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Look to a recent agreement between Johns Hopkins Medicine and Lucent Technologies for a stellar example of what may be on the horizon for the blooming field of telemedicine.
"Anytime you help medical experts expand their capabilities and reach new people, it makes them extraordinarily happy," says Gary Stephenson, spokesman for Johns Hopkins Medicine. "Our partnership with Lucent Technologies will help them do both by giving physicians here and internationally new capabilities to treat their patients and do an even better job."
Think globally, treat locally
Once completed, the arrangement will allow Hopkins to develop international offerings in the areas of health care consulting, patient services, education, and training. "The new medical information management delivery network will position Hopkins to extend its medical expertise to the far corners of the world," states Steven Thompson, CEO of Johns Hopkins International, the corporate arm of Johns Hopkins Medicine that enters into international agreements.
The service should enhance a physician’s ability to maintain and treat a patient locally since all requests to the service will come through a regional physician, suggests Thompson. It will offer a local physician the ability to deliver treatment and may often eliminate the need for a patient to travel to receive a second opinion or specialty care. Should, however, a decision be made to send a patient to Johns Hopkins Medicine, the medical record and diagnostic studies can be forwarded electronically between Johns Hopkins and the referring physician throughout the treatment course.
"The cost to the provider, country, or family to send patients to the USA for consultation and treatment can be minimized by providing expertise to the physicians at the local level," explains Elizabeth Von Kessler, program administrator for the partnership. The system allows patient history (personal data), including video and audio clips within the patient record, as well as images such as CTs, MRIs, and sonograms to be instantly transmitted. The emphasis on local providers lessens the concern that the network will create competition for patients in other countries, say program officials.
The network will also offer the option of quality second opinions, mentoring, and surgical and clinical assistance to participants. International physicians in the network will have available to them the resources and expertise to verify diagnoses, recommend or collaborate on treatment plans, and offer alternative treatment options. As the treatment progresses, follow-up consultations will be provided via video conferencing.
Nurses are key to telemedicine
Von Kessler says that nurses will retain their indispensable role in the patient-care process. "Nurses will have the same role as caretakers and be able to use their nursing judgment in the telemedicine project as they do now. In fact, they are key to the process."
Von Kessler adds that triage will be vital to the success of the telemedicine interaction. "Nurses will perform many of the same activities as they do in a traditional setting. They will somewhat manage the consult from the time that it arrives to when it is sent to the requesting physician." Nurses will review the medical records, check for correctness and completeness, ask questions when necessary, help choose the appropriate physician or specialty for the patient, and then return the consult to the referring physician.
As telemedicine becomes more widely practiced, it will open other avenues of career opportunity for nurses, notes Von Kessler. "Nurses love technology and want to go the extra mile. Telemedicine will give us even more tools in our nursing toolbox."
Several positive patient care results are expected from the project:
• It provides access to Johns Hopkins physicians, many of whom are acknowledged as leaders in their field.
• It keeps patients at home when at all possible, saving money and the distress of traveling abroad.
• It offers an efficient, single point of access to a wide range of expert medical consultation.
• It allows a wide spectrum of sites to be supported from a single acquisition workstation.
• It creates user-friendly electronic medical records for the requesting parties and Johns Hopkins physicians.
• It provides fast turnaround due to automated case management and tracking.
• It fosters real-time relationships between physicians.
• It ensures reliable connectivity through a virtual, private network.
• It expands easily to accommodate additional voice and videoconferencing capabilities.
• It enhances continuing medical education for health care professionals in the user’s country.
Not an overnight success
Telemedicine is broadly defined by the Tele-medicine Research Center as "the transfer of electronic medical data (i.e., high-resolution images, sounds, live video, and patient records) from one location to another." (See story, above right.) Despite what may seem to be the overnight success of telemedicine, notes the center, the field has existed for more than 30 years — longer if you consider telephone consultations between physicians since the telephone was invented.
The field took a giant step forward a few decades ago due in part to the efforts of the National Aeronautics and Space Administration’s (NASA). While NASA pioneered placing humans into space, they simultaneously pioneered monitoring and treating those humans while they were in orbit. Other telemedicine early endeavors include a program to provide health care to a rural Indian reservation in Arizona from 1972 to 1975; a partnership between Massachusetts General Hospital and Logan International Airport to provide occupational health services to airport employees and to deliver emergency medical care to travelers in 1967; and a satellite used in 1971 to communicate with 26 sites in Alaska to see if reliable communication could improve village health care.
Although still breaking new ground, both Lucent and Johns Hopkins are renowned for their particular areas of expertise, and in fact, Johns Hopkins has been involved in telemedicine for years. "We recognized long ago that there was a huge need for high-level medical expertise in other countries. It was economically untenable for the people from those countries to physically come to us or us go to them, so telemedicine allows that to happen," explains Stephenson. "We were the first academic institution to do anything of this sort. In 1998, we reached an agreement with the government of Singapore that resulted in Hopkins-led collaborative research, medical education, and clinical trials there. This venture, called Johns Hopkins Singapore, is now our presence in Asia."
Making it easy to phone home
There are several reasons it was the right time for such an ambitious project, says Von Kessler. "This is an opportunity for us to improve the standards of health care globally as per our mission: research, patient care, and education. The advancements in technology and growth in the use of technology and the Internet globally allows for imaging, [networking], and transmission of a variety of information."
She says that there has been an increasing number of requests for opinions and consults from physicians worldwide due to Johns Hopkins’ expertise.
"Crucial to our view of a global health care enterprise is a communications network that unites our distant centers and home base," says Edward D. Miller, MD, CEO of Johns Hopkins Medicine and dean of its medical faculty. "Lucent’s technology permits real-time, interactive communications that not only help provide better health care at the local level, but also enhance the continuing education and training of physicians throughout the world."
"There is a growing demand in many parts of the world for the innovative medical services for which Hopkins is known," he says. "We want to meet that demand in a way that never existed before. This issue is no longer distance, it’s time, and working with Lucent, we can tailor a sophisticated network that serves customers from the USA to Hong Kong."
Among the countries that may be considered to participate in the network are health care organizations in the Middle East, Asia, Eastern Europe, and Africa.
How it works
Lucent Technologies builds and delivers a wide range of public and private networks, communications systems and software, and data networking systems. There are four phases of the project and the initial phase is planned to be installed this spring. Under the agreement, Lucent will provide:
• A customer relationship management (CRM) system based on Lucent’s CRM products and services, including a comprehensive suite of software to assist Johns Hopkins with customer contact information and management.
• The Lucent Managed Firewall to ensure the confidentiality of patient records.
• Hardware and software to support patient assessment and continuing education through video, e-mail, diagnostic image and record transfer; and an archived video library for publications and video versions of Hopkins’ grand rounds, as well as third-party products to permit real-time telerobotic-assisted surgery.
• State-of-the-art telephony, data, video, and wireless products and the network systems required by the medical facilities to implement telemedicine programs.
• Development of local-area communications networks within Johns Hopkins in East Baltimore, as well as a wide-area virtual private network linking Johns Hopkins international sites with the institution’s facilities in the United States. They will be converged networks supporting integrated voice, video, and data transmission.
• Integration of quality assurance and billing software.
Tapping the global pocketbook
"We estimate that there is a multibillion-dollar market for global health care. In the international arena, these are typically government initiatives," says Jim O’Neill, president of Lucent’s Government Solutions business. Feedback Research Services, a market research firm that specializes in high-tech health care delivery systems, projects that by 2001, the cumulative expenditure on telemedicine in Europe and the Pacific Rim will be $1.4 billion.