Wound Care Teleassistance Using Reacts: Virtual Clinics Serving Patients

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The Telewound Care service developed by the Telehealth Coordination Centre, CIUSSS de l’Estrie — CHUS (Quebec, Canada) enables expert nurses to support, through virtual clinics, resource nurses at each of its facilities facing complex wound issues. This program enables patients to quickly get specialized wound care in their area, helps avoid complications and emergency visits, and cuts down on travel costs and time.

Since 2015, the Reacts collaborative platform’s support of their Telewound Care program has provided a versatile solution to increase the accessibility of wound care expertise, while meeting all safety and performance criteria.

A total of 64 facilities have access to virtual clinics specializing in wound care, spread across the 14 local health networks of 3 health institutions within the RUIS from the Université de Sherbrooke’s territory. Reacts’ innovative features, including the option of using the app in offline mode, enabled increase access to the TASP service, both in a clinical setting and at the patient's home. Moreover, nurses have access to real-time coaching from a wound care expert. This coaching helps leverage the application of wound care prescription rights by reducing the feeling of professional isolation among nurses, who would need to validate certain clinical elements before making a prescription. This timely support cuts down on the time a nurse needs to implement an appropriate treatment plan for the patient’s clinical situation, thereby improving his or her healing.

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Reacts makes tele-ultrasound easy and efficient at the CIUSSS de l’Est-de-l’Île-de-Montréal

logo CIUSSS Est de Montreal
After searching for a technology upgrade solution to relaunch their tele-ultrasound program, the radiology team at CIUSSS de l’Est-de-l’Île-de-Montréal heard about the Reacts platform and its ability to simultaneously and securely transmit multiple video streams in addition to affordably providing a series of interactive collaboration tools that are accessible using existing equipment (computers, standard Internet connection, web cams, etc.). Because Reacts is certified by the Ministère de la Santé et des Services sociaux and supported by the Canadian Medical Association, the platform met the project’s security requirements.

The Reacts solution allowed a significant reduction of costs and led to a wider-scale rollout of the tele-ultrasound service that was quick and easy. The platform also facilitated optimizing mobility by allowing radiologists to conduct Reacts tele-ultrasound sessions from their personal computers, tablets or mobile devices. After a few trial sessions, the team at CIUSSS de l’Est-de-l’Île-de-Montréal decided to proceed with implementation of the Reacts solution for their tele-ultrasound needs.

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Project Using Reacts for Secure Communications at Hôpital du Sacré-Cœur de Montréal

Project Using Reacts for Secure Communications at Hôpital du Sacré-Cœur de Montréal

Communication methods are frequently fragmented, costly, and seldom meet security standards, thereby undermining effective service delivery within organizations and networks, as well as collaboration between healthcare professionals. As the healthcare system is under increasing financial and structural pressure, organizations need to be able to count on simple, secure and integrated collaborative solutions to meet their objectives.

This pilot project’s main goal consisted in assessing the feasibility and impact of implementing the Reacts platform, specifically its instant messaging and secure file transfer features, in order to optimize communications between members of the healthcare teams (physicians, pharmacists, nurses, etc.), and with administrative and support personnel (administrative agents, technologists, coordinators, etc.).

The 11-week assessment project was conducted in the Hôpital du Sacré-Cœur de Montréal’s Cardiology department (CIUSSS du Nord-de-l’Île-de-Montréal), between June 12 and August 24, 2017. The professionals working in the cardiology department must be able to communicate with each other at all times, no matter their specific role within the team (physician, nurse, administrative agent, pharmacist, technologist, etc.) or where they work (ward, outpatient clinic, coronary care unit, echocardiography lab, operating room, interventional cardiology or electrophysiology labs, etc.).

All department staff needing to communicate with other department members were included in this project (n=58), thereby introducing a wide variety of users. Users were divided into two groups: the “Physicians” group (n=22), that included cardiologists and cardiac surgeons, and the “Other Professionals” group (n=36), that included head nurses, administrative agents, technologists, pharmacists, etc. Physicians mostly used the application’s mobile version (iOS) on their smartphones, while most users in the “Other Professionals” group used the standard version installed on their hospital workstations (PC).

