DRAFT 7/16/04. Women, Telemedicine, and the Future

Transcription

1 DRAFT 7/16/04 Women, Telemedicine, and the Future Alison Hughes, MPA Associate Director, Outreach, Arizona Telemedicine Program, and Director Mel and Enid Zuckerman Arizona College of Public Health Rural Health Office Drop the w in the English word, women. What s left is omen. The dictionary definition of omen is any phenomenon supposed to portend good or evil. Omen is a prophetic sign. In Latin, where the word originated, it is a prognostic sign. (Prognostic, of course, means any forecast or prediction.) The root form of omen is o-. The root o- means to announce, to hold as true. (The o- is supposed to have a tiny dash above the letter. and to its right, but my keyboard won t allow completion.) This is perhaps an unusual way to begin a paper about telehealth technology, but as I was asked to convey my experience in gender as it were, it seemed useful to trace the ancestry of the word used to address us. Also, it is important to keep in mind that the omen of women emerges from the plural and not from the singular. The Arizona Telemedicine Program (ATP) has been in existence since By 2003 the program achieved national renown when the American Telemedicine Association named it the telemedicine program of the year. The original network of eight sites has morphed into a gigantic, invisible spider web that connects networks to other networks 1

2 that make communications and telehealth technology possible in over 65 sites throughout Arizona. In the beginning, as in all things, little was known by policy makers or health care providers in Arizona about telehealth technology. The National Aeronautics and Space Administration (NASA) was the first public agency to test telemedicine. NASA engineers were looking for a way to provide health care for astronauts in flight and needed a land-based test site. Their first test site was, in fact, in Arizona Indian country. The Tohono O odham Nation covers approximately 2.8 million acres and extends 90 miles across Pima County, Arizona, into northern Mexico. A portion of these lands were selected for the test in collaboration with the Indian Health Service and the U.S. Department of Health, Education and Welfare. A mobile van was staffed by two Tohono O odham paramedics and equipped with a microwave dish that transmitted images to a second microwave system at the Indian Health Service hospital in Sells. Physicians at the hospital were able to read the images for diagnostic purposes, as well as speak in real time to patients in remote sites. This project was known as STARPAHC, an acronym for Space Technology Applied to Rural Papago 1 Advanced Health Care, and took place between 1972 and The problem with this trial was that it was successful. To the dismay of the I.H.S. physicians staffing the program and the people who received its services, the funding 1 The Tohono O odham people were formerly known as Papago people, a name given to them by non- Indian settlers. The Nation formally adopted the name Tohono O odham Nation in 1986 in a public vote. 2

3 resources dried up and the equipment was dismantled. The villagers no longer had access to health care in their communities and once again had to travel long distances to visit a health care provider. It wasn t until the late 80 s that I started attending telemedicine demonstrations at national meetings of the American Public Health Association and the National Rural Health Association. I realized quickly that this was the future of health care. I discussed it with the director of my office and of my department, at that time in the College of Medicine, at the University of Arizona. We knew it could make a vast difference to the delivery of health care in rural Arizona. A turning point in my thinking (a paradigm shift if you will) occurred when at one meeting a U.S. Army Colonel was showed a video about telemedicine in the battlefield. I learned about the invention of a wrist watch that made possible the monitoring from a remote site of a soldier s vital signs while s/he was in a battlefield. I learned about virtual surgery being performed on a patient hundreds of miles away. I approached the colonel after the meeting and arranged for him to send me a copy of his video. By 1994 national telemedicine initiatives were sprouting up in many states and coming to the attention of state legislators who cared about bringing health care to their constituencies. One of Arizona s leading legislators saw a demonstration about telemedicine technology at a national meeting of legislators and asked a staff member to contact the Rural Health Office to inquire whether Arizona was implementing the technology. The phone call generated a flurry of activity. It reached the desk of the 3

4 Department Head in Family Medicine and thus was born our first proposal to test telemedicine in the state. It was soon learned that the chief of pathology had been an early inventor of telepathology, and he became the dean s pick to head what became known as the Arizona Telemedicine Program. Since I had been advocating for telemedicine for some time through my work at the Rural Health Office, I sort of came along with the telemedicine package deal. In other words, I was lucky to be included in the first telemedicine team at our Medical School. And the pathology chair, Ron Weinstein, MD, who became telemedicine director, turned out to be an incredible visionary who led our team into the future. From the inception of the program we made sure that hospitals serving Native Americans were included in Arizona s emerging telemedicine network. A team of very capable engineers, medical providers, and administrators was assembled to design and implement the network. Part of my role was to educate rural communities about what telemedicine means, and what it does. I created a video in Spanish and in English that I used to introduce rural residents to telemedicine. I will never forget one experience in Nogales, Arizona at the U.S. Mexico border. I showed the video at a senior center one afternoon. After watching the video, an elderly woman questioned me from her wheelchair, So I can talk with a doctor on T.V.? she asked. I answered, Yes you can. She spoke again, So I don t need to travel to see a doctor any more with telemedicine? I answered, That s correct. She exclaimed, Well if I don t have to travel, and I can talk to the doctor in Tucson from Nogales, when can we get this? I am 4

