Advances in Health Care Bring Remote Expertise Close

Telemedicine provides patients with remote dial-in diagnostic capability.

Dr. Chad M. Miller operates the RP-VITA robot at the Ohio State University Hospital in Columbus, Ohio.

Dr. Chad M. Miller operates the RP-VITA robot at the Ohio State University Hospital in Columbus, Ohio.

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Leroy Chiao remembers well doing his first ultrasonic eye exam. The test, which looks for a buildup of pressure inside the skull and changes in the optic nerve that cause persistent blurred vision, involves pressing the ultrasound wand against a person's closed eye and manipulating it to get a glimpse of all the various parts. The medical team that guided Chiao when he practiced his first test in 2004 was working in Houston. Chiao, then the commander of the International Space Station, was orbiting some 220 miles above Earth.

"NASA invented telemedicine," says Bobby Satcher, a former astronaut who flew on the shuttle's 31st trip to the space station and is now a surgeon and assistant professor of orthopedic oncology at MD Anderson in Houston, which has recently announced a big push into teleheath. As long ago as the 1960s, mission control received updates from sensors worn by the astronauts about their heart rates, body temperature and respiration from as far away as the moon. Chiao and his fellow astronauts had previously been trained to observe their crewmates for certain other damaging effects of prolonged minimal gravity, such as degradation of the bones and teeth. Today, he notes, every ISS crewmember receives regular ultrasonic eye exams guided by specialists on the ground.

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Americans are increasingly flooding the path broken by the astronauts. Patients around the country can now teleconsult with distant doctors about everything from nausea and fever to cancer treatments. In January, the Federal Communications Commission announced up to $400 million in annual funding for the development of broadband networks to link rural areas and urban medical hubs. Experienced surgeons are mentoring younger practitioners miles away, watching the action on camera and carrying on conversations. And, if you find yourself desperately in need of a specialist in the ICU, don't be surprised if a robot rolls up to your bedside with a doctor working elsewhere speaking to you on a screen. All told, the telehealth market is expected to more than double in just five years, from $11.6 billion in 2011 to $27.3 billion in 2016, according to a 2012 report from BCC Research.

"Within a minute, I got a call from a patient service representative," marvels Ken Krakaur, 60, of Williamsburg, Va., who was recently so incapacitated with flu-like symptoms when his wife was out of town that he opted to try a virtual doctor visit. As senior vice president of Sentara Healthcare, a hospital system in Virginia and North Carolina, he took advantage of a new health-plan feature, one that will be rolled out to members of selected Optima Health insurance plans this year: an immediate consultation through MDLive, a telehealth provider based in Sunrise, Fla. In just 10 minutes, he was on the phone with a physician, who asked a lot of questions and recommended over-the-counter medication. Sentara calculated that teleconsulting would save money as well as aggravation for patients, Krakaur says. For simple conditions like a cold, the flu, sunburn, joint pain and nausea, for instance, the average cost of care for an office or urgent care visit is $119 versus $39 for virtual care. Plus, "I didn't need to spread my disease to other people in the office," he adds.

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Increasingly, patients with serious or complex illnesses get to tap otherwise tough-to-access expertise. "Anything I want to show him, he can see," says Richard Riggs, 67, a tire salesman from Hays, Kans.,who underwent surgery at the University of Kansas Medical Center for melanoma in 2009. The cancer returned a number of times between 2009 and 2012. Though KU Medical Center in Kansas City is nearly four hours by car from Riggs' home, a video link at a local cancer center in Hays puts him in regular touch with his oncologist there, Gary Doolittle, who gets help from an oncology-trained nurse in Hays with the physical exams and ongoing care.

After repeated surgeries, Riggs began oral chemotherapy, administered by doctors locally, followed when his cancer progressed by a regimen of ipilimumab, a new agent that stimulates the immune system to fight cancer and has shown great promise in a subset of people with advanced melanoma. Now, Doolittle says, scans show no evidence of disease. At first, remote visits were "a little different," Riggs recalls. But the process has "really worked out well."


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