Telemedicine Advances improve health care

and patient-doctor communications
When people think of what the advances in computer technology have done for society in the last few years, most would not realize that the Internet and computers are doing wonders for the health-care industry.
In reality, the technological revolution has brought numerous opportunities for doctors and hospitals to improve patient care through what is being termed telemedicine.
There are several different aspects to telemedicine, according to Jonathon Linkous, executive director of the American Telemedicine Association.
The area that is growing most rapidly is that of specialty services, such as teleradiology. In a clinic where there is no radiologist on staff, a patient can have a scan done and the information is recorded and stored digitally so that it can be sent to a radiologist at another clinic, hospital or if it is after-hours, even to the radiologist’s home, Linkous said.
“Most major specialties are beginning to dabble in telemedicine,” Linkous said, citing other areas besides radiology including dermatology and mental health.
Teleradiology is relatively inexpensive and fully reimbursed by health insurance providers.
Telemedicine is helping to lower costs to patients by reducing the number of hospital stays, emergency room visits and unnecessary doctor visits. Telemedical monitoring systems are paid for by HMOs and provider programs such as Medicare because of the overall reduction in costs that result.
Some areas of telemedicine are Internet-based. Remote monitoring by physicians and even diagnosing over the Web are becoming more common, Linkous said.
The health-care industry is slow in adopting the latest advances in technology, but it is happening.
“Patients love it. They are being given access to care they never had before,” Linkous said. “Physicians are taking a while to understand.”
Most of the companies that are involved in telemedicine are smaller ones, those that make the products and those that are involved in telecommunication and consulting.
One private telemedicine company is TransMedEx, a telemedicine monitoring and diagnostic company based out of Melville, N.Y. It specializes in telemedicine for patients with common heart problems such as palpitations, dizziness, fast heart rate, chest pain, etc.
TransMedEx offers a Web-enabled Holter Monitoring system that can generate the same data as a standard 12-lead EKG, but with only five electrodes instead of 10, causing the patient less discomfort and greater mobility, said Charles Martin, executive vice president of TransMedEx.
The Holter monitor records each heartbeat during a 48-hour period while the patient goes about his or her daily routine. That allows the doctor to gather more comprehensive profile of the heart. It is light-weight, about the size of a pager and runs on a single AA battery.
TransMedEx is also the first company to provide a long-term angina monitor. The system allows doctors to determine if a patient is suffering from a harder to identify disease such as coronary artery disease, ischemia, which is a blockage of oxygenated blood to the heart or angina, which is spasms of pain in the chest due to an anemia of the heart.
The monitor can be worn for up to 30 days. It scans the patient’s heart every 45 seconds. When a patient feels the symptom, he or she presses a record button and the device will record the reaction of the heart for the 45 seconds before, during and after the symptom, Martin said.
The problem for most patients arises when they have the symptom, go to their doctor and the symptom is no longer there. TransMedEx’s eight different monitoring systems give doctors a better chance of finding a serious problem more quickly.
“Some companies mail their monitors to their patients. We don’t,” Martin said. Either the doctor, a member of his or her staff or a TransMedEx technician goes to the patients home and sets up the monitor.
The patients are monitored over standard tool-free phone lines by cardiac trained technicians, registered nurses or emergency medical technicians 24 hours a day, seven days a week. If an emergency situation arises, the patient’s doctor is notified immediately.
TransMedEx has been in existence for 4-1/2 years and has a presence in seven states: New York, New Jersey, Connecticut, Pennsylvania, Florida, Georgia and Arizona.
The only drawback to this technology that Martin could see is the lack of public awareness, although TransMedEx monitors more than 500 patients per month and has 900 physicians referring patients to them.
“Not enough physicians know about (us). If they do, we are the first line of defense,” Martin said. “We’re not only helping lives, but we know we’re doing our part in saving lives.”
CyberCare, Inc., is another network-based telemedicine monitoring company out of Boynton Beach, Fla. Its technology allows doctors to have access to patients’ vital signs over the Internet. CyberCare’s technology is most helpful for managing patients with chronic illnesses.
In the mid-1990s, CyberCare did an evaluation for the military on how to manage the health care of the retired military population all over the world. The firm began using a basic system that stored things such as heart sounds and other vital signs over a phone connection, said Mike Lemnetzer, vice president of business development for CyberCare.
The company has been in operation since 1989, focusing on other aspects of health care such as rehabilitation, but began working on the more modern monitoring technology they use today in 1999, Lemnetzer said.
CyberCare provides the monitoring equipment and the connection but does not monitor the patients.
The technology has a very prominent position in rural areas where a person’s doctor may be 50 miles away. The federal government recently passed a law expanding the area in which a doctor can practice medicine electronically. Now that same patient may only need to drive ten miles to a clinic where he or she can interface with a doctor through video technology, Lemnetzer said.
“The key element is not just the technology,” Lemnetzer said, “but how you use it to the fullest to have medical information.”
Federal funding for advances like CyberCare’s have more than doubled in the last year and will continue to do so, Lemnetzer said.
The cost of the technology is not for everyone, but helps the patients that incur the highest medical expenses.
“We wouldn’t enter into a situation if it wasn’t going to reduce the cost for a patient,” Lemnetzer said. “We’re hoping that spiraling health-care costs will stabilize and then begin a downturn (as a result of telemedicine).”
CyberCare is present in 10 to 12 states, but “is ready to be in all 50,” Lemnetzer said. Programs also exist in Hong Kong, Taipei and Sweden, and plans are being made to roll into the rest of Europe as well, where there is an established broadband system that helps to boost the connections.
Not only are technological advances helping patients receive physicians’ care, but in some cases, the doctors and administrative staff can benefit as well.
The University of Southern California Hospital has recently equipped its staff, including administrators, nursing supervisors and head nurses with Motorola two-way messaging.
“It was an attempt to become more efficient,” said Paul Viviano, USC Hospital CEO. “For a big, sophisticated place with people on the go, it makes sense.”
The health-care industry is what helped make Motorola pagers successful when they were first introduced, said Allan Spiro, marketing manager for Motorola. The technology has evolved from the one-way pagers of the 1980s and early 1990s to the popular T900 and P935 two-way messaging that hospitals like USC are using.
“A large percentage of hospitals are either in transition or looking to implement a two-way messaging system,” Spiro said.
The two-way pagers have a full QWERTY keyboards and the ability to download e-mails from other pagers as well as Internet accounts. Some of the more sophisticated pagers have programs being written for them that would allow doctors to access patients records and other similar pieces of information, Spiro said.
USC Hospital uses its two-way pagers to get health and news updates from MSNBC, USA Today.com and Nutrition.com via the Skytel network. The staff can also store up to 250 contacts, including e-mail addresses, and pager and mobile phone numbers.
USC Hospital’s two-way pagers were first instituted about six months ago, and Viviano feels that the technology has met the hospital’s expectations.
“It eliminates interrupting meetings, leaving voice mail and trying to get back together later in the day,” he said.
Despite all the progress in telemedicine, which is growing by 20 to 30% each year, Linkous insists that telemedicine is not a complete substitute for a doctor.
“There are certainly cases where you should visit a doctor, but there is huge room for growth in telemedicine,” he said. “This is where health care is going and telemedicine is right in the middle.”
Aug. 17, 2001 Small Business Times, Milwaukee