With new tool, surgeon’s consultation is a click away for physical therapists providing home care

Visiting Nurse Association physical therapists who provide home care for patients recovering from joint replacement surgery have a new tool to quickly access expert medical advice in an exchange that’s creating peace of mind, educating caregivers and saving needless trips to the emergency department.

Vocera, a HIPAA-compliant communications platform that’s widely used at Christiana Care, enables clinicians to snap a photo of a questionable wound and text it to a surgeon, who can respond in real-time while the provider is still with the patient.

Brian Galinat, M.D., MBA

“In a few seconds, I can take a look and see the wound is healing properly,” said Brian Galinat, M.D., MBA, chair of the Department of Orthopaedic Surgery and medical director for the Musculoskeletal Service Line. “Non-surgeons helping care for the patient, such as physical therapists and visiting nurses, may be less sure. This new way of communicating is decreasing unnecessary hospitalizations, and it’s an educational professional-to-professional exchange. The peace of mind is worth a million.”

Trial use of the Vocera platform in the Muscoloskeletal Service Line began in November 2016. For now, Dr. Galinat is the sole surgeon recipient of the messages, which he said number about one a week. The effort’s initial focus is on patients who have received knee or hip replacements, he said.

“It is an initiative designed to try to provide more knowledge to the care team,” he said. It also has the potential to reduce the overall cost of care, because the instant consultation can prevent unnecessary visits to the doctor or emergency department.

Physical therapists already used Vocera to collaborate with colleagues and schedulers. The platform was introduced by Christiana Care’s Communications Improvement Project in early 2015.

The idea of exchanging text messages and photos isn’t new, but because of the importance of protecting patient privacy, normal text messaging of this sensitive health information isn’t an option. The workflow using Vocera’s secure platform is designed to protect the privacy of patients’ medical information. After two days, the messages are automatically deleted.

Health care providers aren’t permitted to use patients’ names or addresses using standard messaging software, said Rosalind Kelahan, PT, a physical therapist with the Christiana Care Visiting Nurse Association who has worked in home care for 40 years. Vocera is key to the ability to work as a team, she said.

Kelahan has reached out to Dr. Galinat twice — once for a knee replacement and another time for a healing hip. In both cases, Dr. Galinat advised that the patients did not need to come in to see a doctor.

“By the next day, it was fine,” she said. “I was glad it was nothing to worry about — and that I didn’t have to make the decision alone. The communication with Dr. Galinat is invaluable. It makes you more confident in the field, where you’re by yourself, because you know you have backup. The patient is also relieved that we can actually show a doctor, get an immediate answer and they don’t have to go anywhere.”

Barbara Cymbala, PT, a physical therapist with the Christiana Care VNA for 15 years, said the service is a hit with her patients.

“They love it,” Cymbala said. “I say, ‘Listen, I’m going to take a picture and send it over right now.’ The response is typically in a matter of minutes, when I’m still at the patient’s house. I absolutely love it. I think it has made my job so much easier.”