{"309231":{"#nid":"309231","#data":{"type":"news","title":"Improved Telemedicine System Connects Doctors to Autism Patients in Rural Georgia","body":[{"value":"\u003Cp\u003ETo get the best care for her three autistic children, Mandi Larkin would drive three hours from her family\u2019s home in Tifton, Ga., to Marcus Autism Center in Atlanta. The drive to and from Atlanta was exhausting. Missed work, missed school and the long drive were constant sources of stress.\u003C\/p\u003E\u003Cp\u003EToday, Larkin\u2019s children receive world-class medical care at her local hospital via a state-of-the-art telemedicine link to Marcus Autism Center. The recently improved telemedicine system was optimized by scientists at the Georgia Tech Research Institute (GTRI) and Cisco Systems, Inc. Marcus Autism Center\u2019s telemedicine room is now a showcase for providers of telemedicine, where improved video capabilities and an ergonomic suite allow patients in rural Georgia to meet face-to-face with medical specialists in Atlanta.\u003C\/p\u003E\u003Cp\u003E\u201cThe accessibility to the doctors in Atlanta is the big thing,\u201d Larkin said. \u201cNot everyone has the means to make that kind of a drive. Telemedicine gives us access to the doctors that we normally wouldn\u2019t have access to.\u201d\u003C\/p\u003E\u003Cp\u003EA major goal of the telemedicine redesign is to create telepresence, clinical workflow, and diagnostic processes that can enable clinicians to identify rural children with autism spectrum disorders as early as 18 months. Today, these children are often diagnosed as late as seven years old.\u003C\/p\u003E\u003Cp\u003EGTRI\u2019s telemedicine efforts are supported by a donation from Allen Ecker\u003Cstrong\u003E, \u003C\/strong\u003Ea Georgia Tech alum and executive vice president of Scientific Atlanta.\u003C\/p\u003E\u003Cp\u003E\u201cOne of the biggest issues facing our country is both the cost of healthcare and the scarcity of healthcare providers as the demands of healthcare get larger,\u201d Ecker said. \u201cI think that telemedicine will address both of those problems. It reduces the cost of an appointment and it also reduces the time needed for the clinician.\u201d\u003C\/p\u003E\u003Cp\u003ECisco, as a provider of telemedicine equipment at Children\u2019s Healthcare of Atlanta,also donated approximatelyhalf-a-million dollars\u2019 worth of equipment and software toward telemedicine enhancements at both Marcus Autism Center and Children\u2019s.\u003C\/p\u003E\u003Cp\u003E\u201cCisco worked hand-in-hand with us from the beginning,\u201d said Courtney Crooks, a senior research scientist at GTRI, who is leading the project. \u201cIn a patient-provider relationship, the experience is really important. We wanted to ensure that the telepresence is at least as good as when you\u2019re sitting in the office with a provider. Plus, we wanted to use technology to enhance the clinical workflow and capabilities of the provider, beyond what they may be able to accomplish through manual means.\u201d\u003C\/p\u003E\u003Cp\u003EFelissa Goldstein, M.D., is the primary doctor using the improved telemedicine system at the Marcus Autism Center. Goldstein, a child and adolescent psychiatrist, is one of the most active providers of telemedicine in the state of Georgia. She uses the system for providing early screening and continuing care for children with autism spectrum disorders.\u003C\/p\u003E\u003Cp\u003EUntil this past summer, Goldstein had been using a telemedicine system in her office that, among other human factors problems, had poor lighting, muffled sound, and displaced monitors which created heavily reduced eye contact.\u003C\/p\u003E\u003Cp\u003EThe GTRI systems engineers applied their expertise to Goldstein\u2019s clinical setting. They studied the best way to orient the telemedicine monitors so that the eye contact and visual connection between doctor and patient was optimized without either person having to crane their neck.\u003C\/p\u003E\u003Cp\u003EThe old telemedicine system used two monitors side-by-side. The monitor on the left displayed medical records, while the monitor on the right provided a view of the patients via a webcam atop the monitor.