Healing By 2 Way Video The Rise Of Telemedicine Ny Times

Healing by 2-Way Video - The Rise of Telemedicine - NYTimes.com 9/18/10 2:57 PM

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Michael Stravato for The New York Times
Dr. Jerry Jones uses two-way video at his home in Houston to consult with a patient across town. Dr. Jones is under
contract to NuPhysicia, one of the new telemedicine companies.
By MILT FREUDENHEIM
Published: May 29, 2010

ONE day last summer, Charlie Martin felt a sharp pain in his lower RECOMMEND

back. But he couldn’t jump into his car and rush to the doctor’s TWITTER

office or the emergency room: Mr. Martin, a crane operator, was SIGN IN TO E-
working on an oil rig in the South China Sea off Malaysia. MAIL

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He could, though, get in touch with a REPRINTS
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doctor thousands of miles away, via
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two-way video. Using an electronic
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stethoscope that a paramedic on the MOST POPULAR - BUSINESS
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rig held in place, Dr. Oscar W.
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Boultinghouse, an emergency
medicine physician in Houston, 1. Shortcuts: For the Dishwasher’s Sake, Go Easy on the
Detergent
listened to Mr. Martin’s heart.
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“The extreme pain strongly suggested a kidney stone,” Dr.
4. Shortcuts: The 3,000-Mile Oil Change Is Pretty Much
Boultinghouse said later. A urinalysis on the rig confirmed History
the diagnosis, and Mr. Martin flew to his home in 5. The Illusion of Pension Savings
Mississippi for treatment. 6. Chinese Investors Flock to London to Buy Real Estate
7. Tax Increase Would Hit Few Small Businesses
Mr. Martin, 32, is now back at work on the same rig, the
8. Talking Business: In Skyscraper at Ground Zero,
Courageous, leased by Shell Oil. He says he is grateful he

http://www.nytimes.com/2010/05/30/business/30telemed.html?_r=1&src=busln&pagewanted=all Page 1 of 6


Courageous, leased by Shell Oil. He says he is grateful he Sentiment Trumped Numbers
could discuss his pain by video with the doctor. “It’s a lot 9. Media Decoder: Jon Stewart Plans to Rally Against
better than trying to describe it on a phone,” Mr. Martin Extremism

Michael Stravato for The New York Times says. 10. Collect Now, or Later? Timing Your Social Security
Benefits
From thousands of miles away, Dr.
Oscar Boultinghouse checks the eye
of a patient.
Dr. Boultinghouse and two colleagues — Michael J. Davis Go to Complete List »
and Glenn G. Hammack— run NuPhysicia, a start-up
company they spun out from the University of Texas in
2007 that specializes in face-to-face telemedicine, connecting doctors and patients by
two-way video.

Spurred by health care trends and technological advances, telemedicine is growing into a
mainstream industry. A fifth of Americans live in places where primary care physicians
are scarce, according to government statistics. That need is converging with advances
that include lower costs for video-conferencing equipment, more high-speed
communications links by satellite, and greater ability to work securely and dependably
Can exercise make kids
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“The technology has improved to the point where the experience of both the doctor and
The voices of Schizophrenia
patient are close to the same as in-person visits, and in some cases better,” says Dr. Follow the Well Blog on Twitter
Kaveh Safavi, head of global health care for Cisco Systems, which is supporting trials of
its own high-definition video version of telemedicine in California, Colorado and New
Mexico.
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The interactive telemedicine business has been growing by almost 10 percent annually, to
more than $500 million in revenue in North America this year, according to Find your dream home with
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Datamonitor, the market research firm. It is part of the $3.9 billion telemedicine
category that includes monitoring devices in homes and hundreds of health care Follow The New York Times on Twitter
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Christine Chang, a health care technology analyst at Datamonitor’s Ovum unit, says
telemedicine will allow doctors to take better care of larger numbers of patients. “Some See the news in the making. Watch
patients will be seen by teleconferencing, some will send questions by e-mail, others will TimesCast, a daily news video.

be monitored” using digitized data on symptoms or indicators like glucose levels, she
says.

Eventually, she predicts, “one patient a day might come into a doctor’s office, in person.”

