The Doctor Will See You Now Just Not In Person

Doctors have long dreamed of the time and lives they could save practicing medicine by wire. Years ago, they coined the term "telemedicine" to describe hybrid video and communications technology that would let them swap medical images over high-speed networks. But the hurdles proved enormous. Shuttling X-rays over phone lines was cumbersome, and image quality was low. And clinics found that patients were leery, as were insurers.

Now that's changing. Amid cries for health-care reform, hospitals are more willing to try solutions such as tele-medicine to cut costs. Transmitting medical images is getting easier thanks to fiber-optic phone links. And the technology is getting a political boost. Architects of Bill Clinton's New Information Infrastructure--the basis for the Information Superhighway--have latched on to tele-medicine as a high-profile use that could help drive multibillion-dollar Superhighway investments. Donald A.B. Lindberg, director of the National Library of Medicine and of the National Coordination Office for High Performance Computing & Communications (HPCC), told Congress in May that telemedicine "will assume ever greater importance as the National Information Infrastructure evolves."

CHEAP ADVICE. Last spring, the HPCC--a multiagency initiative Clinton entrusted to develop Superhighway technologies--announced $26 million in telemedicine contracts. In all, federal support for telemedicine will top $85 million in fiscal 1994. Now, states are seizing the initiative. In 1990, only three large medical networks were under construction. Today, there are more than 70. Georgia is spending $10 million to link 60 sites with videoconferencing. Oklahoma is investing $4.3 million on 38 sites, and 18 other states have programs going.

Private companies and universities are major supporters. BellSouth Corp. is bankrolling Georgia's program. And the University of California at San Francisco (UCSF) is linking five hospitals with fiber optics to cut interhospital delivery of scanned medical images from several hours to minutes. Broadly implemented, telemedicine would reduce annual health-care costs by at least $36 billion, or 3% of this year's estimated health bill, according to Arthur D. Little Inc.

Telemedicine advocates say most savings will come from videoconferencing--relieving specialists who are on the road too much. "You can get a stock quote anywhere in the world from a handheld device," says James H. Thrall, chief radiologist at Massachusetts General Hospital in Boston. "But to get medical advice, you still need to get into a plane and fly." Or the doctor has to. On any given day, two out of four radiologists at UCSF are traveling. Having scrutinized health care in Giddings, Tex.--pop. 4,000--American Telemedicine Assn. President Jane Preston figures the technology could save 22% of the cost of delivering care there.

Telemedicine is also boosting hospital revenues. At Mass General, a team of 70 radiologists has X-rays wired from their own telemedicine center in Riyadh, Saudi Arabia. Since February, the team has "seen" 684 cases, and consultations often end with patients flying to Boston for treatment.

LONG WAIT. Some of telemedicine's biggest beneficiaries may be in the rural U.S. Prior to installing videoconferencing and electronic diagnostics last December, the Tri-County Health Systems center in Warrenton, Ga., referred patients to specialists in Augusta, 50 miles west. Often, says Director Debra C. English, patients balked at the journey. Now, technology spares them the trouble. When local doctors failed to relieve cafeteria worker Hazel Grier's hand pains in April, English linked her with a specialist in Augusta who prescribed antibiotics and physical therapy.

Despite such successes, acceptance of telemedicine will come slowly. The Medical College of Georgia spent $166,000 each on its 60 clinics across the state--which are underutilized partly because the population is sparse. At the Tri-County center in Warrenton, two weeks may pass between videoconference sessions. All told, only 1,000 people were treated by wire last year in North America, according to the Center for Health Policy Research in Denver.

Still, with Washington's support, the numbers are bound to increase. And ultimately, for many patients, diagnosis will start with the click of a mouse.

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