Using the Reacts application as a secure instant messaging tool optimized communication between the various stakeholders within the Hôpital du Sacré-Cœur’s cardiology department, with a marked improvement in efficiency and productivity. Participants mastered and used the application easily, and all of them adopted it quickly. Users easily integrated the instant messaging feature in their daily work flow, despite the range of professionals involved and the fact that the study occurred in the summer.

Physicians reported that using the Reacts application facilitated communications with the various stakeholders, thereby enabling them to get an answer to their questions faster (89%), spend less time on hold on the phone (100%) and become more efficient and productive (94%). As relates to users in the Other Professionals’ group, all users reported that the application facilitated and optimized communications with the various stakeholders, and specifically helped them get answers to their questions more quickly, spend less time on hold on the phone, and become more efficient and productive. This last point was further underscored by the fact that 75% of respondents said that improving operational efficiency was instant messaging’s most important benefit.

The hospital’s IT department found the application to be easy to roll out and support, which bodes well for any future large-scale deployment.

Participants and managers all acknowledged that using Reacts made communications more efficient, while complying with security, privacy and protection requirements regarding users’ health information.

Results of this project showed that healthcare teams were very interested in using a tool like Reacts, which facilitates communication and collaboration, and enables them to become more efficient and productive in their daily tasks. This user group’s quick adoption of the Reacts application shows that medical personnel are motivated to adopt and use such tools if they are simple and effective. Increased efficiency and productivity resulting from the various stakeholders’ use of a collaborative communication tool such as Reacts may directly contribute to improving the quality of care given to patients (faster decisions, shorter wait time until patient discharge, etc.). Moreover, greater operational efficiency could help reduce costs.

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Project Using Reacts for Secure Communications at Hôpital du Sacré-Cœur de Montréal

Reacts used in medical simulation at the Collège des Hautes Études en Médecine in France

The Collège des Hautes Études en Médecine (CHEM), founded in Brittany in 1988, is one of the very first French organizations accredited for continuing professional development (CPD). Today, it is a leader in continuing development for healthcare professionals in France and other European countries.

The Reacts platform is used by CHEM instructors at each training session. They have incorporated Reacts in their sessions as a tool that enables them to supervise live clinical simulations and to review the session videos during debriefing sessions with participants.

The CHEM team’s use of Reacts in medical simulation clearly shows the added value that the application provides for both trainers and learners.

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Article regarding the use of Reacts by the National Program for Home Ventilatory Assistance (NPHVA) at the McGill University Health Centre (MUHC)

Published in the October 2017 issue of “L’inhalo”, l’Ordre professionnel des inhalothérapeutes du Québec’s journal, “Telehealth, a virtual reality for patients!”, was written by Véronique Adam, inh., Training and Development consultant at the NPHVA. In summary :

  • The Canadian Thoracic Society guidelines recommend combining home, outpatient and telemedicine visits.
  • The NPHVA provides tele-training services for their partners, multidisciplinary teleconsultations with their partners and patients, and "tele-visits" or virtual visits with patients at home.
  • The NPHVA’s clientele represented almost 1500 patients in 2015, across all 18 of Quebec’s regions.
  • Reacts’ adoption in the NPHVA’s services has reduced travel time, costs and stress, and has provided a sense of security for patients who now have better access to specialized care.
  • Use of Reacts has had positive impacts for the NPHVA, both administrative and clinical, reducing the inherent costs of their practices and increasing the time available to consult with patients.

Published on opiq.ca. See original article on pages 19-22 (note that the article is in French only)

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“REmote SOLutions for Telementoring pocus-Echocardiography”, a study using Reacts, presented at the Society of Cardiovascular Anesthesia 2017 annual meeting

Worldwide, hundreds of thousands of ultrasound users in various medical disciplines require training and/or supervision. The problem for many professionals is obtaining access to adequate, quality training, which often presents a significant bottleneck to improving care.

Dr Choo et al’s team at the Cardiac Anesthesiology department of the University of Ottawa Heart Institute presented their “REmote SOLutions for Telementoring of pocus-Echocardiography (RESOLUTE)” study at the recent annual meeting of the Society of Cardiovascular Anesthesia in Orlando, Florida, April 22nd-26th.

