A Tonic for Telemedicine


Long overshadowed by other communications technologies, telemedicine may finally gain wider acceptance as a result of a decision by federal regulators to provide $400 million a year for rural health-care facilities to obtain high-speed Internet access.

The Federal Communications Commission, as part of a complex restructuring of telephone rates to promote affordable “universal” service for the poor and those living in rural areas, approved the new funding on May 7.

The decision will probably help jump-start telemedicine, which utilizes electronic communications technology such as videoconferencing and computer networking to allow physicians to monitor patients or even make diagnoses from afar. Proponents say use of the technology will lower medical costs and help consumers avoid the inconvenience of traveling long distances for medical treatment.

The impact will first be felt by rural health-care providers who can electronically exchange patient data, research and even perform diagnoses over the global computer network or private computer networks. But experts say providers such as health maintenance organizations that are seeking to lower the cost of medical care are likely to start embracing the technology as well.


“Telemedicine allows me to electronically tuck all of my patient’s records under his arm, so to speak, so that when he goes to another physician, the doctor has all the information he needs. . . . It’s [akin to] an electronic house call,” said Dr. Jay H. Sanders, president of the American Telemedicine Assn. in Washington.

Though telemedicine may sound futuristic, the use of electronic communications technologies to provide clinical care has been around at least since the 1960s, when scientists at the National Aeronautic and Space Administration began electronically monitoring--from afar--the bodily functions of astronauts.

But although some communications technologies such as electronic commerce and e-mail are burning up the information superhighway, telemedicine has been stuck in the garage, hamstrung by technical, legal and financial obstacles.

Many insurers, for example, won’t cover telemedicine out of fear it may spur fraudulent claims. Some lawyers worry about malpractice and privacy issues. And many physicians and diagnostic laboratories view telemedicine as a competitive threat since it could allow others outside their regions to see patients.


“There is still considerably anxiety about the potential of the technology to have an [adverse] impact on local medical practice,” said Robert Waters, a Washington lawyer who is counsel for the Center of Telemedicine Law. Waters said many states have passed restrictive laws to make it more difficult for patients to have consultations with doctors that are not licensed in the state where the telemedicine procedure is being performed.

What’s more, at its most advanced level, telemedicine requires the transmission of huge amounts of data, images and sometimes sound over phone lines already congested with conversations, Web surfers and electronic mail.

Nevertheless, telemedicine is slowly gaining a foothold in modern medical practice, Waters and other experts agree.

The Health Care Financing Administration is conducting trials among 57 health-care facilities in Iowa, West Virginia, North Carolina, Georgia and Michigan to determine whether it should extend payments beyond the narrow range of telemedicine procedures it currently covers--radiology examinations and a few other procedures. If the agency decides to cover more telemedicine procedures, private insurers will probably follow, experts say.

Meanwhile, a growing number of physicians are using telemedicine to let remote labs analyze a patient’s blood or to allow doctors in another location to view or even administer a fetal sonogram, experts say. And some health maintenance organizations, such as Oakland-based Kaiser Permanente, are applying telemedicine to a wide variety of medical uses.

Kaiser says that for the last year, it has been using personal computers equipped with modems to facilitate remote psychiatric evaluations and to monitor cardiac and diabetic patients at home in Sacramento, Marin County and the Antioch area.

Now, scientists such as Geoffrey Fox, a Syracuse University professor of physics and computer science, are working on making remote clinical treatment less passive and more interactive in order to mimic the actual face-to-face contact that doctors say helps facilitate diagnosis.

Fox developed multimedia applications for teaching university courses off campus, in other cities. With that kind of technology, doctors could perform more complex procedures, such as assisting in surgeries.


But even at today’s relatively primitive level of technology, FCC Chairman Reed Hundt says telemedicine’s capabilities are impressive.

“It made a great impression on me at the computer technology conference I attended this winter in California,” Hundt recently told a National Library of Medicine gathering in Washington. “Conference participants were invited to strap themselves in for medical exams from [doctors] 3,000 miles away. . . . One hundred apparently healthy people volunteered. The unexpected result was that of those 100, 15 were found to have serious previously undiagnosed medical problems, including diabetes, hypertension and an eye tumor.”

Indeed, telemedicine is producing real benefits, experts say, even in the most difficult of environments.

In a study involving private, military and Native American health-care facilities in Alaska, the University of Alaska at Anchorage is using a network of 9.6 kilobyte-per-second modems to facilitate remote patient diagnosis and transfer radiology images among health-care facilities.

“Nobody is going to build fiber-optic lines to some of these remote clinics,” said Frederick W. Pearce, director of the laboratory at the University of Alaska that is supervising the project, “so we have to think of more practical uses for the technology we have available now.”


Jube Shiver Jr. covers telecommunications from The Times’ Washington bureau. He can be reached at