'Telemedicine' allows patients to get second opinions in just one visit

August 07, 1994|By Michael Dresser | Michael Dresser,Sun Staff Correspondent

HONESDALE, Pa. -- It was a routine medical consultation, with a 21st Century twist.

Marcellus A. Walker, small town doctor, shined a light into Betty Tuleya's ear and peered in with his otoscope. Harold A. Harvey, a renowned cancer specialist, watched as his colleague examined their patient, who was receiving a follow-up examination after successful surgery for a rare tumor on her adrenal gland.

When he finished, Dr. Walker did not pass the instrument over to Dr. Harvey. There was no need. The specialist had seen everything Dr. Walker saw -- and just as clearly. It would have been a tough handoff anyway. Dr. Walker was in Wayne County, in the rural northeastern corner of Pennsylvania. Dr. Harvey was more than 150 miles away at the Milton S. Hershey Medical Center in Hershey, near Harrisburg.

The electronic collaboration of Drs. Walker and Harvey was made possible by a telephone network called PA HealthNet -- an ambitious state project that is bringing the expertise of large teaching hospitals to small towns such as Coalport, Emporium, Coudersport and Honesdale.

The year-old Pennsylvania project is one of several regional networks that are beginning to change the way medicine is practiced in rural America. Telemedicine, the marriage of medical science and advanced telecommunications technology for diagnosis and treatment, is bringing the Mayo Clinic to Marcus Welby.

"It might be one of the most affordable ways to provide medical care," said Dr. Eric Tangalos, clinical and administrative director of telemedicine at the Mayo Clinic. "It also arguably puts practitioners at any point on the continent in touch with any specialist anywhere in the world."

'Growing like wildfire'

For those reasons -- and many others -- telemedicine is expected to emerge as one of the leading uses of the so-called "information superhighway."

John Linkous, who runs the Washington office of the American Telemedicine Association, said there are telemedicine projects in the works in about 30 states. By next year, he said, there probably will be projects in all 50 states.

"It's a cutting-edge field that is unbelievable. It is growing like wildfire," Mr. Linkous said.

Nobody knows just how much economic heat that fire will generate. Sales estimates of telemedicine equipment are hard to come by because often the same equipment used for medical purposes is used for other applications, such as education.

But clearly the potential is enormous, as shown by a sizable roster of medical equipment manufacturers, software writers, electronics companies and telecommunications carriers scrambling for a piece of the market.

For Pennsylvania's project alone, the vendors included Bell Atlantic Corp. as systems integrator, Medical Televideo Inc. as a supplier of monitors and medical equipment, and Compression Labs Inc. as a provider of digital compression computer technology.

Advocates contend the nation's health care system can realize enormous savings through telemedicine. Mr. Linkous estimated that the more efficient use of time and resources could save $15 billion to $20 billion by the year 2000, not counting the money patients could save in reduced travel costs.

The key to the future of telemedicine is the vast amount of medical information that can be transmitted in digital form. From the sound of a patient's heart murmur, to an X-ray image, to the pattern of an electrocardiogram, medical data can be instantly transmitted over telephone and cable television lines to specialists hundreds or thousands of miles away.

"The only disadvantage is they can't touch and feel, but we're finding that's not critical if you have someone who can touch and feel on this end," said Dr. Walker.

The 36-year-old Chicago native is perhaps the main reason that Honesdale, a bucolic town of 5,000 where the parking meters on Main Street accept only dimes and nickels, has emerged as a hotbed of advanced medical telecommunications.

Pennsylvania officials say Honesdale has been the most active of the six "remote" sites on the network, which also includes teaching hospitals at Hershey, the University of Pittsburgh and Temple University in Philadelphia. Of the 21 cases in which the network has been used for referrals, 11 have come from Wayne Memorial Hospital, all but one of those Dr. Walker's cases.

Dr. Walker said his electronic consultations work better than more traditional alternatives, such as calling a specialist by phone or referring a difficult case to a larger hospital.

"It's a better dynamic because the consulting doctor is on the other end, the primary doctor is in the room" with the patient, he said. At the same time, the visual connection helps create a bond of trust between the specialist and the patient, he said.

New uses envisioned

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