A talking head on a television screen can be a virtual lifesaver for patients being cared for with telehealth—high-speed telecommunications that can reach remote rural areas, underserved urban communities, and almost anywhere else in the world. “Telehealth eliminates geographic barriers,” says Anne Burdick, professor of dermatology and associate dean for telehealth and clinical outreach at UM’s Miller School of Medicine. “You can provide care to people who don’t have access to care or help those who may not have access to the level of care that is needed.”

From the Miller School of Medicine, telehealth delivers essential patient care and health education services. Among the school’s initiatives is a collaboration with the Florida Department of Health’s Children’s Medical Services program (CMS) to provide interactive dermatology and nutrition consultations through live video conferencing to financially disadvantaged, special-needs patients in six South Florida counties.

“A lot of these families live in rural areas surrounding Fort Pierce, about two hours from Miami. And since many of them are day workers, they can’t afford to miss work to take their fragile child down there to get specialized care,” says Mary Hooshmand, the regional nursing director for the CMS network. “Our partnership with University of Miami’s telehealth team has been extremely beneficial, and the telehealth clinics in nutrition and dermatology have been especially helpful.”

Although telehealth lends itself well to visual specialties, its potential crosses many medical disciplines. “This delivery care mode is for everyone,” adds Burdick. “It’s for employers to put in their places of business so their employees don’t have to take time off from work, it’s for nurse practitioners in schools to connect with pediatricians to better assess schoolyard injuries. And it can be used during disaster situations.”

Receiving health care remotely might seem a bit impersonal, but many UM doctors say patients and their families have been receptive.

“When we start to interact with the child, the TV isn’t an obstruction to developing a physician-patient rapport. They wave to the screen, often telling their moms, ‘I’m on TV,’” says Elizabeth A. Connelly, assistant professor in the Department of Dermatology and Cutaneous Surgery and in the Department of Pediatrics at the Miller School. “The parents of these patients are getting the medical attention they can’t get elsewhere, so no one has complained.” Connelly runs a monthly dermatology clinic with CMS in Fort Pierce.

“It’s been working well for me,” says Sabrina Candelaria, a registered dietitian with the Miller School’s Mailman Center for Child Development and Medical Wellness Center. Since May 2007, she’s seen more than 100 patients through telehealth clinics. “CMS realizes the importance of nutrition in the care of their pediatric patients, and it’s a much-needed service since they do not have a dietitian on staff.”

Telehealth can be delivered through videoconferencing technology, where a doctor on one end of a screen talks to a patient with a trained nurse practitioner (presenter) on the other end. At Jackson Memorial Hospital, thanks to a Department of Defense grant, UM physicians are exploring ways to bridge the shortage of trauma and intensive care specialists with the help of a telehealth/videoconferencing robot. CHICO (Computer Hospital Intensive Care Operator) can be rolled around to patients’ rooms, giving skilled physicians remote access to patients. Part of the U.S. Army trauma training program, it is the only such robot in a U.S. trauma center, and it may soon be incorporated into ICU and resuscitation rounds at University of Miami/Jackson.

Another form of telemedicine uses asynchronous store-and-forward technology. Images are captured and transmitted electronically with a history. The person on the receiving end reviews the medical information and sends recommendations back to a secure Web site. “Although this is less expensive, it’s also less efficient because I can’t ask questions,” says Burdick.

Though more widespread in recent years, telemedicine dates back to the late 1920s, when the Royal Flying Doctor Service in Australia combined medicine, aviation, and two-way radio to bring health care to Australia’s outback. In the mid-1950s, the Nebraska Psychiatric Institute used telepsychiatry for educational purposes, installing a video link at a satellite hospital to transmit therapy sessions live to students via closed-circuit television. But telehealth’s connection to astronauts, most experts say, is its modern-day precursor.

“It really started during NASA’s Gemini Program as a way to monitor astronauts in space,” says Scott Simmons, director of telehealth at the Miller School. He was introduced to the field during his ten-year stint at the NASA Johnson Space Center in Houston. Simmons and his team developed and patented the telemedicine instrumentation pack, a portable telemedicine device first used on the space shuttle Endeavour. The pack was used during missions to connect the NASA flight surgeons with astronauts in space.

