Telemedicine Still Has a Long Way to Go

Experiments continue, but the market for telemedicine equipment won't develop until the laws are updated and the technology is better, cheaper and faster

While Lt. Cmdr. Miguel Cubano cuts into his patient's abdomen, Johns Hopkins University surgeon Mark Talamini instructs the less-experienced doctor on what to expect during a laparoscopic hernia operation. "Now slow down because you're likely to find a little bleeding in this section of the abdominal cavity," Talamini advises. For that moment, Cubano and Talamini forget that they are several thousand miles apart.

Talamini is advising on the operation from a small office at the Johns Hopkins Applied Physics Laboratory in Laurel, Md., and Cubano is performing the stomach surgery aboard the USS Abraham Lincoln stationed in the Persian Gulf. A computer in the ship's examining room sends images to Talamini from a tiny camera attached to the laparoscopic instrument inside the patient's abdominal cavity. The two doctors talk to each other over the telephone while Talamini watches each move the ship's surgeon makes. Similar to a football analyst, Talamini draws circles and arrows on the medical image to show Cubano where to place the surgical staples.

This experiment in telemedicine is just one of dozens going on around the world where advances in computers and telecommunications are being used to improve medical care. The trick, however, is making the technologies reliable and cheap enough for the often under-funded communities that they could most help, such as in rural areas or Indian reservations.

"The prices of the systems must come down and the speed and reliability must go up" if telemedicine is to become a reality, said Robert Stewart, the principal Applied Physics Lab investigator for the telemedicine project. The system, from El Segundo, Calif.-based VIC Hi-Tech Corp., cost APL about $3,200. Even though this price isn't too prohibitive, the technology isn't good enough to depend on in life or death situations.

Several times during the two-hour operation the doctors lost either their computer or their telephone connections, disconnecting the physicians.

Also, the speed of the image transmission, which was carried over satellite feed supplied by Comsat Corp. in Bethesda, Md., must be improved. It took at least 10 seconds for the ship and the laboratory to send images back and forth.

In addition to technology and cost issues, legislation is another barrier slowing the spread of telemedicine. Licensing rules that were established to protect patients from untrained doctors are hindering the widespread use of telemedicine applications.

"Right now, doctors [using telemedicine to treat patients] are going out on a limb because there are no standards," said Stewart. In fact, a physician in one state, using a video link to examine a patient in another state, may be subject to licensing laws in both states. The fear of regulatory uncertainty and potential liability is slowing the use of telemedicine, according to a study issued earlier this year.

The report from the Council on Competitiveness found that "uncertainty surrounding a physician's and a patient's legal rights and obligations is limiting the use of telemedicine across state lines." The study also said that because the Food and Drug Administration has not established guidelines for distributing medical software, especially electronically distributed software, medical groups that are developing software are not sharing it because they fear they'll be held accountable for how that software is used.

"The consequence of such legal and regulatory uncertainty is that the full market potential of new applications will be realized first in those sectors such as electronic commerce, entertainment and manufacturing that face less uncertain environments," the study concludes. In other words, the medical community will be one of the last institutions to jump on the information superhighway. And the marketplace already reflects that trend.

A desktop conferencing study by American Business teleCommunications shows that only about 4 percent of teleconferencing professionals used desktop videoconferencing for tele-medicine. Three times as many professionals use the systems for training and 38 percent used desktop videoconferencing for general video communications. Given these statistics, it's no surprise that there are few firms stepping out with technologies designed for telemedicine applications.

Five-year-old VIC Hi-Tech adapts its regular teleconferencing equipment for customers who want to do telemedicine. Alan Shen, vice president of research and development for VIC Hi-Tech, said he expects there will eventually be a large market in using teleconferencing technologies for medical care.

But even though "there's been a lot of medical inquiry," there still aren't enough telemedicine sales for VIC Hi-Tech to offer a specialty product for the medical community.

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