Bridging the doctor-patient gap

Dr. Robert Adams (right), a neuroscience professor and director of the MUSC Stroke Center, says the center's telemedicine specialists have treated about 700 patients in 11 hospitals from Rock Hill to Hardeeville.

New federal grant money and an expanding interest in telemedicine, a technology that allows doctors to remotely diagnose and treat patients, is helping a growing number of specialists in Charleston reach rural residents suffering deadly ailments.

On the heels of reports showing that doctor shortages in rural South Carolina are near crisis levels -- and expected to become even worse in the next several years -- observers said telemedicine soon will become a necessity.

"There is a huge gaping need in rural communities," said Dr. Dee Ford, a critical-care doctor at the Medical University of South Carolina. "They desperately need doctors and nurses with expertise to treat myriad conditions."

The use of telemedicine, a field that dates to the 1960s with the use of microwave transmission, has gained traction in the Palmetto State in the past five years when doctors established a hub of expertise in Charleston to treat depression and stroke patients statewide. Physicians use secure web- sites and a new $9.5 million broadband network to see patients in rural emergency rooms on computer monitors in their Charleston offices.

Technological improvements and increasing cultural acceptance have contributed to the spread of the existing telemedicine specialties, experts said. And within the past year, federal stimulus funding has gotten a new trauma telemedicine initiative off the ground.

Despite recent successes, though, barriers to the field's further spread remain. The medical community and the state legislature must iron out how to handle doctors' credentials, as physicians must be licensed at their base hospital and at the one where their remote patients seek treatment.

Other obstacles are financial. The start-up costs for telemedicine equipment and services, up to about $80,000, can be prohibitively expensive for smaller medical centers, experts said. Other concerns involve disputes about how treatments are billed and reimbursed, they said.

Ford said the administrative tasks of starting telemedicine programs, like the new trauma initiative, are "enormous."

"It's easy to see why such an obvious idea requires an extraordinary amount of work," she said.

State Rep. Kristopher Crawford, R-Florence, a doctor who is involved in a telemedicine business, last week called for new legislation to regulate the blossoming field.

Crawford, who said he would not file his own bill because of a perceived conflict of interest, said the logistical and administrative obstacles Ford described must be addressed.

"You're not going to get neurologists, endocrinologists and oncologists in the rural parts of the state," he said. "There will be a surge in demand for telemedicine in those places. We need to move rapidly to expand the use of it."

Here is a look at some of the latest local advances in the field:

Trauma

Patients who suffer serious trauma stand greater chances of survival or recovery if they are treated within an hour of their injury's onset. Most hospitals in the state, though, are unequipped to treat the most serious trauma cases. The state's highest-rated trauma centers are in Charleston, Columbia, Greenville and Spartanburg, hours from rural residents who must be driven when medical helicopters are unable to fly.

The Medical University of South Carolina, one of the state's four highest-rated centers, recently received $1 million in funding from the American Recovery and Reinvestment Act to start a research project using telemedicine to treat trauma and blood poisoning patients in four rural counties.

MUSC trauma specialists will begin "seeing" patients from Orangeburg County beginning in October, said Ford, the critical care doctor. The following month, specialists will take patients from emergency departments in Barnwell, Bamberg and Williamsburg counties, she said. Specialists in Charleston will use remote controls to maneuver cameras pointed at patients sitting in rural emergency rooms.

"We connect them with experts here despite differences of couple hundred miles," Ford said. "We can bring our expertise to a rural area to evaluate, stabilize and triage patients."

Ford said she expects the MUSC specialists will handle up to 10 calls for consultation a week. Specialists, like the ones involved in the trauma initiative, usually are based in big hospitals where they can access many patients to "support their expertise," she said.

"You can't find primary care doctors in rural counties, so you can imagine how hard it is to find specialists," Ford said.

The grant, awarded a year ago, will pay for trauma care for the four counties for another year, while researchers collect data to show the initiative's progress.

Stroke

In the two years since they began treating patients in rural South Carolina, the MUSC Stroke Center's telemedicine specialists have treated about 700 patients in 11 hospitals from Rock Hill to Hardeeville.

Now, six additional hospitals said they want the service that allows stroke specialists in Charleston to consult with rural emergency room doctors about what drugs patients should receive or whether they should be transferred to a different hospital for more advanced treatment, said Dr. Robert Adams, a neuroscience professor and director of the MUSC Stroke Center.

It is unclear how soon the new hospitals will join the program because "we don't know how fast we can expand," Adams said. "It's clear that people in smaller towns expect and deserve high quality care regardless of the size of their community," he said.

"In South Carolina almost all the stroke specialists are in Charleston," he said. "Without telemedicine, all that expertise would be in one place. This is about outsourcing that specific difficult service."

Depression

Therapists at Charleston's Ralph H. Johnson VA Medical Center have used telemedicine to treat veterans in Beaufort, Myrtle Beach and Savannah suffering from post-traumatic stress disorder and depression since 2005. Grant funding expanded the program's reach to four additional counties since then. All told, more than 1,000 patients have been treated, an official said.

Later this month, the VA specialists will expand their geographic reach even farther and begin treating patients in Dublin, Ga., and Selma, Ala. Veterans from Tuskegee, Ala., will be on the patient list by the year's end.

"It's just as effective as being treated in person," said Hugh Myrick, associate chief of staff for mental health at the VA. "It gives more people access to our very specialized psychiatric care."

The post-traumatic stress therapy repeatedly exposes patients to "triggers" that cause them to react in daily life -- a car backfiring, for example -- while specialists observe them on television screens in Charleston. Patients can see the therapists on their own screens.

"We do the whole therapy just like we'd do it if the patient were in Charleston," Myrick said. "The whole concept of needing to be at the same place as the patient is outdated."

High-risk pregnancy

Up to half of the babies born in South Carolina are carried by mothers with high risks for pregnancy complications, said Dr. Chris Robinson, an assistant professor of obstetrics and gynecology at MUSC.

Many of those mothers live in rural areas, though advanced prenatal specialists are available only in four counties, including Charleston, Robinson said. Telemedicine is necessary to serve the areas in between, he said.

For the past two years, MUSC specialists in Charleston have seen thousands of patients in Beaufort and Florence using telemedicine, Robinson said. They view ultrasounds and talk to patients over the state's secure online health network.

The group of physicians wants to expand their reach to smaller hospitals and more doctors' offices in the coming years, he said.

"South Carolina has some of the highest rates of obesity, diabetes and hypertension," Robinson said. "Many people don't the money or transportation to get to Charleston. We can help improve their conditions right where they are."

Reach Renee Dudley at 937-5550 or rdudley@postandcourier.com.