Friday, December 19, 2008

Telemedicine protects Arizona, its many regional communities

[Source: Nogales International, Roger Conroy] - Centered in Phoenix and Tucson, a beneficial net covers Arizona communities from Ajo to Nogales to Yuma, the New Mexico communities of Bloomfield, Crownpoint, Gallup, Shiprock and Tohatchi and Utah’s Fort Duchesne and Salt Lake City.

The Arizona Telemedicine Network gives people in Santa Cruz County access to specialty care--that’s care beyond what is offered at Mariposa--applying the latest technology, said Mariposa Health Clinic CEO Jim Weldon. “Doctor (Ronald S.) Weinstein founded the program, and it’s very innovative--a national model.” Weinstein was the third guest speaker in the Mariposa Series on Thursday at Holiday Inn Express in Nogales.

The network gives local clinics access to information and specialties above the level normally available in Nogales, Mariposa chief of medicine Eladio Pereira said. Mariposa Clinic uses rheumatology, dermatology and gastroenterology services over the Telemedicine Network. “It’s incredible--speed, accuracy, consults right away. It’s very, very important.”

There are several cases each month that are aided by use of the network at Mariposa, Pereira said.

The network had it’s beginnings at Massachusetts General in 1968, Weinstein said. Telepathology, or remote diagnosis began in the 1980s. The concept is illustrated by the television shows “CSI,: and earlier, “Quincy, M.E.,” Weinstein said.

Arizona Sen. Robert Burns was instrumental in the establishment of the network, Weinstein said. “He’s now president of the Arizona state senate. He founded it. He came to us and asked us to do it.”

The network began at the Phoenix campus of the University of Arizona College of Medicine, where Weinstein is director of the program. It now includes 171 sites in 71 communities. “Doctor Pereira is the best director in those 71 communities,” Weinstein said. “He has been a supporter of Mariposa efforts in telemedicine since the beginning.”

24-hour access

The network gives 24/7 access to pathology (the study of disease) at the UA College of Medicine. “Telemedicine is a large program that provides services at a distance,” Weinstein said.

Nogales came on board through a grant from the Department of Agriculture. Originally, the program was designed for “end of the dirt road” clinics, Weinstein said. Mariposa was brought on to allow doctors in Phoenix and Tucson to travel to a remote site that was easily accessible to evaluate the network in the beginning.

The U of A created a unique network for Arizona. In 1996, there was a problem of broadband access in Arizona, and the U of A created the Telemedicine Network outside the Internet to meet its telecommunications needs, Weinstein said.

By 1998 there were 55 sites, including Nogales. Nogales was the first rural site, Weinstein said.

Communities served include remote Indian reservations and prisons in rural settings. The Department of Corrections facilities are placed in remote locations in Arizona. The Indian reservations saved $200,000 in costs over the last year. “The dollar savings in the Department of Corrections is enough to fund the entire program,” Weinstein said.

It is easier to use telemedicine for the prison system than to transport prisoners, and the prisoners like it better, Weinstein said.

Radiology is huge in the prison system, Weinstein said, but it is only one of the specialties that use the Telemedicine Network.

Real-time use

One example is doctors use real-time ultrasound to diagnose fetal problems. There are many applications, Weinstein said. They include tele-psychiatry, tele-dermatology, tele-cardiology, tele-ophthalmology, infectious disease diagnosis and family teleconferencing.

There are many times a patient is confined for long periods at a hospital and the family is in a remote community. The system allows families to continue interpersonal relations, which benefit the patient, Weinstein said.

Tele-pediatrics and tele-trauma, which began in Douglas, are also important, Weinstein said. “It provides a telepresence for trauma physicians. “It saves lives,” Weinstein said.

Broadband access promises more access for remote communities in the future, Weinstein said. “Many sites are now interoperable over the broadband network. Many of the communications issues are not minimized because of the availability of the Internet. That’s a real advance.”

Thus far, the network has handled more than 700,000 cases. More than 150 physicians from the college of medicine handle cases. “We have a long way to go,” Weinstein said. “The university still doesn’t have access to all the information to assist in all cases.”

That is due to the fragmented nature of the U.S. health-care system, Weinstein said. Some patient records may not be accessible through the network.

The latest advance is in digital mammography, Weinstein said. “The Navajo Nation wants to be first in telemedicine. They now have a 45-minute turn-around for digital mammography, where the follow up was only 50 percent, and entailed a long wait.”

Patients are often without communications on reservations, Weinstein explained. The network shortened a weeklong turnaround to allow patients to remain at the clinic to hear results.

Dramatic change

The change is dramatic. “It has altered the way physicians look at disease,” Weinstein said. It gives physicians the opportunity to communicate and to compare things.

Still, one of four to six visits should be in person, for most cases, Weinstein said. Some procedures can be completely remote, such as the digital mammography, with the on-site physician handling consultation.

The Mariposa Series of lectures is an opportunity to bring folks together for lunch and to hear about the latest developments in medical care from a well-respected speaker, Weldon said. The series began in 2007 and is held twice a year, said Norma Villasenor executive assistant to the CEO.

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