Although telemedicine has been around for years, it is gaining traction as never before.
Medicare, Medicaid and other government health programs have been reimbursing
doctors and hospitals that provide care remotely to rural and underserved areas. Now a
growing number of big insurance companies, like the UnitedHealth Group and several
Blue Cross plans, are starting to market interactive video to large employers. The new
federal health care law provides $1 billion a year to study telemedicine and other
innovations.

With the expansion of reimbursement, Americans are on the brink of “a gold rush of new
investment in telemedicine,” says Dr. Bernard A. Harris Jr., managing partner at
Vesalius Ventures, a venture capital firm based in Houston. He has worked on
telemedicine projects since he helped build medical systems for NASA during his days as
an astronaut in the 1990s.

Face-to-face telemedicine technology can be as elaborate as a high-definition video
system, like Cisco’s, that can cost up to hundreds of thousands of dollars. Or it can be as
simple as the Webcams available on many laptops. Ads by Google what's this?

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NuPhysicia uses equipment in the middle of that range — standard videoconferencing Back Doctor
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doctor that costs far less.

Telemedicine has its skeptics. State regulators at the Texas Medical Board have raised
concerns that doctors might miss an opportunity to pick up subtle medical indicators
when they cannot touch a patient. And while it does not oppose telemedicine, the
American Academy of Family Physicians says patients should keep in contact with a
primary physician who can keep tabs on their health needs, whether in the virtual or the
real world.

“Telemedicine can improve access to care in remote sites and rural areas,” says Dr. Lori
J. Heim, the academy’s president. “But not all visits will take place between a patient
and their primary-care doctor.”

Dr. Boultinghouse dismisses such concerns. “In today’s world, the physical exam plays
less and less of a role,” he says. “We live in the age of imaging.”

ON the rig Courageous, Mr. Martin is part of a crew of 100. Travis G. Fitts Jr., vice
president for human resources, health, safety and environment at Scorpion Offshore,
which owns the rig, says that examining a worker via two-way video can be far cheaper
in a remote location than flying him to a hospital by helicopter at $10,000 a trip.

Some rigs have saved $500,000 or more a year, according to NuPhysicia, which has
contracts with 19 oil rigs around the world, including one off Iraq. Dr. Boultinghouse
says the Deepwater Horizon drilling disaster in the Gulf of Mexico may slow or block
new drilling in United States waters, driving the rigs to more remote locations and
adding to demand for telemedicine.

NuPhysicia also offers video medical services to land-based employers with 500 or more
workers at a site. The camera connection is an alternative to an employer’s on-site
clinics, typically staffed by a nurse or a physician assistant.

Mustang Cat, a Houston-based distributor that sells and services Caterpillar tractors and
other earth-moving equipment, signed on with NuPhysicia last year. “We’ve seen the
benefit, ” says Kurt Hanson, general counsel at Mustang, a family-owned company.
Instead of taking a half-day or more off to consult a doctor, workers can get medical
advice on the company’s premises.

NuPhysicia’s business grew out of work that its founders did for the state of Texas. Mr.
Hammack, NuPhysicia’s president, is a former assistant vice president of the University
of Texas Medical Branch at Galveston, where he led development of the state’s
pioneering telemedicine program in state prisons from the mid-1990s to 2007. Dr. Davis
is a cardiologist.

Working with Dr. Boultinghouse, Dr. Davis and other university doctors conducted more
than 600,000 video visits with inmates. Significant improvement was seen in inmates’
health, including measures of blood pressure and cholesterol, according to a 2004 report
on the system in the Journal of the American Medical Association.

In March, California officials released a report they had ordered from NuPhysicia with a
plan for making over their state’s prison health care. The makeover would build on the
Texas example by expanding existing telemedicine and electronic medical record systems
and putting the University of California in charge.



California spends more than $40 a day per inmate for health care, including expenses for
guards who accompany them on visits to outside doctors. NuPhysicia says that this cost
is more than four times the rate in Texas and Georgia, and almost triple that of New
Jersey, where telemedicine is used for mental health care and some medical specialties.

“Telemedicine makes total sense in prisons,” says Christopher Kosseff, a senior vice
president and head of correctional health care at the University of Medicine and
Dentistry of New Jersey. “It’s a wonderful way of providing ready access to specialty
health care while maintaining public safety.”

