Skip the cart and move to iPads: Telemedicine in Long Term Care

        I have been starting to think about how to make telehealth more accessible to nurses on units in long term care. Integrating telehealth into long term care to improve access to specialist consultation has many benefits as seen in the RAVEN study currently being conducted at the University of Pittsburgh. To access telehealth services, special telehealth carts are wheeled into each room. Or, each room has a Telehealth unit installed. Either situation the unit is expensive, and requires a large capital investment. Accessibility questions, such as what units should the carts be placed on, how many carts are need must be determined to know the capital investment required. However, since Telemedicine is a new frontier for long term care there is unease with investing too much in the technology. Under utilization with a large capital investment is a very valid concern. The training costs are high as well. Specialized training is required on the carts, and due to the large turnover of staff in long term care facilities keeping up with the training requirements is also a challenge.
    I was thinking how can we minimize the capital investment for long term care and make telehealth more accessible for nurses?  MD's are moving to Ipads for charting and to do telemedicine consultation. What would it look like if  we moved away from the carts for nurses and have them initiate telemedicine consultations with iPads? At a Health 2.0 event in Pittsburgh this week on Aging, Mildred Morrison from the Area Agency on Aging discussed that we need to make technology invisible, and integrated it into every day life.  That way it doesn't seem as scary and foreign.   The carts are intimidating, and only a select few "champions" or specialized "Telemedicine Coordinators" often are the ones to operate and use Telemedicine carts. Most RN's have iphones in their pockets and are comfortable using the technology. By using iPads to initiate telemedicine calls it becomes the new age pager for nurses. The remote telemedicine specialist team now becomes an extension of their in house care team.
     Of course you will say, but how can they hold the iPad and help examine their client? How can they zoom in and see a wound? I'm sure there is a place and time for the telemedicine carts.  However, if people are accessing specialists in their own homes using smart phones,  let's put this easy to use, widely available technology into the hands of nurses.