Are the stars aligning for telemedicine's succcess?

The current health care crisis has some experts saying that telemedicine's time has finally come.

While technology companies have been touting the use of virtual technology to allow doctors to remotely examine and monitor patients for decades, up until recently the business case for deploying these expensive systems was hard to justify. But now as lawmakers in Washington, D.C. look for ways to fix the broken health care system, technologies, such as high-definition video conferencing and telepresence, are getting a second look.

Last week, technology giant Cisco Systems and a major U.S. insurer UnitedHealth Group announced a partnership in which UnitedHealth will use a Cisco product called HealthPresence to develop a national program to allow doctors to treat patients remotely. The program will initially focus on providing people in remote and under-served areas with health care. But Cisco and UnitedHealth representatives say eventually the program could be expanded throughout the country.

Part of the reason that telemedicine hasn't taken off in a big way in the past has been cost. While technologies, such as telepresence may eventually reduce the cost of providing health care services, initially they are expensive to deploy. For example, Cisco's high-end telepresence conferencing system that is sold to large companies to replicate a boardroom costs upward of $300,000.

And because these systems require the use of high-definition audio and video, which must be transmitted over an Internet connection between doctors and patients, these systems require significant amounts of bandwidth. This means that without ubiquitous broadband access throughout the country, the cost benefits and usefulness of the technology is limited.

Still, the rising cost of health care and predictions that these costs could cripple the nation, have increased the urgency for nontraditional solutions. This change in attitude coupled with the Obama administration's plan to reform the health care system has stirred more interest from almost every big technology company in the country.

Intel and General Electric are working on a home monitoring system. Google and IBM have also announced an in-home system that transmits data from devices such as blood-pressure cuffs and glucose meters via the Internet. And Cisco and Polycom have retrofitted their corporate telepresence systems to provide near-real-life interaction between patients and doctors.

And they all believe that the health care industry is finally ready to spend big bucks on expensive new technologies today to help stem rising costs for tomorrow.

"What is different right now is that the health care system in this country is being asked to deliver service more effectively and efficiently without increasing the available resources," said Nick Augustinos, senior director with Cisco's Internet Business Solutions group for global health. "So what's needed now is a health care system that can scale. And that is what telepresence and other remote monitoring technologies can do by extending the natural reach of doctors and clinicians in a nontraditional way."

The partnership between Cisco and UnitedHealth is an important milestone in the telehealth movement because the companies will be working together to solve not only the technical and clinical hurdles that come with deploying this technology, but they will also be trying to solve the business problems for delivering health care.

"This is why we partnered with an insurance company, so that we could understand the business model to build a solution that will deliver effective, efficient care at a lower cost," Augustinos said. "And the truth is that if we didn't approach it that way, then we'd have wonderful technology that could provide excellent care to lots of people, but no one would want to buy it because they wouldn't want to pay for it."

One of the challenges in deploying telemedicine has been the fact that insurance companies have been more likely to reimburse traditional face-to-face doctor visits rather than procedures done remotely using telemedicine. But with the partnership between UnitedHealth Group, which insures some 70 million people in the U.S. and Cisco , it looks like insurance companies may be realizing the economic benefits of scaling the health care system virtually.

"Health care is a business," said Bob Preston, vice president of solutions marketing at Polycom, another major telepresence provider in the health care market. "And if medical groups and health insurers can offer services to more patients via telepresence, while reducing their costs, they can increase their revenue."

Using high-definition cameras and monitors, telepresence technology creates a "conferencing" experience that is so intimate people think they are in the same room with the people on the other end of the teleconference. Cisco and Polycom, two of the leading telepresence equipment providers on the market, have adapted technology they developed for large companies for use in medical environments.

Typcially, these solutions are scaled-down versions of the high-end telepresence systems, but they also include adapters for medical devices that can provide vital sign monitoring, such as blood pressure, pulse rate, oxygen saturation and temperature, as well as interfaces for stethoscopes and otoscopes for examining ears.

Cisco has designed its "HealthPresence" system as a small telepresence room, or "pod." And Polycom offers a variety of products that range from full telepresence rooms to a mobile telepresence cart that can be wheeled from room to room in a hospital or clinic.

The way it works is that a doctor sits on one side of the telepresence connection, while a medical professional mans the booth or cart on the patient side of the connection. This technician sets up the call and uses the medical equipment to examine the patient as directed by the doctor.

