Doctors in earlier times traveled far and wide to treat patients. With cutting-edge telemedicine technology, however, doctors now can visit the same patients without ever leaving the clinic.
Telemedicine takes advantage of modern video conferencing equipment and other technologies to conduct patient consultations and public health classes, giving even rural areas easy access to specialized medical care.
This month, Congress approved a grant allocating $25,000 to a project linking Patrick County Community Hospital with the University, making the rural Virginia hospital the 14th of its kind.
The grant is the first of six to be awarded to different rural communities nationwide, housing more telemedicine sites in southwest Virginia than anywhere else in the country.
"We have a world class medical center right here, but there are many places in Virginia where one is hard to get to," Telemedicine Deputy Director Richard Settimo said.
"If a patient out in southwest Virginia was told they needed to come all the way to Charlottesville to see a specialist, they just wouldn't come," Telemedicine Medical Director Karen Rheuban said. "The doctor just flips a switch and goes from clinic to hospital all over the state of Virginia."
Telemedicine technology relies on broadband Internet connections that allow rapid two-way transport of high-quality audio and video information.
NASA and the Department of Defense pioneered the technology to monitor astronauts and soldiers.
The videoconferencing equipment works interactively through live monitors. The University's Office of Telemedicine operates a facility with a monitor that is connected to other monitors throughout Virginia.
Licensed health practitioners work with University specialists by assisting with the examination at the rural site. The practitioner can be a registered nurse or even the patient's primary care physician.
"We even have an electronic stethoscope," Rheuban said. "As the nurse applies it to the patient, we can hear it here in Charlottesville."
The application of telemedicine varies widely. For example, a remote dermatologist can image a patient's skin using a high-tech dermascope.
"You can literally zoom in on a freckle," Rheuban said.As of last week, the University's telemedicine center provided professional consultation for 4,229 patients throughout Virginia in 24 different specialties.
Telemedicine transcends the barriers that traditionally have made it difficult for prison inmates to receive specialized medical care.
Through its telemedicine facilities, the University reaches out to state correctional facilities, serving more than a thousand prisoners each year.
"This keeps the inmates in prison instead of bringing them up with two guards, a van and a 10-hour trip for a 10-minute consultation," Settimo said. "This saves state money, about $500 per inmate per trip."
According to Rheuban, the telemedicine program does much more than merely save tax dollars.
"These are individuals who still deserve access to quality care," Rheuban said. "Now they are getting care from the very best specialists."
Telemedicine also provides new and exciting learning opportunities, allowing the University to broadcast medical classes and seminars to remote sites.
"We've had smoking education and diabetes education. World-renowned specialists come and sit right in here and teach people all over the state," Rheuban said.
Classes and seminars also are available to practicing physicians who need to fulfill the yearly 60-hour learning requirement imposed by the American Medical Association.
This requirement often is difficult for rural physicians, who are hesitant to turn away patients in order to meet the 60 hour obligation.
"To do this he has to close the clinic for days," Settimo said. "With telemedicine, he can take his bologna sandwich, turn on the set, and he is there."
Although the future of telemedicine looks promising, it still is far from perfect. Most likely, state laws governing medical licensure will prevent telemedicine programs from crossing state borders.
But the University need not worry about expanding to other states to bring in more patients.
"There are more than enough medically underserved patients right here in Virginia," Rheuban said.
Telemedicine liability and funding issues also are under debate. Medicaid now reimburses its patients for specific procedures, but Virginia and other states are petitioning for expanded coverage of telemedical procedures.
"The state Medicaid budget for taxes and ambulances alone is 54 million," Rheuban said. "Telemedicine saves money and benefits the patients and the community."
Telemedicine indeed is surging forward. The University has conducted medical consultations throughout the world, most recently in Saudi Arabia and South Africa.
"We've even supported environmental science classes in sub-Saharan Africa," Rheuban said. "Technology has shrunk the world. Whether it's the world of Virginia or the whole world, it really has made a big difference."
One day, every household may link to a telemedicine center through their personal computer.
"My technological colleagues want to put it on every doctor's desktop," Rheuban said. "It's on my desktop now. I am the pilot"
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