MONTPELIER -- Residents at the Helen Porter Health Care and Rehabilitation Center in Middlebury who need to see a doctor are sometimes wheeled down the hall to a special room, where lights are turned down low and the doctor comes in via a television hookup with Fletcher Allen Health Care in Burlington.
Were it not for the telemedicine connection, few of the Porter patients would be able to see the psychiatrist on the other end who is frequently able to offer diagnoses or treatment suggestions and even consult with family members without having to leave the Burlington hospital. Patients get to stay in the environment where they are most comfortable.
"We explain to them beforehand what's going to happen, that there's going to be a doctor and he's going to be on this television screen, but it's really like you're going into his office to talk to him," said Leslie Orelup, an advance practice registered nurse, who works at Porter. "You'd think that because they would be older folks it would be a difficult thing for them to understand, but it's not at all. They do really well."
Telemedicine isn't new. In some forms it's been going on for decades, but the ever-improving technology has been given a boost by new Vermont insurance regulations that make it easier for physicians to be reimbursed for services performed via telemedicine.
"Now that we have the law that says reimbursement is going to be required, more people are going to avail themselves of a telemedicine approach for delivering some of their health care," said Dr. Terry Rabinowitz, the psychiatrist on the other end of the Porter connection, the director of telemedicine at Fletcher Allen and a professor at the University of Vermont College of Medicine. "There may be others who actually may opt for telemedicine even if face-to-face health care is available."
Leigh Tofferi, a spokesman for Blue Cross Blue Shield of Vermont, the state's largest health insurer, said the telemedicine insurance regulations, which took effect Oct. 1, are so new his company hasn't had much experience with them.
"Obviously technology is changing rapidly so I think we are going to see more of this in the future," Tofferi said. "I think the challenge for everybody in the system is to ensure it's used constructively and efficiently and enhances medical care for patients."
Since 2000, physicians in remote parts of Vermont and upstate New York have been able to consult with Fletcher Allen physicians via a telemedicine hookup. At first the system focused on having Fletcher Allen's trauma specialists helping doctors at community hospitals cope with seriously injured patients.
Not long after the system began operating, it began to pay dividends when the expertise of the specialists began to help save the lives of distant patients. Even with the now-quaint dial-up technology, the physicians could control the cameras in the other room and offer life-saving advice.
The first system was dubbed "teletrauma" by the health care professionals who worked with it. The original program has ended, but it was one of the founders of that system, Dr. Michael Ricci, who recruited Rabinowitz to assume the role of telemedicine director in addition to his regular duties.
Now there are 70 health care locations in Vermont, including hospitals, health centers and a variety of other locations and a dozen in New York's North Country all connected with Fletcher Allen.
Psychiatry, such as that practiced by Rabinowitz, is one of the regular specialties that make use of telemedicine. Others include dermatology, an in-demand specialty, and emergency consultations for severely injured children.
Telemedicine is a tool.
"The way we do telemedicine varies from specialty to specialty. Sometimes not touching you is just fine. Other times I may need someone at the distant site to maneuver a limb or to put a piece of paper in front of you with a complex pattern on it that I want you to reproduce to test your cognitive status," Rabinowitz said. "There may be other times all I need to do is have you in front of the video camera and talk with you and that may be enough."