Here are some examples of how
telemedicine is being put into use in Indianapolis:
• St. Vincent Hospital's Stress Centers plans in
January to begin a telepsychiatry program in conjunction
with its affiliate in Winchester. The initial contact
with a psychiatrist would be made in person, but monthly
followup visits will be planned with cameras and
monitors.
Paul Lefkovitz, executive director of
St. Vincent Stress Centers, said the program is a
response to the scarcity of medical specialists in rural
areas and efforts to improve patient access despite
geographic barriers.
• Residents of Lockefield
Village Rehabilitation & Healthcare Center are part
of a trial involving video hookups with doctors on call
nights and weekends. Dr. Michael Weiner, assistant
professor of medicine at the Indiana University School
of Medicine and the school's Center for Aging Research,
said a portable video conferencing work station can be
wheeled into a resident's room and images transmitted to
the on-call doctor's home computer.
Since the
project began in 1999, equipment has been installed in
the homes of seven physicians who share night and
weekend coverage, allowing them to visually assess
patients. That can help them decide, for example,
whether a patient should be transferred to an emergency
room, Weiner said.
• St. Francis Hospital's
radiology department takes many X-rays digitally,
bypassing the more familiar films, and doctors are able
to transmit them electronically.
That allows
second opinions to be obtained quickly, said Roger
Barksdale, vice president of ancillary services at St.
Francis. That can be particularly valuable for medical
professionals in rural areas, he said, such as a general
radiologist who wants a more expert opinion from a
specialist.
Lieann Wade (left),
goes over a record of blood-sugar levels with patient Pat
Kistler. Although Kistler, 62, sees Wade only once a week, and
her doctor visits even less often, her vital signs are
monitored daily with HomMed. -- Matt Detrich / staff
photo
Telemedicine puts aid as close as the phone
Experts say programs are a cost-effective and
convenient way to connect doctors and patients.
Pat Kistler sees a nurse once a week and her doctor
even less frequently. But both health professionals have a regular
accounting of her blood pressure, heart rate and blood oxygen
readings -- all transmitted via a device in her home.
The 62-year-old Northwestside resident and her
health-care team are participating in telemedicine, an increasingly
common approach that uses technology to connect doctors and patients
who aren't in the same place.
In central Indiana, the approach is being used in
areas ranging from psychiatric consultations to X-ray
transmissions.
"There are all kinds of really, really neat things . .
. that are not being used routinely yet, but are out there," said
Julie McGowan, associate dean for information resources and
educational technology at the Indiana University School of
Medicine.
Though some aspects of telemedicine have drawn
criticism for failing to provide safeguards and establish
doctor-patient relationships, proponents say the practice is more
convenient for patients, especially those in rural areas, and could
ultimately lead to better and more cost-effective health care.
"We can't send a nurse to visit a patient every day,"
said Dr. Dev Anuroop Brar, president of Nightingale Home Healthcare
of Carmel, which is distributing home monitoring devices to clients.
"Now we know here (via the computer) what happens with the patient
the other days."
Indiana does not track the number of patients turning
to telemedicine. But the practice is expanding enough that the
Indiana Medical Licensing Board has begun collecting information so
it can develop guidelines to govern its use, said Lisa Hayes,
executive director of the Indiana Health Professions Bureau.
Some information will focus on Internet contact
between patients and doctors who have never met, an area that has
drawn fire. The national eRisk Working Group for Health Care, a
collaboration of medical societies, insurers and medical boards,
recently recommended tougher guidelines for Internet contact between
patients and doctors, saying physicians should establish
relationships with patients before providing services over the
Internet.
But other data likely will focus on the kinds of
transmissions Kistler makes to Nightingale.
Nightingale began distributing its $9,300 monitoring
devices to patients in July, and currently has 28 in use in central
Indiana. By the end of the year, the company expects to have about
45 monitors in the homes of patients.
The device, a phone book-size box into which
attachments such as a blood pressure cuff and a scale can be
plugged, prompts patients to take their vital signs at a specific
time, using the attachments.
After collecting the information, the machine sends it
to Nightingale's Carmel office, where Lieann Wade, a registered
nurse, monitors the numbers.
If the numbers show something's not quite right, or if
the information doesn't come through, Wade follows up with a phone
call. In cases like Kistler's, she makes regular visits to the
patient's home.
Brar said the data collection has multiple uses.
"Sometimes it's about need, but sometimes it's more
about prevention," Brar said.
Telemedicine advocates acknowledge there are still
challenges ahead.
Nightingale's monitors, for example, are not paid for
by insurance. While the company is paying the cost of them now, Brar
said he hopes to demonstrate to Medicare that the monitors make
health care more cost-effective and therefore should be covered.
And while IU's McGowan expects telemedicine to expand
as technology advances, she said the practice has yet to gain full
acceptance.
"The technology will be there when people -- and it's
mostly a people issue -- are ready for it," she said.
