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Tracey S. Roth

Dot Com Commerce

Managing Editor, CUSTOMER [email protected] Solutions

[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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