Although the actual sites and test protocols for the “From Bench to Bedside and Beyond” project have not yet been chosen, two rural physicians participating in a separate but related University of Washington project, the WWAMI Rural Telemedicine Network, explained the importance of systematically evaluating the Internet as a clinical tool.
Dr. Mark Tuccillo is a family physician in Petersburg, Alaska, a fishing village on an island off the coast of the state’s panhandle. Dr. Howard Willson practices family medicine in Thermopolis, Wyo., an oil town in the semi-arid Bighorn Basin. These far-flung physicians often connect via the Internet to the UW academic medical center.
“I’m one of only three providers in town. We don’t have a chance to associate much with other physicians,” Tuccillo said. “Electronic contact with the UW gets us out of this medical void. “Choosing which communications technology to use depends on what’s affordable and what’s appropriate for the situation. Consultations on skin diseases, psychiatric conditions, and some injuries are better when the UW specialists can see and talk with our patients on interactive video. For patient with a chronic heart condition, I might put together an electronic packet containing X-rays, electrocardiograms, and a narrative, and ship this over secure e-mail for a UW cardiologist to review at leisure.”
Tuccillo uses other Internet resources, such as clinical decision tools for trauma and prenatal care. He also looks up community education materials. After a near-drowning during a swimming practice, for example, he might obtain sports medicine ideas to advise on coaching techniques that minimize danger to kids.
“I’ve also gotten a few of my patients hooked up with national support groups, found background on learning disabilities for when I talk with a child’s school, and discovered new facts on fish bacteria,” he said. “I also check studies of drug effectiveness, instead of relying on promotional pamphlets.
“The Web is a place where my patients delve into their health concerns. We have new mothers getting practical tips on breastfeeding from Internet chat rooms with experienced moms in other parts of the country.
“For those of us who teach University of Washington medical students in our rural practices, our Internet links are essential to their clinical education and to staying in touch with their homebase, the medical school.”
Tuccillo approaches the Internet as he would any publication: “I call upon my education and experience as a physician to decide what’s off the wall and what’s applicable. I even read documented clinical evidence with a skeptical eye.”
Looking at the medium itself, Tuccillo said a difficulty in evaluating Internet technology for clinical purposes is its quick obsolescence: “Internet technology is rolling along so fast there’s no telling where it will go.”
Paradoxically, some Internet advances linger for years before they catch on in health care. Dr. Willson in Thermopolis confessed, “I’m a good example of a dinosaur converted to the modern age of computers. Like many doctors, I’m beginning to learn how valuable e-mail consultations can be.”
He explained, “Doctors have a predilection for wanting to see what you’re talking about. That’s why we tell you, ‘Come into the office.’ However, we’re learning a plain old telephone call or e-mail to a specialist can sometimes rival that. You don’t always need to send your patient to a distant urban medical center.”
Taught by his teenage daughter, Willson not only gathers topical medical library resources from the Internet, but, he said, “I’m becoming dependent on the computer for newly published research.”
For health professionals like Tuccillo, Willson and many others, the UW’s “From Bench to Bedside and Beyond” project is seeking solutions to paramount issues in Internet health-care. These include assuring patient privacy, protecting confidentiality, authorizing viewing rights to records, and stopping impersonators. Telemedicine Clinics may be regularly scheduled, just as in-person clinics are, to organize on-line consultations.
The project will develop in stages over the next two-and-a-half-years.