When Robyn Broomell was pregnant a few years ago, she needed advice from a specialist at the University of Maryland Medical Center because she is a diabetic.
But Broomell, 35, of Rising Sun, never set foot in the specialist's Baltimore office. Instead, she met him several times by videoconference while she was at an Elkton hospital, saving her the trip down Interstate 95.
"At first, I was kind of leery" of long-distance medical advice, she said. "I thought it was kind of an odd thing. But it was very convenient, and I could get used to convenience. It takes me 45 minutes to an hour to drive to Baltimore, and I didn't have to do that."
Broomell was an early beneficiary of "telehealth," in which medical professionals using digital tools and the Web can cut the waiting time for care from days or weeks to minutes.
Thanks to factors including a looming physician shortage, the health care reform debate and the increasing willingness of insurance companies to pay for the practice, telehealth is on the verge of becoming routine.
In the near future you could be connected by video to a specialist dozens or hundreds of miles away. Consider something as mundane as a skin rash. If your primary care doctor thinks she needs outside expertise, she can use digital diagnostic tools to generate high-resolution images of the rash and beam them to a dermatologist in another office for rapid diagnosis.
"More and more companies are seeing the benefits of telehealth," said Greg Billings, senior director at the nonprofit Center for Telehealth and E-Health Law in Washington. "If that doctor looking at that skin rash didn't diagnose it as skin cancer until later, the cost of treatment of that skin cancer is going to be a heck of a lot more."
Universities, technology companies and hospital systems, including the University of Maryland, have been experimenting with telehealth since the 1990s. A major insurance provider -- UnitedHealthcare of Minnesota -- recently announced a national push to persuade its network of professionals, including thousands here in Maryland, to adopt telehealth for their patients.
Remote consultation and diagnosis are ways for medicine to become more efficient even as physicians and other health professionals are increasingly in short supply, policy experts say. For patients living away from advanced hospitals in urban areas, they add, it's potentially lifesaving.
Telehealth systems can screen patients for diabetes, eye disease, kidney problems, nerve damage, vascular disease and complicated pregnancies. The technology is available and relatively inexpensive. It's the regulatory hurdles that present the challenge, experts say.
Because of licensing restrictions, specialists might have trouble treating and prescribing medicine for patients they are examining electronically across state lines. Also, only a handful of states require insurers to cover telehealth care -- and Maryland isn't one of them.
"These are the thorny issues," said Dr. Elizabeth A. Krupinski, an assistant director in the radiology department at the University of Arizona and a past president of the American Telemedicine Association. "The nursing profession has done a lot more in that area than physicians in terms of cross-state licensure. The problem is that every state has their own twist on the regulations."
But telehealth is nevertheless growing. Johns Hopkins Medicine International has used telehealth technology to link its specialists with physicians and patients by videoconferencing in other countries, such as the United Arab Emirates, Lebanon, Panama, Singapore, Chile and Turkey.
Alex Nason, the telehealth program director at Hopkins, said the institution is exploring the possibility of applying telehealth approaches within Maryland. The hospital already has a partnership with Howard County General Hospital in which a robot with a video camera can act as a Hopkins doctor's eyes and ears during a patient consultation.
"Telehealth is not about geography; I really think it's about access," said Nason. "Whether you're 500 miles away or 5 miles away, if you can't get there, you can't get there."
UnitedHealthcare this summer kicked off a national tour that emphasizes the latest telehealth technologies. An 18-wheeler parked at a Cherry Hill school contained videoconferencing and digital diagnostic tools. UHC officials said the company, whose network includes 4,900 hospitals and covers 223,000 Marylanders, is building the first national telehealth network to help physicians cater to underserved areas, rural and urban.
"It's a fundamental new way to provide that connection" to specialist care, said James Cronin, chief executive of the Minnesota-based company's Mid-Atlantic division. Such technology isn't intended to replace patients' connection to a primary care physician, he said. Instead, it's meant to hook them up quickly to specialized care that's sometimes difficult to find.
Telehealth equipment can be installed in physicians' offices, small clinics, hospitals, and even workplaces for from $10,000 to $100,000. Hardware could include an electronic records system, digital diagnostic equipment, video monitors and cameras.
With federal subsidies toward incorporating the latest electronic systems, physicians and hospitals have at least some incentive to upgrade their computer networks.
Last year the Maryland Hospital Association found that the state is 16 percent below the national average for the number of doctors available for clinical practice. The shortage was greatest in Southern and Western Maryland and on the Eastern Shore.
The University of Maryland Medical System has had its telehealth program in place for high-risk pregnant women such as Broomell for about four years. She gave birth to a healthy baby boy -- and the experience gave her such confidence that she recently got pregnant again.
The Perinatal Outreach Program, based in Baltimore, connects pregnancy specialists in the city to patients and doctors in Cecil County and St. Mary's County.
Jenifer Fahey, the program's coordinator, said it serves about 50 women a year and may expand to other parts of the state, including Western Maryland and the Eastern Shore.
"The patients love it," she said. "They appreciate not having to travel if they don't have to." To see more of The Baltimore Sun, or to subscribe to the newspaper, go to http://www.baltimoresun.com. Copyright (c) 2009, The Baltimore Sun Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
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