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The Doctor Will See You Now (Part I)

It’s time for Steve Craig’s 3:30 appointment with his new doctor. An assistant ushers Craig into a treatment room and gestures to one corner. "And this is Dr. Prescott," the assistant says.

Dr. Pamela Prescott smiles warmly. She is seated in a room at the UC Davis Health System in Sacramento, Calif. Craig, however, is 31 miles away in the town of Auburn, and he sees Prescott’s glasses and white coat on a 17-inch computer monitor that’s propped against the wall. From Craig’s point of view, his new doctor is about the size of a coffee mug.

"Very good," Craig says, staring at the diminutive Dr. Prescott. As he seats himself on the couch, he adds, "This is unique."

Unique, indeed, but maybe not for long. Craig, a portly 51-year-old, drove 35 minutes from his hometown of Forest Hill to see Prescott, an endocrinologist, to treat his diabetes. He is one of a growing roster of patients who come to the Auburn clinic to see specialists in obesity, dermatology and psychiatric care. The Auburn office is one of 50 remote clinics operated by UC Davis Health System around the state in doctors’ offices, rural hospitals, correctional facilities, and even in a van. And UC Davis’ is just one of hundreds of remote medical programs under development across the United States.

Technology is changing medicine in a thousand ways, but few are poised to transform healthcare delivery like the phenomenon of patients and caregivers talking face-to-face, though geographically distant.

People in rural areas have always been at a healthcare disadvantage. Specially trained physicians usually reside in cities. When they’re sick or injured, people in the hinterlands typically take a day or more off work and drive for hours, often when they’re least fit to do so. Now, instead of delaying that appointment – or not going at all – those patients are able to see that doctor at a nearby clinic, or in some cases, from the living room, via digital media delivery technologies. At the same time, videomedicine is permitting physicians to consult over moving images such as ultrasounds and feeds from tiny cameras that probe many parts of the human body. All this takes place with existing technology and bandwidth.

Videomedicine is a key part of what its practitioners call "telemedicine" – an evolving constellation of technologies that let caregivers talk to patients from afar, monitor their vital signs, and gather patient data into a complete digital record that the doctor can access wherever he or she is.

"The vision of the future, as we’d like to see it, is no matter who you are, or where you are, you get health care when you need it," says Dena Puskin, director of the Federal Office for the Advancement of Telehealth, which has given out $36 million in grants this year.

Telemedicine was born in 1959 when the University of Nebraska used closed-circuit television for group psychiatric sessions. Most current incarnations began, not surprisingly, with the Internet boom. Today, most providers prefer videoconferencing, utilizing Ethernet on local area networks, or ISDN and T1 connections for wide area networks. Straightforward streaming across the Internet is least used in this field, primarily because of quality and privacy concerns.

Government agencies charged with maintaining the health of many people in far-flung locations — the Department of Veterans Affairs, the Indian Health Service, and the military, for example — foresee huge cost savings. So do those who oversee federal and state prisons and county jails, which must send their inmates to hospitals under armed guard. Meanwhile, regional medical centers, such as UC Davis, the University of Iowa and the University of Tennessee, are finding videomedicine a convenient way to reach underserved patients, from the migrant workers of California to the rural poor of Appalachia.

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