Georgia state prisons save an average of $500 in transportation costs and officers’ pay
each time a prisoner can be treated by telemedicine, says Dr. Edward Bailey, medical
director of Georgia correctional health care.

With data supplied by the California Department of Corrections and Rehabilitation,
which commissioned the report, NuPhysicia says the recommendations could save the
state $1.2 billion a year in prisoners’ health care costs.

Gov. Arnold Schwarzenegger wants the university regents and the State Legislature to
approve the prison health makeover. After lawsuits on behalf of inmates, federal courts
appointed a receiver in 2006 to run prison medical services. (The state now runs dental
and mental health services, with court monitoring.) Officials hope that by putting
university doctors in charge of prison health, they can persuade the courts to return
control to the state.

“We’re going to use the best technology in the world to solve one of our worst problems
— the key is telemedicine,” the governor said.

WITHOUT the blessing of insurers, telemedicine could never gain traction in the broader
population. But many of the nation’s biggest insurers are showing growing interest in
reimbursing doctors for face-to-face video consulting.

Starting in June, the UnitedHealth Group plans to reimburse doctors at Centura Health,
a Colorado hospital system, for using Cisco advanced video to serve UnitedHealth’s
members at several clinics. And the insurer plans a national rollout of telemedicine
programs, including video-equipped booths in retail clinics in pharmacies and big-box
stores, as well as in clinics at large companies.

“The tide is turning on reimbursement,” says Dr. James Woodburn, vice president and
medical director for telehealth at UnitedHealth.

Both UnitedHealth and WellPoint, which owns 14 Blue Cross plans, are trying lower-cost
Internet Webcam technology, available on many off-the-shelf laptops, as well as
advanced video.

UnitedHealth and Blue Cross plans in Hawaii, Minnesota and western New York are
using a Webcam service provided by American Well, a company based in Boston. And
large self-insured employers like Delta Air Lines and Medtronic, a Blue Cross Blue Shield
customer in Minneapolis, are beginning to sign up.

Delta will offer Webcam consultations with UnitedHealth’s doctor network to more than
10,000 Minnesota plan members on July 1, says Lynn Zonakis, Delta’s managing
director of health strategy and resources. Within 18 months, Webcam access will be
offered nationally to more than 100,000 Delta plan members.



Dr. Roy Schoenberg, C.E.O. of American Well, says his Webcam service is “in a
completely different domain” than Cisco’s or Polycom’s. “Over the last two years, we are
beginning to see a side branch of telemedicine that some call online care,” he says. “It
connects doctors with patients at home or in their workplace.”

Doctors “are not going to pay hundreds of thousands of dollars for equipment, so we
have to rely on lower tech,” he adds. The medical records are stored on secure Web
servers behind multiple firewalls, and the servers are audited twice a year by I.B.M. and
other outside computer security companies, Dr. Schoenberg says.

In Hawaii, more than 2,000 Blue Cross plan members used Webcams to consult doctors
last year, says Laura Lott, a spokeswoman for the Hawaii Medical Service Association.
Minnesota Blue Cross and Blue Shield started a similar Webcam service across the state
last November.

Doctors who use the higher-tech video conferencing technology say that Webcam images
are less clear, and that Webcams cannot accommodate electronic scopes or provide the
zoom-in features available in video conferencing. “If they are not using commercial-
grade video conferencing gear, the quality will be much lower,” says Vanessa L.
McLaughlin, a telemedicine consultant in Vancouver, Wash.

Last month, Charlie Martin, the crane operator, was back in the infirmary of the
Courageous for an eye checkup. In Houston, his face filled the big screen in NuPhysicia’s
office.

After an exchange of greetings, Chris Derrick, the paramedic on the oil rig, attached an
ophthalmological scanner to a scope, pointed it at Mr. Martin’s eye, and zoomed in.

“Freeze that,” Dr. Boultinghouse ordered, as a close-up of the eye loomed on the screen.
“His eyes have been bothering him. It may be from the wind up there on the crane.”

A version of this article appeared in print on May 30, 2010, on page
BU1 of the New York edition.

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