Medicine at Work brings the doctor to you

But the eighth-grade teacher and mother of three small kids didn't have much time to spend going to and from the doctor.

This time, though, the doctor came to her.

Juhan visited the Medicine at Work clinic on the Woodward Academy campus in College Park and within 30 minutes was back in the classroom with a prescription for antibiotics. Plus, there was no co-pay.

Woodward Academy is the first Georgia employer to use Medicine at Work, a service offered by Houston-based NuPhysicia. Woodward, which has 620 employees, began offering the service in October to staff and teachers.

The clinic uses two-way video that lets patients consult in real-time with a Georgia-licensed  physician, who can be hundreds of miles away. Using special equipment called the T-Cart -- or telemedicine cart -- a doctor and an on-site paramedic can listen to the  patient's heartbeat and take other vital signs or use a special scope that allows the physician to examine the patient's ears, throat, nose and eyes. The doctor can send a prescription to the clinic; the paramedic prints it out and hands it to the patient.

"It was really like being in a doctor's office," said Juhan, whose primary care physician is in DeKalb County. "At first it felt a little strange because I didn’t realize he could see me, but once you got used to it, it was fine."

"This is where medicine is going," she said. "It was neat to look into the future of medicine."

Telemedicine is a lucrative and expanding area of health care that's conquering new frontiers, including helping fill the medical gaps in underserved rural areas. Supporters tout the cost savings and convenience. Critics say it's not an adequate substitute for the care a physician can provide in person.

For Juhan, it meant that she didn't have to rush across town to see a doctor. Woodward benefits because it cuts down on health care costs and reduces absenteeism and loss of productivity.

"We expect that Medicine at Work will offer us tremendous benefits in terms of productivity," said Ski Saxby, director of human resources for Woodward. "Teachers and other staff members will not have to leave the classroom or their jobs for time-consuming medical appointments for minor conditions. There is no co-pay, so we also save employees money in out-of-pocket medical expenses."

About four patients visit the Woodward clinic each day. Most of the ailments have been upper respiratory infections, allergies, rashes and falls. In more serious cases, employees may be sent to the hospital or told to visit their primary care physician or a specialist.

Saxby says Woodward doesn't have enough data yet to analyze the cost of the program, but school officials think it could also cut Woodward's health care premiums. Because the clinic is on the campus, employees are more likely to take care of problems before they get worse and need to take days off from work.

"The benefits are huge," said Soumaya Khalifa, president of Khalifa Consulting, a human resources and intercultural consulting firm. She estimates that worker illness cost U.S. businesses more than $1.4 trillion in lost productivity in 2008.

"Having a service like that on site is a win-win situation for the employers, the employee and the medical practitioner," Khalifa said. "When workers leave to go to the doctor or have a prescription filled, they lose time at work."

Time adds up. She said it can take a worker as much as four hours to drive to the doctor, wait to be seen by a physician and return to the office. Factor in tests and it could take even longer.

According to NyPhysicia's Web site, Medicine at Work provides all the furnishings, equipment, clinical staff and medical services for a fixed monthly cost per employee.

NuPhysicia, which formed in 2007, grew out of a program at the University of Texas Medical Branch in Galveston that had contracts for telemedicine services with the Texas Department of Criminal Justice, county health departments and cruise ships.

Dr. Michael J. Davis, one of NuPhysicia's founders and its senior vice president for telemedicine program development and speciality services, said patients will notice little difference in care because they're not sitting across from a physician.

"It's very personal because there's so much eye contact because this uses electronic medical records," he said. "Typically, in an office setting the physician will start writing."

But some say that while telemedicine has its uses, it shouldn't be viewed as a substitute for in-person contact.

"As a physician and a patient, I'm not sure how I'd feel about that," said Dr. Leonard Reeves, president of the Georgia Academy of Family Physicians and assistant director of the Floyd Family Medicine Residency Program in Rome. "I like to be able to interact with my patients, listen to them and pat them on the back. There are things a machine can't feel. ... There are things where the touch of a physician's hand makes a big difference."

But telemedicine continues to grow, partly because it can overcome access issues personal care cannot.

Patients at the Emory Transplant Center use telemedicine technology to "see and talk" with physicians. Developed through the Georgia Partnership for TeleHealth, the program's goal is to improve health care and establish telemedicine programs in rural and underserved communities.

Web-based computer cameras send live video and real-time medical information. According to Emory, a nurse provides assistance and performs specific parts of the exam at the physician's request.

Emory also uses telemedicine at the Emory Heart & Vascular Center and at Wesley Woods at Emory.

"Obviously, providing senior patients with the opportunity to consult with a care provider without fighting traffic is a major benefit for these patients, many of whom have difficulty in getting transportation or do not like driving themselves," spokesman Lance M. Skelly said.

Telemedicine technology has been used to access a physician, information and for self-monitoring, said Jonathan Linkous, chief executive officer of the American Telemedicine Association.

Sometimes, telemedicine goes where a physician cannot.

At NASA, telemedicine capabilities include ultrasound imaging, electrocardiograms, fundoscopy, skin surveys and laboratory analysis. The doctor can provide telemedicine consultation to the astronauts from Mission Control for either a routine exam or urgent diagnosis.

"You can't get a doctor to do a house call when you're thousands of miles up in space," Linkous said.

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