The Answers to Patients Prayers
Rural areas are discovering how telemedicine can save lives, time - and money.

Sage Colleges
    On the other side of the country lies the Adirondack Mountains. It is a 7-million-acre public park that is home to 700,000 people, a tribal reservation and three universities. Aside from Alaska, this is about as remote as you can get in the United States.

     Three years ago, David Bonner, director of technology initiatives at The Sage Colleges, initiated a project linking the local area networks (LANs) of institutions in the northern part of New York State. The resulting wide area network (WAN) provides the local Adirondack communities with distance learning, videoconferencing, telemedicine and remote legal advice.

     “Due to the limited number of health care facilities in the Adirondack Region, individuals must travel long distances for medical attention,” Bonner explains. “The potential of telemedicine is tremendous, particularly in the area of rural health care where risk factors are high, access to health facilities is limited, and recruitment and retention of health care providers is difficult.”

     Having grown up in the area, Bonner knew that the telecom infrastructure there was poor at best. “I did some legwork ahead of time and found that the people wanted something done as well,” he says.

     Bonner worked with local school districts and hospitals to recruit support for a network that could sustain rural telemedicine needs. He came up with the original grant concept to fund the project. The resulting Adirondack Area Network (AAN) provides high-resolution transfer of diagnostic procedures — such as Magnetic Resonance Imaging (MRI), X-ray and other test results — for expedited diagnosis and referral.

     “If a specialist is required, physicians connected to the network can consult with physicians at Albany Medical College, the Samuel Stratton Medical Center or other participating hospitals,” Bonner says.

     AAN today serves more than 50 institutions, including colleges, school districts, health care centers and hospitals. Another 50 institutions in New York State as well as about 28 health care centers in neighboring Vermont want to join. The AAN might have 150 partners online in the near future, Bonner says.

     The network is the result of efforts from The Sage Colleges (Troy, N.Y.); Albany (N.Y.) Medical Center, the Franklin-Essex Hamilton Board of Cooperative Educational Services (BOCES; Malon, N.Y.); Champlain Valley Educational Services (Plattsburgh); and the New York State Education and Research Network (NYSETnet); as well as the region’s service provider, Bell Atlantic, and videoconferencing vendors RADVision and VTel.

     Rather than using ISDN lines, AAN’s developers turned to standard Transmission Control Protocol/Internet Protocol (TCP/IP) over frame relay, believing it to be a stable, easy and relatively inexpensive solution. By connecting a video interface unit (VIU) to room videoconferencing hardware, AAN’s developers found a way to enable the network to access the video stream as ‘just another piece of data’ that needed to be routed. The VIU takes the video’s H.320 stream and converts it into an Internet Protocol (IP)-encapsulated H.323 stream.

     AAN put its network to use in January when ice storms ravaged the Northeast. The State of New York was able to maintain direct voice and video contact with its lead people who were working around the clock to rebuild power and telephone systems. The network connected emergency response headquarters in Albany to the disaster recovery sites, and linked local clinics and health care facilities in the Adirondacks to physicians, nurses and staff at the medical center at State University of New York at Albany.

     Aside from disaster response, the Albany Medical Center uses AAN to conduct panel discussions, symposia and committee meetings. For example, New York has a complex set of laws governing the care of terminally ill patients; using the videoconferencing network, Albany Medical Center has been able to expand its doctors’ expertise in medical ethics.

Up in the Mountains
    Adirondack Medical Center in Saranac Lake, about three and a half hours from Albany, has been using telemedicine technology since 1997. “It brings the most up to date information to all of the hospital staff and allows us to explore new opportunities without travel,” says Cora Waterson, manager of in-service education.

     The network was put to economical use when the medical center was working with a Minnesota-based architectural firm to build a fitness center. “What could have been a costly 20-minute meeting [had the firm visited the area] turned out to be quick and cost-effective by use of video,” Waterson says. “We hooked up and saved a lot of time and money on both ends.”

     In another instance, the Adirondack facility also was able to help a young girl’s family and friends learn more about anorexia. “We don’t have those kinds of resources here, because we are so remote,” Waterson recalls. “I picked up the phone, called the dean at Albany Medical Center, and in 20 minutes he had a specialist ready to speak with about 12 of the girl’s classmates and her parents about what they could do to help.

     “Once they were over the initial fear of seeing themselves on camera, they were fine. They didn’t ask a lot of questions of the speaker, but from what I understand, once they got back into the car, they didn’t stop talking about the telemedicine experience and how much it helped them understand about the disease,” Waterson says.

     The center is in the process of setting up two 32-inch screens for its prenatal outreach program and to provide online distance learning for medical students.

     “It’s now possible to purchase a stethoscope, hook it up to the videoconferencing equipment, and the doctor can use it to listen to the heart of a patient miles away,” Waterson says. “If that’s not the wave of the future, than I don’t know what is.”