Simmons most recently served as assistant director of the Telemedicine Center at East Carolina University in Greenville, North Carolina, where he doubled the size of its telemedicine network. His work with the state-funded Eastern North Carolina School for the Deaf, which is equipped with a nurse-staffed infirmary, is an example of telehealth’s impact. Prior to telehealth, a semi-retired physician visited once a week. On any other day, sick children would often be sent to the emergency department (ED) or picked up by their parents. “So kids spent less time in school, and ED visits were expensive and often unnecessary,” Simmons says.

The School for the Deaf got ECU’s Department of Pediatrics to allow one of its pediatricians to take over as the school physician, augmented by telehealth. Instead of a weekly visit in person, the new physician took a daily “sick call” via telehealth. “There was dramatic im­provement in time spent in class and a drop in ED utilization,” Simmons says.

The University’s telehealth track record dates back to 1974, when physician Jay Sanders won a Westinghouse grant to complete one of the first telemedicine pilots with the prison system and Jackson Memorial Hospital using microwave technology.

“There are many uses for telemedicine in the prison system,” Burdick explains, citing the expense and escape risk of transporting prisoners.

The 1990s brought the Internet, the digital camera, and decreasing telecommunications costs. Codec technology (short for “coder-decoder”) provided a way to compress and decompress audio and video, allowing live audio or video clips to be broadcast over broadband Internet.

In 1994 the University installed live videoconferencing technology at Martin Luther King Jr. Clinica Campesina, enabling University of Miami physicians to see and treat migrant patients in Homestead, Florida, without the two-hour commute. The University also entered into teleradiology contracts with U.S. Customs to read abdominal X-rays of suspected drug smugglers.

Using the store-and-forward system, the Miller School’s teledermatology consults also have provided care to military personnel and their dependents at 31 bases in 17 states in the U.S. Army’s Great Plains Regional Medical Command. Senior residents write the draft diagnoses and recommendations, which are then reviewed and edited by attending dermatology faculty. Since 2006 the program has provided more than 2,000 consultations.

Telehealth is becoming a powerful educational tool. “Typically when I work with residents, they enter the patient’s room alone to greet them,” explains Connelly. “With telehealth, I can see how they interact with the patient, perform the exam through the use of the prompter [the nurse practitioner on site], and take the patient’s history.”

The technology already is being used for some UM grand rounds, lectures, and meetings and will soon expand throughout South Florida. “It’s amazing how rapidly the videoconferencing infrastructure has expanded through the University of Miami Health System and partner sites,” observes Tom Brewer, the director of telehealth operations. Before joining the UM telehealth team in October 2007, he was director of telemedicine for St. Vincent Hospital and Health System in Billings, Montana, where he developed and managed an extensive videoconferencing network. He sees parallels in rural and urban telehealth benefits. “Access and convenience of health services can be greatly improved,” he says. “The geographic barriers are different, but equally daunting—whether I need to navigate snow-covered roads in Montana or I-95 during rush hour in South Florida.”

Developed several years ago by the University of Miami and the Universidad Autónoma de Nuevo León in Monterrey, Mexico, a series of academic videoconferences for interactive health care lectures and grand rounds in dermatology and plastic surgery are still taking place today. Burdick recently received a grant from the American Academy of Dermatology to expand the Monterrey, Mexico, program to a number of sites worldwide.

The University plays an equally valuable role in researching and developing telehealth applications and technologies. “Research and development in telehealth requires interdisciplinary ap­proaches that will involve scientists and engineers from across the UM enterprise,” notes Simmons. “It includes technology development, health communications, human factors, health economics, and health services research.”

Burdick adds that “crucial policy changes will be catalyzed via better evidence of telehealth’s clinical, economic, and societal benefits.”

So, what’s the future of telehealth? “Look at the effect of the Internet on other industries,” says Simmons. “We have become 24/7 consumers of information, products, and services. We want to get what we want, where and when we want it. Until now, we have not demanded this level of service from health care. As people learn about telehealth, we expect that to change rapidly.”

The Miller School telehealth team plans to be at the forefront of that change.

LISA SEDELNIK, M.A. ’00, is a freelance writer in Coral Gables, Florida.