Telemedicine Growth Dependent on Faster Regulatory Review, Genachowski Says
SEATTLE -- The extensive use of telemedicine at a major regional hospital “should be the rule,” but is “still largely the exception in the United States,” FCC Chairman Julius Genachowski told Seattle Children’s Hospital doctors who participated in a demonstration and news conference late Friday. The obstacle is a slow regulatory approval process for new services and devices, he said. The FCC and its new partner in one particular effort, the Food and Drug Administration, are working to make it “streamlined and effective to encourage investment in new technologies,” Genachowski said.
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Genachowski declined to say much about the future of stakeholder talks on net neutrality and possible broadband reclassification, in the wake of the Google-Verizon proposal, other than to make clear the issue isn’t dead for the FCC. “We'll continue to move forward on that” because it’s inextricably linked to “innovation,” he later told reporters in Q-and-A.
Confusion on the FCC’s authority over broadband, as illustrated by Comcast’s court victory over the agency in a network-management dispute, is nothing new, Genachowski said. “The legal issues are complex,” but the real-world benefits of clarified FCC authority -- in this case, improved health care -- are obvious, he said. The commission is “trying to shine some light” on the benefits of broadband in other areas, by improving digital literacy and showing Americans the “relevance” of broadband to their lives, he said.
The “superstar subspecialists” at Seattle Children’s have conducted more than 10 million telemedicine visits since the service started in 2001, covering patients and local doctors in Washington state, Idaho, Montana, Alaska and even Ukraine under a mutual-review agreement with a Kiev hospital, said Chief Information Officer Drex DeFord. Making regular trips to Seattle after initial treatment is a heavy burden for many families, he said.
Telemedicine visits for several procedures spiked in 2009, said Cardiology Division Chief Mark Lewin. His most recent figures were from 2008, when doctors performed just over 1,000 echocardiograms, for example. Remote visits provide “urgent and immediate answers” to families and improve neonatal survival rates, he said. The hospital also uses interactive live streaming for a third of its meetings with other doctors, such as “grand rounds” gatherings in pediatrics and a cardiology conference, Lewin said: “This is really part of our practice."
Lewin did a live telemedicine visit at the news conference with a Richland, Wash., hospital’s newborn intensive care unit. Using a live feed from the S-video port on an echocardiogram machine, he directed a Richland ICU doctor to provide a “parasternal long axis view” of a baby’s heart. Seattle Children’s has been checking in regularly on “Baby Apollo” for the past two weeks, Lewin said. Future applications of telecardiology include monitoring of post-operative patients in rural areas, improved regional connectivity for clinical and educational purposes, rapid data transfer and better care of fragile patients, he said.
Telepsychiatry is taking off at Seattle Children’s, where psychiatrists remotely serve 900 children in the Pacific Northwest, with Montana to be added soon, said Kathleen Myers, telepsychiatry program director. “Families are very satisfied” with the sessions, with an extensive waiting list, and children who meet her after remote sessions perceive an “aura” around her, as if she’s a TV star, Myers said. There are “some subtle things you don’t always pick up” in remote sessions, though, because video cameras usually aren’t positioned for direct eye contact and there’s a “millisecond” lag between audio and video, she said.
As Genachowski, a former emergency medical technician, visits hospitals around the country, “there are more and more of these examples that I see” of telemedicine saving lives, he said. He met a mother in Oakland, Calif., whose baby’s heart problem was discovered by monitoring technology, and chemotherapy patients in one rural area who have reduced their in-person visits for a six-month treatment by 90 percent due to telemedicine, he said. “It becomes increasingly easy to see the benefits” in reduced travel burdens and expenses: Patients and families no longer have to choose between keeping jobs and protecting their health.
Up to a third of rural health facilities lack or have poor broadband options, which the FCC plans to remedy through $400 million a year in an expanded pilot program, Genachowski said. “Think of it as an ‘H-Rate’ program,” he said, a hospital version of the federal E-Rate program for connecting schools, that will in turn spur the use of electronic health records. The problem with eye contact in telepsychiatry visits, mentioned by Myers, can be addressed through faster review and approval of medical devices that already exist, Genachowski said. The commission’s new agreement with the FDA to clarify jurisdiction over and speed review of wireless medical devices will encourage investment, he said.