Doctors’ House Calls Possible Via Technology

Dr. Luis Hernandez, Pain Management Specialist, Joins Medical Staff


It’s a dialogue.

The new portability of telemedicine could allow people and health care professionals to link to each other from wherever they are.

Cunningham said the health centers had previously used a substantial federal grant to purchase an expensive telemonitor unit. But advances in consumer digital technology have dramatically reduced the price of telemedicine.

The software that’s now available allows for very meaningful video connection without an expensive Polycom unit, he said.

Long-distance telemedicine can be traced back to the Civil War, when casualty figures and medicine supply orders were reported via telegraph, according to a 1996 article in the Bulletin of the Medical Library Association. But the first modern telemedicine systems were developed by NASA scientists who sought to monitor physiological functions such as heart rates, blood pressure and respiration during the first manned space flights.

One of telemedicine’s earliest goals of telemedicine has been to connect top-notch medical professionals to patients in remote geographic areas. It’s an enduring objective that has driven much of its use in the North Coast.

When Dr. Javeed Siddiqui, an infectious disease specialist, first began providing telemedicine services to Sonoma Valley Hospital in 2007, telemedicine units and broadband services such as T1 lines were extremely expensive.

Siddiqui provides infectious disease consultations to Sonoma Valley Hospital. The hospital also links up to a UC Davis specialist for pediatric emergency care and an acute stroke specialist at Sutter Health’s California Pacific Medical Center in San Francisco.

Siddiqui, who later co-founded TeleMed2U, said telemedicine became less cost prohibitive once it freed itself from expensive telemonitors and other legacy units. Also, he said, the adoption of telemedicine platforms that can run on any computer operating system made it possible to use devices such as laptops, tablets and even cellphones for medical consultations.

It’s not about the device, Siddiqui said.

The platform that allows this type of connectivity is provided by the nonprofit California Telehealth Network, which recently teamed up with video conferencing firms Arkadin and Vidyo. The joint effort allows network members, which include community clinics and critical-access hospitals such as Sonoma Valley Hospital, to connect patients and providers using a standard wired or wireless Internet connection.

We bring them things that allow them to connect to resources in Northern California that are not easily accessible. We help save them money, leveraging economies of scale, said Eric Brown, the California Telehealth Network’s president and CEO.

Mark Noble, senior director of product marketing for Vidyo, said that nationally there has been a perfect storm brewing for rapid adoption of telemedicine. Politicians in Washington eager to grapple with the skyrocketing costs of health care are turning to telemedicine, he said.

The political climate has become right, Noble said. The cost of health care has to be brought under control.

Meanwhile, the North Coast’s largest health care providers, Kaiser Permanente and Sutter Health, continue to adopt telemedicine in new ways.

At Kaiser, the video visit is directly integrated with the provider’s system of electronic medical records. In the near future, some Kaiser members will be able to conduct video visits using mobile devices that use either Apple’s iOS or Google’s Android operating system.

This is a huge deal. From a technology standpoint, this is one of our biggest operational improvements to our members, said Dr. Hari Lakshmanan, a physical medicine specialist and Kaiser’s assistant physician in chief for technology.

Lakshmanan said Kaiser is working to ensure the service has a secure firewall and other safety features before we roll it out to all our members.

Sutter Medical Center in Santa Rosa, which was one of the North Coast’s early adopters of telemedicine in the intensive-care setting, has begun using the technology for acute stroke care.


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B.C. medical specialists struggle to find work

The report doesn’t address the issue of whether there are too many specialists for the Canadian health care system, in which operating room time and budgets are fixed. But it makes it clear that doctors are competing for resources. The report also pinpoints reasons why newly certified specialists are having trouble finding work: older doctors are delaying retirement; established surgeons are protecting their precious (often only one day a week) operating room time so young doctors aren’t getting the hospital/surgical positions they covet; and a lack of cohesion in medical resource planning and coordination between medical schools, governments and hospital or health care authorities. As well, there are relatively new categories of health professionals encroaching on doctors’ territory, such as advanced practice nurses, nurse practitioners and physician assistants. Respondents to the survey were graduates of Canada’s 17 medical schools and/or Canadian residency training programs in fields such as cardiac surgery, neurosurgery, nuclear medicine, ophthalmology, radiation oncology, urology, critical care, gastroenterology, general surgery, hematology and medical microbiology. The report does not include data on family doctors. While about one in five specialists or subspecialists said they are having challenges finding jobs, another 22 per cent of newly certified specialists said they are taking locum positions or other various part-time positions. Locums assume another doctor’s duties during holidays or extended absences. In the survey, 40 per cent said they weren’t happy they had to do that. Dr. Dave Snadden, associate dean of education at UBC medical school, said since the report is based on a survey with a response rate of about onethird (43 per cent in B.C.) of 4,233 doctors polled, it has to be seen as less than perfect from a research methodology perspective. He defended UBC’s approach to matching residency training positions with community needs and noted that is one reason why UBC has been pushing for more and more family medicine residencies.

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