Ray Hino, CEO of Mendocino Coast District Hospital

The following interview was edited from remarks made by Mr. Ray Hino, CEO of Mendocino Coast District Hospital, on May 13, 2010 at a public meeting of the Southern Humboldt Community Healthcare District.

How has Mendocino Coast Hospital improved its financial stability from implementing telemedicine?

Mr. Hino: Our hope was that by gaining access to specialists via telemedicine at our small, isolated hospital would result in fewer patient transfers to large urban hospitals. We felt that if we could safely admit and retain more patients at our facility that the result would be a substantial increase in revenue, and we’ve seen that occur. Since OffSiteCare started services we are seeing about six additional admissions per month, which translates to hundreds of thousands of dollars of previously-unrealized revenue for our facility.

For years we had been hiring outside hospitalists to provide 24/7 coverage for our hospital. The going rate is $75/hour, which translates to $1800 per day. By working with OffSiteCare, we created the concept of teaming up with our sister hospitals to share the expense of having a single hospitalist provide nighttime coverage at two, three, or even four hospitals. Using this approach, we have lowered our costs dramatically. The program has been so successful that we are considering using telemedicine to fill occasional day shifts as well.

Would you please describe the robot?

Mr. Hino: We call it a robot, but it’s really a computer on wheels. The head is a flat-screen monitor, and you see the face of the consulting physician on-screen. There is a camera on top of the screen that enables the remote MD to focus in on patients at our facility, and to comfortably interact with our doctors and nurses. It kind of looks like R2D2 with a flat-screen monitor as the head of the robot. Now that I think about it, the twin camera lenses on top make it look a little like Wall-E!

Using a joystick control, the OffSiteCare physician can control the robot from a laptop or a desktop control station, and drive it around the hospital, going from bedside to bedside and seeing patients. Sometimes they need a little help from the nurses. For example, one morning the robot was stuck in the hallway – there are no arms, so it can’t open a door – and one of our nurses could hear a voice saying “Please open the door!”

The FDA-cleared robot is specially designed for medical applications, and it has a stethoscope attachment so the remote physician can hear the heartbeat and airways of the patient through headphones. The high-resolution cameras make it well-suited for dermatology, it works beautifully for ear, nose, and throat (ENT) exams, and the visuals are clear enough to evaluate x-ray images over the Internet.

Can you describe the interaction between the remote physicians and your on-site medical personnel?

Mr. Hino: The OffSiteCare physicians are able to interact normally with our doctors and nurses. They discuss test results, lab values, look at x-rays together, and then make the determination whether or not the patient can be safely cared for at the rural facility. If not, transport can be quickly arranged to a larger urban facility.

Our staff was skeptical at first, because they didn’t think that a medical robot could do as good a job as an on-site physician. However, much of our previous night coverage was via telephone, and actual treatment was deferred until morning. The OffSiteCare physicians provide a full assessment of the patient at the time of admission, and our ER doctors and nurses feel that our patients are getting better care at night than they were before.

Are there other benefits to enhancing the hospital’s ability to provide local care?

There are compelling reasons to provide care locally – in the event of a stroke, great damage can occur if treatment is delayed during transport, and other conditions can be negatively affected by long ambulance rides or even helicopter transport. Patients generally prefer to remain at their local hospital and consult with their own doctors, and their families love being able to participate in their care without having to drive to a distant urban facility.