How Skype and FaceTime inspired remote care for home-ventilated patients

Casavant telemedicine home ventilationFrom a series on researchers and innovators at Boston Children’s Hospital. At left, David Casavant demos TeleCAPE at a Boston Children’s Hospital Innovators Showcase.

It is said that necessity is the mother of invention, so when David Casavant, MD, observed his teenagers routinely using FaceTime and Skype to connect with friends, he had a lightbulb moment. Could videoconferencing help him support his patients—children and young adults who require mechanical ventilation in their homes?

“It just seemed obvious,” says Casavant, a physician in the Boston Children’s Hospital’s CAPE (Critical Care, Anesthesia and Perioperative Extension & Home Ventilation) program, part of the Division of Critical Care Medicine. “In my work we are always weighing the risk versus the benefit to the patient. It’s easy for ambulatory patients to swing by their primary care office, get a prescription or go for an x-ray, but that’s not the case for patients who have to have their oxygen, their suction or their ventilator. If you don’t have to put them on the road you are better off not to.”

Using encrypted, HIPAA-compliant software, Casavant put the “Tele” in “CAPE” to form TeleCAPE, a voice and visual connection between clinicians and their medically fragile patients at home. Casavant’s research, recently published in the Journal of Telemedicine and TeleCare, documented 27 remote TeleCAPE encounters and showed that they prevented the need for 23 clinic visits, three emergency department visits and likely one hospital admission. Vector caught up with him this week.

What is TeleCape and its potential impact on patients or care?

TeleCape is a videoconferencing technology that provides visits to patients who are ventilated in their homes. We use a technology similar to Skype or FaceTime but with much more security in order to protect patient information. We set up a pilot project with 14 families—some for routine health care maintenance, some for follow-up visits and some with patients who were acutely sick. Recently we published our findings, and basically what the data showed is that the sicker you are, the more valuable the image of the patient becomes. The image may reveal things like fatigue or difficulty breathing that may not be easily conveyed by telephone alone.

A clinician's eye view during a telemedicine visit
A clinician's eye view during a telemedicine visit

If you weren’t innovating at Boston Children’s what would your dream job be?

I would want to be a fireman, because I love to play cards. But I am not so hot on the running-into-the burning-building part.

Which innovator or scientist (current or historic) would you most like to have dinner with?

I would like to have dinner with Galileo. It is astounding what he was able to discover using his observations made simply with a telescope, and how much that cost him as a person: he was condemned by the Catholic church for challenging the theory that the earth was the center of the universe.

What sparks your imagination?

Necessity sparks imagination. It drives ideas to solve practical problems.

What innovation could you not live without?

The telephone. It’s the connection piece. You can communicate, but you don’t have to be in the same place.