The drama of Internet-enabled telesurgery has produced extraordinary results, allowing world-class surgeons to operate using a combination of secured Internet access and robotics on patients in remote areas of the world.
But of even greater import is the quiet advance of telemedicine into rural communities for use with everyday healthcare.
It certainly made a difference to Michael Harrigan, a financial advisor who suffered a stroke in April 2009 while driving on an interstate highway midway between Milwaukee and Madison, Wisc. Harrigan said that his face was feeling odd and that his breath was getting short. He managed to pull to the side of the highway and call 911 -- and was taken to the nearest available medical facility, a community healthcare center 22 miles off the highway.
“Paramedics from the town of Johnson Creek picked him up,” says Jacklynn Lesniak, vice president of patient services at the Watertown Regional Medical Center. “In the past, he would have been treated by a physician in the ER. Now, we activate our telemedicine protocols with a stroke alert over an Internet-enabled ERS [emergency response system].”
Thanks to the new telemedicine system, the alert traveled a T1 line to the University of Wisconsin Medical Center, which patched it through to a doctor who is a stroke specialist. He examined Harrigan remotely using a high-definition video link back to the Watertown ER. Within 90 minutes of his collapse, Harrigan had started IV treatment of the clot-dissolving drug tPA for his stroke -- a “gold level” response, given the three-hour window of tPA’s post-stroke effectiveness.
“This is very important to rural healthcare centers because often victims of stroke don’t get to the ER soon enough,” says Lesniak. “Then, if you don’t have a stroke specialist on staff, there is a hesitancy to use stroke treatment medications right away, since they also have their risks. You want to run all of the tests first.”
Justin Sattin, a neurologist at the University of Wisconsin, describes the previous difficulties for rural patients: “Before telemedicine, we were communicating with the physician in the emergency room via telephone. The ER physician would verbally describe to us how the illness was presenting itself and would report on what the exam results showed. Then he would tell us what the radiologists had told him. There was no visual contact with the patient or the family.” With treatment discussions going through second- and third-hand recountings, there was always the risk that critical factors were getting lost in translation. Meanwhile, the clock was ticking.
“Time is a critical element in the treatment of strokes,” says Sattin. “Awareness of stroke symptoms is absolutely critical. Sudden weakness or numbness on one side of the body, trouble speaking, a bad headache, incoordination, visual disturbances, slurred speech, or a droopy face are all signs of stroke -- and patients have to recognize that this is an emergency… Although there is new evidence that treatment can occur as late as four-and-a-half hours after the onset of stroke, the standard window is treatment response within three hours.” If you delay beyond that, the chances for a successful outcome diminish by 15 to 20 percent.
Sattin sees telemedicine as a way to level the treatment “playing field” between urban and rural areas. The University of Wisconsin Medical Center envisions a statewide network of telemedicine centers within the next five years.
The plan for a statewide net is a solid one, since licensure of physicians across state boundaries is a major legal hurdle for telemedicine. States have unique licensing requirements -- though federal agencies are reportedly working to create a model that would support interstate telemedicine.
The other legally active areas are security and privacy. “In the past, healthcare institutions, not their business partners, have been held accountable by the federal government to meet HIPAA [Health Insurance Portability and Accountability Act] requirements,” says Cheryl Camin, senior associate at law firm Fulbright & Jaworski LLP. “But with the new high-technology initiatives in the growth stimulus bill, the scope of HIPAA compliance is extended to healthcare business partners like telemedicine vendors, who will face civil and criminal penalties if they don’t comply."
New compliance requirements are likely to place pressures on vendors, but they are unlikely to deter adoption of telemedicine.
“Telemedicine is so promising,” says Sattin. “It gives us a much better chance to get to stroke patients in time.”
— Mary E. Shacklett, President, Transworld Data