TeleMedicine
The newsletter for the Midwest Rural Telemedicine Consortium - March/April, 1997

News on the wire:

The MRTC recently received the Telemedicine Research Center's annual report on telemedicine usage for 1996.

An overview of the report shows:

98% of the patients seeing a specialist via telemedicine were satisfied with their care. Only 11% of the patients seen in 1996 would rather have seen the specialist in person.
Use of telemedicine for specialty consultations saved the patient from traveling an average of 83 miles (one way) to receive specialty care.
The average length of telemedicine consultations in 1996 was 21 minutes. In 85% of the consultations, a diagnosis was either established or confirmed using telemedicine.

In November, the MRTC was featured in a health segment on the five and six o'clock news on KCCI-TV 8 in Des Moines. Thank you to Dr. B. Chandramouli and his patients for agreeing to be interviewed.

The MRTC was recently featured in the Iowa Communications Network's (ICN) 1996 Annual Report. A neonatal case study and a dermatology clinic were included as part of a story dealing with Dialable Wideband Video Service.

Teleradiology Arrives at Rural Hospitals -- Part Deuce

In the January/February issue of Telemedicine an overview of the definitive teleradiology project in use at Mercy Hospital Medical Center and its affiliate hospitals was presented. In this issue, our attention turns to North Iowa Mercy Health Center and its affiliate's preliminary diagnosis and supplemental teleradiology project. As noted in the last issue, each teleradiology system meets specific functionality requirements set by the reviewing facility.

North Iowa Mercy in Mason City and Franklin General Hospital in Hampton were the first locations in the MRTC network to deploy the technology, primarily to assist in radiology coverage. Like so many rural hospitals today, the low volume of radiology cases does not quantify the expense for a full-time radiologist.

Barb Bell, a radiology technologist at Franklin General commented, "All of the cases that we've sent to North Iowa Mercy have been conducted during non-coverage times (off hours or no visiting radiologist on site). Our particular system allows us to send the images to the Radiology Department at North Iowa Mercy, or directly to the home of the on-call radiologist."

The teleradiology system utilized by Franklin General is an EMED Lumiscan system. It is comprised of a PC-Windows platform, an on-board modem and a 512 kb by 512 kb resolution scanner. The system uses existing Plain Old Telephone Service (POTS).

"Transmitting a case is quite simple," says Bell. "A patient is brought into our radiology department for x-rays and the films are developed. I create a facsimile coversheet with the patient's demographics and brief case history. After the patient's films have been developed, they are scanned into the computer, reviewed for clarity and sent."

"The Radiology Department at North Iowa Mercy is notified when the images are sent, and whether or not the case is urgent. In most cases, a telephone call from the reviewing radiologist is received within 20 to 45 minutes," says Bell. Because Franklin General receives a preliminary diagnosis via teleradiology, every case (films and report) is then sent to the reviewing radiologist in Mason City for a definitive and final report.

The teleradiology system at North Iowa Mercy and Franklin General Hospital has been in operation for a year. The system has been used to diagnose cases ranging from child pneumonia to second opinions on chest exams. However, up to this point, teleradiology, in general, has not been utilized to its full capacity. Causes linked to the low volume of cases maybe a lack of protocols (which has since been resolved) and unfamiliarity with the technology. Other Developments in Teleradiology

Trine S. Bergmo of the Department of Telemedicine at the University Hospital of Tromso, Norway, recently presented a case study named An economic analysis of teleradiology versus a visiting radiologist service in the Journal of Telemedicine and Telecare [Volume 2, No. 3 - 96]. Bergmo's study indicates a radiology department at a tertiary hospital can save $422,100 per year by using teleradiology services at a rural hospital, rather than having a "circuit rider" radiologist visit that rural site -- assuming that 6000 patients (or 8000 examinations) were seen per year (an average of 25 patients per day).

Another study Teleradiology services for a rural hospital: a case study was also featured in the same issue of the Journal of Telemedicine and Telecare. This study, compiled by E.A. Franken, Jr., and W. L. Smith at the University of Iowa, and P. Whitten at the University of Kansas Medical Center, revealed "approximately one-half of all US hospitals have fewer than 100 beds, and each of these hospitals performs an average of about 7000 radiographic examinations annually. This constitutes about 12% of all radiographic examinations performed in the USA."

The two articles mentioned above, depict several reasons why it is important to examine whether teleradiology is more or less cost-effective than a visiting radiologist. The analysis in both articles indicates that teleradiology is possibly a cost-effective tool for rural patient radiographic workloads above 1,576 annually. With radiographic technology and telecommunications constantly fusing together, it will be the progressive organizations rural and urban who will profit from harnessing its awesome potentials.

