Telemedicine For The Masses: Experts On Wheels
(A cardiac patient and his doctor using the Medikart telemedicine cart.)
A few weeks ago, a 70-year-old man showed up at the emergency room of a small Baja California hospital with a cardiac syncope, meaning he suffered a brief loss of consciousness. After performing an EKG and lab analysis, a young general practitioner found a complete blockage of the man's electric impulses to the heart. The patient was in trouble, and so was the doctor.
With no cardiologist on staff or anyone else to turn to, the doctor deployed a high-tech medicine cart loaded with a fast PC and A/V links and dialed up a doctor hundreds of miles away. Moments after the virtual consultation via high-definition video, the patient was put on an external pacemaker that allowed time for a specialist to arrive and install a permanent internal device.
The cart was designed and outfitted by the Mexico-based company Medicina a Distancia. There are now a dozen of the firm's telemedicine carts, called the Medikart, in Mexican hospitals. The carts are designed so that patients not only receive more thorough and immediate care, but also save time and money by being in the same room, so to speak, with medical specialists regardless of where they are actually located. Since the company rolled out its first Medikart in the Baja California town of La Paz in 2010, for example, heart patients of Hospital General de Zona No. 1, for example, only need to make a single trip across the Gulf of California to meet with cardiologists in the state of Sonora.
"We've reached a point where patients are only traveling one time for surgery," said Dr. Carlos Iglesias, CEO of Medicina a Distancia. "The rest is happening in that town."
Besides enabling doctors who are geographically separated to hear and see each other while consulting, patient information such as charts and scans can be shared in seconds. The carts, which run on second-generation Intel Core i7 processors, can be connected to equipment that collects vital patient data and runs medical diagnostic procedures. Information gathered by such devices as a heart monitor, blood pressure machine, thermometer, X-ray machine, CT scanner and ultrasound system can be transmitted as it is being measured, enabling the specialist to view both the patient and data in real time in order to make a fully informed diagnosis and prescribe a treatment plan on the spot. Graphics plays an obvious major role.
"The highest definition image possible is critical," Iglesias said. "The opinion of the expert depends on the quality of the information. If a clinic is asking if I see a fracture based on a badly pixilated image of an X-ray, I would probably say I see nothing. With a high-quality image, I could perform a diagnosis. I could see calcification."
Iglesias, who performed his last surgery in June 2011 to focus on his fledgling company, said he's now able to help more people than before by, as he puts it, "providing a way to stretch my arm electronically through telemedicine devices."
Iglesias said each successful patient outcome aided by thetelemedicine cart reaffirms that he made the right career choice. One that continues to affect him deeply occurred shortly after the first carts made their way into small-town medical facilities in 2010.
On a typically hot Mexican summer day a woman about to give birth was in jeopardy along with her unborn child, Iglesias recalled. The expectant mother's placenta was very low in the uterus and covering her cervix, meaning the full-term baby could be prevented from entering the birth canal properly. The woman was bleeding heavily, and to make matters worse this was happening in a modest-sized clinic that lacked personnel trained for such emergencies. Making the hour's drive to a hospital in Durango was not an option, so with no time to spare the resource-strapped medical team put its trust in the telemedicine cart that had just arrived and was barely out of the box.
Using the Medikart the clinicians communicated with the emergency department at a Mexico City hospital some 550 miles away. The experts guided the clinic's staff through a delivery that could have been fatal without their assistance.
"I truly believe the mother and baby would have died without the cart," Iglesias said. "I'm so happy to say that the mother and the child, now a happy and healthy toddler, are doing well."
Iglesias sees a future beyond the telemedicine cart. Medicina a Distancia is working on a tablet version that, like the cart, will enable doctors in multiple locations to access medical records. The handheld unit, however, will also include such features as a telestrator that allows a doctor to draw a freehand sketch over a moving or still video image -- "like what you see during a football broadcast, only with medicine," Iglesias said. Expected to be in prototype stage soon, the tablet is based on the third-generation Intel Core processor.
"The portable version will consume less power and have enormous capabilities," Iglesias said. "We're building something that can be used in the far reaches of Mexico, Africa, the Amazon -- remote areas where the conditions are not what you would expect for a small clinic.
"You could even have a medical consultation under a tree," he added. "Of course, I'd prefer not to provide a consultation under a tree, but my point is it could be done anywhere."
With nearly half of Mexico's populace living in poverty, Iglesias sees a strong need for the products and services Medicina a Distancia provides. He acknowledges that growth has been slow in part to the economy and the fact that his company is new. Another factor is Mexico isn't mentioned in the same breath as other countries when it comes to telemedicine leadership.
"We have a long way to go in that area," said Iglesias, who in 1997 helped launch Mexico's telemedicine network while on the surgical staff at Mexico City's National Autonomous University.
Jonathan Linkous of the American Telemedicine Association said such ventures as Medicina a Distancia are helping Mexico "catch up" with the world's telemedicine leaders.
"The need is certainly there in Mexico," said Linkous, CEO of the Washington, D.C.-based organization. "Need often accelerates growth, as we've seen in Brazil, Canada, China and parts of Europe. When it comes to use of a cart or other communications system that links a rural clinic or community health center to a larger facility with specialists, these countries and regions are way ahead of Mexico, and even the United States."