Telemedicine: Bringing Healthcare to the Patient

CITRIS research in telemedicine will help improve medical access for those in remote regions throughout the state.

by Gordy Slack


healthcare has never been better. However, this is true only for those
who have access to the state’s top medical specialists and the labs and
equipment on which they rely. For the millions of Californians who live
far from large medical centers, or are in prison, or on the streets,
lack of access often means lack of good healthcare or none at all. A
host of CITRIS telemedicine and remote access projects are attempting
to correct this disparity.

“If it is too expensive or
difficult to bring the patient to the specialist, we can increasingly
bring the specialist to the patient,” says Ravi Nemana,
Director of Healthcare@CITRIS, the newly created healthcare research
center and Executive Director of CITRIS’s Services: Science, Management
& Engineering program. For seven years Nemana was the lead
technologist at the UC Davis Center of Health and Technology, where the
fields of telemedicine and remote healthcare services took off in the
early 1990s.

In those days, telemedicine simply meant a
teleconferencing device connecting doctors in remote clinics and
hospitals to specialists and information resources at the UC Davis
Medical Center (UCDMC). The first institute to participate was a small
hospital in Colusa County that nearly lost its obstetrics department
when doctors were no longer comfortable practicing without the backup
of specialists in emergency situations. Thomas Nesbitt, a physician and the Executive Associate Dean for Clinical and Administrative Affairs and Director of the Center of Health and Technology at UC Davis,
linked a fetal-monitoring device in the Colusa hospital to UC Davis and
then later added a tele-ultrasound, so that in difficult cases
obstetricians could get real-time advice from on-call specialists in
Davis. “That linkup gave the obstetricians the confidence to keep
delivering babies in Colusa Country,” says Nesbitt, who was recently
named the CITRIS Chief Scientist at UC Davis. “Thanks to that program,
it is still possible to be born a native of Colusa.”

Thomas Nesbitt, Director of the Center of Health and Technology at UC
Davis, and recently appointed CITRIS chief scientist at UC Davis

the decade and a half since then, the technology of telemedicine and
remote health care has come a long way. And Nesbitt, Nemana, and their
colleagues have done much to address the disparity in access to medical
expertise by making specialists and information available when and
where they are needed: in remote parts of the state, at accident
scenes, and in the homes of patients.

Videoconferencing has
long been a staple of telemedicine, but what was originally a
technology designed to allow bankers in Los Angeles and San Francisco
to meet without traveling is now taking on a distinctly medical tint,
says Nesbitt. High-resolution images zoom out to include the patient’s
entire body, or zoom in to magnify a small part of it, permitting
physicians at a distance to do comprehensive exams. Even though
consulting off-site doctors may not be able to touch distant patients,
the availability of real-time 3-D images enables them to recommend
treatment for many conditions.

“It becomes unnecessary for a
doctor to know what a joint feels like, say, if he or she can see
inside of it and know exactly what is going on,” says Nesbitt.

some cases, it is even possible to conduct surgery from afar with the
use of robotic equipment that permits highly detailed operations
conducted through a video display. “It does not matter whether that
screen is three feet away from the patient or three hundred miles away,
as long as someone is nearby to take over in the event of emergency,”
says Nesbitt.

Nesbitt’s program at UCDMC provides
telemedicine services to over 65 sites around the state, and that
includes small hospitals, clinics, and even correctional facilities.
Bringing prisoners to hospitals is expensive and time consuming. So is
bringing medical specialists in to prisons; and frankly, says Nesbitt,
many just are not willing to go. Allowing prison doctors to consult
with specialists at Davis via digital video link and other monitoring
devices is both more affordable for the state and time efficient,
extending top healthcare services where they have not traditionally

In addition to developing administrative systems and
work-flow models to ease the passage of resources from big medical
centers to patients in remote locations, CITRIS researchers are also
developing a number of devices that will bring doctors, and data, and
labs closer to the patients who need them, says Nemana.

UC Berkeley assistant professor of bioengineering Daniel Fletcher and his students, for example, are developing an inexpensive optical attachment for
cell phones that will eventually allow for magnification up to 50x, a
resolution sufficient for the examination of single red blood cells and
potentially the identification of malaria-infected cells. Such a device
would allow medical professionals and others who are far from any
healthcare facility to send in data that could result in an inexpensive
and nearly instant diagnosis.

Other optical cell phone
fittings in the works will allow field practitioners, or paramedics, or
parents for that matter, to photograph eardrums and take close-ups of
lacerations or rashes that could help ER physicians triage cases before
transport. Fletcher, whose students won support for the project in a
CITRIS white paper competition earlier this year, imagines a time when
such devices are common parts of a home medical kit. "Instead of
bringing your child to the ER, you could snap a picture of his or her
ear and send it instead. The doctors could tell you to come in, or,
even better, save you the trip and simply prescribe an antibiotic,"
Fletcher says.

With the ability to send MRIs, CT scans, and
even 3-D animated images of, say, a beating heart, along with real-time
visual and sound data, “we are decoupling diagnosis and treatment,”
says Nemana. “The patient can be in one place, the test can occur in
another, and the diagnosis can be done in yet another. Then the
treatment can be delivered wherever most appropriate. Often that is
right where the patient already is,” he says.

“This will be
especially appreciated by the baby boom generation, which wants to age
at home and not in nursing homes or in the hospital,” says Nesbitt.
When people can send in not only their heart rate, blood pressure, and
oxygen readings, but also do on-site blood tests and gather biometric
data on how conditions are responding to treatment, the quality of home
care will improve a lot, he says, and the number of visits will be

The culture and practice of medicine are placing
as great a limitation on the growth of telemedicine as technological
challenges are, says Nesbitt, whose Davis program is forging new
practices in the areas of patient confidentiality, billing for remote
services, and coordinating on-call experts for the hundreds of
tele-consultations that happen each month.

But the
opportunities are easily worth the effort, says Nesbitt, on both the
receiving and giving ends of digitally transmitted expertise. The
technology not only gives underserved patients quick and efficient
access to experts in arcane medical subspecialties, it also give those
specialists access to patients who can fully exploit their training,
putting such valuable doctors to the best possible use.

For more information:

The Center for Health and Technology:

Spotlight on Telemedicine:

Computerworld Honors UC Davis Telemedicine: