NewYork-Presbyterian specialists use telemedicine to treat stranded Puerto Ricans

TelehealthNewYork-Presbyterian Weill Cornell Medical Center sent an emergency team to work with patients on the ground in Puerto Rico and conduct visits with specialists using telemedicine tools in the wake of Hurricane Maria’s devastation.  The move comes amid a 2017 hurricane season during which other hospitals such as Nemours, and telemedicine companies including LiveHealth Online, Doctor On Demand and EpicMD, have been offering free virtual consultations to people in storm-ravaged areas in Florida, Texas and Puerto Rico.  Beginning on Oct. 27, NewYork-Presbyterian sent people to Puerto Rico to deploy the telemedicine equipment that enabled them to consult with specialists back in New York.   “On the first day, I received a call from physician assistant Nancy Pagan that she needed a consultation for a 2-year-old boy with diabetes who had elevated blood sugar for the past two weeks,” said Shari Platt, MD, chief of pediatric emergency medicine at the medical center. “Within one hour, we were using our telemedicine service to perform peer-to-peer consultation in a three-way communication.” That live video conference included Pagan, Platt and and Zoltan Antal, MD, the chief of pediatric endocrinology at NewYork-Presbyterian Weill Cornell Medical Center.  The caregivers were able to virtually see the child, speak with the mother, and advise Pagan on how to adjust the insulin dose and diet to better manage his diabetes, which had become uncontrolled. “Being able to see the child, and assess his behavior, his level of comfort and hydrated state, and his well appearance, was a priceless aspect of this evaluation, as a simple phone discussion could not have provided this critical information that helped to guide his care,” Platt said. “Further, for his mother to be able to speak with Dr. Antal, to see his face, and have an eye-to-eye contact, offered a powerful connection and an intangible sense of trust and faith in our care.” Clinicians are using such telemedicine technologies in Puerto Rico Rico and elsewhere to deliver specialist and sub-specialist care in ways that emergency teams simply cannot without the tools.  “Many of the patients have had complex medical conditions that even in our own emergency department would be managed with the consultation of a sub-specialist,” Platt said. “And this level of specialization cannot be duplicated by emergency teams on the ground.”  Access to specialized medical care is frequently difficult, if not impossible, following disasters. And with people having grown accustomed to seeing and speaking with friends and family via video or Facetime, Platt said telemedicine enables patients to be cared for by a specialist when necessary. That said, it’s still early to tell for certain what impact telemedicine will have on Puerto Rico overall as it continues to recover and what that might mean for other areas that face storms in the future.  Telemedicine bridges the gap and allows the medical center’s physicians to treat patients as if the medical center’s caregivers were there in person. So from that standpoint, the use of telemedicine in Puerto Rico is in essence a proof of concept that the digital health services can be of tremendous value in emergency and disaster response situations.  “What we can say is that as a result of our time providing aid in Puerto Rico, we know now that we can still provide access to general and sub-specialty care that can adequately address chronic conditions such as diabetes and dermatological care for certain skin reactions that occur during times like this and especially when the patients might not have access,” said Rahul Sharma, MD, emergency physician-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center. 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