About Phone DOCTORx

How It Works

Participating facilities have a wireless videoconferencing unit that can easily be wheeled to a patient’s bedside by a nurse or other health care worker. The unit contains a sophisticated camera and a high resolution monitor screen the meet exacting standards set by PhoneDOCTORx. This allows the physician at the Medical Control Center to clearly see and visually evaluate the patient with the help of the SNF facility nurse. It also allows the nurse, the patient and the patient’s family to clearly see and speak with the physician in real time.

When a patient develops an acute problem, the videoconferencing unit is wheeled to the patient’s room. The physician initiates the connection and is able to visualize and speak with the patient and the patient’s nurse. The physician may remotely control the camera in order to more clearly examine specific lesions (such as examining a wound for signs of infection). The patient’s nurse can provide information on the patient, including past history, medications, vital signs, lung sounds, etc.

By combining direct visual and auditory evaluation of the patient with a verbal report from the nurse, along with access to the patient’s record, many patients are able to be effectively treated in the SNF facility rather than being transferred to an emergency department. While some patients are ill enough that they will require triage to an emergency department, many of these visits may be avoided by timely and appropriate treatment in the SNF facility. This approach provides a benefit to patients, their families and the participating facilities.

DIRECT PATIENT ACCESS PROGRAM

The Direct Patient Access Program, which is currently under development, is a “covering physician” plan for primary care physicians (PCPs) who contract with PhoneDOCTORx to provide such coverage for their patients. As a result, PhoneDOCTORx provides coverage for minor, non-emergency illnesses and conditions for patients of contracted physicians whenever the PCP is not available to personally provide care for such conditions.

Our Story

The concept originated years ago when Dr. Paul Bulat, President and Founder of PhoneDOCTORx, found himself as a patient in the current health care system. As a result, he had an opportunity to visualize the health care delivery system from an entirely different vantage point and perspective. Dr. Bulat learned that numerous patients who sought advice from their pharmacist were unable to access their primary care physicians in a timely manner. The concept of PhoneDOCTORx was born. Our original approach concentrated on the Direct Patient Access Program. As time and fate collided, another personal situation led Dr. Bulat to New Bedford Health Care Center and the Skilled Nursing Facility Program.

In 2005, Dr. Bulat’s mother took ill and needed the services of a skilled nursing facility. He and his family chose New Bedford Health Care Center. Once again, Dr. Bulat was able to observe the health care system as a “non-provider.” In speaking with the facility’s staff and leadership, an opportunity to work collaboratively in order to improve the quality, accessibility and delivery of patient care was unearthed. Telemedicine at New Bedford health Care Center was not far behind.

SKILLED NURSING FACILITY PROGRAM

In February, 2006, PhoneDOCTORx contracted with New Bedford Health Care Center (NBHCC) in New Bedford, MA, to provide direct patient care for residents of its subacute unit. At the same time, PhoneDOCTORx and HealthBridge Management, the management company for NBHCC, began working on the development and implementation of a telemedicine program at NBHCC in order to provide enhanced coverage for its residents after hours and on weekends. The concept is to provide physician coverage for acute problems that occur outside regular office hours via telemedicine, in which the physician is able to visualize the patient and perform an assessment with the help of a nurse at the skilled nursing facility (SNF). This telemedicine assessment in no way replaces a primary care physician (PCP) or personal visit. Instead, it replaces a regular telephone call from a covering physician, who often does not know the patient and who would have much more difficulty assessing and treating the patient without direct visualization. Information regarding the telemedicine encounter is always provided to the patient’s PCP so that he/she may provide follow-up and ongoing care. Following a successful trial at NBHCC, PhoneDOCTORx plans to expand this program to other SNF facilities.

Telemedicine

Telemedicine includes a wide range of services. NASA was one of the earliest users of telemedicine when it developed the means to monitor astronaut's heart rates and other vital signs while the astronauts were in space. Less complicated uses include a physician consulting a colleague by phone concerning the care of a patient. The higher end of the spectrum includes the capability to perform surgery from a remote location through monitors and manipulating robotic arms.

Other telemedicine applications include land-based emergency physicians directing the care of injured or ill crew members on ships at sea via radio, as well as radiologists reading MRIs, CT scans and other x-rays taken on patients who are hundreds or thousands of miles away. On a more local level, radiologists often have equipment in their homes that allow them to read CT scans and other studies from home during the night. Additionally, primary care physicians in a rural area may be able to transmit a picture of an unusual skin condition to a dermatologist located at a major medical center. Psychiatrists are able to interview patients during the night through videoconferencing in order to determine if the patient requires psychiatric hospitalization. Utilizing telemedicine in prisons avoids the danger of transporting inmates outside the facilities. Patients at home also benefit from telemedicine when their pacemakers and other medical devices can be checked by telephone, avoiding the need for a visit to the doctor's office.

Telemedicine employs both store-and-forward technology and real-time videoconferencing. In store-and-forward technology, a digital image (e.g., an x-ray, picture of a rash, etc.) is taken and stored, then forwarded to a specialist later that day or on a future date. PhoneDOCTORx utilizes videoconferencing in which two parties are able to both see and speak with each other in real-time.

The benefits of telemedicine in the modern world are well recognized. The Federation of State Medical Boards stated:

Traditional medical practice is being rapidly transformed by such factors as managed care, the politics of health care reform, and technological and other medical advances. Such advances, which include telemedicine, offer opportunities for improved health care delivery.

While telemedicine has been evolving in the United States and abroad for the past 35 years, interest in the field has increased dramatically since 1990 because of the demand for accessible and cost-effective health care. Additionally, government support for the development and testing of sophisticated telecommunications systems has risen recently. Many federal agencies, including the Department of Commerce, Health Care Financing Administration, the Office of Rural Health Policy, and the Department of Defense have begun telemedicine research and demonstration programs to study the use of telemedicine over large distances.

Some of the potential benefits of telemedicine include increased access to health care (especially in underserved areas), expanded utilization of specialty expertise, rapid availability of patient records and reduced cost of patient care.

The Telemedicine Research Center explains the following advantages of telemedicine:
Providing healthcare services via telemedicine offers many advantages. It can make specialty care more accessible to underserved rural and urban populations. Video consultations from a rural clinic to a specialist can alleviate prohibitive travel and associated costs for patients. Videoconferencing also opens up new possibilities for continuing education or training for isolated or rural health practitioners, who may not be able to leave a rural practice to take part in professional meetings or educational opportunities. While studies have yet to confirm this, it appears that the use of telemedicine can also cut costs of medical care for those in rural areas.

The Telemedicine Research Center further states the following:
It's not too much of a stretch of the imagination to realize that telemedicine will soon be just another way to see a health professional, just as seeing friends and family while talking to them on the phone is becoming commonplace. Farther down the road, it has been theorized that we each could have a 'Personal Diagnosis System' as part of our home entertainment centers. This system would monitor our daily health status and automatically notify a health professional if we become ill.

Ten years or fifteen years ago we had no idea we would rely heavily on faxes, answering machines and e-mail, tools which are now low-tech and taken for granted. In the mid-90's Ronald C. Merrell, from Yale University School of Medicine said, "The innovations we will encounter as we step beyond feasibility are dazzling in their potential." In the early 21st century, the potential of telemedicine, telehealth and e-health is still left to our imaginations.

Additional information regarding telemedicine may be obtained from the American Telemedicine Association.