If you haven't visited your doctor by television or the Internet yet, you soon may, particularly if you live in outlying areas.

Telemedicine is growing fast across the state and across the Pacific, and is filling medical care gaps caused by shortages of specialists, patients who can't travel, the need for consultations with out-of-town doctors, high travel costs and more.

"This is an ever-expanding, growing field," said Dale Moyen, telehealth manager at Hawai'i Pacific Health, which runs Straub, Kapi'olani, Pali Momi and Wilcox hospitals.

When the Veterans Administration experienced a doctor shortage on Maui last year, it announced telemedicine would be used to help meet the need.

"I think that it's really a very exciting field, especially for places that are geographically isolated. It brings the services of top-of-the-line physicians to places that wouldn't have that," said Marsha Durbin, director for emergency and trauma services at The Queen's Medical Center.

In its simplest form, telemedicine is an opportunity for a doctor to talk to a patient in a different place. Each has a camera and a viewing screen, and they can respond to each other in real time. Many systems also allow specialized diagnostic equipment to be added to the mix. Some systems are medical applications using the Internet.

"We have done telemedicine to the war zone," said Dr. Becket Mahnke, a physician manager of one of Tripler Army Medical Center's telemedicine projects.

"One of our physicians was deployed in Iraq. He took a picture of a rash, uploaded it, and 12 hours later he had an answer," Mahnke said.

One of the first statewide telemedicine systems was aimed at women with high-risk pregnancies who needed the help of a specialist, but either could not safely travel to the specialist or the specialist could not easily reach the patient.

REAL-TIME EXAMINATION

Ten medical centers on five islands were outfitted in 1998 with systems that allowed a specialist at Kapi'olani Fetal Diagnostic Center to view two screens—one showing the adult patient, and the other showing the results of a fetal ultrasound procedure being performed in real time on the patient.

Patients can go to hospitals on Kaua'i, O'ahu, Moloka'i, Maui or the Big Island to be seen through the system.

"It is a great benefit for patients. The doctor can interact with the sonographer (who does the ultrasound) as well as with the patient," Moyen said.

Early telemedicine systems were operated largely with grant funding, and some still are, but the technology is increasingly becoming a valued part of regular medicine in the state.

"We have been operating telemedicine since 2003 without grants. It is part of our standard clinical services," Moyen said.

And while real-time videoconferencing system can still be expensive, some forms of telemedicine that use the Internet represent no added costs. They're simply using the computers and Internet connections most medical offices already have, Mahnke said.

Doctors still like to see a patient in person early in their relationship, but some patients in the South Pacific and Western Pacific may receive treatment from Honolulu specialists without ever meeting them except electronically.

"We do teleservices for our children's specialty center, in which specialists examine children with bone and joint problems. Some of these kids are in American Samoa, Guam and Saipan," he said. In many cases, patients in outlying areas and remote islands have their followup visits via telemedicine, Moyen said.

Shriners Hospital also does telemedicine to the Neighbor Islands and other parts of the Pacific.

"Telemedicine is not a substitute for an in-person visit, but it can improve efficiency and cost, especially when you consider the cost of travel for a parent and child," said Jana Lindsey, telemedicine chief at Shriners.

Telemedicine links medical facilities that are otherwise quite independent. In various telemed hookups, there are links involving Hawai'i Pacific Health, The Queen's Medical Center, Hawaii Health Systems Corporation, Hawai'i Primary Care Association (HPCA) and its clinics, Moloka'i General Hospital, state Department of Health, Shriners Hospital, Castle Medical Center and Hawaii Radiologic Associates.

There are also very focused systems, like a direct video link between Tripler and a medical center in Guam, which is called an electronic intensive care unit, allowing video and voice connections between the specialists at Tripler and the clinic in Guam.

In other parts of the Pacific, Tripler uses a system in which messages are sent and then responded to. Tripler employs a system for military families called Pacific Asynchronous TeleHealth system, and one for residents of U.S.-associated islands in the Pacific, called Pacific Island Health Care Project.

"The reason that this is used is that remote locations are where we tend to send junior physicians. This lets them take advantage of the experience of more senior people," Mahnke said.

Most of the systems in place across Hawai'i are focused on care for children and pregnant women, but that is changing. Kapi'olani, Pali Momi and Wilcox medical centers have the ability to bring a consultant in to view and comment on endoscopic surgery procedures, and there is a telepsychiatry capability between Kahi Mohala, Hilo Medical Center and Maui Community Mental Health Center. New telehealth capabilities are being added this year between O'ahu and the Big Island (see story).

PROBLEMS TO CONSIDER

If there's a problem with the state's telemedicine systems, it is that there are so many of them, and that many can't talk to each other — you can't readily link a telemedicine hookup built for pediatric use in one hospital to another telemedicine site developed for surgical applications in another, meaning someone has spent a lot of money on systems with very limited uses.

A goal, Lindsey said, is to establish a statewide, robust, unified system based on the broadband capabilities of Internet2 — .a very fast computer network based on fiber optic cables, linking universities, government agencies, research agencies and others — but not the general public.

Lindsey, a member of the board of the American Telemedicine Association, said a group of Hawai'i telemed officials are planning to apply for a Federal Communications Commission rural healthcare grant. The program will cover up to 85 percent of the cost of having "public and nonprofit healthcare providers construct state and region-wide broadband networks to provide telehealth and telemedicine services."

The FCC says such a system would not only improve the provision of healthcare to rural areas, but could be invaluable in helping the nation respond to a national health crisis.

Reach Jan TenBruggencate at jant@honoluluadvertiser.com.