www.countrydoc.com: BellSouth helps bring telemedicine to rural patients

I'm 60 years old, I've been involved in rural medicine for a long time, and this is the most exciting thing I've seen yet," said J. Raymond Fletcher, medical director of telemedicine at the University of South Alabama College of Medicine.

He's talking about the new joint effort by his institution and BellSouth to open the first in a planned network of "wired clinics" around Mobile, Ala., in areas that are underserved by full-time physicians. Fletcher and his team began the $3 million Southwest Alabama Rural Telehealth Network on June 18.

When operation begins July 1, patients in impoverished pockets of Mobile and Washington counties will be able go to local clinics and get top-notch medical help. Local health care practitioners will be able to consult with experts at the university's medical college and access its on-line medical libraries.

This will be done digitally over T-1 lines in the BellSouth network, said Ernie Schoolfield, health care industry manager for BellSouth Business Systems. "We're linking four primary remote locations now, with plans to expand that number later," he said. "The sites range from about 15 miles to 60 miles from the USA College of Medicine. Then, we bring those T-1 connections back to the same [central office] in Mobile that serves the university, connect them with a DS-3 hub connection and add a service that allows for bandwidth allocation between video and data transport."

Each rural site has PCs and a two-camera mobile examination module from VTEL, called the Friendly Rollabout Examination for Doctors, or FRED. The site will also get electronic stethoscopes, opthalmoscopes and other equipment.

South Alabama's medical specialties are pediatric and maternal/fetal health care, so practitioners at the remote sites will also perform ultrasound echocardiograms. The results will be transmitted in real time to a pediatric cardiologist in Mobile who can listen for heart problems in the fetus.

The system can also do teleradiography, Fletcher said. "That feature digitizes X-rays taken at a remote site and sends them to a PC monitor here at the university. These are diagnostic-quality X-rays."

Rural health care practitioners can also use the system for distance learning, taking courses and consulting with university staff that will help them in their careers - and perhaps let them remain in the communities that need them.

Scheduling these conferences and transport sessions will be done simply at first. Health care workers will visit the College of Medicine's Web site, look at a posted public timetable of classes and examinations and contact Fletcher's team to set up a connection. Starting this summer, that scheduling will be done on-line at a password-protected site.

It's hard to point to results that prove the cost-efficiency of telemedicine because the alternative - a trip to a far-off hospital - is hard to calculate, said Fletcher. But he hopes to open another six or eight sites by next summer, and feels convinced that as the Alabama system spreads, it will prove itself in lower costs per patient treated.

"This area is economically depressed in the broadest sense," Fletcher said. "It's mostly rural, and the labor force is not very highly skilled. We have an opportunity here to take health care to where the patients are - to give them a network that can become a real community resource. The potential is very exciting for the patient and the practitioner."