Eric Tangalos, a primary-care physician from the Mayo Clinic in Rochester, Minnesota, who demonstrated telemedicine for the forum audience, reflected on the role telemedicine can play as our health-care system changes and the national information infrastructure grows.The Mayo Clinic in Rochester, Minnesota, was connected to Northwestern University's Thorne Hall with a fiber-optic T1 link, enabling physicians in both cities to examine patients simultaneously. Eric Tangalos, a primary-care physician from the Mayo Clinic, was in Chicago. Tangalos consulted specialists in Rochester--who could see and talk to his patients in Chicago--for advice on orthopedic and otologic (ear) problems. And, in what was surely the first father-son telemedicine session, Henry Roenigk, a dermatologist at Northwestern University, consulted his son, Randall Roenigk, a dermatologist at the Mayo Clinic. During the forum, Tangalos offered his views on telemedicine.
"I have spent a lot of time thinking about health-system reform, and I spend a lot of time thinking about the national information infrastructure because of my interest in telemedicine. Telemedicine is right at the juncture of both of these movements. It stands in the perfect place, at the right moment in time. We have 37 million Americans, many of them rural and most of them underserved, who could benefit from advanced communication modalities to receive care they are currently not getting. We stand at the brink of developing an information system that should link all of our states and all of our peoples, so they can receive a variety of educational and medical services over a vast network that many have likened to the interstate highway system built in the 1950s.
"I think that in the big cities, such as Chicago, there will be some delays in seeing more of telemedicine. However, in the rural states, this activity is going on at a quickened pace. There are more than 20 states now delivering care using compression technology and advanced CODEXs to deliver fairly cost-effective care. Now we must also remember that the fee-for-service environment in which we live will probably not embrace telemedicine. Chicago will be one of the last bastions of fee-for-service medicine, but managed care will come to Chicago. And managed care will use these kinds of technologies to deliver comprehensive care in cost-effective ways.
"Let me give you one example: delivering health care into an individual's home. The fight between the cable companies and the telephone companies is over this kind of two-way communication access. Assume that a managed-care company has--out of their population of 100,000--25 very high-risk asthmatics and that these asthmatics spend a lot of time coming to the emergency room seeking medical care. If they come to the emergency room too late for care to be delivered appropriately, they end up in the hospital. In a managed-care environment, that is very costly, and that is what you try to avoid.
"We can deliver care to those individuals' homes via monitors and equipment. We can hook them up with an emergency room or a primary care practice or a specialist's office, monitor their spirometry, monitor their breath sounds, and take care--in an interactive session--of the therapy they need at any given point in time. Models have already been created using cable companies to deliver these services in individuals' homes to keep them from coming into an emergency room or a hospital. However, telemedicine systems are costly and cannot stand alone. You cannot have a system like this and use it only for one purpose. Once states are connected to the information highway, people will use the services for medical care, continuing education, and business opportunities. Multiple uses of the technology will make it more cost-effective.
"We know that there are not enough physicians in rural areas to begin with. How does this communication technology help? We have to provide a better way for rural physicians to feel a part of an integrated health system. We have to allow them to practice where they want to practice and yet get the quality of consultation and the educational support they need to go about their business. In almost every demonstration we have going in the United States, what we hear from the rural practitioners is that they are now part of a bigger health-care system. They get continuing education, and they get to keep their patients in the community. These physicians enjoy practicing in the rural environment; they do not want to come to the big city. Telemedicine allows them to stay where they are and practice the way they want to practice in the late 20th century.
"Also important to the great medical centers of the world is that, ultimately, telemedicine will help us use our specialists more appropriately and more successfully. As we rediscover primary care, and with more and more physicians going into primary care, we still need to recognize the need for specialty, secondary-, and tertiary-care medicine. And we need to provide physicians practicing that art the best opportunity to do so as successfully as they can. Clearly, the more patients specialists see in their particular field of interest, the more expert they are going to be. What better way to do that than through a virtual system that allows patients to access the right doctors anywhere in the world?
"Telemedicine should allow the great medical centers to provide their tertiary expertise irrespective of drive time, state boundaries, national boundaries, or even international boundaries. Mayo, along with a number of other major medical centers, is very interested not only in delivering services to the rural and underserved, but in developing an international network as well. Toward this end, we have established a venture in Amman, Jordan, to carry out telemedicine projects in the Middle East. We at Mayo have been involved with telemedicine since 1986. The early work involved satellites and analog video. We have now started to migrate toward compression technologies with the expertise we have developed over time to get the job done. I personally think the future is very bright and very exciting with regard to telemedicine and delivery of care."
A videotape of the telemedicine forum has been produced because this interactive demonstration is best represented in a more dynamic format. Please contact The Annenberg Washington Program to obtain a copy of the videotape.
The Annenberg Washington Program and Northwestern University Medical School extend their thanks to the technology partners that helped make the telemedicine demonstration possible: Ameritech, Andries Tech, NEC, Northwestern Technologies Group, Sprint, and US West.