By Lucy Jokiel
A 76-year-old woman living in rural Kau on the Big Island suffers from congestive heart failure and severe arthritis. She needs to see her physician, but lives several hours from the nearest clinic. Thanks to telemedicine, the doctor comes to her in a virtual house call, via a videoconferencing device in the woman's home that lets her speak with, and be seen by, her physician.
On Molokai, patients interact with psychiatrists on Oahu over video-links that allow them to have a two-way conversation with real-time picture and video. Each side of the exchange has its own television-mounted camera, positioned so that doctor and patient can look into each other’s eyes.
These are just two examples of how modern telemedicine is providing instant access to medical care in the Islands.
Telehealth is generally used as an umbrella term to describe all the possible variations of health care services using telecommunications, including non-clinical applications such as medical education. The term telemedicine (sometimes called remote doctoring) describes the direct provision of clinical care via telecommunications – diagnosing, treating or following up with a patient at a distance.
Telemedicine can be delivered in linked networks of health care facilities that cooperate with one another. The State Telehealth Access Network (STAN) and the Pan-Pacific Education and Communication Experiments by Satellite (PEACESAT) connect 22 Pacific Island jurisdictions over a geographic area of 4.8 million square miles. It interconnects 40 health care facilities and provider networks statewide.
The concept of telemedicine has actually been in existence for over four decades, beginning with the transmission of the electrocardiogram (EKG) over wireless communication in the mid-1900s. But it wasn’t until the early 1980s that multi-point networks were designed specifically to improve access to health care for distant monitoring from home, or remote hospitals and clinics.
In the late 1990s, Hawaii launched a number of initiatives to promote telehealth, including the Akamai Project at Tripler Army Medical Center that provided connectivity and consultations to Micronesia and the Pacific Rim; and the Weinberg Foundation’s funding of 29 hospitals with grants of $200,000 each for telehealth equipment and start-up funding.
In November 2007, a symposium was convened in Honolulu to develop a statewide collaborative to advance telehealth throughout the state. Recognizing the strategic importance of telehealth for health care in Hawaii, the HMSA Foundation assisted with funding.
Shortly after the symposium, the Federal Communications Commission Rural Health Pilot Program granted over $417 million to 69 telehealth networks in 42 states and three U.S. territories. Hawaii’s Pacific Broadband Telehealth Demonstration Project will receive almost $4.9 million to link 96 health care facilities throughout Hawaii and the Pacific Islands with the STAN network.
This connectivity will greatly expand telehealth access across our state and the Pacific by providing many more low-cost network access points. This will enable rural facilities to communicate with urban Oahu health care specialists, as well as provide emergency and disaster response communications.
Some predict that telemedicine will someday become as common as talking on the phone. For a geographically isolated island state like Hawaii, telehealth could offer new technology to benefit the delivery of health care services by improving access and reducing costs.
Despite its obvious potential, however, the adoption of telemedicine in Hawaii has been slow. It has yet to make the transition from a feasible device to an integrated tool in health care delivery. Barriers exist such as a lack of collaboration between health providers and private and government organizations. Some physicians say it doesn’t account for the human factor and is often too costly.
“Telemedicine has tremendous potential to address the specialty care access needs of remote areas,” says HMSA Vice President of Professional Relations and Provider Advocacy Jim Walsh, a member of the Pacific Islands Chapter of the American Telemedicine Association (PICATA), “but we need to address the liability concerns and comfort of the physicians and patients with the technology.”
