In a school nurse’s office, near a poster about asthma and a television monitor, Lynette Cook holds a piece of telemedicine’s future.
Using an otoscope equipped with a camera, Cook is spotlighting the infected red areas inside little ears for live video images being evaluated more than 100 miles away. Without having to wait for an appointment and make a trip to the doctor’s office, children at Lowell Elementary School in Phoenix are being diagnosed by doctors and nurse practitioners at the St. Elizabeth of Hungary clinic in Tucson. Prescriptions are called in, and usually within 24 hours, kids are feeling better.
"This is beyond your wildest imagination that this is possible until you see it," said Cook, Lowell’s school nurse, who is continuing an effort that began three years ago as a state pilot program for telemedicine. "It just has so much potential."
The virtual doctor’s appointments are an example of what’s possible — and what’s coming — with the help of telemedicine.
Next summer, the University of Arizona College of Medicine plans to create a hub for telemedicine at its new medical school under construction in downtown Phoenix.
The Institute for Advanced Telemedicine and Telehealth, or THealth, which will be started with help from a $1.2 million federal grant, will develop the medical devices, imaging and telecommunications systems necessary for telemedicine.
"We’re going to be strongly encouraging Phoenix hospitals to look for major roles to become telemedicine providers across the state," said Dr. Ronald Weinstein, director of the Arizona Telemedicine Program. "I think (telemedicine) will be part of ordinary care in the next 5 to 10 years."
Telemedicine — the practice of medicine between two locations with the help of video, audio and electronic information transfer over a telecommunications system — is already widely used in Arizona, mainly in rural areas where access to health care is limited. But leaders in telemedicine, more broadly referred to as telehealth, hope to expand its use in urban settings.
They point to dramatic advances that telemedicine has made in delivering health care services and medical education quicker and easier. Examples of its use include:
• High-tech medical equipment in Tucson that helps specialists quickly evaluate breast biopsies and get results back to the patient in two to three hours instead of two to three weeks. If needed, patients can see an oncologist by video conference the same day. Doctors want to duplicate the process for prostate, cervical and skin cancer screenings.
• More than 1,000 diabetic retinal screenings of patients linked by telemedicine to the Arizona Foundation for the Eye at St. Luke’s Medical Center in Phoenix. The link has resulted in the identification of hundreds of previously undetected eye problems.
• Psychologists and patients who appear to each other over the TV monitor, making therapy sessions possible across a 60,000-squaremile area in northern Arizona. The program, provided through the Northern Arizona Regional Behavioral Health Authority, has seen about 18,000 cases since 1996.
• Inmates who don’t have to leave prison because telemedicine connects them to specialists in the Valley. About 80 percent of subspecialty care for Arizona prisoners has been done by telemedicine.
• Video-conferencing between Banner Desert Medical Center and Banner Thunderbird Medical Center to share medical knowledge gained from pediatric rounds. The UA College of Medicine plans to similarly link classrooms at its Tucson and Phoenix campuses so that professors can teach both places at the same time. In January, Banner Health plans to link its surgery simulation laboratories with the UA College of Medicine.
"I’ll be able to stand in my lab at (Banner Good Samaritan) and teach students in Tucson," said Dr. Mark Smith, Banner’s director of telemedicine. "We’re leveraging resources over larger areas."
Technology that makes health care services and education possible across long distances can also make health care more accessible within metropolitan areas, where the demand for specialists means patients often wait weeks or even months for an appointment, said Weinstein.
Some dermatologists in Tucson, for example, are practicing more efficiently by video-conferencing, allowing patients to be seen in a day or two, he said.
But it may take some time before the virtual doctor’s appointment goes mainstream, health care authorities said.
Patients must be willing to give up face-to-face interaction with a doctor, and physicians have to be comfortable with the technology.
Weinstein said he’s encountered surprisingly little resistance from doctors since the telemedicine project had its first case in Tucson in 1997.
There are times, however, when a physician decides to see a telemedicine patient in person, such as when a dermatologist needs to palpate a skin lesion, or when an orthopedic surgeon wants to see an injured patient before surgery, he said.
"It’s always better to see someone face-to-face," said Cook, the school nurse from Lowell Elementary. "But if your child is sick . . . this gets them care in a timely manner."
Setting up a telemedicine system is not cheap. Although the cost has come down from more than $150,000 in 1996, a standard set-up today costs about $50,000, according to telemedicine officials.
The payoff, however, is improved medical care, they say. The Arizona Telemedicine Project is linked to about 100 sites, provides consultations in 60 subspecialities and has served more than 200,000 patients so far, said Weinstein.
In some cases, telemedicine saves money, he said. Transportation costs for doctors and patients are the biggest savings, with telemedicine officials estimating that telehealth provided in prisons has saved more than $1 million is costs to transport prisoners.
A 1998 study by the Whiteriver Hospital on the Fort Apache Indian Reservation found that it saved $182,000 by avoiding 27 air evacuations because a specialist off-site was able to read CT scans and determine when there was no neck injury.
In one case, telemedicine helped save the life of an 18-month-old child hurt in a car crash when a trauma surgeon at University Medical Center in Tucson provided guidance to a local physician at the Southeast Arizona Medical Center in Douglas, according to telemedicine officials. The guidance, provided over a teletrauma system, helped stabilize the child enough to be transported to an intensive care unit in Tucson.
"There’s no doubt lives have been saved using the system," Weinstein said.