Technology A Lifeline Telemedicine Allows Long-Distance Monitoring

After three miscarriages, Cindy and John Shea still wanted another child.

Doctors and nurses at Sacred Heart Medical Center watched the Moscow, Idaho, couple’s latest pregnancy very carefully - from 75 miles away.

They saw the bumps and spikes of the fetal heartbeat with the help of telephone lines and computers that connect rural hospitals to the Spokane medical center.

“It was stressful, but I felt confident they were monitoring the situation closely,” said Cindy Shea, who suffers from a disease that can send blood clots into the womb, killing the fetus.

“They assured me if they picked up readings on the fetal monitor board or the ultrasound, they would have 24 hours to intervene. I felt if something happened, I wasn’t going to lose my baby.”

Sacred Heart’s Fetal Monitor Network is an example of telemedicine, a national trend that allows doctors to examine patients over long distances.

Telemedicine keeps people from having to travel many miles to see a specialist. Community doctors can consult big city experts while exams are being given. It saves money and eases minds.

“It’s like we’re standing there with them, but we’re not,” said Brenda Covert, coordinator of the Fetal Monitor Network. “It’s another piece of information, another tool to use.”

About 50 telemedicine programs are under way nationwide, twice as many as last year.

The military’s Bosnia mission will employ more telemedicine than ever by the military, said Capt. Greg Mogel, a radiologist at the Brooke Army Medical Center in San Antonio, Texas.

Doctors at the Army medical center used computers to interpret CAT scans from soldiers injured in the Persian Gulf War, Somalia and Haiti.

Closer to home, the University of Washington Medical Center is spending $1.5 million in federal money to test telemedicine in small towns. The program links UW specialists with patients and their doctors in Colville; Driggs, Idaho; Ronan, Mont.; and Petersburg, Alaska.

Nearly 40 people have had long-distance consultations since August, from the Ronan woman who hurt her neck in a car accident to mental health patients in Petersburg, where there are no psychiatrists.

Telemedicine “is extremely important for rural physicians and for places where there isn’t enough medical care,” said Dr. Tom Norris, an assistant dean at the UW School of Medicine.

Yet there are pitfalls: Insurance companies are reluctant to pay for telemedicine consultations. Liability and privacy are also potential problems.

Doctors in five states - Kansas, Oklahoma, Nevada, South Dakota and Texas - are banding together to block interstate telemedicine, and at least 20 other states are considering similar restrictions.

Neither the Idaho nor Washington state medical associations have adopted positions on telemedicine.

Critics fear the technology paves the way for the super hospitals, Wal-Marts of medicine that will put small operations out of business.

“We’re concerned about balancing access to care with preserving quality in care,” said Dr. George Kamp, the chairman of the committee on government relations for the American College of Radiology, the specialty that helped pioneer telemedicine. “All of telemedicine has wonderful potential. But you cannot compromise the quality of care.”

Some people also wonder whether medical licensing laws allow doctors sitting at a computer in one state to interpret tests being sent in from another state.

Sacred Heart’s Covert said Spokane doctors and nurses involved in the Fetal Monitor Network aren’t violating licensing laws.

To calm some of the concerns, the American Medical Association is urging all medical specialties to develop telemedicine standards.

The Federation of State Medical Boards, based in Euless, Texas, urged members at a national meeting last week to require doctors regularly practicing telemedicine to be licensed in the state where a patient is diagnosed.

“There is a healthy degree of skepticism about telemedicine,” said Mogel, the Army radiologist. “In some cases, it’s justified. Questions are going to have to be answered. We’re very comfortable with our concept of going to see the doctor. But will we be comfortable with the idea of going to visit a kiosk with a monitor?”

Sacred Heart’s Fetal Monitor Network reaches seven hospitals, from St. Maries, Idaho, to Omak, Wash., Colville to Moscow. Another hospital in Quincy, Wash., soon will be on-line.

Before the network was set up, nurses and doctors in rural hospitals consulted with experts by telephone and blurry faxes of fetal tracings. High-risk pregnancy patients had to drive to Spokane for more intensive tests.

Now Spokane experts can read the blips and spikes when the mother is connected to the fetal monitor, miles away at her hometown hospital. The monitor hooks two belts around the mother’s belly, one that picks up the fetal heartbeat and another that monitors the uterus.

Reviews of the network are glowing. Last year, it was used an average of five times a month. About 20 women were helped, including Cindy Shea.

“It could have been really difficult for her family life to travel back and forth to Spokane,” said Kim Ingram, clinical coordinator for the Family Birth Center at Gritman Medical Center in Moscow. “Our whole goal is to keep our people in our community with the best care possible. It keeps down health care costs all the way around.”

After being monitored twice a week for the last three months of her pregnancy, she gave birth on June 7 to an 8-pound, 15-ounce boy named Greg.

“We’re just thrilled to have a little boy,” Shea said. “The girls love their little brother. It had a happy ending. It was worth every minute of stress.”

, DataTimes ILLUSTRATION: Color photo Graphic: The Fetal Monitor Network