Pa. docs use Web to help tiny patients miles away

September 27, 2010 at 12:00a.m.

Associated Press

PITTSBURGH

Dr. Ricardo Munoz goes from room to room, examining three infants, one just three days old. He watches their chests to see how they are breathing, checks their vital signs flashing on monitors above their hospital beds and views X-rays and electrocardiograms.

And he does it all from more than 2,500 miles away.

Wearing a headset and looking at his laptop screen, the chief of cardiac intensive care at Children’s Hospital of Pittsburgh checks on pediatric heart patients weekly at Fundacion Valle el Lili, a hospital in Cali, Colombia. The pilot program started earlier this year as a way to share the expertise of rare pediatric specialists with hospitals all over the world.

“Basically, this is globalization of medicine,” Munoz said. “I don’t need to travel. Via telemedicine, everything is possible.”

Munoz, a native of Colombia, had visited the 700-bed adult and pediatric hospital before and worked with doctors there. From time to time, he would consult on pediatric heart cases but found himself at a disadvantage.

“I was not able to see the patient. I was not able to see the monitors. So my advice was somehow a guess,” Munoz said.

So instead the hospital explored a technological solution and started their pilot telemedicine program earlier this year. The technology to set it up cost about $15,000.

The system is similar to a teleconference: A camera on Munoz’s laptop beams his picture to a monitor attached to a wireless cart at the hospital in Cali, and doctors there can wheel it from room to room. Microphones allow Munoz to talk to the doctors and patient’s family, and he can control a camera on the cart that can zoom in to give him a better look at whatever he wants.

Munoz can give advice in real time, something doctors in Colombia say is vital to these critically ill children. The hospital’s medical director, Dr. Martin Watemberg, calls it more than getting a second opinion — it’s a “simultaneous opinion.”

“We can take care of the patients just the same way as they would be by being in Pittsburgh,” Watemburg said. And the advice of the Pittsburgh doctors is just that; it’s up to the doctors in Colombia to make the final decisions on patient care.

Telemedicine has existed in one form or another for about 30 years, but has gained significantly in popularity in the last decade as technology has evolved to become faster and cheaper. In many rural states, like Wyoming and Alaska, telemedicine is used to get medical care to patients who otherwise would have to travel hundreds of miles. In Hawaii last year, a program began that lets doctors have face-to-face consultations with patients via computer and receive everything from advice to prescriptions.

Internationally, there are about 100 hospitals that use telemedicine to link to other countries and that number is growing, said Jonathan Linkous, chief executive officer of the American Telemedicine Association. Such programs can present barriers — language, culture, liability — but those issues can be overcome, he said.

Linkous’ association is lobbying for public aid from the federal government for telemedicine. They are also setting up an international resource center to get a better handle on how many cross-border telemedicine programs.

“We’re in a global community and no longer can we think of health issues in our country in isolation,” said Dr. Dale Alverson, medical director at the center for the University of New Mexico’s Center for Telehealth and Cybermedicine Research.

Doctors at Children’s believe using telemedicine in a cardiac critical care setting like pediatrics is vital since there are very few specialists in the area in the world.

Munoz said the program has so far been a success, with the hospital’s mortality rate in the pediatric critical care unit dropping from about 18 percent to 6 percent since the program started in January.

He said its important that the doctors speak the same language of the hospitals they are working with, and understand a bit of the culture, too. Munoz has established a relationship with doctors in Cali, who also periodically come to Pittsburgh for training and continuing education.

Jeanne Casilli, the hospital’s vice president of strategic business development said that Children’s is in talks with hospitals in Brazil, India and Qatar about setting up similar programs. Children’s is also setting up a telemedicine center on the hospital’s second floor where doctors can easily access other hospitals globally at a moment’s notice.

Dr. Maria Victoria Motoa, director of the cardiac intensive care unit at the hospital in Colombia, said it’s amazing to bring the best health care available in the U.S. to her patients — in real time.

“As many times as we need to contact them, it’s immediate,” she said.