\u0026nbsp;\u003C\/p\u003E\u003Cp\u003E\u201cI\u2019d have to tell the family when I would start that \u2018If I look away, it\u2019s not because I\u2019m not paying attention to you. It\u2019s because I\u2019m looking at your chart,\u2019\u201d Goldstein said.\u003C\/p\u003E\u003Cp\u003EThe GTRI engineers saw that a redesign of the monitors was required; one which did not require the doctor to turn their head or shift their gaze in an obvious way.\u003C\/p\u003E\u003Cp\u003ECrooks\u2019 team shadowed Dr. Goldstein during her appointments and developed a streamlined, ergonomic telemedicine system.Now the monitor that displays medical records is above the patient monitor. A powerful webcam sits in the space between the monitors. If Goldstein moves her gaze from the top monitor to the bottom monitor, all the patients see is a slight movement of her head. Goldstein said the improved eye-contact is the biggest advantage to the new system.\u003C\/p\u003E\u003Cp\u003E\u201cGTRI worked with us really carefully to maximize eye contact, and I feel like it\u2019s really adding to my ability to provide good patient care by telemedicine,\u201d Goldstein said.\u003C\/p\u003E\u003Cp\u003EThe new telemedicine system is now in a room of its own. The lighting in the larger space was designed to make Goldstein appear natural, and not dark and shadowy like in the old system. The desk and monitors are now ergonomic, and the room is soundproof.\u003C\/p\u003E\u003Cp\u003EGone is the need for the old-fashioned webcam remote control, and in its place is an iPad which acts as the central control station for the telemedicine system. Goldstein now can tap the screen to control the camera. She can pan and zoom to follow children around the room as they play with toys, or tightly focus on the parents as they praise or discipline their children. The iPad is also enabled for capabilities such as touchpad tagging of behavioral events of interest that may occur during a session.\u003C\/p\u003E\u003Cp\u003EIf Goldstein needs to note a significant event, she can flag it in the system. Later, she analyzes the data to look for trends, such as how a symptom develops over time.\u003C\/p\u003E\u003Cp\u003EAnother improvement is the system\u2019s ability to load unique settings for individual families. Goldstein can also share her screens remotely, as she does when giving lectures. This feature can also be used to share educational materials with families during session, as needed.\u003C\/p\u003E\u003Cp\u003EThe new telemedicine system was transitioned over the summer of 2013. Crooks\u2019 research team is in discussions with several other funders for ways to use the system for different clients\u2019 needs, such as teletraining, parent education, and dependent care in the military. Those applications are still under development, but the system\u2019s value to families with children is already changing their lives.\u003C\/p\u003E\u003Cp\u003EWhen Mandi Larkin arrives to her appointment at Tift Regional Medical Center with her children -- ages three, four and six -- a nurse guides them through registration and paperwork, then takes the kids\u2019 vital signs and leads the family to the telemedicine room. When they arrive, Goldstein is already on the telemedicine video screen.\u003C\/p\u003E\u003Cp\u003E\u201cIt\u2019s usually very prompt, and that\u2019s something I really like,\u201d Larkin said. \u201cOnce you get there you have your appointment time and there\u2019s never more than a 5 minute wait.\u201d\u003C\/p\u003E\u003Cp\u003EAfter her telemedicine session, Larkin is faxed a report detailing the visit. Before, she had to bring a pen and notepad to every appointment to have a record of what transpired.\u003C\/p\u003E\u003Cp\u003ELarkin said she would prefer to be with the doctor in person, but that isn\u2019t realistic, so telemedicine is the next best thing. In some cases, telemedicine is even better than being with the doctor in person, Larkin said.