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The technology, known as telemedicine, combines satellite broadcasting capabilities with Internet-type links, and allows health care providers in remote areas to confer with their peers in other parts of the state. Both state and federal organizations have helped create the web of patients, therapists and physicians; and that's only the groundwork, according to one state official.
Terry Baines, the telehealth coordinator for the Department of Health and Social Services' Division of Public Health, said telemedical practice has been growing for about three decades, but it has come into its own in the state over the past six or seven years. What was once a matter of radio contact is now a matter of live video conferencing, he said.
Telehealth technology takes two forms in Alaska, said Steve Constantine, the senior manager of IT technology at General Communications Inc. GCI, along with ATT Alascom, provide telehealth technology across the state.
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Getting the technology where it is needed does not come inexpensively, Constantine said. GCI's core technology costs $250,000 per site, he said. But, he added, the unique nature of Alaska's geography minimizes the cost by eliminating expensive and sometimes unnecessary ambulance or Medivac trips.
"Those can cost around $40,000," he said. "At that cost, a couple of those (trips) saved and the equipment has paid for itself."
But, Baines added, $20 million is available each year in federal funding to help supplement those costs. About $15 million, or 75 percent of that funding, is available for Alaska, he said.
"That's a good thing, because doing business in Alaska can get pretty expensive," he said.
The United States Department of Agriculture and Rural Development has contributed to the funding, as well as to the linking initiatives, said Joseph Freedman, the executive director of Health TV. In October of 2002, the department gave the channel $500,000 to establish an educational presence for health care providers in remote areas of the state.
Freedman said the channel hopes to kick off the program in June, and that it could benefit about 164,000 Alaskan across the state.
Telemedicine in Alaska isn't just a federally or state-funded initiative, Baines said. Several organizations and private medical institutions, including Bartlett Regional Hospital in Juneau, have established their own telemedical networks to remote villages.
That support, he said, helps increase both the confidence and the communication-levels of providers in remote locations.
"When providers have an opportunity to stay in touch with their peers, they are more likely to have higher morale and feel as though they haven't been abandoned."
Constantine added that the potential to streamline medicine within the state is endless.
"As we move forward into the days of a true electronic medical record, we'll be able to move patients from one provider to another with much more ease, or reduce the amount of moving that is necessary," he said.
Privatizing the system
For the state's largest and smallest health care providers alike, telemedicine is becoming an increasingly important part of patient care.
Bartlett Regional has pursued telemedical capabilities since 1994, said Marijo Toner, the regional affairs coordinator for the hospital. For the last eight years, the center has worked primarily with Seattle-based Virginia Mason Medical Center; but, in the last year, they have created a program that links Bartlett with health centers in Ketchikan and Metlakatla.
The local loop, which Toner categorized as "very exciting," consists of a picture unit controlled from Bartlett. It's predominately used, she said, to provide children with mental health treatment, and allows the psychiatrist to control the image that he gets of the patient.
"In many cases," she said, "the doctor will watch a child playing in the background while the case speaker is talking."
Ron Adler, the executive director of the Gateway Center for Human Services, which shares the loop with Bartlett, said the technology is filling a void in medical care available to the Bush.
"The most under-served health subspecialty in Alaska is child psychology," he said. "This is so applicable to Alaska."
Adler said the loop has all but eliminated a problem he consistently faced with medical care in the Bush. When a child psychologist comes from Outside, he or she has to be flown to the remote locations, Adler said. He estimated that one of every four trips ends up canceled because of weather or timing problem.
"I got tired of having to face parents and them that the psychiatrist couldn't see their child because he or she was stuck in Juneau or going back to his or her own clinic the next day," Adler said.
Some 15 children at the Gateway Center now meet consistently with a staff-psychiatrist from Bartlett, Adler said, and that's only the beginning of where the technology will go.
"We're just scratching the surface of what we can do with this," he said. "The implications for the Interior and remote Bush areas of the state are numerous."
In the Interior city of Galena, similar technology is, literally, in the process of being set-up. Marvin Yoders, the city manager, said the community is adding teleradiology equipment to their existing teleconferencing and video conferencing equipment.
The newest in radiological equipment, he said, will mean that x-rays, which previously had to be flown to a hospital, can be sent electronically to be read in Fairbanks. The technology captures the image onto an electronic disc and sends it on-- through store-and-forward systems -- to the radiologist.
Yoders said that could reduce the amount of time and money invested in the x-ray.
"In the past, if you had any doubts at all, you had to put them (the image) on a plane and fly them in," he said. "Here, you get x-ray readings in a matter of a few minutes as opposed to a matter of a few days."
Yoders estimated that the Galena medical center serves up to 2,000 people from the community and surrounding villages every year.
The state's AFHCAN
One telemedicine initiative, the Alaska Federal Health Care Access Network, or AFHCAN, was designed to serve the state's federal beneficiaries.
Linda Lekness, the director of AFHCAN, said her program links 235 sites throughout the state and has sent more than 5,000 referrals in the last 12 to 16 months.
The network was established in 1999, as an initiative of the Indian Health Service, Defense Department, Veteran's Administration, Coast Guard and Alaska Native Health Consortium. Lekness said it was modeled after the flow of health care from the villages to major cities.
"AFHCAN is really designed to support the existing referral patterns," Lekness said.
AFHCAN operates largely on a store-and-forward system, but between 30 and 40 of the operating sites also have video capabilities, Lekness said. She added that spreading that technology across the state could be a more far-reaching project.
"It takes time and effort for it to be set up and folks learn to use it," she said.
AFHCAN's efforts have not gone unnoticed. In the last year, the organization has won two national awards and served approximately half of the state's population, Lekness said.
As proud as AFHCAN is of its recognition and accomplishments, Lekness said its first priority is patient care.
"We feel passionately because we know that we're changing the way that federal beneficiaries receive health care," she said. "It's very exciting."
