Thursday, June 7, 2001

Kapiolani perinatologist Dr. Jana Silva performs an
ultrasound exam while Laura and Dennis Brown of
Honolulu view the image of their unborn 4-month-old
daughter. They are already the proud parents of two
boys, ages 14 and 6.

gives boost to
neighbor-isle women

Expectant mothers can get
care at 7 satellite sites without
traveling to Honolulu

By Helen Altonn

Thousands of neighbor island women with high-risk pregnancies and their unborn babies now can receive immediate emergency and specialty care without traveling to Honolulu.

It is being done via the telephone with telemedicine technology.

The Fetal Diagnostic Center at the Kapiolani Medical Center for Women & Children in Honolulu is linked to seven satellite clinic sites that are providing real-time fetal tele-ultrasound diagnostic services to high-risk expectant mothers.

"Using telemedicine technology, we connect with the ultrasound machine in the particular site, and we basically view the images in real time as the technician is doing an examination," said Dr. Greigh Hirata, Fetal Diagnostic Center medical director and principal investigator for the program.

"Telemedicine also allows us to have voice communication so we can direct the technician to move left or right, kind of like telling someone how to scratch a back," he said.

A second camera permits the patient to see the medical team members in Honolulu watching the exam, he said. "Most of the time, we concentrate on using a camera hooked up to the ultrasound machine."

Hirata said the system is a perfect solution to the round-the-clock schedules and travel required of him and his colleagues to cover roughly 3,000 high-risk pregnancies in Hawaii annually.

The Fetal Diagnostic Center is the first obstetrical clinic in Hawaii to provide comprehensive and integrated services for high-risk pregnant women. It has four maternal-fetal medicine specialists, genetic counselors and other professional and support personnel who provide perinatal services, prenatal tests and genetic testing and counseling.

Hirata said, "We are driven by our mission to serve the needs of our patients, but our problem has always been one of time, distance, expense and concern for the comfort and safety of patients who have had to travel to Oahu because they couldn't wait until our next visit to their island."

Kapiolani doctors go to the neighbor islands every two weeks to see patients, he said in a telephone interview yesterday from the Big Island.

With use of telemedicine, he said, they can determine if the patient is at high risk for a birth defect and direct them to visit Kapiolani in Honolulu.

Others with a "normal variant" may be seen at the regularly scheduled appointments every two weeks, he said.

"Sometimes it's hard for patients to be put up in hotels, or they don't have relatives in Honolulu," Hirata said. "This enables us to follow them from a distance. Then, when they deliver, they come here, but they don't have to come back and forth."

Hirata said the fetal tele-ultrasound network, which he helped conceive and develop, "is like being able to be in two or more places at the same time.

"We can extend our care to more patients in more locations, and in a more timely way that minimizes discomfort, inconvenience and expense."

Full-motion, high-resolution ultrasound images can be sent in real time from any satellite location linked to the Fetal Diagnostic Center. They are instantly read and interpreted by the center's perinatologists, which could mean lifesaving or vital interventions for mother and baby.

Kapiolani's maternal-fetal medicine specialists can interact across the distance with the patient, physician and ultrasound technician. The fetal center specialist can ask the sonographic technician to zoom in on the baby's heart or ask the mother to shift her position.

Hirata said the technology also allows doctors to answer questions people have about babies.

The doctors are able to reassure pregnant women who are worried about their unborn babies, or to triage them to get them treated sooner, Hirata said. "Most of the time, the patient is so anxious to begin with. Fortunately, we have a high likelihood of giving them reassurance."

Hirata said people initially are a little apprehensive about the technology, "but it's quite remarkable, the images and quality you get.

"It still will never replace being at the bedside, but it comes pretty darned close," he added.

The doctors had their first telemedicine patient about two months ago and now are doing two to four tele-ultrasound readings daily.

The telemedicine network links Kapiolani Medical Center with ultrasound machines at seven remote sites: Wilcox Memorial Hospital in Lihue; Hawaii Radiologic Associates in Kailua-Kona, Women's Imaging Center in Hilo and the North Hawaii Community Hospital in Waimea, all on the Big Island; Maui Radiology consultants in Kahului; and on Oahu, Kapiolani Medical Center at Pali Momi in Aiea and the Waianae Coast Comprehensive Health Center in Waianae.

The system not only is advantageous in "geographically challenged" Hawaii, but would be helpful for patients in Guam and other Pacific areas, Hirata said.

"It's not a 25-minute plane ride (to Guam); it's nine hours," he said. "Sometimes they (patients) come and there is nothing we could do, and we send them right back.

"Service to Guam would greatly improve health care there," he said, noting Guam has only six or seven obstetricians and a high volume of deliveries.

He said the system would be helpful for consultation for high-risk patients, as well as diagnostic ultrasound purposes.

He plans to visit Guam this summer to see what is available and to look into setting up programs between the hospital and Kapiolani's fetal diagnostic team, pediatricians and pediatric cardiologists.

Kapiolani obtained a grant for the project in 1999 from the Department of Commerce's Technology Opportunities Program, which promotes availability and use of advanced telecommunication technologies.

Hirata said the first year was spent setting up contracts and agreements, equipping facilities and training staff.

The federal grant required Kapiolani to contribute toward the cost.

Telemedicine infrastructure and equipment were provided by the Harry and Jeanette Weinberg Foundation.

The project was recently named the top award winner in the telemedicine/health-care category at the 19th annual awards competition in California.

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