Telemedicine offers rural hospitals window on progress

Technology connects health professionals in remote areas to educational, diagnostic opportunities
Special to the Times Union

They call it Nintendo surgery, which is a joke -- sort of.

One of the first in the region occurred two years ago when David Bonner allowed a bunch of tubes -- including a miniature camera on a wire -- to be threaded through a half-inch hole in his stomach for a hernia operation at Albany Medical Center.

The procedure was different because the job of fixing a hernia had in the past required a big enough incision to allow the surgeon to get his hands inside. Now, the doctor did the manipulation remotely. And the high-resolution camera actually allowed the surgeon, Dr. T. Paul Singh, to see better.

It was the first operation at Albany Med's minimally invasive surgery center.

Bonner was pleased with the results. Not only because he was back on his feet in a few short hours after the operation -- one of the benefits of minimally invasive surgery -- but also because his operation was broadcast to seven different locations as part of a "hernia repair workshop.''

Doctors throughout upstate were watching to see how this relatively new style of remote-control surgery works. Tuning in were: A.O. Fox Hospital in Oneonta; Adirondack Medical Center in Saranac; Champlain Valley Physicians Hospital in Plattsburgh and Mary McClellan Hospital in Cambridge, as well as two other sites in Albany.

Bonner was one of the stars in the operating theater, and he had a leading role behind the scenes as well. He is president of the Adirondack Area Network, or AANet, a kind of two-way television network that is being used for a wide range of purposes, primarily educational. And AANet broadcast his hernia operation.

Adirondack Area Network is a kind of two-way TV network that is being used for a wide range of purposes, primarily educational. From left, Frederick "Jackie" Ford, vice president of technology initiatives; Kenneth Sperl, vice president of network technology; and David Bonner, president.

AANet is based on the Albany campus of The Sage Colleges, where Bonner and the other officers of AANet are on the faculty. Bonner is a professor of mathematics. AANet's other principals are Frederick "Jackie'' Ford, who serves as vice president of technology initiatives, and Kenneth Sperl, who is vice president of network technology

The medical community, in particular, has put AANet to vigorous use in the five-plus years of its existence. "It is really a boon to the outlying rural areas,'' said Natalie Slohm, director of public relations at Mary McClellan Hospital.

Two years ago, the small Washington County hospital received a grant of nearly $250,000 to buy equipment needed to offer telemedicine and distance learning delivered over AANet. The money came as part of a Clinton administration initiative to improve medical care in rural areas. Now, its telemedicine system is up and running.

"It (telemedicine) is a costly undertaking,'' Slohm said. "I don't think that this can be done (by rural hospitals and clinics) without some assistance.''

But once things are connected, the benefits are obvious.

Recently, McClellan physical therapist Mike Keyes was able to teach a class to students in the physical therapy assistant program at Herkimer County Community College from Cambridge. And doctors in Cambridge, Plattsburgh and Saranac -- as well as other remote areas -- are able to go on "grand rounds'' at Albany Med through its continuing education program. This year, doctors at McClellan will attend an Albany Med seminar on medical ethics via the network.

Slohm said the network also was being used to train emergency medical technicians, a program Bonner said included better and more routine training.

"Emergency medical training used to be done whenever possible,'' he said. "That is, the crews for rural areas would come for training in their spare time. Now, at the end of their shifts, they go to their local hospital and participate from there.

"They used to have to travel to the main site giving the program. So to watch a two-hour program, they may have had three hours of travel time to obtain it,'' he said.

But more than teaching is being done over AANet.

Doctors and nurses at Elizabethtown Community Hospital in Essex County no longer have to worry that someone might break a leg when the hospital's sole radiologist is off duty. Now, using AANet, they can transmit an X-ray to Plattsburgh and have a radiologist at Champlain Valley Physicians Hospital do an immediate diagnosis. That's called teleradiology.

There are, however, concerns that the rise of telemedicine means the loss of physician contact with patients, said Dr. Henry Pohl, an assistant dean at Albany Medical College who is involved with the region's telemedicine initiative.

But, he added, "One can use video in a very personal manner with the proper training and with the proper equipment.''

That way, the patient shouldn't feel less attended to, Pohl said. And physicians, too, can meet with families or have consultations facilitated by the technology.

But in the end, Pohl advocates for telemedicine only to make up for manpower deficiencies at distant sites. "When at all possible, there should be face-to-face meetings at least once,'' he said.

The Medical Society of the State of New York, an association of 30,000 physicians, is seeking legislation that would require doctors practicing telemedicine in New York "at the very least be licensed and registered in New York,'' said society spokesman Michael Murphy. It also is working to discourage the prescription of medicine via the Internet.

Nationally, telemedicine is growing rapidly, said Jonathan D. Linkous, executive director of the American Telemedicine Association, a Washington, D.C.-based nonprofit focused on promoting the deployment of telemedicine in this country and worldwide.

Membership in the association now stands at 1,600 and is doubling every year, Linkous said. And it should increase even more rapidly following President Clinton's signature on legislation that will increase Medicare reimbursement for telemedicine services, he added. The law, which takes effect Oct. 1, expands eligible areas for covered telemedicine services from rural communities with medical shortages to more populated regions.

The association does not calculate a dollar figure on what is being spent now on telemedicine because much of the equipment used -- in radiology, for example -- does not have telemedicine as its exclusive use.

Linkous said another nationwide trend is telemedicine in the home. People with chronic conditions, such as heart disease, now can have their conditions monitored at home, rather than having to stay in the hospital. Linkous said the new telemedicine law also includes language stating that "telehomecare'' will be an eligible service under Medicare funding for home care.

Right now, the prime objective of AANet is to connect doctors at hospitals and clinics to the network. But AANet's Ford and Bonner have looked at home telemedicine.

"One problem is the expense,'' Ford said of connecting patients at home. But compared to an institution, home telemedicine would be much less expensive.

Here in the Capital Region, Bonner said AANet is working on its own unique innovation: "doc-on-a-stick'' -- a portable device that can be moved from room to room, allowing medical professionals in rural areas to tune in to places like Albany Med, where doctors there can do remote diagnoses.

"It is very easy to wheel around in a hospital and simply plug into a wall jack similar to a phone jack,'' Bonner said. "It even has a power supply on board so that docs don't shut it off while moving it. All the signals (that monitor the patient) come off the back of it. They can project the images or view them on a liquid-crystal monitor that is attached to the unit.''

Originally appeared in the Sunday Times Union March 11, 2001