Then the equipment sends data and images gathered during the examination via an Internet connection to the doctor. The doctor can control the camera to zoom into different parts of the body. At the same time, electronic medical records and other data can be viewed by the doctor on a separate computer screen.

While high-definition cameras and screens have made it possible to diagnose many illnesses and injuries, there are still limitations. For example, the experience doesn't allow doctors to actually touch patients, which in some circumstances can help them more accurately diagnose an illness or injury. But for many minor injuries and ailments, telemedicine works very well, experts say.

Depending on the type of service that is being offered, the professional on the patient side of the call could be a trained technician, or he or she could be a registered nurse or general practitioner doctor.

"Nurses and doctors are in short supply in some places, so depending on what level of care that is being provided, the HealthPresence system can be manned by less expensive resources," Cisco's Augustinos said. "By using a lower cost professional or technician, the insurer or medical group providing the service can maximize their resources."

The private medical group NuPhysicia is using Polycom's mobile Practioner Carts to provide walk-in health services at Houston-area Wal-Mart Stores. Instead of using higher paid nurse practioners at the retailer's clinics, the group is using paramedics and remote doctors over the telepresence system to see patients.

The first implementation of the Cisco/UnitedHealth Group partnership is to provide a mobile medical service called Connected Care. Working with an organization called Project HOPE, Connected Care will have a mobile truck or van that travels through four counties in New Mexico offering basic health screenings and treatment for chronic ailments, such as diabetes.

Cisco and UnitedHealth Group have already tested their Connected Care program with Cisco's own employees. In a pilot program launched last year, more than 300 Cisco employees in the company's San Jose, Calif., headquarters used primary-care physicians in Los Angeles via the telemedicine system. Now the companies have expanded the trial to Cisco's Raleigh, N.C., campus where 4,000 employees will have access to five primary care physicians in Cisco's corporate health care center in San Jose.

These trials follow another pilot program that Cisco conducted last year at the Aberdeen Royal Infirmary in Scotland. So far the results have been good. In addition to Cisco's own employees being satisfied with the service, Cisco reported last week that roughly 93 percent of people who received care via the telepresence system in the Aberdeen trial said they would recommend the service to someone else.

Polycom's telepresence gear has also been used to serve people in rural communities. The Cherokee Health Systems has been using the mobile telepresence system to provide medical care to 17 rural school clinics in Tennesse with only two nurse practitioners. And NuPhysicia has used Polycom gear to provide medical care to workers on offshore oil rigs.

"There is a huge shortage of general practitioners especially in rural areas," Polycom's Preston said. "And as the population ages and people become more immobile, telepresence solutions can help provide access to doctors to people who would otherwise have to travel long distances to see someone."

But Cisco's Augustinos points out that telemedicine is not just for providing medical services to people living in remote areas. It can also be used in urban settings where access to health care professionals is readily available, but where patients must sit in waiting rooms for hours to be seen because demand is so high.

Using presence technology, the Cisco HealthPresence product allows doctors to search the database in a given medical group or ecosystem to find a doctor or specialist anywhere in the country who is available at that moment to see a patient. This allows for a more efficient and cost-effective way to run an urgent care clinic that often sees walk-in patients.

Augustinos explained that the concept is similar to using an 800 number to contact a any service provider's customer support. People call the number, and they are asked to identify the problem or issue they're having so the call can be routed to appropriate pool of operators.

In this case, patients willing to see the first available doctor would be triaged and a doctor, who meets the patients criteria, would be contacted via video-conference to examine the patient.

Another scenario where HealthPresence is useful is when a doctor is examining a patient in his or her office and if he detects a problem during an examination that requires consultation with a specialist, he can look to see who is available in the network. Instead of writing a referral and having the patient schedule an appointment with a specialist, the doctor can dial-in the available specialist for the consultation right then and there.

Augustinos believes that using telemedicine in this way can help lower overall medical costs.

"The thing that drives prices up is an imbalance between supply and demand," Augustinos said. "But if you can more efficiently distribute the resources that exist and optimize those resources, then you can flatten the pricing curve."

But he admitted that no technology, whether it comes from Cisco or anyone else, will be a magic pill to solve all of the health care system's problems.

"We won't solve every ill in health care industry," he said. "But we are suggesting that if you optimize the scarce clinical resources that are available today, you can use the money that is put into the system more efficiently. And that is a start."