What is the feasibility of a telemedicine otolaryngology clinic with use of currently available technology?
A synchronous or real-time pilot otolaryngology telemedicine clinic was found to be equivalent to a standard otolaryngology clinic in terms of diagnostic concordance and patient and provider satisfaction. This study provides further evidence that a real-time telemedicine model may be a viable option to expand specialty care to remote or underserved areas. The long-term goal of this project ultimately is to establish a general otolaryngology clinic run by a physician extender, with remote teleconsultation provided by a board-certified otolaryngologist. As this clinic model develops, further data will be needed regarding feasibility, long-term outcomes, patient and clinician satisfaction, and overall economic impact.
Explore this issue:May 2018
Background: Telemedicine is the practice of using telecommunication technology to provide remote-access medical care, typically to an underserved region. Its use has been well established in many fields of medicine including radiology, cardiology, dermatology, and psychiatry, but its role for use in academic surgical subspecialties is yet to be fully explored. Otolaryngologists represent a relatively small subset of surgical specialists, mostly located in urban areas and largely underrepresented in the rural community setting. Additionally, a primary component of the patient evaluation in otolaryngology depends on images that can be digitized, which are well suited for remote viewing using current technology.
A telemedicine application that has received less attention but would impact a much larger volume of patients is the rural or underserved patient populations. These patients often are faced with limited access to otolaryngologic care or may routinely be required to travel long distances for an otolaryngology consultation. The authors of this study developed a synchronous (real-time) general otolaryngology telemedicine clinic, with the long-term goal of expanding care to rural Ohio communities.
Study design: Prospective.
Setting: Rural otolaryngology clinics in Ohio.
Synopsis: Patients in a rural otolaryngology clinic were enrolled in a pilot telemedicine clinic. To assess system fidelity, an on-site and remote (consulting) otolaryngologist conducted simultaneous patient evaluations using streaming telecommunication technology for all aspects of the clinical encounter, including high-definition examination and endoscopic images. Both physicians and patients were blinded and diagnoses recorded.
Post-encounter physician surveys and an original patient-centered TeleENT Satisfaction Questionnaire (TESQ) were used to assess overall satisfaction.
Twenty-one patients were enrolled consecutively. Visual technology was found acceptable in all cases, and audio technology was acceptable in 20 of 21 encounters. Patient satisfaction was 96%, and patients felt comfortable using a telemedicine system in the future. Encounters were not significantly longer than traditional encounters.
Physician diagnostic agreement was found in 95% of cases, and the consulting physician indicated that all encounters provided sufficient history, examination, and high-quality images to generate an accurate diagnosis, order additional workup, and/or make an appropriate referral.
Citation: Seim NB, Philips RH, Matrka LA, et al. Developing a synchronous otolaryngology telemedicine clinic: prospective study to assess fidelity and diagnostic concordance. Laryngoscope. 2018;128:1068–1074.