Telemedicine: Adventures in time and space
In April 1924, Radio News Magazine ran a splashy futuristic cover story: "The Radio Doctor – Maybe!" Kids sit around a new-fangled doohickey and say "ahhh" for a distant doctor on a video screen. In this weekly Health & Wealth update, the future is now! Telemedicine is expanding to rural hospitals across the country.
Twenty years ago, telemedicine was new technology, with just a handful of experiments at hospitals here and there. But, now, more and more frequently, rural patients are interacting with urban specialists via live video feed. In small town hospitals, general practice doctors can share high-resolution images and live diagnostics with doctors at big urban hospitals.
Last week, the USDA announced a new round of rural development grants, $34 million going to telemedicine and distance education projects in rural America. In Missouri, eight rural hospitals will get new telemedicine equipment, a total of $776,000.
The biggest chunk goes to Mercy, which runs 30 hospitals in the Midwest. Mercy will use the money to set up telemedicine carts in 12 of its most rural hospitals, where instant access to specialists can save lives.
"One of the main things we want to be able to bring forward to these communities is stroke management in the emergency rooms," said Timothy Smith, with Mercy's Center for Innovative Care. If patients get the clot-busting drug tPA within three hours after a stroke, they have a much higher chance full recovery. Smith says in small hospitals general practice doctors can be reluctant to administer the drug, which can have dangerous side-effects and complications.
In hospitals already using telemedicine for stroke victims, Smith said there is strong evidence that it works. In one Mercy hospital in Arkansas, prior to getting a telemedicine cart, local doctors only administered tPA twice over the course of a year. Once they could communicate with neurologists via the telemedicine cart, they administered the clot-busting drug three times in just the first month of the program.
Another grant recipient is Cardinal Glennon Children's Medical Center in St. Louis, which is getting $144,000 to expand a program connecting rural pregnant women and their local doctors with maternal-fetal medicine specialists in St. Louis.
James Davison is an obstetrician at the county hospital in Rolla, and has been part of Cardinal Glennon's telemedicine pilot program for a little over a year. "There are just an infinite number of reasons why we might want to have a subspecialist look at a baby," he said. If a parent has a family history of birth defects, if the baby seems to be growing abnormally, or if the mom is pregnant with twins, Davison can share a high-resolution ultrasound in real-time with specialists. Pre-telemedicine, moms would have to travel 90 to 100 miles to Columbia or St. Louis to get this sort of care.
I asked Davison if he saw any drawbacks to the technology. The only one he could think of was that it can be so convenient that it might be tempting to overuse it. "You have to make sure that you actually have a good reason to use that service, rather than just asking for it."
I put a similar question to Timothy Smith, the doctor at Mercy. Could this technology enable a two-tiered system, where urbanites get to interact with human doctors face-to-face, and rural residents are left consulting with computer screens?
"I understand the question," he answered. "But I think what we already have is a two-tiered system. You know, where all the specialists are available in the metropolitan areas, and the remote, rural, and frequently underserved areas don't have any specialty care at all."