Medical College of Georgia

Telemedicine Morning Report Helps Ensure Continuity of Care

by Toni Baker

It’s just a few minutes past 8 a.m. and Dr. Kevin Trapnell is watching his watch.

"I want to go ahead and get started," he says. The residents, students and faculty are still gathering on the fourth floor of the Medical College of Georgia Hospital for family medicine morning report, but there’s a lot that needs to be covered.

Dr. Trapnell begins by introducing new interns and the family medicine team treating inpatients. His introduction primarily is for the extended team that morning, the staff treating patients more than 50 miles away at Tri-County Health System, Inc., in Warrenton, Ga., a network of outpatient clinics serving Warren, Glascock, Taliaferro and Hancock counties.

The two sites have a natural connection because MCG has helped Tri-County provide primary care in these counties; they have an electronic connection as well because both are part of the Georgia Statewide Telemedicine Program.

"I don’t know if y’all can see our list right now, but it’s mainly Tri-County patients," the affable young doctor said, stirring laughter from his colleagues at MCG and those in Warrenton.

"I love it," says Dr. Joseph Hobbs, chairman of the MCG Department of Family Medicine, as the monthly interchange winds down about a hour later. Until he became chairman in the summer of 1998, Dr. Hobbs frequently provided coverage of inpatients on the family medicine service at MCG Hospital and, as is true today, a large number of those patients are referred from Tri-County. He kept hearing concerns from the doctors in Warrenton about not receiving timely information on the status of patients sent to Augusta and it dawned on him that the telemedicine technology that enabled MCG doctors to see patients in Tri-County could be used to discuss patients requiring hospitalization in Augusta.

"I think the biggest thing is it improves continuity," says Dr. Deborah Crawley, medical director at Tri-County. Often patients will be discharged from the hospital and back at her clinic before she gets their discharge summaries. With monthly morning report via telemedicine, the health care providers at both ends get to sit down and review what’s happening with patients of common interest at that moment, including reviewing lab tests, X-rays, computerized tomography or magnetic resonance imaging scans.

Today one of the patients Dr. Trapnell is discussing is an elderly male patient of Dr. Crawley’s whose family left him in the emergency room of a nearby hospital complaining of abdominal pain and with an elevated blood pressure. The hospital referred him to MCG. By the time he arrived, the abdominal pain had passed but his blood pressure still needed treatment. Also a touch of pneumonia in his right lung was detected. Upon discharge he was placed – amazingly quickly – in a nursing home in Warrenton.

"I’ve seen him since. He’s very happy there," Dr. Crawley says. "Yes. He was living by himself and I think that was a concern," Dr. Trapnell says. "He wasn’t eating or taking his medicine. He’s obviously much better off now."

There are many other patient whose stories are shared this morning, such as the two newborns, both generally healthy, but one whose abnormal genitalia caused concern and prompted a referral to pediatric urology; the 87-year-old woman with an altered mental status and a history of urinary tract infections; the fussy 7-week-old with a fever in the early stages of a viral infection; and the 45-year-old with a history of fatigue, malaise, increasing dizziness and difficulty breathing. Information and comradery flow in both directions. "We know the patients well," Dr. Crawley says, so the health care providers in Tri-County provide their insight into a patient and fill in the many blanks that medical records don’t cover.

Telemedicine morning report also is an additional opportunity for MCG residents and students to interact with health care professionals outside of the university and get a flavor for how medicine is practiced in rural settings.

"That’s the kind of medicine I’ll eventually be practicing," says fourth-year medical student Christopher Haddock. He’s from Ringgold, Ga., and has a commitment to practice in rural Georgia. "Technology facilitates rather than hinders," he says. "It would be so difficult with everybody here and everybody there coordinating schedules to get everybody to come to a meeting. With the technology, everybody can meet in one place where they are, take an hour out of a day, discuss the issues, then get back to their regular work routine." He and Dr. Trapnell, a native of Douglas, Ga., who plans to return there to practice, would like such face-to-face professional interaction whenever they get where they are going.

"The person who wins in all this is the patient because the patient doesn’t have discontinuity of care," Dr. Hobbs says. "When the patient comes in to see Dr. Crawley on Monday, regardless of whether the paperwork is there, Dr. Crawley already knows the care that has been provided for that patient. It makes things go a lot smoother. If she needs specifics, such as lab results, she has a better idea of what already has been performed before she orders additional studies."

This telemedicine morning report between two old friends in just the beginning, Dr. Hobbs says. He’s started the same thing with Satilla Regional Medical Center in Waycross, which has a joint rural track family medicine residency program with MCG, and has plans for reaching out similarly to many cities where there is a concentration of physicians who work with MCG family medicine.

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Medical College of Georgia Telemedicine Center