By Craig T. Kojima, Star-Bulletin
Dr. Karen Nauschuetz, chief of anatomic pathology,
goes over a slide sample with Robert Whitton, technical
director. Both are with telemedicine technology
at Tripler Army Medical Center.

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Tripler on cutting edge
of telemedicine

A Tumor Board is the latest
in the hospital's Internet-linked
diagnostic tools

By Susan Kreiffels
Star-Bulletin

In Guam, Lt. Cmdr. Bruce Cairns, a Navy general surgeon, circles "hot spots" on the X-ray displayed on his desk computer screen.

Thousands of miles across the Pacific Ocean at Tripler Army Medical Center, an "Internet Tumor Board" of a dozen cancer specialists watches Cairns' scribbles on their own computers. Together they will decide a treatment for the Guam patient that will make her medical evacuation to Hawaii shorter, more comfortable, maybe even unnecessary.

The Internet Tumor Board is one of the newest developments in telemedicine and telehealth, a concept that fits well in the remote state of Hawaii, where some islands lack the specialists found on Oahu.

This month various state deparments and the University of Hawaii will sponsor a three-day conference for the medical community to discuss the technology, legal and political issues and economics of long-distance medicine and consultation.

Experts from Hawaii and the mainland will speak at the "Institute for Telehealth & Telemedicine -- Mapping the Future for Hawaii" being held Sept. 24-26 at the East-West Center.

A Tripler team will discuss the tumor board at the conference. "This can be a model for the rest of the world," Cairns said. "It's low cash, easy to manage and effective."

Hawaii has a number of telemedicine and telehealth activities already in place, said Norman Okamura with the Office of Telecommunications and Information Research and Applications at UH's Social Science Research Institute.

Among them:

Queen's Medical Center initiated a pilot project to use teleconsultation in emergency room services between Molokai General and Queen's Hospital.

A project at Kaiser Foundation Health Plan Inc. allows doctors to view X-rays from home. Kaiser is also studying the possibility of extending programs to the Pacific islands and Asia.

Dr. Mark Schwab of Valley Isle Cardiology and Maui Memorial Hospital visited Guam with the University of Southern California School of Medicine to set up a teleradiology trial where images would be sent to the USC School of Medicine and to other radiologists for consultation.

"We have many hospitals at different stages developing their own systems," said William Dendle III, chief of the Department of Health's Office of Planning, Policy & Program Development. "It's happening but in isolated trial and applications xxx They need to share among themselves. It's competitive, of course, but they definitely have common interests to become cost-effective."

Dendle said federal grants are available for rural communities to develop the infrastructure for telemedicine.

Deane Neubauer, a UH professor of political science, said thorny issues emerging in telemedicine include liability, patient confidentiality, reimbursement and legislation that will allow doctors to do consultations on patients out of state. Although some states are passing laws, pressure is building for federal regulation.

"If something goes wrong, who is to blame?" Neubauer asked. "Who gets paid and how much?"

Telemedicine and telehealth can make costly medical evacuations unnecessary, or at least make a patient's time away shorter, more successful and more comfortable. Tripler's Internet Tumor Board, kicked off on Guam late last year, has reviewed 11 Guam cases since May, and four medical evacuations have been avoided due to the Internet consulting.

Being at home with family when they hear a diagnosis rather than far away and alone also helps patients get through a "devastating diagnosis" and makes them feel they already know faraway medical staffs if they have to be evacuated, Cairns said.

Cairns said off-the-shelf software, two computer assistants and himself were all it took to initiate the teletumor conferencing, making it more affordable than relying on expensive satellite time.

Tripler is on the cutting edge of telemedicine technology, said Col. Cal Delaplain, Tripler's acting chief of radiology and a pioneer in telemedicine. In the early 1990s Congress funded the Akamai Project, a multimillion-dollar telemedicine facility at Tripler. One of the project's goals is to expand telemedicine in the Pacific, and Hawaii's civilian medical community can take advantage of Tripler's expertise.