Digital doctors: telemedicine improves medical care in remote areas, but faces some policy obstacles.

• Author: Johnson, Alissa

Nancy, mother of a 3-year-old with spina-bifida, lies nervously on the examination table in Pocahontas, Ark. Her husband and mother are with her in the room, along with her obstetrician, who has just performed a prenatal ultrasound. Fortunately she will not have to wait long for the results. More than a hundred miles away in Little Rock, Ark., a maternal-fetal medicine specialist reviews the scan and tells Nancy that her baby is developing normally.

When Nancy's obstetrician in Pocahontas decided to consult an expert because of the family history of spina-bifida, there were no local specialists. However, through a state telemedicine network, they could have access to a specialist without leaving town. Thanks to the expansion of telemedicine--or the use of information technology and other means of communication to deliver health-related services and health care remotely--women like Nancy are more easily able to get medical care that was once out of reach.

But, as routine as this scenario is becoming, policy issues such as licensing, reimbursement, privacy and confidentiality, liability and a lack of infrastructure may hinder the continued growth of telemedicine.

Nancy was reassured about her pregnancy by the University of Arkansas' Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS). A consultative service for a wide range of physicians including family practitioners, obstetricians, neonatologists and pediatricians, ANGELS receives support from the Arkansas Medicaid Program. Physicians and patients from around the state connect with Little Rock's maternal-fetal medicine and neonatal specialists, genetic counselors and other high-risk pregnancy experts via interactive video about 40 to 50 times a month, according to Tina Benton, the project's director.

Through ANGELS' call center and telemedicine network, Arkansas women and their physicians can take advantage of medical services at the University of Arkansas, the only academic tertiary care center in the state. At least 21 sites with ultrasound capabilities allow specialists in Little Rock to see images live and talk directly with patients and their physicians living elsewhere. Benton says that a 20 percent increase in the number of ultrasounds conducted since telemedicine became an option at ANGELS indicates that they may be reaching some women who would not have received prenatal care otherwise. In addition, the telemedicine site has significantly fewer no-shows (about 10 percent) than the clinic (up to 40 percent).

REACHING MORE

Telemedicine has several advantages, according to Dale Lea, who once directed a successful pilot project that provided genetic services to a hundred patients, mostly children, living in Maine's rural communities. "For people who are in rural or island...