Feature

Telemedicine working group aims to address ‘big gaps’ of emergency cancer care

The Association of Community Cancer Centers has formed a five-person telemedicine working group comprised of e-health and cancer care experts to address how technology can better serve patients with cancer in the ED.

Junaid Razzak, MBBS, MD, PhD, director of telemedicine in the department of emergency medicine at Johns Hopkins University, and colleagues of the working group have proposed interventions and platforms that will mitigate barriers to care for patients receiving cancer immunotherapy.

“The telemedicine working group explores avenues for improved delivery of immunotherapies for certain forms of cancer, and specifically how telemedicine can help,” Razzak told HemOnc Today. “We met once in person and several times online or over the phone to talk about various applications for the use of telemedicine for diagnosis, treatment and educational purposes. Because I’m an emergency physician, my perspective is shaped by what happens when patients come to the hospital seeking care.”

Junaid Razzak

HemOnc Today spoke with Razzak about the role of telemedicine in the ED and how technology might impact care going forward.

Question: What is the role of telemedicine for patients with cancer who are presenting to the ED?

Answer: There have been rapid advances in chemotherapy and immunomodulating drugs over the past few years. As emergency physicians, we take care of a wide variety of patients with all sorts of illnesses and across all age groups. A small percentage of patients are coming in with cancer and, within that group, a very small percentage are on immunotherapies. The telemedicine working group discussed how to keep emergency physicians up to date with information that’s relevant to our practice but doesn’t overwhelm us.

Often, emergency physicians either are not aware of or are not comfortable with the use of these quickly evolving treatments. If a patient comes into my ED and is on specific medications or, more importantly, is experiencing side effects from them, how do I learn more about it and communicate with experts? This quandary spurred us to talk about the use of telemedicine, specifically using the model of poison control centers, which are available throughout the country by calling a 1-800 number. We’re envisioning a platform that would allow physicians and specialists to interface and discuss what is going on with the patient. This is the idealized use of telemedicine in the ED.

Q: What does telemedicine in the ED look like from the patient’s end?

A: A process called telestreaming allows us to see a patient soon after they arrive in the ED and after the nurses have triaged them. If they do not have life-threatening illnesses, we have a physician or a physician’s assistant see the patient on the telemedicine platform. The patient will go to a room, be evaluated by a physician or PA and answer a few questions, and the diagnostic workup will begin while the patient is in the waiting room.

On the other end, when the patient is in the ED, we need to consult with the oncologist, typically over the phone. These oncologists know their patients very well, so we bring telemedicine into patients’ rooms. With video conferencing, oncologists can see their patient, talk with emergency physicians and patients, and come up with a joint plan that satisfies all parties involved.

There is room for improvement on this front, as it can be implemented much more than it is currently. Telemedicine also allows for educational opportunities. This technology can be used to educate emergency physicians, especially by creating platforms that we can access at the time of care. If I’m seeing a patient and am not sure about the specifics of a medication or its side effects, there is a platform I can use to enter and access information if I need to talk to somebody in this area.

Q: How have you seen telemedicine evolve over the course of your career, and what do you think is coming next?

A: We are still at the early stages of telemedicine use in health care, especially in the ED. In my field, specialties including neurology, radiology and psychiatry have taken this on much more than others. Many hospitals have a tele-neurologist or telepsychiatrist available but lack other specialists. This is driven by market forces, and telemedicine for direct provision of emergency care by emergency providers has been somewhat limited.

The linking of in-home monitoring and early recognition of worsening conditions for a patient to the existing emergency care system is a big gap that we need to fill and focus on. As acceptance of telemedicine technology in the health care system increases, we will see its use evolve with the mindset surrounding it. – by Joe Gramigna

For more information:

Junaid Razzak, MBBS, MD, PhD, can be reached at junaid.razzak@jhu.edu.

Disclosure: Razzak reports no relevant financial disclosures.

The Association of Community Cancer Centers has formed a five-person telemedicine working group comprised of e-health and cancer care experts to address how technology can better serve patients with cancer in the ED.

Junaid Razzak, MBBS, MD, PhD, director of telemedicine in the department of emergency medicine at Johns Hopkins University, and colleagues of the working group have proposed interventions and platforms that will mitigate barriers to care for patients receiving cancer immunotherapy.

“The telemedicine working group explores avenues for improved delivery of immunotherapies for certain forms of cancer, and specifically how telemedicine can help,” Razzak told HemOnc Today. “We met once in person and several times online or over the phone to talk about various applications for the use of telemedicine for diagnosis, treatment and educational purposes. Because I’m an emergency physician, my perspective is shaped by what happens when patients come to the hospital seeking care.”

Junaid Razzak

HemOnc Today spoke with Razzak about the role of telemedicine in the ED and how technology might impact care going forward.

Question: What is the role of telemedicine for patients with cancer who are presenting to the ED?

Answer: There have been rapid advances in chemotherapy and immunomodulating drugs over the past few years. As emergency physicians, we take care of a wide variety of patients with all sorts of illnesses and across all age groups. A small percentage of patients are coming in with cancer and, within that group, a very small percentage are on immunotherapies. The telemedicine working group discussed how to keep emergency physicians up to date with information that’s relevant to our practice but doesn’t overwhelm us.

Often, emergency physicians either are not aware of or are not comfortable with the use of these quickly evolving treatments. If a patient comes into my ED and is on specific medications or, more importantly, is experiencing side effects from them, how do I learn more about it and communicate with experts? This quandary spurred us to talk about the use of telemedicine, specifically using the model of poison control centers, which are available throughout the country by calling a 1-800 number. We’re envisioning a platform that would allow physicians and specialists to interface and discuss what is going on with the patient. This is the idealized use of telemedicine in the ED.

Q: What does telemedicine in the ED look like from the patient’s end?

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A: A process called telestreaming allows us to see a patient soon after they arrive in the ED and after the nurses have triaged them. If they do not have life-threatening illnesses, we have a physician or a physician’s assistant see the patient on the telemedicine platform. The patient will go to a room, be evaluated by a physician or PA and answer a few questions, and the diagnostic workup will begin while the patient is in the waiting room.

On the other end, when the patient is in the ED, we need to consult with the oncologist, typically over the phone. These oncologists know their patients very well, so we bring telemedicine into patients’ rooms. With video conferencing, oncologists can see their patient, talk with emergency physicians and patients, and come up with a joint plan that satisfies all parties involved.

There is room for improvement on this front, as it can be implemented much more than it is currently. Telemedicine also allows for educational opportunities. This technology can be used to educate emergency physicians, especially by creating platforms that we can access at the time of care. If I’m seeing a patient and am not sure about the specifics of a medication or its side effects, there is a platform I can use to enter and access information if I need to talk to somebody in this area.

Q: How have you seen telemedicine evolve over the course of your career, and what do you think is coming next?

A: We are still at the early stages of telemedicine use in health care, especially in the ED. In my field, specialties including neurology, radiology and psychiatry have taken this on much more than others. Many hospitals have a tele-neurologist or telepsychiatrist available but lack other specialists. This is driven by market forces, and telemedicine for direct provision of emergency care by emergency providers has been somewhat limited.

The linking of in-home monitoring and early recognition of worsening conditions for a patient to the existing emergency care system is a big gap that we need to fill and focus on. As acceptance of telemedicine technology in the health care system increases, we will see its use evolve with the mindset surrounding it. – by Joe Gramigna

For more information:

Junaid Razzak, MBBS, MD, PhD, can be reached at junaid.razzak@jhu.edu.

Disclosure: Razzak reports no relevant financial disclosures.