\u003C\/p\u003E\u003Cp\u003E\u201cI think the doctor gets a little bit more interaction from the kids through the screen because they more or less shut down around new people,\u201d Larkin said. \u201cWith telemedicine, to the kids it\u2019s just somebody on a TV screen talking to them. The doctor can see a little bit more and get a little bit more from them than if she was in the room in front of them.\u201d\u003C\/p\u003E\u003Cp\u003EResearch shows that children in rural areas, on average, aren\u2019t diagnosed with autism spectrum disorders until age seven. Ideally, diagnosis should take place as early as 18 months so the children can benefit from proper care as early as possible. The new telemedicine system could help bring earlier diagnosis to rural children.\u003C\/p\u003E\u003Cp\u003E\u201cWe\u2019re helping to screen a lot of children with developmental disabilities so that it\u2019s no longer seven years until they are diagnosed,\u201d Goldstein said. \u201cThe younger you can diagnose, the better off you are.\u201d\u003C\/p\u003E\u003Cp\u003EGoldstein also travels to rural clinics throughout the state, where many of the families have never seen a specialist for children with developmental disabilities. Future work with the telemedicine system will convert all six of her outreach clinics to video conferencing clinics.\u003C\/p\u003E\u003Cp\u003EOverall, Children\u2019s Healthcare of Atlanta partners with Georgia Partnership for Telehealth (GPT) to see patients at more than 30 telemedicine sites throughout the state of Georgia in a variety of specialties ranging from Cardiology to Sports Medicine. GTRI\u2019s work with Marcus Autism Center will also be applied to other telemedicine suites at Children\u2019s Healthcare of Atlanta. \u0026nbsp;\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003E\u201c\u003C\/strong\u003EIn collaboration with Cisco, we came up with a standard that other clinics can adopt,\u201d Crooks said.\u0026nbsp;\u003C\/p\u003E\u003Cp\u003EIf enhancements to remote site systems are desired, this standard can be used to customize a suitable package that will be interoperable with the system at Marcus Autism Center. Sites may be eligible for funding for these upgrades through a variety of sources.\u003C\/p\u003E\u003Cp\u003EThe work between GTRI, Cisco and Marcus is continuing with the ultimate goal of being able to perform diagnosis and therapy in the child patient\u0027s home, with the parents as the caregivers, directed by clinicians using the telemedicine system.\u003C\/p\u003E\u003Cp\u003EIn the meantime, the new telemedicine system is already improving lives. Larkin has been using telemedicine for about three and a half years. To her family, it\u2019s meant a major improvement in the quality of life.\u003C\/p\u003E\u003Cp\u003E\u201cIt\u2019s all worth it because I get to see the doctor and I don\u2019t have to drive three hours with my three autistic kids,\u201d Larkin said.\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EResearch News\u003Cbr \/\u003E Georgia Institute of Technology\u003Cbr \/\u003E 177 North Avenue\u003Cbr \/\u003E Atlanta, Georgia\u0026nbsp; 30332-0181\u0026nbsp; USA\u003Cbr \/\u003E \u003C\/strong\u003E\u003Ca href=\u0022https:\/\/twitter.com\/GTResearchNews\u0022\u003E\u003Cstrong\u003E@GTResearchNews\u003C\/strong\u003E\u003C\/a\u003E\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EMedia Relations Contacts\u003C\/strong\u003E: Brett Israel (\u003Ca href=\u0022https:\/\/twitter.com\/btiatl\u0022\u003E@btiatl\u003C\/a\u003E) (404-385-1933) (\u003Ca href=\u0022mailto:brett.israel@comm.gatech.edu\u0022\u003Ebrett.israel@comm.gatech.edu\u003C\/a\u003E) or John Toon (404-894-6986) (\u003Ca href=\u0022mailto:jtoon@gatech.edu\u0022\u003Ejtoon@gatech.edu\u003C\/a\u003E)\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EWriter\u003C\/strong\u003E: Brett Israel\u0026nbsp;\u003C\/p\u003E","summary":null,"format":"limited_html"}],"field_subtitle":"","field_summary":[{"value":"\u003Cp\u003EA recently improved telemedicine system was optimized by scientists at the Georgia Tech Research Institute (GTRI) and Cisco Systems, Inc. Marcus Autism Center\u2019s telemedicine room is now a showcase for providers of telemedicine, where improved video capabilities and an ergonomic suite allow patients in rural Georgia to meet face-to-face with medical specialists in Atlanta.