The Dawn of Telemedicine
By Dan Wilchins
In 1995, Dr. James Rosser led an operation on a patient who suffered from chronic heartburn--surgery was the only solution. Rosser coached a team of doctors through a delicate procedure, telling them how to reinforce the door between the esophagus and the stomach to help prevent heartburn. It was a standard operation.
Standard, except for the fact that Rosser was in New Haven, and the patient was in Hawaii.
A new marriage
Yale is a leading center in the development of a new sort of technology, broadly termed telemedicine. A marriage of telecommunications technology and medicine, telemedicine strives to bring doctors closer to their patients and one another.
Dr. Rosser, director of Endo-Laparoscopic surgery at the Yale School of Medicine, led the operation in Hawaii through sophisticated video conferencing technology: a camera in the operating room transmitted the entire operation to his office in New Haven via satellite.
Thanks to a recent $12.5 million grant from the National Aeronautics and Space Administration, (NASA) doctors in the Department of Surgery are investigating even more sophisticated telemedicine possibilities at the Yale School of Medicine.
Dr. Peter Angood, a co-investigator of the grant and assistant professor of surgery, believes that this sort of research is crucial for the study of medicine. "Our goal," he said, "is to reinvent surgery and medicine for the next century." Doctors may one day be able to diagnose, treat, and even operate on patients--or astronauts on missions for NASA--from thousands of miles away.
Angood explained how the Department of Surgery plans on structuring its research. "Our goal is to develop sensors to detect physiological data," he said. "We're also working on transmitters to send that information to doctors, and effectors, like robotic arms, to allow doctors to deliver medication--and even perform surgery--remotely."
Rosser has already performed remote surgery; he performed surgery on an animal in Atlanta from a hospital in Orlando. A small camera and specialized surgical tools were inserted through incisions in the animal's stomach. Rosser manipulated the camera and the tools via remote control. "It was a great success," he explained.
Less glamorous, but no less important
Such real-time interaction is exciting, but costly. Video information can't easily be streamed through conventional phone lines; it is usually sent up to a satellite via a special transmitter, then beamed back down to a satellite dish on earth. But using a satellite, Angood said, "can cost upwards of $500 an hour," on top of the costly equipment required.
But telemedicine is not limited to real-time communication. "We're also developing technology for the lowest common denominator," Brett Harnett, Telemedicine Systems Manager for the Commercial Space Center, said. (The Commercial Space Center is a telemedicine research center in the Department of Surgery). "Anyone with a desktop computer, a modem, and a phone line can take advantage of telemedicine."
Telemedicine in the Amazon
For 10 days each year, Dr. John Persing plunges into the Brazilian Amazon to perform pro bono reconstructive surgery in a clinic in the city of Manaus. A professor of plastic surgery at the Yale School of Medicine, Dr. Persing has limited time to devote to the clinic each year. But advances in telemedicine--in particular the use of digital photographs sent as email attachments-- have allowed him to fully exploit his time in Manaus.
Leo Otake, MED '00, is part of the team of students and doctors that Persing brings with him each year. "In the past, when we went down on these missions, hundreds of people would flood the clinic [in Manaus]," Otake said. "There were more people than we could handle, and we had to turn people away. That's discouraging for people."
In 1996, Otake began colloborating with doctors in Manaus to develop a solution to this problem. Now, doctors in Manaus take pictures of patients with digital cameras throughout the year. These images are then sent to Otake as attachments to email messages; Otake compiles the photographs and sends them to Persing and other members of Persing's operating team.
This collection of digital patient photographs allows the members of Dr. Persing's operating team to prescreen patients. Those most in need of attention are given appointments to meet with Dr. Persing. Patients no longer flood the clinic when Persing's operating team arrives; they come only if they have appointments.
But more importantly, those patients that Persing and his team can operate on receive better post-surgical care. "We can follow up on our patients now," Otake explained. "It used to be that we would just operate on patients and never see them again. But now, doctors in Manaus can send up pictures of patients we've operated on. If they [the patients] need more help, we can give the doctors in Manaus advice about what to do."
The future of medicine
Angood believes that telemedicine will change field of medicine in the future. "Telemedicine is a great tool to increase communication in medicine," he said. "It lets physicians and patients communicate with each other regardless of physical location. It will allow for health care anywhere in the world."
Do you believe that telemedicine is a great tool? Is it practical on a large scale?
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