Telemedicine expands reach of medical specialists

At the Jules Stein Eye Institute, an ophthalmologist with a special interest in diabetes looks at images of the fundus — the back of the eye — of a diabetic patient, checking for troubling signs that could lead to blindness.

 

In the Obstetrics and Gynecology Department, an obstetrician reviews an ultrasound image to determine whether all is well for an expectant mother.

 

In another part of the medical campus, a dermatologist checks an image of a skin lesion to decide whether this patient should come in to see a specialist.

 

All of these images have been sent to campus from remote locations across California. In these early-stage pilot programs, medical specialists at UCLA are exploring the use of high-tech tools of telemedicine — special cameras, computers and other equipment — to exchange images and patient data.

 

With an infusion of $18 million during this academic year and $17 million expected in the future, the use of telemedicine will be expanding for UCLA physicians and medical students, who will eventually be able to practice in clinical situations using telemedicine. 

 

The funds, which are going to the David Geffen School of Medicine, are part of a payout of nearly $200 million that will go to UC’s five medical campuses. Each will get $35 million for telemedicine projects and projects related to a new Program in Medical Education (PRIME). The money comes from a bond measure, Proposition 1D, that was passed by voters in 2006 for voter-approved construction projects.

 

Telemedicine became a major goal for the state after policymakers and lawmakers realized that the state's medical schools were probably never going to be able to educate enough specialists to serve in rural and underserved areas throughout California.

 

"It's just a daunting task to think about — having a cardiologist or a pediatric psychiatrist in every town in the state," said Associate Vice Chancellor of Medical Sciences Dr. Alan Robinson, who is also the executive associate dean of the Geffen School of Medicine.

 

But by using telemedicine, primary-care physicians in remote areas will be able to give their patients remote access to specialty consultations in obstetrics, dermatology and other fields of medicine.

 

In addition to exploring the practical ways in which telemedicine can be used, UCLA's pilot programs have another benefit, said Robinson. “We will be educating a special group of students who want to become doctors to change the way medicine is practiced in order to help people in underserved areas."

 

A new Learning Resource Center opened recently on the UCLA campus, where medical students will be trained in the use of remote technologies. Students will practice working in telemedicine scenarios with assistance from medical mannequins and actors who are trained to role-play patients.

 

Other telemedicine — or telehealth — projects are also brewing. Patients who are at risk for heart failure are using a "smart scale” to weigh themselves each morning. The scale automatically transmits this data to UCLA's general internal medicine department, where it is reviewed daily by a nurse, nurse practitioner or other health care worker. A sudden weight gain would be one danger sign to watch for in heart patients, said Robinson. “The first thing that happens when someone has heart failure is that they start to retain fluid in the chest and lungs."

 

Robinson said UCLA's telemedicine project will also provide access to quality continuing education for physicians and nurses who are out in rural and underserved areas of the state. "We have many conferences here that would benefit doctors and nurses working out in the community, but they can't get here," he said, noting that telemedicine technology could lead to a system that would allow UCLA medical conferences, lectures and presentations to be available via the Web for specialists off campus to view at their convenience.

 

This is an opportunity for UCLA physicians and medical educators "to think every day about how we can do this better," Robinson said.