The doctor is in -- or at least, online

- From his office in Fort Myers, using a protected internet connection, Dr. Nima Mowzoon spoke to us from the emergency department of the Medical Center of Trinity, 140 miles away. 

"When patients have a stroke, the clock is ticking. There's data that suggests that almost 2-million nerve cells die each minute," the tele-neurologist explained.

Saving brain cells may involve clot-busting drugs. The goal is to start them within 60 minutes after patients hit the door. But first they need a thorough workup. 

"The advantage of actually doing telemedicine is we can multi-task and do many things.  We can be looking at the C.T. obtaining history on one side, looking at the labs as they come up," Dr. Mowzoon explained. 

He says although he can't perform the physical exam personally, he can observe as it's being performed. 

E.R. physician Dr. Onier Villarreal says the tele-neurologists not only help expedite the process, they've increased the number of patients getting clot-busting drugs.

"It's definitely something that has improved the way we take care of stroke patients by leaps and bounds," Dr. Villareal said.  
      
"It's a brave new world," offered Dr. Larry Feinman, the CEO for HCA West Florida.  He says the telestroke program is becoming their standard.  "We have 11 hospitals on this platform."

Along with evaluating stroke patients, the Trinity E.R. uses telemedicine to evaluate psychiatric patients -- saving time, money and improving care. 

"If we have a patient that comes in with the Baker Act, for example, in many hospitals, since you don' t have a psychiatrist on board, they tend to stay in the emergency room for a long time," he said.

Elsewhere, virtual specialists are making their mark in intensive care units

"In the critical care world, so much of what we do is based upon technology," explained Dr. Dellice Dickhaus, medical director of Advanced ICU Care.  His St. Louis-based company services more than 60 hospitals across the country, including Florida Hospital Carrollwood in Tampa.

Special software helps process the patients' vital signs and data while a remote camera zooms into the patients' rooms.

While Dr. Dickhaus can't be hands-on, she says being able to virtually see the patient is a plus.  

"It makes all the difference in the world.  Having someone tell you that a patient is short of breath. It means something different when you can actually see the patient and judge the degree of the shortness of breath," she stated.

"I was very skeptical, actually, because I wasn't sure how someone sitting in St. Louis or New York can assess my patient,"  ICU medical director Ashok Modh admitted.

Before the virtual docs -- for the past 30 years, in fact -- Dr. Modh and others had to cover calls from home.  After spending time in a different hospital to see how it worked, he was sold. 

"They can look at the X-rays, they can look at vital signs, they can look at the patients' lab work."

He says the 24/7 nursing access to the critical care experts is improving outcomes for patients.

Along with treating more serious illnesses, Tampa General Hospital's senior vice president believes it is also the wave of the future for minor ones. 

"We see telemedicine, telehealth as a real growth part of medicine," Michael Gorsage stated.

TGH is now partnering with a national group allowing patients to "see" primary care physicians for $49.  Specialists like psychiatrists cost a little more. 

Gorsage believes the benefits outweigh the cost. 

"Many people think that this is the wave of the future for mental health because of the stigma attached to going in and out of a psychologist or psychiatrist's office."

With home monitoring systems for heart rhythm, blood pressure, and weight becoming more available, home health care is also adopting a tele-medicine approach.  One major goal is to help keep heart-failure patient admissions to the hospital in check --  A goal that will improve quality of life and also greatly reduce health care costs. 

Doctors must be licensed in the state where they are offering services.  And like all medicine, mistakes may happen with remote consultations. One lawsuit in California was won because the tele-neurologist was not consulted, resulting in an alleged missed opportunity to provide the clot-busting medication. 

But with all the potential applications, and as technology improves, expect this tidal wave of telemedicine to eventually become a tsunami.  

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