Indianapolis Business Journal

Telemedicine: From outer space to Indiana
Technology makes remote medical care more common
By Tracy Donhardt

January 30, 2006

It started as a NASA experiment in the early 1960s. Medical personnel at the Johnson Space Center needed a way to transmit the heart rates, body temperatures and other vital statistics from orbiting astronauts to Earth. Extravehicular activity—what telemedicine was called then—was initially performed on astronauts during the earliest manned Mercury space flights. Today, telemedicine—medical information exchanged from one site to another via electronic communications—provides access to care in rural areas, prisons, schools and numerous other locations worldwide. And it’s gone way beyond transmitting simple vital statistics. Today, videoconferencing, still-image transmission, remote follow-up care, continuing medical education and nursing call centers are all part of telemedicine. Networked programs link hospitals or specialists with outlying clinics and community health centers. The links use dedicated high-speed lines or the Internet to provide real-time communication between patient and doctor.

Peripheral medical equipment connected to a monitor allows doctors hundreds or thousands of miles away to perform the same services they would if patient and doctor were in the same examination room.

Telemedicine today is used in radiology, oncology, cardiology, pediatrics, psychiatry and home health care, said Pam Whitten, an expert in the field and a professor at Purdue University. Whitten has studied and launched programs in rural hospitals, elementary school nurses’ offices, jails and mental health centers in Michigan and Kansas. She started Kansas’ telemedicine program through the University of Kansas Medical Center in 1995. She joined the Purdue faculty in August and now has plans to increase and improve the use of telemedicine in Indiana. Whitten plans to release in February findings from a telemedicine policy meeting she organized in October. About 60 representatives from the health care industry, as well as telecommunication vendors, offered their ideas for expanding telemedicine in Indiana.

“Telemedicine here still is on a fairly small scale compared to other states, but we’re well poised to move forward,” Whitten said. “In 12 months, we’ll see huge progress.”

There are four established telemedicine programs in Indiana. Riley Connections got off the ground in early 2004 with a grant from the U.S. Department of Health and Human Services. Since then, the Clarian Health Partners program that links to clinics in Evansville, Bedford and Terre Haute has helped with more than 600 pediatric cases.

A Riley Hospital for Children patient who lives in Evansville doesn’t necessarily have to make the seven-hour, round-trip drive to Indianapolis, explained Greg Beck, the program’s director.

Peripheral devices connected to videoconferencing equipment allow a doctor in Indianapolis to check sutures or zoom in on a mole on a patient in Evansville. A digital stethoscope allows a Riley cardiologist to hear the heartbeat and breathing of a child in Bedford.

And since many follow-up visits can be done remotely, new patients are seen faster, Beck added.

St. Vincent Health Services has a telepsychiatry program that is linked to a critical-access hospital in Winchester and a mental health facility in Elwood.

Psychiatric evaluations are done via v i d e o c o n f e r e n c e , many of which are for children diagnosed with attention deficit hyperactivity disorder or elderly patients who need prescription management help.

“It’s a very informal setting for a child,” explained John Winenger, in charge of regional network development for the St. Vincent program.

With kids already familiar with television and computer monitors and gadgets, the equipment is non-threatening.

“It’s fun for the kids,” Winenger said.

And a doctor sitting in his office in Indianapolis has the ability to monitor a heartbeat, if desired, and zoom in on the child and watch facial and body movements that might indicate nervousness.

“We’re affecting numerous kids’ lives,” Winenger said. “We’re keeping them in school more because they have to travel less to Indianapolis.”

The St. Vincent telemedicine program also has a distance-education component for health care professionals at the rural sites.

Nurses, doctors and others in health care can participate in video courses and receive continuing-education credits in topics that include updates in family practice, patient safety and clinical nursing, among about 200 others.

Despite telemedicine’s growth, many programs—in Indiana and elsewhere—are facing the same hurdles, Whitten said.

Reimbursement by insurance carriers, long-term funding and full integration into the health care delivery system are common problems, she said.

Medicare first endorsed telemedicine about 10 years ago for consultation for certain conditions, Beck said. And about 30 states have passed policies or legislation that tells payers to reimburse for the same insurance codes Medicare reimburses for.

“Indiana isn’t one of them,” he said. “But the state is evaluating the issue.”
Progress is being made to expand Medicare’s acceptance of more telemedicine services, he said.

Insurance carriers often follow Medicare’s lead in deciding what to reimburse for, said Jonathan Linkous, executive director of the American Telemedicine Association in Washington, D.C.

“A lot of work is being done with policymakers to get Congress to better understand [telemedicine],” Linkous said.

Numerous congressional proposals that address topics like hurricane reconstruction, mental health services for troubled youth, and Medicare reimbursement include provisions encouraging the use of remote medical services, he said.

Some insurance companies reimburse for telemedicine, as do more and more private payers. Still, “the culture here in Indiana is it’s easy for an insurance company to tell the insured they must drive to the doctor.”

But Indiana’s state Medicaid program lags behind them all, say Beck and Winenger.

“Medicaid is the bogey we have to figure out how to deal with,” Winenger said.

He and others are considering forcing legislation that says Medicaid can’t discriminate against the technology.

“It’s just fear of the unknown,” Beck said. It can’t be the cost, because the net cost for telemedicine is no higher than for traditional care, he added.

Doctors generally bill the same fee they would for the same service performed in an office, Beck said. The cost of the equipment is partly offset by fewer travel expenses incurred by doctors and nurses who can monitor more patients remotely than they can by visiting each one personally.

With the federal government expected to spend nearly $1 billion this year on research and grants related to telemedicine, the funding hurdle is partly being addressed as well.

“Some health systems are just making an internal investment themselves to expand their telemedicine programs,” Whitten said.

That leaves the hurdle of integrating telemedicine into mainstream medicine.

The goal is to get to the point where telemedicine is not considered a separate medical specialty, but simply part of a person’s overall, complete medical care, Linkous said.

“It’s no different than cell phones or microwaves that in the past were unheard of,” Winenger said. “Someday, it’ll just be part of a person’s daily life.”

And if people like Whitten, Beck and Winenger have their way, someday will be soon.