UA telemedicine helps address needs of rural Arizona

Dr. Sue Sisley, a psychiatrist, is shown at right participating in a demonstration of telemedicine technology Monday, Feb. 4, 2008, at the University of Arizona College of Medicine in Partnership with Arizona State University in downtown Phoenix

PHOENIX – Dr. Sue Sisley, a psychiatrist, believes in personal touches. When she works with patients, they can expect smiles, understanding looks and expressions of support.

"I think that the most important aspect is delivering high-quality care with compassion," Sisley said.

That makes it seem a bit odd to see her in an office containing little more than an empty desk with a computer. Instead of a couch for patients, there’s a large video monitor against the wall with a camera pointing back.

Sisley is part of a growing telemedicine program at the University of Arizona College of Medicine. On Mondays, she comes from her private practice to the UA’s new downtown Phoenix medical school, a partnership with Arizona State University, and uses communication technology to help patients and advise medical professionals around the state.

Telemedicine works much like video conferencing used by businesses, adding in electronic transmission of digital images and data over the Internet.

With Arizona facing a physician shortage that’s most severe in rural areas, the medical school is using telemedicine to connect with patients and medical professionals who otherwise would have to travel hours for help. Besides psychiatry, the system links remote communities with practitioners of surgery, pediatrics, radiology and pathology, among other specialties.

"I hope that eventually this will be a mainstream way of providing healthcare," said Dr. Ronald Weinstein, director of the college’s Arizona Telemedicine Program, which was established in 1996.

The college recently expanded its role by founding the Institute for Advanced Telemedicine and Telehealth at the Phoenix school, offering distance learning, including degree programs and continuing medical education, in addition to health care.

The school’s telemedicine system has communication hubs in Tucson, Phoenix, Flagstaff and three points on the Navajo Nation, including Tuba City, and provides services to 171 clinics and hospitals around Arizona and into New Mexico.

Jon Linkous, executive director of the American Telemedicine Association, based in Washington, D.C., said the UA telemedicine program is one of the oldest and best known in the country.

"There is huge promise in telemedicine," Linkous said. "I hope it expands and it grows."

Benson Hospital has taken advantage of the system twice when dealing with trauma cases, linking doctors there with trauma experts at University Medical Center in Tucson.

"When we do get these traumas, it can be scary," said Teresa Vincifora, Benson Hospital’s emergency department supervisor. "UMC sees traumas daily; now rural areas can have access to that knowledge and information."

The Arizona Department of Corrections, which operates 10 prisons around the state, has used UA’s telemedicine system thousands of times, said Dr. James Baird, ADC’s medical director for health care services.

"This is a perfect example of a program that allows us to keep the public safe," Baird said. ‘There is no transport with a telemedicine appointment, so there is no chance of escape or mischief by the inmates."
Sisley, who serves as assistant director of interprofessional education with the Arizona Telemedicine Program, demonstrated the system recently with help from two colleagues.

As they chatted with a reporter, Sisley, Janice Disbrow, telemedicine site coordinator at Payson Regional Medical Center, and Herb Schwager, a Willow, Alaska-based telepsychiatrist, displayed right to left on Sisley’s video display.

As Sisley demonstrated how to present one of the three people in a larger frame to allow a better look at patients, Schwager, who serves as medical director for the Arizona Telemedicine Program-Payson, said all of the patient consultations he has offered since moving to Alaska have been via teleconference. Those sessions sometimes include Sisley, who consults on drug treatments.

"This could not happen without telemedicine," Schwager said. "I can see everything that the on-site physician sees."

While Sisley and Disbrow use a state-of-the-art telemedicine interface _ hospital setups can cost up to $20,000 _ Schwager uses a basic webcam costing about $300.

Disbrow said some patients in Payson are hesitant at first about using the system because they are shy about being on camera, but they recognize the advantages of not having to travel to Phoenix.

"Feedback from patients has been overall good," Disbrow said.

Sisley said telemedicine will continue to expand, helping homebound patients, those who can’t or won’t drive and the elderly. She hopes the technology’s success will prompt the government and private insurance companies to reimburse for telemedicine systems.

"My main goal is to improve access to health care in the remote parts of the state," Sisley said.