Telemedicine provides high quality patient care to even the most rural of communities.  It allows the patient to remain within their community and be seen by specialists, eliminating the expense and need for time-consuming travel.  A care plan can be developed with the patient, their local provider, and the remote specialist together, or the need for transfer to Fletcher Allen Health Care can be determined.  Should transfer be decided, the patient has already met with the doctor who will provide the care here at Fletcher Allen.  Though virtually every clinical specialty at Fletcher Allen is available for teleconsultations, the areas below have been the busiest of late.

Rural Trauma Care 

Fletcher Allen Health Care provides real time, high quality trauma care and education through the telemedicine system.  There are trauma surgeons on call 24 hours a day to provide on-demand trauma support for rural hospitals in Vermont and upstate New York.  When an emergency room doctor at a remote hospital places a phone call to Fletcher Allen's Provider Access Service (PAS) the teletrauma doctor on call, located at Fletcher Allen, can dial into the remote emergency room via telemedicine to assist as needed.  The teletrauma physicians at Fletcher Allen each have videoconferencing units located in their homes.  Therefore, when emergency trauma calls come in outside of normal working hours, physicians can respond immediately.

Education for rural ambulance personnel as well as providers is also available via telemedicine.  Each month a trauma lecture is held covering topics from head trauma to hypothermia.  Emergency responders, often very remotely located, can remain in their local areas, eliminating travel costs and time.

Surgery

Since 1996 the Department of Surgery has offered various services through the telemedicine system.  Most frequently, wound care has been delivered by vascular surgeons, podiatry and plastic surgery.  Patients with chronic wounds and diabetic foot ulcers, both pre and post-operatively, have avoided travel by having follow-up visits performed over the telemedicine system.

Various surgical services have used telemedicine to demonstrate surgical procedures using a camera mounted on a "boom" or a head mounted camera.  Surgeons from Fletcher Allen have demonstrated laparoscopic procedures, arterial repairs and even coronary artery
bypass surgery as far away as California
and Vietnam.    

Dermatology Clinic 

Each week Fletcher Allen's Dermatology department holds a telemedicine clinic with regional hospitals and several New York State Correctional facilities.  Using an AMD exam camera the Dermatologist located at Fletcher Allen Health Care can receive comprehensible live video from the remote location to make diagnoses for the patients.  There has been and continues to be a strong demand for teledermatology.  Fletcher Allen Health Care has done over 400 Dermatology consults via telemedicine since 2002.

Telepsychiatry 

Tele-mental health services are utilized more often than any other clinical telehealth application in the United States.  Fletcher Allen has established this service at Alice Hyde Medical Center in New York and is expanding availability.  This program has proven to be a successful one and continues to regularly provide a much needed service.  Dr. Terry Rabinowitz will be presenting his experience with Telepsychiatry at Fletcher Allen at the American Telemedicine Association conference in May of 2004.  To view his abstract click here.

Renal Services 

Renal Services would not be effective in the management of satellite units were it not for the telemedicine technology at Fletcher Allen Health Care. There are dialysis units located all throughout the state of Vermont. The distance to travel to Burlington for Patient Quality Council, weekly multidisciplinary meetings, and management and CyberREN committee meetings would constitute several thousands of dollars spent on mileage and wasted travel time.

We have used this technology to troubleshoot equipment failures at the remote satellite units. We have trained technical staff that, when supported by the system's technicians from Renal Services with the aid of "tele-tech-ing", can troubleshoot the dialysis equipment and send down the appropriate hardware to fix the problem or use existing hardware that is on site. Our equipment utilizes modular design, and keeping down time to a minimum gives our patients excellent support.

We also assist the vascular surgeons when they are asked to consult the dialysis nurse when one of our patients is having problems with their access. With the surgeons' ability to see the graft they can make determinations on whether the patient needs treatment at Fletcher Allen or they can ask the on-site clinical staff to treat the graft. This demonstrates that the patient did not need to travel to Burlington for their care.

Our attending physicians and the nephrologists presently visit with our patients once per month. They think that face-to-face contact with the patients is very important.

How to Schedule a Consult? 

When a physician located at Fletcher Allen decides to do a telemedicine consult to a rural hospital they should contact the Telemedicine Department at telemedicine@vtmednet.org or 847-8266 to arrange the time, support, and a room.  The remote physician should contact the technical staff located at their respective hospital to make arrangements on their end.

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