\u0026nbsp;\u003C\/p\u003E","format":"limited_html"}],"field_summary_sentence":[{"value":"A recently improved telemedicine system was optimized by scientists at the Georgia Tech Research Institute (GTRI) and Cisco Systems, Inc."}],"uid":"27902","created_gmt":"2014-07-17 16:32:17","changed_gmt":"2016-10-08 03:16:48","author":"Brett Israel","boilerplate_text":"","field_publication":"","field_article_url":"","dateline":{"date":"2014-07-17T00:00:00-04:00","iso_date":"2014-07-17T00:00:00-04:00","tz":"America\/New_York"},"extras":[],"hg_media":{"309211":{"id":"309211","type":"image","title":"Felissa Goldstein","body":null,"created":"1449244726","gmt_created":"2015-12-04 15:58:46","changed":"1475895020","gmt_changed":"2016-10-08 02:50:20","alt":"Felissa Goldstein","file":{"fid":"199822","name":"felissa_in_new_telemed_room.jpg","image_path":"\/sites\/default\/files\/images\/felissa_in_new_telemed_room_0.jpg","image_full_path":"http:\/\/hg.gatech.edu\/\/sites\/default\/files\/images\/felissa_in_new_telemed_room_0.jpg","mime":"image\/jpeg","size":7846870,"path_740":"http:\/\/hg.gatech.edu\/sites\/default\/files\/styles\/740xx_scale\/public\/images\/felissa_in_new_telemed_room_0.jpg?itok=GvBkLlB-"}},"309201":{"id":"309201","type":"image","title":"Courtney Crooks","body":null,"created":"1449244726","gmt_created":"2015-12-04 15:58:46","changed":"1475895020","gmt_changed":"2016-10-08 02:50:20","alt":"Courtney Crooks","file":{"fid":"199821","name":"crooks-telemed-2.jpg","image_path":"\/sites\/default\/files\/images\/crooks-telemed-2_0.jpg","image_full_path":"http:\/\/hg.gatech.edu\/\/sites\/default\/files\/images\/crooks-telemed-2_0.jpg","mime":"image\/jpeg","size":1590574,"path_740":"http:\/\/hg.gatech.edu\/sites\/default\/files\/styles\/740xx_scale\/public\/images\/crooks-telemed-2_0.jpg?itok=dXSNrBGK"}},"309221":{"id":"309221","type":"image","title":"Telemedicine system","body":null,"created":"1449244726","gmt_created":"2015-12-04 15:58:46","changed":"1475895020","gmt_changed":"2016-10-08 02:50:20","alt":"Telemedicine system","file":{"fid":"199823","name":"telemed-system.jpg","image_path":"\/sites\/default\/files\/images\/telemed-system_0.jpg","image_full_path":"http:\/\/hg.gatech.edu\/\/sites\/default\/files\/images\/telemed-system_0.jpg","mime":"image\/jpeg","size":1587293,"path_740":"http:\/\/hg.gatech.edu\/sites\/default\/files\/styles\/740xx_scale\/public\/images\/telemed-system_0.jpg?itok=vWpINAx8"}},"309191":{"id":"309191","type":"image","title":"Allen Ecker","body":null,"created":"1449244726","gmt_created":"2015-12-04 15:58:46","changed":"1475895017","gmt_changed":"2016-10-08 02:50:17","alt":"Allen Ecker","file":{"fid":"199820","name":"allenecker.jpg","image_path":"\/sites\/default\/files\/images\/allenecker_0.jpg","image_full_path":"http:\/\/hg.gatech.edu\/\/sites\/default\/files\/images\/allenecker_0.jpg","mime":"image\/jpeg","size":13539,"path_740":"http:\/\/hg.gatech.edu\/sites\/default\/files\/styles\/740xx_scale\/public\/images\/allenecker_0.jpg?itok=IRtJ-otr"}}},"media_ids":["309211","309201","309221","309191"],"groups":[{"id":"1188","name":"Research Horizons"}],"categories":[],"keywords":[{"id":"98091","name":"allen ecker"},{"id":"8899","name":"Childrens Healthcare of Atlanta"},{"id":"98101","name":"courtney crooks"},{"id":"98121","name":"felissa goldstein"},{"id":"7794","name":"Marcus Autism Center"},{"id":"98111","name":"telemedicine"}],"core_research_areas":[{"id":"39441","name":"Bioengineering and Bioscience"}],"news_room_topics":[{"id":"71891","name":"Health and Medicine"}],"event_categories":[],"invited_audience":[],"affiliations":[],"classification":[],"areas_of_expertise":[],"news_and_recent_appearances":[],"phone":[],"contact":[{"value":"\u003Cp\u003EBrett Israel\u003C\/p\u003E\u003Cp\u003E404-385-1933\u003C\/p\u003E\u003Cp\u003E\u003Ca href=\u0022mailto:brett.israel@comm.gatech.edu\u0022\u003Ebrett.israel@comm.gatech.edu\u003C\/a\u003E\u003C\/p\u003E","format":"limited_html"}],"email":["brett.israel@comm.gatech.edu"],"slides":[],"orientation":[],"userdata":""}}}