Dr. William Wooden is examining a barely visible blemish on the cheek of Kathleen Snyder. "It looks like a pigmented intradermal nevus," says Wooden, reassuring Snyder that what she has on her face is a mole. Just another day at the doctor, right? Actually, no. Wooden, working in his office in eastern North Carolina, is looking at a video image of Snyder, who sits three time zones away in the Los Angeles Convention Center.
"I'm very impressed," grins Snyder, one of more than 80 people who received a telemedical consultation during Siggraph. "Can you imagine having this in your home? I want it pumped into my living room."
Glowing responses like these bring a smile to the face of David Balch, director of the Rural Eastern Carolina Health Network (REACH-TV). No country bumpkin, Balch heads up the East Carolina University School of Medicine's Center for Health Sciences Communication in Greenville, North Carolina. After earning a masters in telecommunications, Balch moved to North Carolina and got a job running the audiovisual department for the medical school. Twenty-two years later, he's still there - and having a ball. Balch is a bit of a Renaissance man: he's shown computer animations at Siggraph, directed music videos, and even produced an hour-long concert by the Pointer Sisters. "I like to do fun stuff," he says. "Now, telemedicine has replaced music videos."
Fun aside, REACH-TV "is a needs-driven project," Balch stresses, "not a let's-go-and-play-with-technology thing." Indeed, eastern North Carolina is in desperate need of better health care: in 1988, its infant mortality rate was one of the highest in the nation; of the 100 counties in North Carolina, 18 have no hospital, 20 have no obstetrical services, and two have no physicians.
REACH-TV began in early 1992 when the medical school wired Central Prison, the state's largest correctional facility, 100 miles away in Raleigh. Since then, the project has expanded into four rural hospitals, one ambulatory clinic, and a Marine base.
It takes more than a souped-up videoconferencing system and a cutting-edge computer network to make telemedicine work. The cornerstones of REACH-TV are its four telemedical suites - soundproof 6-by-12-foot chambers stocked with virtual medical instruments: viewing monitors, electronic touch-screen displays, digital stethoscopes, teleradiology scanners, and various high-resolution cameras used by nurses and physicians. Coupled with computerized patient records and scheduling software, the suites form the basis of an integrated health care information system.
But are patients willing to have the cold hand of technology mediate the doctor-patient relationship? "Once the patients see the physician face to face on screen," says Balch, "they forget where they are. All the barriers fall. Within a minute or two, they're telling really personal stories."
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Dr. Video
