UAB Synopsis, Vol. 24, No. 25, July 4, 2005

Telemedicine extends specialist expertise to underserved areas

The 42-inch flat-screen monitor hanging on the office wall of pediatric surgeon William Hardin, Jr., MD, gives him a live, high-definition view of Children's Hospital burn and trauma rooms. Several of his colleagues' offices and selected operating rooms at Children's also are equipped with the videoconferencing system.

"These units are the start of what I hope will be a telemedical network used for evaluation of acute burns and follow-up care of pediatric burn patients," Dr. Hardin says. "Telemedicine has many potential applications and benefits for pediatric burn patients; it could, for example, allow Children's burn specialists to begin the complex treatment process as soon as a new burn patient is admitted to a remote Emergency Department (ED).

"Patients referred to us often have burns whose size and depth have been grossly underestimated. As a result, these patients are usually underresuscitated and may require rapid administration of fluids to correct the deficit," he explains. "With telemedicine, we could look into an ED with real-time technology or receive digital images documenting the appearance of the burns, which would allow us to accurately estimate burn depth and the percentage of affected body surface area to determine appropriate initial fluid resuscitation."

Has telemedical technology advanced enough to allow precise medical decision making for burn patients? That is one of the questions Dr. Hardin and colleagues are addressing. "Burns are a surface disease, and good digital or video images probably mirror what we see during in-person assessments," he says. "The literature suggests we can make accurate estimates from a distance, but many issues must be addressed before we can put the system into widespread use."

Preparing for Prime Time

Dr. Hardin and colleagues are exploring telemedicine's potential in a number of pilot studies. One investigation compares accuracy of evaluations of burn patients made by the referring hospital with an in-person assessment made in Children's burn room and estimates made by physicians viewing video footage of burns.

"I think we're going to find that telemedical evaluation of patients by burn specialists comes close to in-person assessments made in burn centers and that both are far superior to estimates from nonburn professionals who are often asked to perform initial evaluation and stabilization of pediatric burn patients," he says.

Pediatric burn specialists at Children's also are working with the Alabama Department of Public Health to purchase and investigate the efficacy of mobile telemedical carts equipped with computers and audio-visual capabilities. "We're going to evaluate the carts for use in follow-up care," Dr Hardin says. "Many of our patients must travel considerable distances for the after-care burns demand. We believe there are large hidden costs associated with follow-up care. In addition to travel expenses, for example, parents must often take time off work. Teleconsultations could provide a cost- effective alternative to clinic visits."

This same technology could be used to extend services to the Black Belt and other underserved regions, says Dr. Hardin, who also expects telemedicine to play an important role in the aftermath of terrorist attacks or natural disasters.

"Experts estimate about 30% of individuals injured during a terrorist event or natural disaster will be burn patients and a significant number of the injured will be children," he says. "Our ability to respond to these situations depends on efficient communication channels. The proposed telemedical network will help us rapidly prepare for a large number of patients or deploy needed personnel to a location that's being inundated through some sort of disaster."

"Telementoring" is yet another use for high-end videoconferencing, Dr. Hardin says. "This technology can be used for remotely assisting with pediatric surgery. My colleague, Dr. Keith Georgeson, has already used our equipment to telementor an operation in New York state."

Many issues must be resolved before making the leap from telemedicine's experimental phase to full-scale implementation. "Connecting multiple specialists to EDs around the country presents a number of technological challenges," he says. "Much of this technology was initially developed by the Department of Defense, and they have worked out many logistical problems — we must now transfer some of those solutions from the military environment to the civilian health care sector."

Health care organizations must also address licensure and reimbursement issues, but Dr. Hardin and colleagues hope to extend telemedical expertise to remote areas within a year. "Right now, we are focusing on gathering data that will tell us about the system's technological limitations, cost-effectiveness, and benefit to patients and how we can best integrate telemedicine and our existing clinical services," he says. "Our goal is to serve as a major burn center for children in the Southeast. High-level pediatric burn care, which requires specialized resources and the expertise of a large team of surgeons, therapists, and support personnel, is a scarce resource. My colleagues and I believe telemedicine can serve as a bridge to extend our services into underserved areas in Alabama and neighboring states."

*Photographer Jeff Tombrello