physical on the patient and establish their plan of care. We are able to collect and review the data in order to provide updated and complete patient information to the daytime staff. Many times we decrease the work load by answering questions and discussing the results with the patient, family, and even staff. The patient and family really appreciate the “face to face” interaction. The day time physician can feel comfortable knowing someone is taking care of their patients while they are not there.
Question 5: Do you use multiple technologies to see patients? Why or why not?
Answer 5: We do use multiple technologies. Some are on carts and require assistance to get where it needs to go. Other types of technology have the ability to be driven directly to the patient’s room which gives the telehospitalist a bit more freedom to move about the floor. Either way the software and internet that are used is the same. Neither of these technologies affects the patient encounter or physical exam. The patient interaction with the telehospitalist is the same no matter what technology is used.
Question 6: How do patients accept your service?
Answer 6: It has been amazing to see all the support and acceptance the telehospitalist service has received. We have received high satisfaction scores from our patients. Many patients feel that they are getting special treatment. Some take pictures and ask questions about the technology or where the physician is located during their exam. Most are not surprised by the technology. In fact, they experience technology in so many areas of their life, that they feel it is natural to see technology in medicine..
Question 7: What are your limitations as a telehospitalist?
Answer 7: As a telemedicine physician, I am unable to physically touch the patient, so I can’t perform any procedures. . It is also difficult to go to the country club or dinner with the onsite physicians or medical staff. We certainly want to recognize the limitations up front and make a plan to mitigate those limitations.