The primary objective of their study was to determine the feasibility of telementored instruction of cardiac point-of-care ultrasound (POCUS) using Reacts. They sought to investigate whether bedside ICU nurses with no previous sonographic training could be instructed remotely, using Reacts, to obtain five standard cardiac POCUS images on a high-fidelity ultrasound simulator. 33 cardiac surgery intensive care unit (CSICU) nurses with no previous sonography training were recruited to participate in the study. An instructor guided each subject in real time, using Reacts, to obtain sufficient POCUS cardiac views on the ultrasound simulator to determine the underlying pathology. The subject, instructor and reviewing expert were blinded to the diagnosis. Mean instructional time was 2.37 minutes; mean time required to acquire 5 standard TTE views was 3.60 minutes; and mean time required for instructor to guide a subject through a POCUS exam and obtain a diagnosis of underlying pathology was 1.42 minutes. Both reviewers correctly identified 32 out of 33 underlying pathologies.

The study concluded that, guided via Reacts, telementored CSICU nurses with no previous sonography experience were able to acquire sufficient quality POCUS images for basic interpretation both rapidly and consistently. It demonstrated the feasibility of remote instruction of the psychomotor skills necessary to perform point of care cardiac ultrasound by sonography-naive subjects. The study also validated that remote instruction extends the reach of the expert physician not only for instruction, feedback and troubleshooting of POCUS education but also that it could bypass the need for local experts entirely.

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Reacts presented at World Congress Ultrasound in Medical Education

Dr. Peter Steinmetz’s team from McGill University presented their abstract on “Teaching the FAST algorithm with the Reacts platform – a pilot study” at the World Congress Ultrasound in Medical Education, which was held Sept 23rd-25th, 2016, at Texas Tech University Health Sciences Center. Their project aimed at determining whether Reacts could be used to remotely teach the focused assessment with sonography for trauma (FAST) algorithm, a well-established bedside ultrasound skill. They also wanted to determine whether teaching via Reacts could be as effective as in-person for imaging the main components of the FAST algorithm. Finally, they wanted to determine whether teaching via Reacts is as effective as in-person training in terms of practical and theoretical ultrasound skills. Six ultrasound naïve medical students (n=6) received study material and a session on how to perform the FAST exam. One group of students was taught remotely (Reacts; n=3) and the other group was taught in person (In-person; n=3). Effectiveness of Reacts versus in-person teaching techniques was assessed by completion of a practical and theoretical test before the teaching session (pre-test) and identical tests immediately after the teaching session (post-test).

The study results and conclusions were that: 1. Reacts teaching was equivalent to in-person teaching for the acquisition of practical ultrasound skills; 2. Reacts can be used to remotely teach ultrasound-naive students the bedside ultrasound skills necessary to identify discrete components of the FAST exam.

The presentation of the abstract was very well received at the congress and got excellent comments. We congratulate Dr Steinmetz’s team for their superb work and innovative forward thinking in bringing ultrasound education to the next level.

This great work demonstrates once again the important role and benefits of Reacts for remote ultrasound education.

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See other news on the use of Reacts for ultrasound education:

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First project using Reacts, presented at the Carrefour des connaissances of the CIUSSS du Centre Sud de l’Île de Montréal

Published on iitreacts.com (pdf) (French only)

The first edition of the Carrefour des connaissances, held on June 2nd, was organized by the CIUSSS du Centre Sud de l’Île de Montréal and focused on motor, sensory and language impairment. For the first time, thanks to the integration of the physical impairment continuum within the CIUSSS, research teams and practitioner-researchers from l’Institut Raymond-Dewar and l’Institut universitaire en réadaptation Gingras-Lindsay-de-Montréal joined their counterparts from the Centre de réadaptation Lucie-Bruneau to present a comprehensive overview of current research in the field. Since March 2015, speech therapists from these institutions have made progressive use of remote intervention methods using the Reacts technological platform. Results from the "Telerehabilitation in Speech Therapy: a Growing Intervention Modality within Physical Disability" pilot project were presented as a poster at the event. The project demonstrated the following significant therapeutic advantages:

