Telehealth changing care from outer space to local clinics
By Michael Coren
(CNN) -- A coach for the Detroit Red Wings hockey team beams an ultrasound image of a player's ankle from the locker room to a nearby hospital. Doctors diagnose a fracture.
A similar ultrasound device, miles above on the international space station, peers into astronauts' chests and examines how their lungs weathered a recent spacewalk.
Welcome to the world of telehealth. Those examples are a few from the field, more narrowly defined as telemedicine. Telehealth uses digital technology to project a doctor's presence in places as different as rural Kansas and outer space, without the patient ever stepping into a physician's office.
Telehealth made a shaky debut in the early 1990s, when high costs, regulatory barriers and plodding Internet speeds hampered its acceptance. But today, improved technology and falling costs have made innovations like videoconferencing, home medical monitoring and digital records available to more Americans.
It has even become a White House priority.
"The 21st century health care system is using a 19th century paperwork system," President Bush said during an address last month in Baltimore.
Bush cited the subject in his State of the Union address this year, asking Congress for $100 million to improve health care information technology. A presidential committee has said it will release a report in June recommending that federal agencies make it an integral part of the nation's health care planning.
Interest in better medical oversight has spiked since a federal study in 1999 estimated that 98,000 people die annually from medical errors that occur in hospitals -- some of which could be prevented by computerized systems to check prescriptions, monitor drug interactions and offer better access to records.
"Patients will be the greatest winners," said Jeffrey Dunbar, who founded a telemedicine firm in the mid-1990s and now works for Emory University in Atlanta, Georgia. "The technology has come a great way ... We have taken a quantum leap in the past five years."
From e-mail to robotic surgeons
Telehealth technology includes both the prosaic and what was, until recently, science fiction.
Digital records are the simplest and potentially the most groundbreaking telehealth innovation to affect a large number of Americans. Electronic versions of X-rays, body scans and medical charts are increasingly common. Doctors hope that, besides reducing mistaken prescriptions and unnecessary tests, convenient digital records will increase patient access and involvement in treatment.
The Department of Veterans Affairs is already offering patients access to their medical records over the Internet.
Medical specialists can also harness telehealth to reach states or regions where their expertise has been scarce.
One pioneering company called NightHawk Radiology Services has made telehealth into a global business. It offers radiology services in 46 states and more than 400 hospitals -- yet none of its 27 doctors are based in the United States.
The company's U.S.-certified radiologists -- in Australia and soon in Switzerland -- examine X-rays and other medical scans when doctors at U.S. hospitals are off-duty or unavailable. Later, medical staff on-site can review the patient's case personally.
"There is tremendous demand for this type of service," said John Berger, vice-president of Idaho-based NightHawk. "The main reason for all of this is that it will improve patient care. They get an expert who's awake during the daytime to look at those results."
NASA science officer Peggy Whitson uses the ultrasound equipment on the international space station.
Other sophisticated applications of the technology are emerging.
They include interactive devices such as bedside computers that link nurses to patients, tailor drug regimens and head off signs of complications.
Robots -- remotely controlled by surgeons across the room or, possibly, across the country-- are also performing surgery in more than 100 U.S. hospitals.
The American Telemedicine Association, an industry group founded in 1993, counts about 150 telehealth networks operating in the United States. Each network may consist of a large central hospital linked to as many as a hundred small clinics or even homes.
"Telemedicine is [being] integrated into medicine," said Jonathan Linkous, executive director of the ATA. "It's kind of how we want it."
Telehealth in the field
Telehealth success stories have attracted the interest of multinational companies, universities and the military. The U.S. Army is testing battlefield versions of the technology in Iraq to check soldiers for bullet wounds and lung injuries. Companies are outfitting remote outposts such as oil rigs and mining sites with the equipment.
The University of Kansas Medical Center now uses telehealth to treat cancer cases, provide psychiatric care and assist school nurses across the state. According to the center, patients from rural Kansas have access to 300 specialists through its teleconferencing centers.
Linkous said the $2 billion industry is becoming so integral to traditional medicine that it will soon be the standard of care in many places.
He added that fears of losing contact with doctors -- and concerns about quality of care -- have proved unfounded. Although some jobs require a physician's physical presence, others can be accomplished efficiently with technology.
"When you look at clinical efficacy studies [of telemedicine], the results have uniformly come out to be just as good," Linkous said. "I don't think we're going to put doctors out of business, but the quality of care will improve dramatically."
The government is also vying for a place at the forefront of telehealth.
The Department of Veterans Affairs recently announced it will launch a telehealth program covering 5 million people within its health care system this fall. The VA initially expects at least 25,000 people to use the technology, such as videophones and computers, to help manage chronic diseases. During the coming years, it hopes to roll its system out to every branch of the organization.
"The VA is the world's leader in what is being called telehealth," said Adam Darkins, chief consultant for VA's office of care coordination. "It's an extension of the health information system."
Despite rosy projections for the future, barriers to telehealth remain. They include technical hurdles as well as slow-moving regulatory regimes.
Out-of-state physicians are still prohibited from practicing -- even via teleconference -- without a medical license from the state and hospital receiving their services.
Payment is still contentious. Although congressional legislation made telehealth eligible for insurance reimbursement in 1997, private insurance companies are still developing their policies toward telemedicine.
Perhaps greatest of all, the cost of setting up digital record-keeping and telemedicine systems remains formidable. To convert a large hospital to a fully digital system can require an investment topping $100 million dollars.
Although efficiencies from telemedicine could offset some of those costs -- especially as the price of technology falls -- much of that money will go toward improving patient care, not the bottom line.
But promoters of telehealth say health concerns will eventually triumph over cost.
"It's not really about the technology," Darkins said. "It's about the care of patients."