Live… From The Surgery Room

Months after the sept. 11 incident, a fear of flying has boosted the demand for telemedicine.

January, 2002

The rapidly growing industry of telemedicine has done more than save Hawaii’s medical sector hundreds of thousands of dollars. The use of telecommunications to treat residents, especially those in rural areas, has revolutionized how local patients receive healthcare.

“Ideally, telemedicine can help overcome time and distance barriers that might prevent people from getting the care they need,” says Dr. Dan Davis, medical director of clinical informatics at The Queen’s Medical Center.

Telemedicine has helped locally to address problems presented by an aging population, the shortage in nurses, the explosion in medical knowledge and the restructuring of healthcare reimbursement, Davis says.

Videoconferencing equipment has facilitated consultations between physicians across the state on patients with various conditions. The technology has also enabled neighbor island medical staff to receive training at their hospitals, rather than having to fly to Honolulu for sessions.

Dennis Sato, vice president of Hawaii Health Systems Corp., says the 12-facility system has taken a leadership role in expanding the telemedicine industry in Hawaii.

Established in 1996, HHSC is the largest health care provider for neighbor island residents, with facilities on the Big Island, Maui, Kauai, Lanai and Oahu.

“A lot of these facilities do not have consultants in terms of psychiatry, dermatology, dentistry, radiology… because most of our facilities are rural facilities,” Sato says. “In order to assist rural healthcare in these communities, one of our first priorities was to start implementing telemedicine.”

With the help of a $3 million grant from the Harry and Jeanette Weinberg Foundation as well as two grants totaling $700,000 from the Department of Agriculture, HHSC was able to launch a number of telemedicine projects in 1998. Initial costs – including equipment, infrastructure, staff and training – cost about $200,000 per facility.

Equipment purchased from the PictureTel Corp. allowed for administrative videoconferencing.The corporation’s major meetings are now held via videoconferencing.

That technology has saved HHSC about $1.4 million in airfare and productive time between July 1998 and October 2001, Sato says.

Last year, HHSC linked all of its facilities for a videoconference to address concern over bioterrorism and dengue fever, he says. More than 160 people statewide participated in the conference, led by an infection control expert in Honolulu.

This two-way communication is made possible by the State of Hawaii Telehealth Access Network (STAN), which provides links between Hawaii facilities and educational institutions, as well as to the Mainland.

Sato says HHSC has also made strides in applying telemedicine for clinical use in an array of disciplines, including radiology, psychiatry and cardiology.

In hospitals, such as Leahi and Maluhia on Oahu, where there are no radiologists onsite, telemedicine allows physicians to transmit X-ray images to specialists at the Kauai Veterans Memorial Hospital, instead of having to mail them.

“The use of this is really unlimited,” Sato says.

Since July 1998, about 13,000 people have benefited from HHSC’s telemedicine program. As of November 2001, about 20 doctors had participated in the program.

At Queen’s, one of the system’s most recent telemedicine endeavors is a Web-based congestive heart failures disease management project sponsored by Merck Pharmaceuticals.

“It’s basically two nurses that use a Web-based program as a tracking database and clinical communication tools that allow them to track specific disease parameters, such as weight and blood pressure, for patients with severe heart failure,” Davis says.

Future telemedicine projects at Queen’s are dependent on grant funding, but one project it intends to launch is creating a virtual preoperative, preanesthesia clinic.

Neighbor island patients will get a chance to learn about their surgeries and have a virtual tour of the hospital before admission, In selected cases, patients will have to do a video visit with a nurse.

Sato says that HHSC is trying to collaborate with all of Hawaii’s health facilities, most of which use some sort of telemedicine technology.

“Given the tough times of healthcare, it’s very tough to do business now,” Sato says. “If we can collaborate, I think we can reduce the costs of all facilities and, at the same time, improve the healthcare of our communities.”

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