By Paul Wenske,The Kansas City Star

KANSAS CITY, Mo. – An intensive-care patient grimaces as she clutches her chest.

“Tell me about your chest pain,” the physician inquires calmly. The woman reaches for a spot on the left side of her chest. “Right where your hand is?” asks the doctor. The woman nods.

Sounds routine – except the patient is at St. Luke’s Hospital in Kansas City, Mo., and the physician is 20 miles away. The doctor is seated before a video screen and a bank of computers and monitors, watching and measuring the woman’s vital signs in a high-tech in Lee’s Summit, Mo.

The futuristic ICU monitoring system is the latest in a quiet medical revolution in which health care is increasingly delivered through broadband technologies – land-based and wireless networks that allow continuous communication of data, voice and video at ultra high speeds.

Medical innovations include wristwatches that monitor the heart, cell phones that can prick the finger of a diabetic patient and send the information to a doctor, and bedroom floor sensors that can discern an elderly patient’s unsteady gait or even predict the onset of Parkinson’s disease.

Supporters seeking to accelerate the use of these new technologies say they will not only make health care more accessible, but also improve treatments and reduce costs.

How much? A scholar with the Ewing Marion Kauffman Foundation and the Brookings Institution estimates savings of nearly $1 trillion.

While independent experts confirm these savings are realistic, they also complain the U.S. telemedicine revolution lags the rest of the world. Most Americans still don’t have access to broadband, smaller hospitals can’t afford the technology and current laws slow the approval process of the technology for medical use or make it hard to use across state lines.

In short, they say there is an urgent need for a national policy on telemedicine.

“The promise is gigantic for improving the quality of care and the convenience of care,” said Steven Findlay, a health-care analyst at Consumers Union, which publishes Consumer Reports. “The writing is on the wall – it’s just a matter of how we are going to get there.”

In a report released last month, Robert E. Litan said expanding telemedicine to hospitals, doctors offices, nursing centers and homes can in 25 years save billions by lowering medical costs, reducing institutionalized living and allowing seniors and people with disabilities to remain active in the labor force.

Litan, vice president for research and policy at the Kauffman Foundation and senior fellow in the economic studies program at the Brookings Institute, said that telemedicine benefits “are as substantial as what the federal government is likely to spend on homeland security over the next 25 years.”

He said under the right policies, savings “could exceed what the United States currently spends annually for health care for all its citizens.” Health care currently consumes 16 percent of the nation’s gross domestic product.

Since last January, St. Luke’s Health System has used its broadband network to monitor 66 ICU beds at three hospitals, allowing one on-call specialist to provide critical bedside care and respond to emergencies without stepping into a patient’s room.

It will expand to a fourth St. Luke’s hospital this month.

Jennifer M. Ball, director of St. Luke’s eICU system, said it was too early to say whether the system saves money. Ball said the priority is to provide constant and intensive monitoring of patients, which has been shown in studies to improve care.

An on-call doctor has instant access to a patient’s electronic chart and can zoom in with an in-room camera to examine a patient’s physical responses. There is no need to wake up sleepy doctors at home and get their reaction to observations read to them over a telephone.

“They’re (doctors) looking at intervening early and preventing complications,” Ball said. “All the care still goes on at bedside with nurses. This is an enhancement. An additional layer of care.”

So far, the eICU system, developed by Baltimore-based Visicu Inc., is used in 34 health systems serving 150 hospitals in 22 states, including an Air Force facility in Honolulu that monitors patients in Guam. Telemedicine is spreading “but this is still the tip of the iceberg,” Ball said.

The promise of telemedicine to improve care and reduce costs also is being tested at the University of Kansas Medical Center in Kansas City, Kan. At KU, an oncologist, cardiologist or pediatric specialist can confer with doctors puzzling over a medical case at a rural hospital in Kansas, which may lack access to a specialist.

There’s no need for a patient to come to Kansas City or a specialist to drive hundreds of miles to Fort Hayes, Kan., said Ryan Spaulding, director of the Center for Telemedicine and Telehealth at KU Med Center. Instead, a medical examination is set up over a secure Internet line.

KU also is working with schools in Kansas City, Kan. Kathy Archer, a nurse at M.E. Pearson Elementary, can use a minicam and instruments hooked to a computer to check a child for an earache.

“It’s an awesome thing,” Archer said. “Mom doesn’t have to take off to drive a child to the doctor. The doctor’s online.”

Spaulding noted that “in real time we could look in a kid’s ear 300 miles away if we want and prescribe medications … it’s lower cost and more access. And because it goes over the Internet, this technology can be useful in the home, nursing homes or anywhere broadband service can go.”

Cerner Corp. in North Kansas City has developed online technology to allow young diabetes patients to upload their glucose meters for faster feedback from caregivers. The service is used at Children’s Mercy Hospital in Kansas City and is being marketed to hospitals elsewhere.

Cerner also is developing online services to allow consumers at home to track their medical histories and interact with health providers to schedule prescriptions, treatment and office visits.

“It’s turning medicine from a reactive mode to a proactive, preventive mode,” said John Larsen, senior practice manager at Cerner.

Even so, barriers remain that slow telemedicine’s growth, said Russell Bodoff, executive director of the Center For Aging Services Technologies, which last month made a presentation at a White House conference.

One major barrier is that only 40 percent of Americans have access to broadband. That compares with 75 percent in Japan and South Korea. The United States ranks 18th in the world in broadband access.

“It’s absolutely essential to get broadband to more citizens,” Bodoff said.

Current U.S. laws also run counter to the technology. For instance, Americans can’t use Asian equipment that allows diabetics to use cell phones fitted with blood testing kits. The reason? A cell phone is not an approved medical device.

Medical licensing laws also don’t allow a specialist in certain states to monitor the health of a patient in another state, shutting off some patients from a specialist.

In addition, the technology is so new that most insurers won’t reimburse hospitals for the costs, so most health providers absorb it as a cost of doing business – at least for now.

Even if these problems are resolved, a debate is growing over who should deliver the service. Telecommunications and cable companies maintain that the best way to increase broadband access is to create an incentive by giving them exclusive rights unimpeded by state or city laws.

Consumer groups, however, argue that it is better to encourage competition, and that includes allowing cities to have some control over franchising and providing broadband access, especially wireless.

“Part of the problem is how far behind we are in broadband development,” said Jeannine Kenney, a Consumers Union senior policy analyst studying the issue. “We still don’t have a national broadband policy in this country to make it available to Americans at affordable prices.”

Until then, Kenney said, the promise of quality and affordable telemedicine – beamed from wireless towers atop prairie silos – remains a pipe dream.

—

(c) 2006, The Kansas City Star.

Visit The Star Web edition on the World Wide Web at http://www.kcstar.com/

Distributed by Knight Ridder/Tribune Information Services.

—–

PHOTO (from KRT Photo Service, 202-383-6099): telemedicine

AP-NY-01-06-06 0615EST

Copy the Story Link