Telemedicine Abdominal Exams & Imaging
Telemedicine Abdominal Exams & Imaging
A study of patients with abdominal pain being seen by physicians at an academic emergency
 department and by physicians who are based remotely (telehealth).

 Hypothesis: When a patient with abdominal pain is examined by a physician at the hospital
 versus a physician who is remote (i.e. not at the hospital), they will agree most of the time
 for the need of abdominal imaging for the patient within 12 hours of their examination.
This will be a prospective, observational, blinded diagnostic concordance study of patients
 being seen for abdominal pain at an academic emergency department (ED) at Massachusetts
 General Hospital (MGH).

 The study will consist of two phases. Both phases will have an on-call telemedicine physician
 who will assess the patient and answer the question about need for imaging.

 The first phase mitigates technical issues with the telemedicine technology by using the
 high-resolution MGH TeleHealth Stroke Cart. This will allow telemedicine hardware that has
 been vetted in the high-acuity and high-reliability Acute Stroke Service and will minimize
 the impact of potential technical problems with iPads and wireless connectivity.

 The second phase will substitute the Stroke Cart with an iPad to mimic the devices that the
 patients will likely be using from home in a direct-to-patient telehealth program.

 Target enrollment is 72 patients total over two phases. Each phase would need 30 patients for
 significant results, and another 6 patients are estimated for patients that may become
 ineligible during the study visit (e.g., potential for contamination if the subject mentions
 the abdominal imaging plans of the in-person provider during the telemedicine examination).

 After consent, the research staff member will page the on-call study telemedicine physician
 and bring the stroke cart (iPad in the second phase) into the examination room. The on-call
 physician will connect to the secure video application and will interview and examine the
 patient. The telemedicine physician will not tell the patient their thoughts on what is the
 cause of their pain, nor tell the patient the next steps in their care. The physician will
 thank the patient for their time and log off of the video call. The telemedicine provider
 will not place orders for the patient's emergency department visit, nor will they document in
 the patient's chart in the electronic medical record. The telehealth provider will only
 perform a telehealth-based examination and answer the study questions asked by the research
 staff member; all responses will be recorded on the electronic data capture (EDC) system. The
 research staff member will notify the in-person team that the telehealth examination is
 complete.

 The in-person examination will follow the current standard of practice with the emergency
 physician scheduled for that shift. The research staff member will ask the same questions to
 the in-person provider after their examination and record the data on the EDC.
Inclusion Criteria:

 -  Patient presenting to the MGH Emergency Department with abdominal pain

 -  English-speaking

 Exclusion Criteria:

 -  Known to be pregnant

 -  Patients with altered mental status

 -  Patients who are critically ill or unstable