- Associated Press - Sunday, June 29, 2014

SEAFORD, Del. (AP) - Nicole Tolosa had rearranged her family’s life so they could shuttle her 6-year-old son, Ezekiel, upstate for treatment and therapy for his hearing problems. He has cochlear implants in his ears - the first one when he was 13 months old - and calibrating them meant frequent visits to audiologists at Nemours/Alfred I. duPont Hospital for Children in Wilmington.

That was a long slog from where Tolosa, her husband and their four kids lived in Millsboro, but they managed by making the appointments whole-family trips, with stops for shopping and eating out. “If his appointment was at 2 p.m., we were having to leave here by noon,” Tolosa said. “It became expensive. You’re spending that gas money, paying tolls, having to eat out.”

So when Nemours doctors asked Tolosa if she wanted to try a new way of getting Ezekiel the help he needed, by conducting appointments via a webcam set up at a Nemours’ office in Seaford, she leapt at the chance.

For the past few weeks, she and her son did the therapy in a large children’s exam room equipped with a remotely controlled webcam and a large television screen that showed Ezekiel the doctors he’d been working with in Wilmington. For sessions of an hour or more, they walked him through games and tests designed to show whether the delicate computer and sensors he wears to hear were well-tuned to his auditory nerves.

“It really freed up an entire day. That’s what I feel like,” Tolosa said. “It was very extensive therapy, but I felt like it wasn’t more difficult than being there. And I’d definitely rather drive a half-hour instead of two.”

Ezekiel was the first Nemours patient to use the audiology department’s newly acquired telemedicine equipment in routine care, according to Yell Inverso and Liesl Looney, two pediatric doctors of audiology who work with the 6-year-old.

In an interview conducted using the video chat system, Inverso demonstrated how doctors on her end, in Wilmington, can move the Seaford clinic camera’s field of view around the room and zoom in or out. The clarity of their voices was crisper than what you’d hear on a landline or cellphone call, and the video showing them on a living-room-size TV screen hardly skipped.

“What’s great about a setup like this compared to a computer with Skype, for example, is that we can manipulate the camera. If you were the parent right now, sitting behind the child, I could zoom in on you. Or if the child decided to move around the room I can actually change the direction of the camera and capture the whole experience as if the child were right here with us,” Inverso said.

The Seaford clinic is some 80 miles south of the main Nemours campus, and significantly closer for Sussex County and some Kent County patients.

“The more often we can see a family and the more often we can program the implant, the higher the success level of the child,” Inverso said. “The greater the distance, the more of a struggle it is and the more of a hardship it is for families. … That’s time a child is not in school, when they need to be.”

Other Nemours departments - and, for that matter, other regional hospitals, including Christiana Care Health System - have been using telemedicine for a few years, but they’re still smoothing out how it works for their particular departments. Dr. Nick Slamon, Nemours’ fellowship program director for pediatric critical care, notes his hospital has used iPad FaceTime calls to look at patients at medical centers in Delaware, Maryland and Pennsylvania, helping figure out whether they need to be transported to Nemours.

More recently, the hospital started making those video-call connections even within its own departments, from one end of the hospital to the other. “We’re able to make a virtual connection in 30 seconds versus about five minutes, which can be a harrowing five minutes,” Slamon said. “We can give a few interventions, saying ‘Do this and this,’ while we’re on our way up to see them.”

The collection of far-away hospitals that Nemours can use iPads to collaborate with on patient transfers, is expanding, Slamon said. Nanticoke Hospital in Seaford joined two months ago, and Beebe Healthcare in Lewes might soon link in as well.

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Information from: The News Journal of Wilmington, Del., http://www.delawareonline.com