Feature

Doctoring At A Distance

Advanced telecommunications mean that specialists will be able to treat people from afar.

by Vicki Hyde

It can be hard getting a doctor sometimes, especially if you're hunting a specialist who might be anywhere from deep in the bowels of a patient to deep in the sand at the 7th hole. Telecom hopes to see that changed in the future.

For some time now doctors have carried bleepers or pagers -- electronic devices that alert them when their services are required. Many of these are able to carry simple messages, telling the doctor who is calling and what is needed.

The problem comes when trying to explain a complicated condition or its treatment over the phone. A doctor or specialist needs a great deal of information concerning a patient's medical history, their medication, test results and so forth. Life-threatening mistakes can occur when full information is unavailable.

Hospitals and communications specialists are collaborating on developing a more efficient system of transmitting vital information to an electronic medical notebook. The "notebook" would combine a patient database with communications software in a personal computer the size of current electronic diaries.

Telecom is excited about the prospects for the future. The corporation's managing director, Dr Peter Troughton, thinks that the use of such a notebook in the New Zealand medical scene is not too far away.

"The technology is virtually here today to do it, " he maintains. Fibre-optic communication channels and digital networks make it possible to transmit a variety of data through the telephone lines, including everything from x-ray information to videos of the patient. Link sophisticated telecommunications services with intelligent computers and you have the basis for doctoring at a distance.

Dr Troughton believes that increasing competitiveness in the New Zealand medical scene will push local hospitals and specialists to support such a concept.

"It will be much much cheaper as well as more efficient, " he says. The notebook would also improve health services considerably, allowing specialists to respond rapidly to their patients' needs and spreading the workload on harried medical personnel.

Specialists could have all the relevant information on their patients at their fingertips regardless of their location. When the patient experiences problems -- a heart attack or post-operative complications -- all the current information could be downloaded to the medical notebook and displayed on a small screen.

The notebook would be able to call up stored data on the patient's history and previous treatment, as well as any pertinent records. The hospital computer could transmit data on the patient's immediate condition using a telecommunications link to monitoring equipment on the ward.

Graphics capabilities would allow x-rays, brain scans and electrocardiograms to be transmitted and examined. Developments in the videophone area would allow a doctor to talk to and examine a patient who is across town.

Thus the specialist would be able to do everything but touch the patient. Even that may change with the eventual development of sophisticated "waldo" units used to manipulate objects at a distance. The operator controls the unit's movements through a pair of "gloves"; as the operator moves the gloves, the waldo unit mimics those motions. Medical waldos would need to be far more sensitive than the ones currently developed for industry, and would also have to be able to transmit tactile information to the physician.

The patient doesn't even have to be in hospital to benefit from "doctoring at a distance." St John's ambulance teams have an electrocardiogram system which transmits cardiac information directly from their ambulances to the hospital. The system sends information on the patient's heart condition to the coronary unit where a doctor may advise appropriate medication or action to be undertaken while the patient is on the way to hospital.

Cardiac halters are used by many New Zealand hospitals to monitor patients at risk. The monitor is clipped to the patient's belt and stores data on the patient's heart functions for up to 24 hours. The next day the patient returns to the hospital and the data is read and analysed.

A more patient-interactive system is under testing in the United States. A cardiobleeper is used to check the electrical activity of the heart and transmit this information over a telephone line to a hospital's heart unit.

The receiving physician is able to "read" the electrocardiogram and recommend whether medication is needed. As part of the system, the patient carries a pen-sized device that can deliver a dose of lidocaine to stabilize the heartbeat.

With the aging population and the number of doctors per head decreasing, doctoring at a distance could well become more than just a convenience -- it may become a necessity.

Vicki Hyde is the editor of New Zealand Science Monthly.