Applications of Telehealth Technology to the Perioperative Process
The pressure to reduce surgical costs was escalated this week after a study published in the British Journal of Surgery found that direct medical costs of surgery would put almost 44% of the world’s population at risk for financial catastrophe. Meanwhile, The Lancet Commission on Global Surgery has proposed the elimination of impoverishment due to surgical expenses by 2030. In order to make surgery attainable and affordable to a global population, we need to leverage technology that can streamline processes, improve access, and cut costs.
Incorporating telehealth technology is likely to be central to achieving this goal. Patient perceptions of telehealth, previously found to be positive among patients with chronical medical conditions, more recently appear to be favorable for surgical patients. In a 2013 study, for instance, over 90% of cholecystectomy patients and 70% of hernia repair patients accepted telehealth as the sole method of post-surgical follow-up. And more recently, a VA study found that the majority of patients actually preferred telehealth follow-up after low-complexity operations.
Although the role of telehealth in the perioperative process is still under exploration, these four applications carry promise in delivering improved efficiency, access, and value in the perioperative process.
The use of telehealth technology to perform pre-operative evaluations remotely has already been adopted in many rural health care centers, where the distance between providers and patients limits the feasibility of face-to-face encounters. In one rural pediatric center, 97% of patients and 73% of physicians reported satisfaction with pre-operative telehealth visits. The virtual visits also led to major cost reductions: almost half of the patients reported they saved over $500 in travel costs.
The recent VA study that highlighted strong patient preference for remote post-op visits comes as little surprise from a patient standpoint. As long as no major issues arise, the last thing post-op patients want to do is trek back to the hospital and wait an hour for a 10-minute check-up. And for patients in nursing homes or rehabilitation facilities, the use of telehealth technology for post-operative evaluations could be particularly advantageous: transportation back to the hospital is not only financially and logistically burdensome, but it also takes patients away from valuable physical therapy time.
In rural and remote areas, the lack of surgical specialists often translates to sub-optimal management of complex surgical problems. Frequently, however, audio and visual information are adequate for specialists to make accurate diagnoses and recommend treatment plans to in-person providers, either in the emergency room or the clinic. Plastic surgery is particularly amenable to telehealth services since the field relies primarily on visual information and radiographic data to make the diagnosis. A 2016 study found that when emergency physicians sent key clinical information and images to a remote plastic surgeon, response time decreased from 48 minutes to 8 minutes while maintaining over 85% agreement between in-person consultation and visual consultations.
Operating on a patient in a different time zone? It’s not science fiction. On September 7, 2001, surgeon Jacques Marescaux, in New York, successfully performed a cholecystectomy on a French patient – 6,230km away – using a robotic surgical system. The landmark operation was dubbed “Operation Lindbergh,” a nod to Charles Lidnbergh’s pioneering transatlantic flight from New York to Paris. Since then, Canadian surgeon Mehran Anvari has operated on over 20 patients living in North Bay, a town 400km away from Dr. Anvari’s home base of Hamilton, Canada. These successes have, understandably, sparked intense interest in further development of telesurgery. The US military is working to incorporate telesurgery in their Trauma Pod project, which they hope could one day help military units dramatically increase chances of survival for injured soldiers. MD Anderson recently led an initiative to refine and develop telesurgery technology to increase accessibility of oncologic surgery worldwide. Although ethical issues and regulatory problems currently limit broad implementation, as Dr. Anvari puts it, the science is already there.