5 pleased to report that the Arizona Telemedicine Program installed a telemedicine system at the community health center in Nogales. Today, in some parts of Arizona Indian country telemedicine is fairly commonplace.. We installed what we call full service telemedicine systems at Whiteriver I.H.S. hospital in Whiteriver Apache country, and at Hopi Health Care Center in Polacca, and at Sage Memorial Hospital in Ganado, Navajo Nation. In the beginning we worked with hospital administrators and medical staff members to ensure medicine men were brought in to bless the telemedicine equipment before it was used, with tribal leaders witnessing these occasions. We obtained a small grant from a foundation to train I.H.S. community health representatives (CHRs) to use small telemedicine modules that enabled health monitoring to take place between a Navajo Nation chapter house in Red Rock and the Tuba City I.H.S. hospital. (CHRs are for the most part women.) Two weeks ago I visited hospital staff members at Sage Memorial Hospital in Ganado. I met a Navajo woman who coordinates the special diabetes program. Deborah Caybeto is one of the most visionary, energetic women I ve met in recent years. When I explained how a non-mydriatic camera works in eye care, and how tele-opthalmology could help to transform the lives of some of the more severe diabetic patients with eye care problems, she jumped at the chance of getting this technology. She is busy hunting down funding to purchase the system, and have no doubt she will succeed! Deborah is one of the omen women. She sees the whole picture and has the capacity to make a difference. She saw that traditional diabetes education wasn t working. She started a community 5

6 garden right in the middle of the hospital grounds. School children and surrounding neighbors help to tend the garden. The vegetables grown there are used for cooking and nutrition education at the diabetes program. She refurbished a community auditorium to make exercise equipment available to and accessible to diabetics. She did all this within nine months. This week she asked me how she can learn to operate the full service telemedicine equipment so that she can make sure the telemedicine system is available when needed for her patients. (We are working to make this happen!) The definition of telemedicine that we use in Arizona is, The practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data and education through interactive audio, video or data communications. (Telehealth is sometimes used interchangeably with telemedicine, but actually is considered to be a broader term.) In Arizona the technology is used for specialty care such as dermatology, ophthalmology, cervical cancer screening, cardiology, ear-nose-throat care, psychiatry, fetal ultrasound, home health care, pain management, and health education all at a distance. The medical director of the Arizona Telemedicine Program is another phenomenal visionary who belongs in the omen category of women. She is Anna Maria Lopez, MD, an oncologist who exercises national leadership in telemedicine technology by using it as a vehicle to improve women s health care. Over the past four years the Arizona Telemedicine Program team members skills were transplanted to the country of Panama where they helped the Panamanian Medical 6

7 School and Engineering school teams to create a telemedicine system in that country. The Panamanian physicians noted clusters of ovarian cancer in indigenous women in a particular region of the country, and felt that a telemedicine system might help them to better understand the source of the problem as well as to contain the disease. Today, Panama has an active telemedicine system that is transmitting X-rays from Panama to Tucson for second opinions and diagnosis and treatment discussions. Telemedicine can be more than what it is today, however. The U.S. government reimbursement system provides more incentives to urban telehealth users than to those in remote sites. Consequently, only those rural providers who really want to help their patients use it frequently. A community health center CEO once told me that he didn t want his physicians in the telemedicine room with a patient for extensive periods, as during the same period of time billings could have been done for numerous patient encounters. I will never forget that remark. It was not the CEO s fault. It is the health system that drives physicians to see patients less and face revenue realities of clinic or hospital survival. Women as consumers can become a strong force as advocates for telemedicine technology in rural and remote areas of the world. First, we need to understand its amazing possibilities. Then we need to work with our policy-makers to create the political will to bring telemedicine technology to our communities, and to create a telemedicine reimbursement system that works for both urban and rural providers. Students in elementary schools and high schools need to learn about telemedicine in their 7

8 curricula, and school board members can start asking for this to happen. Medical schools and nursing schools also need to integrate telemedicine training into their curricula so that the health providers, like Dr. Anna Maria Lopez, will use it as naturally as they now use their palm tops and cell phones. Young women need to learn more about the Anna Maria Lopez s of the world so that they, too, can follow in her footsteps. I predict that if women worked together to bring telemedicine technology to rural and remote areas of the world, we can transform the meaning of accessibility to care. Through collaborative action we can ultimately, and most assuredly impact the reduction of disease and promote strong and healthy societies. 8