Throughout rural America, patients are discovering that the big-city medical center is just a mouseclick away. Once dismissed as gimmickry, “telemedicine” networks like the one tying Eastman to Augusta could soon link “every medical center and physician’s office in the country,” according to a recent report by the American Hospital Association. Since 1990, the number of U.S. networks has jumped from three to at least 30, and virtually every state is now developing one. Doctors have yet to try anything more heroic than an examination over the phone lines, but advances in robotics and digital communication may soon give specialists the power to treat and even operate on patients from thousand of miles away. “We’re bringing medicine out of the industrial age,” says Col. Richard M. Satava, Washington-based military surgeon and virtual-reality guru “and moving it into the information age.”
A typical telemedicine network includes a dozen or more facilities–doctors’ offices, nursing homes, prisons each one linked to a regional medical center through computers, cameras and video monitors. One camera has a zoom lens that can pan a whole examining room or focus on a single skin pore. A second may transmit images of records and test results, while a third attaches to scopes that can be used to inspect the colon, the stomach or the inside of someone’s ear. By activating the system, a far away specialist can discern almost anything that a physical exam would reveal–and he can do it in seconds rather than hours.
The benefits of virtual medicine aren’t confined to emergency care. Try finding an oncologist or a psychiatrist in a town like Ransom, Kansas (population: 448), and you will likely be disappointed. Few rural communities generate enough business to attract such a specialist. But electronics could change all that. From his well-wired office in Kansas City, Dr. Gary Doolittle is now preparing to launch a twice-weekly oncology clinic for cancer patients all over north-central Kansas. And Dr. Ace Allen, director of the state’s Telemedicine Research and Evaluation Program, says other specialties will soon follow suit.
While Kansas dreams of electronic clinics, health officials in Georgia are taking the same idea a step further. In the not-too-distant future, they say, anyone with a special TV may be able to conjure medical assistance without leaving the living room. Over the next few months, researchers from the U.S. Army and Medical College of Georgia will install computer-linked cable TVs in 25 Augusta homes, inaugurating what they call the electronic house call. The computers have ports for several diagnostic instruments; by holding, say, the stethescope to his chest and clicking the appropriate icon on the computer screen, the user will be able to send readings to doctors while talking to them on the TV monitor.
These cable units will run $10,000 to $15,000 apiece. Yet Dr. Jay H. Sanders, director of the Telemedicine Center at the Medical College of Georgia, predicts they will reduce costs by preventing needless hospital stays. As the technology gets cheaper, he says, virtual checkups could become as routine as pay-per-view programming.
Detecting a tumor is one thing, treating it is quite another. Even if telemedicine does revolutionize diagnostics, surely surgery will still require direct contact between patients and doctors. Or will it? Several engineering teams are now perfecting “robot-assisted microsurgery” systems that could reach the market by the end of the decade. These devices, which carry out commands issued on an electronic console, promise both to extend surgeons’ reach and to enhance their performance.
One of the pioneers in virtual surgery is Dr. Steven Charles, a California eye surgeon who has long wished for a better way to treat the ocular damage caused by diabetes and high blood pressure. A surgeon can sometimes stem the loss of vision by cauterizing injured blood vessels are too small to mend with any finesse. So Charles and engineers at NASA’s Jet Propulsion Laboratory have developed a robotic arm that mimics anything the surgeon does with an electronic pointer, but at less than a fifth of the original scale. Human tests won’t begin before next year, but the device could give surgeons unprecedented access to remote regions of the eye, ear, spine and brain.
At MIT, engineers are pursuing even wilder techno-fantasies. One group, led by instrumentation scientist Ian Hunter, has developed a system that not only executes the surgeon’s commands but gives him the illusion of working directly on the patient. Hunter’s surgical robot–he calls it a “slave”–works much like Charles’s. But it has a head housing two small cameras that continually transmit magnified images back to a nearby video console. By looking into the console, the surgeon sees through the robot’s eyes, which are more powerful than his own. And by manipulating surgical tools that are mounted on the console, he can direct the robot’s movements, adjusting the scale as needed. The MIT researchers have yet to venture beyond animal studies, but Hunter envisions a day when specialists in Chicago will use the system to perform surgery in Montana. With the help of a fiber-optic cable, he says, the system would work as well from across the country as it does from across the room.
Whether the folks in Montana will want their skulls severed by robotic slaves is another issue. Even in more modest guises, electronic medicine faces practical obstacles. Most states still bar doctors from practicing across state lines, and insurance companies are understandably reluctant to start paying for remote consultations. They worry that once virtual services are reimbursable, everyone will get them, regardless of need. Ethicists, for their part, fear a loss of confidentiality as people’s medical records start floating around in cyberspace. Still, the evidence to date suggests that telemedicine has vast potential. Used properly, it could reduce the nation’s health costs by $36billion a year, according to a 1992 study by the Arthur D. Little consulting firm. Patients say they appreciate the convenience, and small studies suggest the results are just as good as those achieved by doctors in the flesh. So stay by your screen
