The Arizona Telemedicine Program: Technology that Improves Lives

Distance learning: Conferences and educational programs based at the Arizona Health Sciences Center can be shared with audiences across Arizona and the nation. The time it used to take to transport a patient from Nogales to Tucson for a consultation now is reduced to a four-minute transfer of information over telephone lines.

To help bridge that distance, the Arizona Health Sciences Center (AHSC) is adapting technology to share its expertise with people throughout the state.

Using telecommunication links, high-resolution video imaging and advanced computer workstations, UA College of Medicine faculty are beginning to share AHSC's wealth of health care talent and knowledge with medically underserved populations far from Tucson. They are learning how to be "telephysicians" who deliver medical services at a distance. In the process, they are being introduced to exciting new opportunities in medicine as it may be practiced in the 21st century.

In 1996, the Arizona State Legislature gave strong support to telemedicine for rural communities when it appropriated $1.2 million to fund an eight- community Arizona Rural Telemedicine Network. The Arizona Department of Health Services contributed an additional $125,000 that year. The funds are being used to create a novel health-care telecommunications network and to equip telemedicine facilities in rural communities and at the hub site at AHSC. The first installations are up and running in Nogales and Tuba City, and others - in Springerville, Payson, Ganado, Yuma and Holbrook - will come on-line soon.

The College of Medicine responded to the state's initiatives by creating the Arizona Telemedicine Program, which integrates service, training and technology assessment activities. A recently established telemedicine training center provides instruction for physicians and other health care workers in telemedicine procedures. An AHSC-based telemedicine technology assessment center evaluates new telemedicine technologies and instruments before they are deployed to rural sites.

Telemedicine will play a central role in certain educational programs. Initially it will be used to create multi-site "virtual classrooms" for medical students and other students of the health care professions. The first users will be students with a special interest in careers in rural Arizona.

Through the use of satellites and a specially designed tele-conference room, Biomedical Communications at AHSC broadcasts internal medicine lectures to a dozen locations throughout the state. Students in the Arizona Graduate Program in Public Health simultaneously attend the same classes at The University of Arizona, Arizona State University and Northern Arizona University. Video conferencing equipment brings the three sites together as seamlessly as possible, creating an exchange of ideas among public health students living and learning in different Arizona cities.

Plans are under way to introduce health sciences students to telemedicine early in their education. Medical students will perform pre-clinical rotations in rural communities and then keep in touch with their rural physician-preceptors through teleconferencing. Then, while on their clinical rotations at rural communities during their third and fourth years of medical school, the students will stay in contact with faculty at the College of Medicine in Tucson.

"From an educator's perspective, telemedicine also provides a valuable way to teach students about the uses of modern information technology for patient care and continuing medical education," says Ronald S. Weinstein, M.D., head of the Department of Pathology and director of the Arizona Telemedicine Program.

Already, the program is supplying students and residents with state-of-the-art palm-top computers that can be used to generate electronic patient records, capture digital images, and record voice. Dr. Weinstein predicts that the devices will evolve into mobile telemedicine workstations that link physicians to large health care information systems.

The telemedicine program also may provide today's students with glimpses into the future of medical practice. "It seems reasonable to predict that some physicians will be members of 'virtual group practices,' linked by computers. Medical specialists will be available at the press of a button to answer primary care providers' questions and to speak directly to rural patients by video conferencing,"Dr. Weinstein says.

"The sense of geographic isolation in rural areas will fade as communities become linked to the information superhighway. By introducing ourstudents to telemedicine now, they are gaining knowledgethat will be indispensable to them in the future."

"This is an exciting part of The University of Arizona's role in the state," says James E. Dalen, M.D., M.P.H., vice president for health sciences and dean of the College of Medicine. "Telemedicine brings the Arizona Health Sciences Center nearer to the people we serve and represents an integral commitment to the health of all Arizonans.

"Drawing on an international reputation for excellence in education, research and service at the College of Medicine, the telemedicine program already is facilitating the statewide mission of AHSC. The time it used to take to transport a patient 65 miles from Nogales to Tucson for a consultation now is reduced to the few minutes required to transfer digital information over telephone lines.

Already, many problem cases have been diagnosed by the telephysicians in Tucson. The UA has 270 specialists on staff and can provide high-level expertise for almost any medical problem, offering rural areas easy access to some of the best doctors in Arizona.

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