Telemedicine system enhances comanagement

Issue: May 1998

BIRMINGHAM, Ala. - When seeking another opinion, telemedicine can be quick, accurate and convenient.

"It's nice to have a second opinion sitting in your office at any given time," said Jack L. Schaeffer, OD,in group private practice here. For the past year, Dr. Schaeffer has used telemedicine to consult with an area ophthalmologist on a host of ocular conditions.

Both practitioners use the RealView telemedicine system (VCOM Systems), which is a complete hardware/software platform designed to capture high-resolution digital images from a slit lamp or fundus camera.

"We have a direct modem line to the ophthalmologist's office for sending pictures," Dr. Schaeffer explained. "The ophthalmologist's technician retrieves the images on their system. In less than 10 minutes, both the ophthalmologist and I can review identical pictures while the patient is in the chair."

Reduces face-to-face consults

There have been a number of instances where Dr. Schaeffer's patients have saved a trip to another office for a consult. "Every week, we have at least one patient who doesn't need to make a trip," Dr. Schaeffer said. "We look at maculas, we look at skin lesions, we look at corneal diseases."

In February, Dr. Schaeffer saw a patient with two isolated infiltrates that "didn't appear to be new, but I did not want to sit on them. I normally would have referred the patient." But after transmitting images of the condition to the ophthalmologist, "we started therapy," he said. "I knew what I wanted to do, but I needed someone else to say that it was OK. In essence, it's a consultation opinion by telephone."

In this particular instance, confidentiality was omitted so the patient could overhear the discussion. "I told the patient that he had something I had never seen before," recalled Dr. Schaeffer. "So I took some pictures, then walked into another room to care for another patient. In the meantime, my technician saved the pictures and transmitted them to the ophthalmologist. When I returned to the room, I talked to the ophthalmologist on the phone while the patient was sitting in the chair."

External, retinal problems

Mark G. Bearman, MD, n ophthalmic plastic and reconstructive surgeon in Birmingham, is the ophthalmologist with whom Dr. Schaeffer communicates via telemedicine from four to six times a week. "We consult mostly on external ocular problems and retinal diseases, particularly diabetes," Dr. Bearman said, as well as lesions on the eyelids (whether they are malignant or not) and infectious conditions.

Recently, Dr. Schaeffer transmitted images of eyelid lesions to Dr. Bearman for his opinion on whether they needed to be removed. "We felt that they were malignant, so, via the telephone, we scheduled the patient for the procedure," said the ophthalmologist.

An image of a diabetic's macula is a common consult. Dr. Schaeffer may ask if a lesion needs treatment or if it is safe to see the patient in 3 months. Dr. Bearman may respond that the patient should be treated within the next 3 to 4 days or that the lesion is too far from the center of the macula and will not affect the patient's vision for the next several months.

Based on patient history, the findings Dr. Schaeffer provides and the transmitted images, "at least 50% of the time I never see the patient," Dr. Bearman stated.

Screening patients

Telemedicine helps Dr. Bearman screen patients and decide if it is an emergency or if the patient can wait to see him in a few days.

By reviewing images in advance, the MD can prepare for the scheduled appointment. "Sometimes, it helps me identify equipment I may need to bring to Dr. Schaeffer's office in order to excise a lesion," Dr. Bearman said.

Patients also save time and money by not having to travel to a second office.

In addition to telemedicine, Dr. Schaeffer uses his video capture system for simply taking and storing images electronically (both anterior and posterior segments). "I can store pictures of all types of patient problems, including retinal problems," he said. "You can use a 90 D or any one of the precorneal lenses. You end up with a clear photograph that is of much higher quality than any retinal camera. So it's ideal for following any retinal as well as corneal disease."

Useful for patient education

Patient education, especially concerning contact lenses, is also key. "We know that patients abuse contact lenses more than any other item in the eye care field," Dr. Schaeffer said. "When patients come in wearing disposable lenses that are a month old with protein deposits, you can talk until you're blue in the face, but they don't grasp it." Therefore, "I show them their deposits on the computer monitor, then I take off their lenses and show them what it is doing to their eyes."

In some instances, Dr. Schaeffer records corneal neovascularization, resulting from sleeping with contact lenses. "I can show them the vessels growing into the cornea," he said. "It's a very impressive communication tool. Not only do my patients have my word, but they have a visual for reinforcement." The system allows for images to be printed, as well.

Useful for lectures

The video capture system also comes in handy when Dr. Schaeffer lectures. "I have a bank of pathology slides that I can call up by name or diagnosis," he said of his approximately 4,000 to 5,000 slides.

Despite the cost of the RealView telemedicine system ($15,000 to $20,000, depending on features), "It is the best investment I have ever made in a piece of equipment," Dr. Schaeffer said. "I don't know how I'd live without it."

Dr. Bearman added: "I think it's a great way for ophthalmologists and optometrists to network, especially those who are in remote settings." As for offsetting some of the cost, "photos with an appropriate diagnosis can be billed to insurance carriers."

For Your Information:

Jack L. Schaeffer, OD, can be reached at the Schaeffer Eye Center, 1598 Montgomery Hwy., Birmingham, AL 35216; (205) 979-202; fax: (205) 978-6487. Dr. Schaeffer has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

Mark G. Bearman, MD, can be reached at Eastern Ophthalmic Associates, 52 Medical Park Dr. East, Suite 214, Birmingham, AL 35235; (205) 838-3050; fax: (205) 838-3814. Dr. Bearman has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

The RealView telemedicine system is available from VCOM Systems, 809 N. Dixie Hwy., Suite 200, West Palm Beach, FL 33401; (800) 936-1333; fax: (561) 659-5126; e-mail: info@vcomsystems.com; Web site: www.vcomsystems.com.