When the doctors at University of Texas Medical Branch are reading an ultrasound, examining an X-ray or evaluating an echocardiogram, the patient they are treating is not necessarily right in front of them.
Instead, the patient is often in one of the farthest-flung corners of the Earth: a scientific research station in Antarctica.
Using telemedicine, Galveston, Tex.-based physicians provide treatment to scientists and support staff who would otherwise have access to only very basic medical care. With the help of videoconference technology and specially designed medical instruments, doctors can diagnose heart attacks, inspect a lesion or even provide psychiatric counseling to National Science Foundation workers from thousands of miles away.
“We can really be virtually looking over their shoulder,” said Scott Parazynski, director of UTMB’S Center for Polar Medical Operations.
Although telemedicine has been practiced for decades, a burst of innovation in recent years has greatly improved its quality: Higher video and image resolution help lead to more accurate diagnoses, while more efficient use of bandwidth has led to more reliable connections. And the increased adoption of electronic medical records allows documentation to be shared more easily and quickly.
The way that telemedicine technology is being applied in Antarctica offers a window into its potential to reshape health care in less remote parts of the world.
The capabilities of the health facilities at the United States’ three Antarctic research stations are limited.
“They can treat most primary care issues and some emergencies, at least in terms of initial stabilization,” said Michael Montopoli, the chief medical officer at NSF’s division of polar programs.
But they are not equipped to give CT scans or MRIs, nor do they have a surgical center or postoperative facilities.
Telemedicine can help fill the gaps. A secure video conference can allow a specialist to talk to the patient and on-site caregiver to assess symptoms. The same technology can also be used to have a specialist coach an on-site clinician through a highly skilled procedure such as an echocardiogram.
A new array of tools can also help the remote doctor work as if she is in the exam room. Stethoscopes equipped with microphones enable a far-away doctor to instantly hear a patient’s heart or lungs. Special ophthalmoscopes, which come with a light source and a camera, allow the doctor to see inside a patient’s eye in real time.
Polycom, the maker of the telemedicine products used by UTMB and NSF, has made this set of equipment fit inside a case small enough that it could be stowed in an overhead bin on an airplane.
Telemedicine capabilities have been influential in how NSF health centers deliver care.
“It’s allowed us to make critical decisions about either treating the patient there at the clinic or launching a medevac operation,” Montopoli said.
The difference between those two courses can be important, not only for a patient’s health but also for a client’s bottom line.
Leaving Antarctica can be an outright odyssey: Flights are limited because it is often so cold that airplanes cannot function. In winter, the surface of the ice runway at McMurdo Station requires special preparation to accept aircraft.
And those are just the obstacles to departing a coastal facility. Travel out of the inland South Pole station is sometimes nearly impossible.
Accordingly, Montopoli said a medical evacuation from Antarctica can cost “several hundred thousand dollars.”
While telemedicine has broadened health-care options in Antarctica, physicians and patients still must contend with some limitations. Amundsen-Scott South Pole Station only gets Internet access for about 12 hours a day because of the positioning of the satellites that provide connectivity.
“We can provide very good technology on each end that provides the most effective use of bandwidth, but if there’s nothing to run it over, there’s a challenge,” said Ron Emerson, global director for health care at Polycom.
In the same way telemedicine has flung open the doors for more and improved care in Antarctica, its practitioners and advocates say it could have the same power closer to home.
In America’s rural areas, it can often be difficult for residents to get access to specialist physicians. As the Affordable Care Act extends health insurance to millions of Americans who previously did not have it, experts say that shortage is likely to be felt even more acutely.
Polycom and UTMB say telemedicine could help meet the swell in demand.
“The financial incentive is going to be there,” Parazynski said, for his hospital and other health providers to increase their telemedicine offerings.
In fact, UTMB pediatricians already use telemedicine technology to serve children in rural areas.
Oliver Black, systems analyst services manager at UTMB, said telemedicine could also be used in the future to monitor patients with chronic conditions in their homes.
Still, there are obstacles to more widespread use of telemedicine. A telemedicine consultation is not typically billable in the same way an office visit would be, which can create difficulties for physicians wishing to practice this way.
And there are some aspects of an in-person physician-patient interaction that telemedicine can not quite replicate.
“You’re relying on the person on the scene to pick up on the subtle changes in facial expression,” Parazynski said. “And you miss out on touch.”
Technologists and practitioners say they still see room for innovation that would also further telemedicine’s reach. Advancements in surgical robotics, for example, could make it possible for operations to be done from afar, rather than just consultations and examinations.