[December
27, 2000]
When The Internet Becomes Your Physician
Traditionally, people going to an isolated place for any length of time
-- explorers or archaeologists in Africa, for example, or astronauts into
space -- would have operations to remove non-vital internal body
structures to prevent life-threatening medical conditions. Dian Fossey,
who spent long amounts of time in the mountains of Africa studying
gorillas, had her healthy appendix removed before her first trip, as a
sudden attack of appendicitis far from medical facilities would have been
life-threatening. For the same reason, these adventurers usually step up
the amount and kinds of immunizations they receive far beyond the level of
the average person.
Most of us do not live in such extreme circumstances, but a majority of
the people of the world do live a considerable distance from top-notch
specialists and first-rate medical facilities. (That's not even mentioning
military personnel living abroad or the tiny, but growing, population of
people expected to live in space for long periods of time.) Enter the
burgeoning field of telemedicine, a technology that will shortly begin to
change health care as we know it. In a quest to explore the almost
unending potential of the Internet in daily life, I came across a
cutting-edge technology whose limits exist only in our imaginations.
Let's imagine a scenario. An Olympic runner is vacationing with his
family in a poor country, perhaps a Caribbean island. He is a stuck by a
car and sustains considerable injury: not only are his internal organs
affected (so it would be ill-advised to move him), but his bones are
injured, as well. While the truly top-notch professional athletes might be
able to have their personal sports physicians come to them, it's more
probable the athlete would face a dilemma. Does he risk the trip back home
and the potential resulting damage, or does he put his injuries into the
hands of an overworked and possibly under-trained physician who has no
experience with sports medicine?
Today's Scenario
Imagine that with a simple Internet connection, the X-rays and diagnostic
tests performed by a physician in the Caribbean can be transmitted to the
athlete's sports physician back home. The doctor can order tests from
thousands of miles away, view the results and direct the hospital to begin
the best course of treatment. He can locate a nearby source for the drugs
he wants his patient to receive if the hospital does not have them in
stock. He can receive regular updates of the athlete's radiographs, CT
scans, vital signs and blood tests, and direct the Caribbean hospital to
alter care based on those results. This kind of scenario is used today.
Sports medicine was one of the first areas to begin developing
telemedicine for a few reasons, the most obvious being that the amount of
money attached to sports medicine exceeds that of many other professions.
There is capital and impetus to develop such technologies within the
field.
Tomorrow's Possibilities
Let's take this scenario a step further. In the not-too-distant future,
the home-based sports physician might decide, based on the images he has
received from the Caribbean hospital, that immediate surgery is necessary
to save the athlete's strength and range of motion in his injured limb.
The Caribbean hospital has been equipped with a surgical robot a
relatively small device that can perform surgery via remote control. The
athlete is prepped, put on monitors and anaesthetized. The surgical robot
is moved into place, and the athlete's personal sports physician sets
himself up in his office back in New York in front of a monitor. He
proceeds to perform four hours of reconstructive surgery on his patient,
from thousands of miles away (and with no need to gown and scrub up).
Where Are Mrs. Jones' X-Rays!?
If you've spent any time in the healthcare system recently, you know how
scattered procedures can be. In today's "customer is first"
environment, it's a little irritating to have to repeat your medical
history to every physician, physician assistant, nurse, med tech, lab tech
and radiographer you come in contact with. More often than not, medical
test results are still delivered on film or on paper, and in a large
physicians' office or hospital, things get misplaced, misfiled, usurped
and just plain lost. Imagine having a central database for Mrs. Jones, one
that can be accessed by each healthcare worker who comes in contact with
her. A physician and an advance-practice nurse can view her X-rays
simultaneously from different locations, blood tests need not be repeated
due to lost results and a specialist across the country can be easily
consulted with little or no delay.
Leveling The Field Of Healthcare
I'm lucky enough to live close to both New York City and Yale New Haven
Hospital. Chances are, there will always be published and lauded
specialists nearby. But let's think about northern Alaska or northern
Canada, poor areas of the rural South, and isolated farming communities in
the Midwest. Imagine if in the future, each home could be equipped with
relatively inexpensive equipment to monitor vital signs, heart sounds and
blood chemistry. A patient might access a program that performs virtual
triage, or situation evaluation. "Are you feeling out of breath? Is
your heart pounding? Do you have any pain? What did you eat for dinner
last night? What medications are you taking?" This information could
be transmitted to a physician, along with the results of the
self-administered tests. A remote physician could then judge, "I
think you are experiencing indigestion based on the fact that you ate four
and a half pepperoni pizzas last night" or "An ambulance has
been dispatched for you. Rest quietly until it arrives."
Where Telemedicine Is Evolving
On the technology front, the foremost telemedicine conference has been,
and continues to be, the Medicine
Meets Virtual Reality Conference (to be held in Newport Beach,
California in January). The conference program was designed to put forward
the most ground-breaking applications of telemedicine and medical virtual
reality, and will extensively explore the possibilities of image-guided
surgery (robot surgery), computer modeling for reconstructive surgery, the
operating room of the future (which may contain no one but the patient),
surgical training using virtual realty and telepsychology (which is
exactly what it sounds likeall the benefits of a shrink without the
tacky couch.)
As Always, It's A Cost Issue
There is, obviously, a fat lot of expensive equipment to be bought by all
parties for the very advanced stages of telemedicine, and just as with
computers and the Internet, the technology will hover at the very top of
the pyramid for a long time before it begins to trickle down to the masses
below. (Though considering the technology may help eliminate the
prohibitive and rising costs of extra staffing, overnight hospital stays,
referrals, in-home health care, wasted time and unnecessary surgeries,
treatments and hospitalization, some of this equipment might begin to pay
for itself very quickly.)
There will certainly, and probably always, be procedures that cannot be
replaced by technology. Ask any woman who has given birth how she would
feel about having a robotic labor coach and you might get a grimace. All
the advanced telemedicine technology in the world will never replace the
calming effect of human touch. But it sure would take the pressure off
pediatricians who could remotely calm first-time parents tempted to bring
their newborn into the doctor's office each time the baby sneezes.
For now, I just keep hoping that someone will invent an easy-to-use
medical information database so the next time I go in for a physical, I
need not relay my insurance information and date of birth to fifteen
different people and wait an hour for a clerk to locate my x-rays from my
previous visit. But regardless of what level of sophistication
telemedicine will attain in the future, my guess is the examining table
and stethoscope will always be ice cold.
Tracey E. Schelmetic welcomes your comments at tschelmetic@tmcnet.com.
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