  • Saves time and money for clientele
  • Optimizes less popular time slots
  • Generalization of exercises in another context
  • Greater user availability for interventions, due to avoidance of constraints associated with travel (e.g. fatigue, stress)
  • Access to the home, providing an added value to the interventions (access to family, and a better understanding of the user’s environment)

Other Findings

  • It is possible to perform speech therapy directly in the user’s living environment, at low cost to the organization through this new technology
  • Telerehabilitation enables continuity of services and promotes learning, contributing to social participation and quality of life

The project also demonstrated high user satisfaction, both among patients and healthcare professionals. The next step in this project is the integration of telerehabilitation as a permanent means of providing services, as required by the CRDP. Applications for future exploration include for users who are returning to work, receiving chemotherapy, or who cannot afford travel costs.

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Reacts Makes a Difference in the Lives of Ventilation-Assisted Patients

Reacts has been selected by the McGill University Health Center’s (MUHC) National Program for Home Ventilatory Assistance (NPHVA), to enhance its overall telehealth services and improve remote support for its home-based ventilation-assisted clientele.

The NPHVA team is composed of ultra-specialized professionals that supports patients and their families in their home settings, while complementing various local and regional healthcare professionals through a range of clinical, technical and training services. In order to optimize the team’s efforts, the MUHC decided to replace their old telehealth platform with Reacts, a versatile technological solution providing unique interactivity.

"Reacts allows us to provide innovative remote support and care for patients in the comfort of their own homes, no matter where they are,” says Lyne Noel, Coordinator of Respiratory Services, Adult Sites, MUHC. “With this digital video collaboration platform, we can really make a difference in the quality of life of patients and their families."

With Reacts, the NPHVA’s professionals can use their own computers or mobile devices to interact with patients and caregivers, regardless of location. They can propose virtual home visits, organize collaborative sessions between healthcare professionals, provide remote training to patients and providers, all thanks to a variety of features such as audio-video exchanges, remote auscultation, secure file transfers (e.g. respirator data), etc.

"The Reacts platform is easy to use, secure and focuses on collaboration, supervision, education and remote assistance,” says its founder, Dr. Yanick Beaulieu. “It therefore meets the NPHVA team’s many needs, and more importantly brings healthcare professionals and their patients closer together."

The NPHVA team introduced Reacts to its service delivery model in January of 2016. Implementation at the provincial level will continue throughout 2016.

Source : Canadian Healthcare Technology - Vol. 21, No. 3, April 2016

Reacts used to provide tele-assistance in neurosurgery at the Centre Hospitalier Universitaire de Montréal (CHUM)

Published on chumontreal.qc.ca (pdf) (French only)

Summary from the EXPERIMENTATION DE REACTTM COMME OUTIL DE TELEASSISTANCE EN NEUROCHIRURGIE report, published by the Service de l'évaluation des technologies et des modes d'intervention en santé (ETMIS), Centre Hospitalier Universitaire de Montréal (CHUM).

Telehealth will undoubtedly play an expanding role in the delivery of healthcare. Information technology can facilitate consultation, surveillance and follow-up. This technology can also enhance the exchange of information between health professionals and patients, as well as between health professionals. A review of the literature provides evidence in support of the feasibility and safety of surgical tele-mentoring. The Reacts platform (Remote Education, Augmented Communication, Training and Supervision) was developed by Innovative Imaging Technologies, a Montreal company.

This technology was used to provide tele-assistance during the supervision of neurosurgical residents and fellows in a CHUM pilot project. The assessment focused on technical performance as well as tester rating of the tool’s user-friendliness, and was undertaken by means of questionnaires and a group discussion. The results were positive. Participants gave “perfect” and “almost perfect” scores in response to questions pertaining to the quality and resolution of images transmitted, the speed of real-time transmission (no delays), set-up time and usability of the Reacts interface. This interface allows live two-way interaction between the learner and the supervisor, by means of tools beyond mere sound and image. Such is the case with the chroma-key, pointers and multiple video streams on a single screen (e.g. simultaneous transmission of microscope or fluoroscope images to both the surgical setting and supervisor). Participants also noted an increase in sense of security and smoother supervision.

In conclusion, Reacts’ technology allows remote assistance of surgeons, owing to the real-time interactivity provided by this tool.