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October 19, 2001

TELEMEDICINE
New visions for health care emerge in Rural Texas

By Mike Barnett
Editor

As a second-grader at Hunt Elementary in Cuero comes in complaining of a sore throat, Nurse Sandra Tate springs into action.

Instead of taking the child's temperature and sending her home—as is generally the case in most schools— Nurse Tate seats the student in a chair facing a computer console. She turns on a video camera and takes a picture of the student's throat. She checks her temperature and other signs. The nurse records the information and sends a picture and data to the local clinic.

Nurse Tate calls the clinic. Then, with real-time audio and video through her computer monitor and speakers, she visits with the doctor located at a clinic over two miles away.

"He's seeing the same picture I'm seeing," Nurse Tate enthusiastically explains. "He's seeing the child. The child's seeing the doctor. And we do whatever is necessary."

In this case, the doctor calls in a prescription to the local pharmacy. The pharmacy delivers the medicine to the school and the child stays in class.

Welcome to instant diagnosis, via the internet. The benefits? Mom and dad don't take off work to take the child home or to the doctor. The school receives money from the state for the child being in class. And most important, the child remains in school, learning.

Just another typical day at Hunt Elementary in this South Texas town. A pilot project involving the whole community here, however, could revolutionize the health care industry in rural Texas.

The Cuero Community Hospital, Bohman Clinic and the Cuero Medical Clinic have formed the backbone of this telemedicine project, sponsored by a state-funded endeavor led by the Texas Telecommunications Infrastructure Gateway (TTIG). The TTIG sponsored four pilot demonstration projects that showcase the multi-service networking and applications utility of advanced technologies.

A wonderful tool

Dr. Dan Dugi, a local physician and a champion of telemedicine for rural Texas, calls the new technology a wonderful tool. And he says its applications extend much farther than children in schools.

Doctors are few, transportation options are poor and distances are great in parts of rural Texas. Telemedicine can help close that gap.

For example, Dugi now has the ability to put a laptop computer in a nurse's or nurse practitioner's hands and send them to a patient's home. Using the camera attached to the laptop, pictures are taken of the patient's problem (a wound for example, or follow-up on surgery). Vital signs are recorded. The nurse listens to the hearts and lungs.

"Then they go ahead and transmit all that information by plugging it into the phone," Dugi says. "During our first study, we went ahead and did real time. That was with an older generation of software. There was a little delay. The newer versions, the newer software from HealthCare Vision, has been tremendously upgraded and makes it almost seamless. It makes it look almost like a real-time movie."

That same study of 300 patients showed a number of benefits of the new technology.

Among the findings of the study:

•Over $200 was saved by individuals not having to miss work to take those at home to the doctor.

•Over 80 percent of the telecon-sults in school allowed the student to stay in school.

"When reimbursement for the school district is made upon the average daily attendance, then it becomes critical for them to stay in school," the physician says. "So we're able by connecting to the schools to help the nurses make good medical decisions that protect the child, but also help protect the school."

•Again, the survey with parents showed they saved time and money by staying at work when their sick child was diagnosed well enough to stay in school.

"They found it extremely convenient for us to be able to interact with their child and the school nurse and save them from having to leave work," he says. "And this was a godsend to most parents. They really, really appreciated it."

•All patients responding to the survey said they were satisfied with the technology.

"They were really pleased with the outcomes," Dr. Dugi says. "Our outcomes were very good. And the patients really became champions of the technology."

•The technology is easy to use.

"It's click and point," the doctor says. "It's almost foolproof."

A bright future

Dugi is already making use of the new technology, primarily for at-home visits with home-bound post-op patients and the elderly in nursing homes.

He sees a bright future for tele-medicine in Texas as others realize its benefits and adopt the technology. In fact, he championed its cause in the last legislative session, diagnosing a patient back in Cuero from the state Senate floor in Austin.

New legislation passed in that session should help telemedicine spread, he says.

For example, Senate Bill 789 by Sen. Mike Moncrief will allow telemedicine (mainly consultations, evaluation and management) to be eligible for reimbursement, including Medicare and Medicaid.

"One of the biggest limitations has been reimbursement," says Craig Walker of HealthCare Vision, the company that provided the hardware, software and technical development for the Cuero project. "And most of what is being conducted in the school is for evaluation and assessment."

The reimbursement provisions in the legislation will also make it more likely for rural health physicians to hook up with specialists in larger towns and cities, improving health care in rural communities.

The legislation also encourages pilot projects in the areas of mental health and teledentistry.

A related bill was Senate Bill 65.

"It was designed to help provide pharmacy services to numerous counties and communities that do not have the immediate availability of local pharmacists," Walker says.

Although Dr. Dugi predicts telemedicine will revolutionize rural health care, he notes it will never replace doctors.

"Rural Texas is underserved by doctors," he says. "This will never replace a talented physician, nurse or nurse practitioner. However, what it allows them to do is extend their coverage to utilize their time more efficiently, and to improve access for patients."