Telemedicine was first used during the 1985 earthquake in Mexico. Its application was simple: via satellite, doctors provided voice-based assistance and coaching to Red Cross and Pan American Health Organization workers.
Since then, the Internet has expanded the possibilities for telemedicine to instant transport of images and x-rays, documents and instructions, voice-based coaching, and live video observation and interaction with patients who may be thousands of miles away from an attending specialist in a major medical center. The process even goes one step further: specialists in different areas of the country or the world have been able to perform minimally invasive surgical procedures remotely on patients by being able to operate via Internet-transmitted signals to robots in the operating room.
The benefits of cyber-medicine were directly felt by Michael Harrigan, a financial advisor who suffered a stroke while driving on an interstate highway in rural Wisconsin. As Harrigan retold his experience to the Milkwaukee Journal Sentinel, his face had felt odd and his breath had gotten short. He managed to pull to the side of the highway and call 911. Then he was taken to the nearest available medical facility -- a community healthcare center 22 miles off the highway.
“Paramedics from the town of Johnson Creek picked him up,” said Jacklynn Lesnia, vice president of patient services at the Watertown Regional Medical Center, which treated Harrigan. “In the past, he would have been treated by a physician in the ER (emergency room). Now, we activate our telemedicine protocols with a stroke alert over an Internet-enabled EMS (emergency response system).” The alert immediately goes over a secure T1 line to the University of Wisconsin Medical Center, which patches the alert through to a doctor who is a stroke specialist.
In Mr. Harrigan’s case, Internet-facilitated treatment resulted in a 90-minute window between onset of the stroke and treatment -- a “gold-level” response. “This is very important to rural healthcare centers because often victims of stroke don’t get to the ER soon enough,” said Lesnia. “Then, if you don’t have a stroke specialist on staff, there is a hesitancy to use stroke treatment medications right away, since they also have their risks. You want to run all of the tests first.”
With a telemedicine communications link, a specialist in a major medical center can directly interact visually and verbally with a patient in a rural area. This means that critical factors that frequently get lost in translation no longer do, because the specialist can see for himself what is going on.
The IT behind this medical immediacy consists of not only leasing and monitoring pipelines that are wide enough to transport heavy data over IP, but also a complex of failover mechanisms. So if one pipeline goes down or degrades, the communication can be cut over to another pipeline, in order to maintain constant uptime.
Central to this communications strategy is also the management of multiple ISPs (Internet Services Providers) in the process. Many sites insert network routing with advanced intelligence and then program these routers with business rules for a combination of both wireless and wireline service providers. These various providers can then be brought into the communications mix, depending on load balancing or failover requirements.
The message for healthcare IT is that communications strategies must be as well-funded and managed as application deployment, security, and data repositories. This is especially true in an era when more remote medical applications will be needed for underserved rural environments.
That message wasn’t lost on Michael Harrigan, who today is fully recovered from his stroke. “Time is a critical element in the treatment of strokes,” said Dr. Justin Sattin, the neurologist who worked over a dedicated telemedicine link to the clinic in Johnson Creek to treat Mr. Harrigan. “Although there is new evidence that treatment can occur as late as 4.5 hours after the onset of stroke, the standard window of treatment is treatment response within three hours,” Sattin said. “If you delay beyond that, the chances for a successful outcome diminish by 15 to 20 percent.”