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Telemedicine brings high-quality care to rural Virginia

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Print this page by Richard Foster

At Harrisonburg Community Health Center, pregnant women come to a clinic each Wednesday to see University of Virginia obstetrician Dr. Christian Chisholm via high-definition videoconference.

Most of these patients are poor or uninsured, and all are deemed to have high-risk pregnancies because of pre-existing health conditions such as diabetes or hypertension. Previously, to get prenatal care from such a specialist, they would have had to travel more than an hour to Charlottesville, a difficult proposition for many because of their financial and family situations.

“What we were finding was a lot of women were not going to their prenatal visits in Charlottesville because of the distance or problems with transportation,” says the health center’s executive director, Christopher Nye. Now with the center using high-def videoconferencing, the patients are able to show up for their prenatal appointments at the local clinic.

The remote obstetrics clinic is one of several telemedicine programs through which the University of Virginia Health System offers appointments with medical specialists via remote videoconferencing. A growing number of new eHealth programs in the commonwealth are using technology to bring quality care to rural communities in Virginia, many of which have major shortages of physicians and medical specialists.

“There are telemedicine programs in every state, but Virginia has proven itself to be a very proactive state in advancing telehealth as a tool for our communities,” says Dr. Karen S. Rheuban, director of U.Va.’s Center for Telehealth. Rheuban is president of the nonprofit Virginia Telehealth Network, which promotes telemedicine in the state. Rheuban is also a past president of the American Telemedicine Association.
“We are a state of innovators,” Rheuban says. “We have a robust broadband infrastructure and a very supportive regulatory environment.”

Aiding the integration of telemedicine in Virginia, she says, are programs such as the state’s initiative to upgrade the broadband infrastructure in rural localities and recent General Assembly legislation mandating third-party insurance coverage for telemedicine.

Through federal and state grants, U.Va. last year created the Mid-Atlantic Telehealth Resource Center, which will support the expansion of telemedicine throughout Virginia, Delaware, Kentucky, North Carolina, Maryland, West Virginia and Washington, D.C. Charlottesville-based Broad Axe Technology Partners is assisting with the effort. (Virginia firms such as Broad Axe and Richmond-based SyCom Technologies design and install telemedicine systems for medical centers, but the videoconferencing hardware and software they use are designed by global technology corporations such as Verizon, Polycom and Cisco’s Tandberg division.)

Telemedicine pays off for rural Virginia communities, Rheuban and others say. For instance, by increasing prenatal care appointments, U.Va.’s telemedicine program has reduced early births by more than 25 percent in rural localities, says Rheuban.

And that in turn cuts health-care costs. “The outcomes have been stellar,” Nye says. “If you have a low birth weight [baby] that ends up in NICU [neonatal intensive care unit], you’re talking about a lot of money versus the pennies it costs to get appropriate prenatal care.”

“We strongly believe we present a terrific tool for access to care. We have saved Virginians more than 7 million miles of travel to access health care,” Rheuban says.

“The challenge of finding a specialist in the rural community can be quite daunting,” Rheuban says. “A patient may have to take off work when they’re unable to receive services in their own community, and they may have to take a family member with them.”

The Harrisonburg center also is utilizing U.Va.’s telemedicine services for prescription drug management for HIV patients, and it is examining the potential of expanding the program to provide geriatric specialists and some psychiatric services.

At Virginia Commonwealth University Health System, doctors also conduct telemedicine appointments with patients in rural health clinics and hospitals in locations such as Emporia and South Hill, but VCU’s largest telemedicine client is the Virginia Department of Corrections.

VCU offers specialists via remote videoconferencing to more than 30 prisons. Before telemedicine technology was available, it wouldn’t have been unusual for a prison inmate to be transported four or five hours for something like routine medication management for HIV, says Dr. Vladimir Lavrentyev, coordinator of VCU’s telemedicine program.

“Patients would have to travel that far for a 5- or 10-minute visit. Can you imagine?” he asks. The telemedicine program not only has cut transportation costs, he says, but has increased safety for physicians and the public, eliminating possible escapes.

Typically, as in VCU’s prison consultations, medical specialists seeing patients via videoconferencing will work in cooperation with a licensed health professional such as a nurse or primary-care physician who is with the patient and able to assist with monitoring the patient’s vital signs, Lavrentyev says. Some health systems are experimenting with using remote videoconferencing for home health care and for monitoring intensive-care patients remotely.

Advances in Internet and video technology have made the growth of telemedicine a reality, he says. New, encrypted medical videoconferencing systems can deliver high-definition videos via lower bandwidth with security protocols that are HIPPA-compliant.

Telemedicine doctors also have a variety of new peripheral tools at their disposal, such as a handheld camera that captures high-definition imagery and a remote stethoscope that Lavrentyev says “provides a very high quality of sound, better than your conventional digital stethoscope.”

Future applications of telemedicine are boundless, Lavrentyev says.

One of the products in global testing now, he says, is a special pad that would be placed on a patient, allowing distant doctors to virtually palpate portions of the patient’s body and feel as if they were touching the patient in person.

Perhaps the most sci-fi of future telemedicine applications is remote surgery performed via robot. While admitting it’s a “very sexy” idea that captures the public’s imagination, Lavrentyev says that practical application is still 10 to 25 years away, though it would be very useful for emergency surgeries on soldiers on distant battlefields or for astronauts in space.

Several remote surgical procedures have been tested in Canada, and in 2001 a New York doctor performed a transatlantic robotic gall bladder surgery on a patient in France. But the process still has many obstacles to overcome, Lavrentyev says, including maintaining broadband integrity and preventing signal delay from the surgeon’s hands to the robot.

“If you ask me would I lay on the operating table as a [remote robotic surgery] patient these days, certainly no, I would not. But it’s coming,” he says. “I believe it will be something that will one day be a daily-basis procedure.”

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