Dean Douglas was skeptical at first about a doctor diagnosing his 10-year-old great-nephew from hundreds of miles away via a large flat-screen video monitor — unable to touch him or even be in the same room.
A small-business owner and single parent to his great-nephew, Douglas knew taking time off to drive to an Atlanta specialist would cost him hundreds of dollars in lost work, gas and motel expenses. So, despite some doubts, he took the boy to the Berrien Elementary School health clinic in Nashville, Ga., to see a kidney specialist and a psychiatrist using cutting-edge, telemedicine technology that offers parents needed access to top specialists rural areas lack.
“I couldn’t make it without telemedicine,” said Douglas, who repairs restaurant equipment for a living. “It saves me a fortune.”
Georgia has established itself as an innovator in telemedicine technology — using it to expand access to health care, transform the way care is delivered and cut overall costs.
The Georgia Partnership for TeleHealth network has rapidly expanded in recent years to include nursing homes, school clinics, emergency departments, primary care and other providers with 175 physicians in 40 specialties. Statewide, telemedicine sessions have soared from roughly 200 in 2006 to more than 40,000 this year.
Telemedicine offers convenience for patients and can also lower health care costs by reducing avoidable hospital visits and providing regular access to care in remote parts of the state, said Georgia Partnership for TeleHealth CEO Paula Guy.
Patients in nursing homes can be seen by a doctor without a costly ambulance trip to the ER. Trauma specialists can advise doctors in community hospitals on how to care for a patient, avoiding flights to larger facilities. Parents who can’t afford to take time off from work can have their child seen via telemedicine in a school health clinic instead of letting an illness get so bad they end up in the ER.
“If you’re getting access to care ... you’re not going to end up in the hospital nearly as frequently,” Guy said.
Saving time, money
On a recent afternoon, Dr. Michael McConnell, a cardiologist, sat in front of a 24-inch, high-definition monitor in Atlanta to talk with a mother roughly 180 miles away in Tifton about her 10-year-old son who has had three open-heart surgeries and has needed new medication evaluated.
Telemedicine technology has vastly improved since McConnell first started using it in the mid-1990s. When meeting with patients, he can hear what the nurse hears via wireless Bluetooth technology that sends a signal to his stethoscope. Nurses can use a special camera to examine a child’s eyes, nose or throat, and the images appear on McConnell’s screen.
“You can almost see better” than looking through the small hole of an instrument in person, said McConnell, medical director of the telemedicine program at Children’s Healthcare of Atlanta. Children’s program includes allergy, orthopedics, neurology and other services.
A telemedicine visit saved 310 miles and nearly six hours of traveling on average, according to a study by Children’s examining 609 appointments in the first nine months of this year. It estimated that 86 percent of patients would have missed school and more than 80 percent of parents would have missed a full day of work to come to Atlanta.
“We can help deliver better care and do it more cost-effectively,” McConnell said.
Telemedicine, however, has its limitations.
It may work well for radiology, where specialists can easily read images from a remote location, said Soeren Mattke, a senior scientist at the nonprofit research group RAND Corp. Performing surgery with robots using a video link is riskier, he said. If something goes wrong, someone will have to be on-site to fix problems, he said.
Some patients also may not feel comfortable or trust the diagnosis, Mattke said.
“You feel more comfortable if you sit in a room together and make eye contact,” he said, adding that telemedicine is still likely a trend that’s here to stay.
‘Before its time’
Across the nation, telemedicine is catching a second wind.
A decade ago, the technology was clunky, unreliable and hard to operate, and broadband Internet wasn’t widely available, Mattke said.
Doctors hesitated about not being hands-on, Guy said.
“It was almost before its time,” she said. “We were begging people to participate in the network.”
In 2005, Georgia lawmakers passed a rule requiring insurers to reimburse doctors for telemedicine sessions the same amount they would for in-house visits — key to the technology being more widely adopted, Guy said.
Today, the partnership runs a Web-based system that allows doctors and nurses to schedule visits and provides marketing, education and training. Providers can electronically share medical records, X-rays and other data. The partnership is working to replicate its system in Alabama and hopes to eventually do so in South Carolina and other states, Guy said.
Demand for the technology is even rising in some urban areas, she said. “Travel in Atlanta, of course, can be a nightmare.”
‘Tip of the iceberg’
For Douglas, whose great-nephew regularly talks with a psychiatrist using a video link, his concerns about telemedicine quickly dissipated once he saw how well the nurses and doctors worked together.
“The doctor can see you; you can see the doctor,” he said. “It’s pretty much like being there.”
The school system in Berrien County, which has two family doctors, uses telemedicine at two schools with plans to expand to all five next year, said Sherrie Williams, director of the MED Clinic for the system.
Students can walk into a clinic and see a doctor within an hour and a half, she said. Local pharmacies deliver medicines to campus. If a doctor orders blood work, which a school nurse isn’t allowed to do, someone from the local hospital will come and do it. The system is already well on its way to surpassing the 300 telemedicine visits it conducted last school year, Williams said.
“I do think we’re at the very tip of the iceberg,” she said.
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