By Jim Barrett
Everyone on this TV network is a star because each one is making health-care history.
Using interactive two-way teleconferencing, the Health Science Center is bringing a new dimension to health care and health education in South Texas, a vast region that covers 53,000 square miles.
The new South Texas Distance Learning and Telehealth Network reaches clinics and learning sites in cities hundreds of miles away from San Antonio. The network grew from a $700,000 legislative appropriation to make the Health Science Center a "campus without walls" able to serve South Texas.
Now medical specialists are only seconds away from patients. And access to educational courses for nurses, physicians, dentists, dental hygienists, and occupational therapists is almost as easy as switching on the TV at home.
"This technology was made for Texas," said Kenneth L. Kalkwarf, DDS, dean of the Health Science Center's Dental School and chairman of the campus planning group on distance technologies. Based on the group's recommendations, the Health Science Center established its Center for Distance Learning and Telehealth. The center is responsible for coordinating telecommunications-assisted health care and education activities for the Health Science Center.
"This technology wouldn't be nearly as important in Chicago, New York, or other urban areas where the expertise may only be a few blocks away. But in Texas, we are looking at long, long distances and several hours driving in a car," Dr. Kalkwarf said.
Several projects are under way. Patients are the big winners in one experimental, 15-month program that began last April. It is helping children with cancer who live in the lower Rio Grande Valley, the southernmost part of South Texas.
Most of the children are receiving chemotherapy. With no pediatric oncologist in the Valley, the children and their nurses and doctors consult with a Health Science Center specialist who visits there once a month. The oncologist drives five to six hours to Harlingen, 250 miles south of San Antonio, where the children receive care at a local hospital. Any other time, the parents of the child drive to San Antonio.
Now, pediatric oncologists spend each Thursday consulting on cases using a telehealth connection. They can examine charts, diagnostic imaging, blood smears and bone marrow aspiration slides that are important to learn the child's condition. Doctors feel closer to their patients. They found and corrected an error in medication in the first month of the project.
During the consultation, the physician is in a room on the fifth floor of the Health Science Center's Medical School in San Antonio. The patients are at South Texas Hospital, an 84-bed facility in Harlingen. The oncologists still make their monthly visits by car, but distance no longer prevents any patient from getting quick and expert attention.
"The doctors and nurses can keep up with a case much better with the weekly consultations," said James D. Legler, MD, principal investigator for the project. Dr. Legler, associate professor of family practice medicine, is a medical informatics fellow with the National Library of Medicine.
The consultations have been expanded to include tuberculosis patients. Tuberculosis is a serious health problem in South Texas. Barbara J. Seaworth, MD, an infectious disease specialist from the San Antonio State Chest Hospital, consults with physicians and patients at Harlingen once a week. "This has made a world of difference having one of the nation's greatest TB authorities looking at our cases," said Teresa Lightner, MD, an internist who works both the oncology and tuberculosis sessions in Harlingen.
The physicians average about 20 consultations per month, and say patients feel at ease during the sessions.
Besides saving time, the telehealth system may prove to save money, too. A cost-benefit analysis of the project is being conducted by Dr. Legler and economists with the university's Center for Health Economics and Policy.
In a telehealth session, people at both ends see each other on color monitors. They also can exchange digital images such as x-rays, CAT scans, MRIs and other information important in medical evaluations.
A unit at each end contains a camera and video monitors that show the people at both ends or medical images needed for evaluations. Personal computers and other peripheral accessories can be attached to store and display data.
The computer is the object that helped pull the cancer project together. A year ago, computer specialists from NASA visited the Health Science Center to display new technology. Frank S. Stafford, PhD, director of the campus Computing Resources Department, had met NASA officials through a professional organization called HOST, short for the Health Care Open System and Trials Corp., a consortium of public organizations and private companies involved in the use of information technologies in health care delivery. "They were eager to help universities such as ours, especially with long-distance medical consultation technology," Dr. Stafford said.
With an assist from NASA, the cancer project got rolling. VTEL Corp. in Austin, which makes video conferencing systems, donated the end units at Harlingen and San Antonio. Sprint, the telecommunications company, supplied a fiber optics connection. NASA provided technical consultation and funds from its Dryden Flight Research Center in California. The donated equipment and services are valued at $400,000.
The telehealth network links clinics and learning sites at Brownsville, Corpus Christi, Del Rio, Eagle Pass, Laredo, McAllen, Pharr and Uvalde. New ways to use it are being tested almost daily.
Another project on the network links the Health Science Center's family practice residency programs at Corpus Christi and McAllen with physicians who are on call at the emergency room at University Hospital in San Antonio. University Hospital is one of the Health Science Center's teaching hospitals.
"Virtually every type of specialist is available to our San Antonio family practice residents in the University Hospital emergency room. This connection lets our affiliated residents at Corpus Christi and McAllen reach the same specialists when the need arises," Dr. Legler said.
The expanding telehealth network is the result of the Texas Legislature's South Texas/Border Initiatives to enhance higher education in South Texas. The Health Science Center has received about $14 million from the 74th Legislature's South Texas/Border Health Education Initiative to provide health-related education and ultimately improve health care in the region.
"We are the health science center for South Texas. There is a great need out there for health care. Many patients are indigent. The region is underserved," Dr. Legler said. The federal government has designated 26 of the region's 38 counties as underserved, meaning they lack the health care personnel deemed adequate and available in other parts of the United States.
The network also carries educational programs, most of which go to small classroom settings and use smaller, portable audio- visual units.
The School of Nursing provides instruction for bachelor's and master's degrees offered at The University of Texas at Brownsville and a doctoral program at Texas Tech University in Lubbock, 480 miles away.
In the School of Medicine, 80 faculty members have volunteered to lecture on 250 topics through telehealth connections. Physicians and nurses in South Texas simply request a specific topic, and the Health Science Center arranges the link- up.
And dental hygienists, lab clinicians and occupational therapy students soon will receive interactive instruction with a hook-up to the School of Allied Health Sciences. A bachelor's program in occupational therapy is scheduled to begin in May at UT Pan American at Edinburg, and much of the program will rely on instruction originating at the Health Science Center.
As an educational vehicle, distance learning lets other universities in South Texas offer courses that otherwise are only available in San Antonio, Houston or Dallas. Many state legislators have determined it is too costly to build another health sciences university in South Texas in the near future. The goal is to make education easily available via distance learning so South Texas will have more and better skilled health-care professionals.
In clinical use, telehealth helps provide the specialists who usually are found only in the nation's largest cities. Questions remain, however. Health-care insurers as yet do not reimburse physicians for most telehealth services. And changes may be needed in the system of physician licensure.
"In theory, you could be a physician in San Antonio having a consultation with a patient in Brownsville and easily hook up with a physician in Los Angeles who is a subspecialist in a particular area," Dr. Kalkwarf said. "Now we have a question about reimbursement but we also have a question about licensure. Is the physician in California practicing medicine in Texas, and, if so, does he or she need a Texas medical license?"
Telehealth technology crosses old boundaries, and lets universities serve larger numbers of people. In both classroom and clinical settings, the technology helps distribute expertise and opportunities in areas far from the major cities. And its future seems bright. Some educators are even looking to the day when the two-way interactive clinic or classroom can run on desktop computers.
In the meantime, the Health Science Center is putting the technology to the test, and helping build a virtual "campus without walls" that spans an area larger than many states.
