Telemedicine in Alaska.

• Author: PARMELEE, CATHERINE

Alaska's rural communities depend on telemedicine to get the health care they need.

In a small, remote Alaska village a young girl is struck by a snowmobile. Are her injuries superficial, or does she require extensive care? A man injures his wrist while working at a fish processing plant. In Kodiak, the wrist is x-rayed and put in a splint. Does that take care of the problem? On an isolated island, a community health aid examines a screaming child's eardrum. Is it infected?

Telemedicine, or telehealth, helps answer these questions and more. The U.S. Department of Health and Human Services defines telehealth as "the use of telecommunications and information technologies to share information and to provide clinical care, health professions education, consumer health education, public health, and administrative services at a distance."

Technically, something as simple as calling 911 utilizes telemedicine. But giant steps in telecommunications mean distance will no longer be an obstacle to quick, quality health care.

The lead scenarios are actual incidents. In the first situation, the health aide snapped digital photographs and wrote a description of the young girl's injuries and sent them via e-mail for expert evaluation. The photos revealed the injured girl needed more specialized attention, and she was put onboard the next regular flight from her village to Bethel.

"A decision was made right away, thanks to the digital pictures," said Alice Rarig, data and evaluation unit manager of the state's Department of Health and Social Services Alaska Telehealth Advisory Commission. "Without the pictures, care may have been delayed, and she may have gotten worse."

In the second predicament, the x-rays were electronically transmitted to Providence Alaska Medical Center and examined by a specialist who determined the patient's treatment was sufficient.

The ear infection is an everyday type of occurrence. With the help of a digital otoscope, a community health practitioner can photograph the eardrum. If the practitioner is still uncertain of the diagnosis, the pictures can be electronically dispatched to a physician. The photos improve diagnostic capabilities, which helps reduce unnecessary use of antibiotics. Furthermore, as community health aides become better at reading the pictures, fewer calls have to be made.

"The whole package is wonderful," Rarig said. "It's win-win."

Telemedicine in Alaska

The potential applications of telemedicine are astounding and include the ability to monitor patients in their homes, provide long-distance medical training and demonstration and provide fast and easy access to medical research (or conferences) via video phones. The Alaska Department of Corrections uses video phones for many of the psychiatric consultations with clients in correctional facilities. To date, the system has been highly effective, cutting costs and facilitating higher quality doctor-client relationships than those developed in phone interviews.

"It enables a small staff to meet many needs," Rang said.

Presently, a multitude of telemedicine projects and services are in place across the state, and plans are being laid for more. In Southeast, Juneau's Bartlett Regional Hospital, Petersburg Medical Center and Wrangell Medical Center formed an alliance known as HISEA, or Health Information in Southeast Alaska. The medical facilities work together to provide health information to the public on the Internet. The alliance is connected by an Intranet in order to improve the region's health services...