Ongoing Educational Opportunities

Grand Rounds
First and Third Tuesday of each month
Various Topics and Speakers
7:30 - 8:30 a.m.
1 hour CME Category
0.1 CEUs (1 contact hour)
offered by Mercy Hospital Medical Center, Des Moines
There is no charge for this program.

Lunch Lecture
Every Thursday
Various Topics and Speakers
12:00 - 1:00 p.m.
1 hour CME Category
0.1 CEUs (1 contact hour)
offered by Mercy Hospital Medical Center, Des Moines
There is no charge for this program.

Trauma Conference
First Wednesday of each month
7:00 - 8:00 a.m.
1 hour CME Category
0.1 CEUs (1 contact hour)
offered by Mercy Hospital Medical Center, Des Moines
There is no charge for this program.

Did you know....?

The Iowa Communications Network (ICN) is the world's largest full motion interactive video network -- ICN 1996 Annual Report.

Telemedicine Exceeds Patients' and Physicians' Expectations

Physicians and patients at Palo Alto County Hospital (PACH) were pleased with their first encounter with the clinical use of telemedicine. Although anxious to be using the new age communication tool, the patients and their families were able to confer with their primary care physicians and the oncologist at the same time.

"I thought is was great because I don't drive and didn't have to find a driver to take us to an out-of-town appointment," said one patient's spouse. "It not only saved time and expense but also the pain of having to travel for an hours drive to Mason City when you're sick."

Another patient commented, "I was kind of anxious to see what was going on with my cancer treatment and chemo. I found out that I didn't have to be on chemo and I felt much better. I was able to ask the doctor questions and it felt just like he was in the room with me and Dr. Veltri. I thought it was just great. I was much calmer after I talked with Dr. Silberstein."

Dr. Patricia Banwart, participated in a telemedicine conference with one of her patients, a family member of the patient and Dr. Peter Silberstein. "I was anxious at first but Trisha Travis, the telemedicine coordinator at PACH, and Dr. Silberstein put me at ease," commented Dr. Banwart. "I felt there was good feedback with Dr. Silberstein and the patient. Since I was present with the family as they conversed with Dr. Silberstein, I thought it was easier to get an idea on how the patient and their family perceived the information they were receiving. We had very good communication between all parties involved. All in all, it was a very positive learning experience."

Everyone who has been involved with telemedicine at PACH, from physicians to patients to hospital personnel has commented it has more than met their expectations. The patients have not seen any disadvantages to meeting with the specialist over telemedicine rather than in person.

Since the installation of the portable equipment at PACH in October, six oncology patients and one dermatology patient have been seen by specialists in Mason City using telemedicine.Federal Agencies Develop Cooperative Efforts in Telemedicine

The next time you are surfing the web take a look at The Federal Telemedicine Gateway located at http://www.tmgateway.org. Developed by a number of federal agencies collaborating as the Joint Working Group on Telemedicine (JWGT) the web site includes information on federally funded telemedicine projects and links to other telemedicine resources.

The gateway was introduced at the Third Annual Rural Telemedicine Grantees Meeting, sponsored by the Federal Office of Rural Health Policy, (ORHP) held on November 14 and 15, in Bethesda, Maryland. Paul Maakestad, MRTC project director, and Fred Eastman, MRTC technical support coordinator, attended the meeting with representatives from nineteen other OHRP funded telemedicine projects from across the nation. Others in attendance included representatives from federal agencies involved in the JWGT and various research organizations.

Two busy days focused on development of federal telemedicine policy -- encompassing reimbursement issues, telemedicine project evaluation, future funding opportunities and telecommunications statutes. Lectures and break-out sessions covered the various topics, and time was also set aside for participant networking.

Among the hot topics discussed were the Health Care Financing Administrations' (HCFA) Medicare waiver, telemedicine project sustainability and the cooperative efforts of HCFA and ORHP to jointly adopt evaluation processes and instruments. The Telemedicine Research Center (TRC) of Portland Oregon, has been designated as the evaluator for both federal initiatives. The MRTC is currently collecting data for the HCFA study using evaluation tools developed by the TRC. Nationally the MRTC will be one of two telemedicine projects collecting evaluation data for both HCFA and ORHP studies.

To submit an article or for more information, please contact Tina Collins at 800/637-2994 ext. 8750 or 515/643-8750 or Brenda Epsteen at 800/433-3883 ext. 7875 or 515/422-7875.