This fall, General Communication Inc. is rolling out a new system called ConnectMD that is "basically, a private Internet for medical customers only," said Martin Carey, vice president of broadband services for GCI.

He said the company has spent about 18 months developing the network, which offers physicians in Alaska the ability to tap into virtually unlimited sources of professional information and assistance.

Users can also participate in continuing medical education programs through a partnership with Children's Hospital and Medical Center and Virginia Mason Medical Center in Seattle, Carey said. The system can be accessed easily by doctors from their homes and offices.

Carey said the idea for creating the service was prompted by an act of Congress, the Health Insurance Portability and Accountability Act of 1996.

"It places a lot of liability on doctors, if they mishandle patient records, not only electronically, but in the office," Carey said. "It became obvious to us that it may be an impediment to telemedicine advancement if doctors were reluctant to interconnect with each other because of that liability. So we decided to build a network that is encrypted and secure and meets the requirements," of the federal legislation.

Connection costs for medical professionals depend on the size of the "pipe" or amount of bandwidth used, Carey said. A doctor hooking up at home would pay about $100 per month for a basic modem and encryption device, while more sophisticated applications at clinics and hospitals could cost up to $2,500 monthly.

"It also becomes a way to aggregate services into a community. Quite a few of the regional health care corporations are connected to it," he said.

For example, he said, Maniilaq Health Center in Kotzebue recently signed a contract with Alaska Open Imaging, a provider of radiology and MRI diagnostic services in Anchorage.

"The cost to Maniilaq to enter into that contract, from a telecommunications standpoint, was zero because they already had connectivity into the ConnectMD network," Carey said. "The folks at the imaging center just had to make one connection, and now they have the ability to enter into business relationships," and negotiate arrangements to pay for more bandwidth, as needed.

A medical billing service in Anchorage with several physician clients also is using the system, Carey said. "It takes the security headaches away from the docs, it's one less thing they have to worry about."

He said the ConnectMD system is accessible through "points of presence" -- long distance connections in Anchorage, Fairbanks and Seattle and soon in Juneau. "As the network grows, we'll just continue to build more points of presence, which will lower everybody's costs over time," Carey said.

Help from Washington

Meantime, a separate statewide telemedicine network, complete with diagnostic equipment, has been developed over the past five years using federal grants totaling $30 million.

The network is jointly operated by GCI and AT&T and has connections in 235 communities and 25 public health nurse facilities across the state, said Dr. Thomas Nighswander, a spokesman for the Alaska Telehealth Advisory Council.

The council was established in 1999 to manage funding for the Alaska Federal Health Care Access Network created under legislation supported by U.S. Senator Ted Stevens.

"And now," Nighswander said, "the question is, 'how much is it being used?'"

Nighswander said the system has generated more than 11,000 health care consultations statewide, where physicians in remote areas transmit diagnostic images and patient information to specialists at other hospitals and clinics.

Some regions of the state have made more use of the system than other areas, Nighswander said, also citing the Maniilaq Health Center in Kotzebue as one entity that has pioneered new methods to help meet the needs of patients.

He said they use the basic "store and forward" technology, where images and data are collected and sent to a consulting physician, who later responds. "But they also have in all the villages, 'polycom' units, so they can do live interactive face-to-face stuff," he said.

Communities in the Aleutian Islands and in the Lake Iliamna area of the Alaska Panhandle also use the system extensively through connections with the Alaska Native Medical Center and the Southcentral Foundation primary care center in Anchorage, Nighswander said.

A common use of the system is for "teleradiology," he said, which involves doctors in Anchorage examining x-ray images sent from villages. "They get about 1,000 of those a month," he said. "And routinely now, if you have a CAT scan done in the middle of the night at the hospital, the radiologist reads it at home. They don't even have to come in for it."

The network developed under the federal grant has, so far, focused on providing service through federal agencies. The next phase of telemedicine progress in Alaska, Nighswander said, is to spread the concept of "public-private partnerships" and make the benefits of the technology available to all Alaskans.

"What we're puzzling out now is how to go forward," he said. "The network and all the infrastructure is there, the (diagnostic) carts have been deployed. The question is, what's the new role, and those discussions are going on as we speak."

A soon-to-be completed study is looking into ways to tie more communities and small health care facilities into the loop at reasonable costs that can be supported over time, he said.

"These systems need care and feeding," Nighswander said. "What we're going to need in this state is a centralized resource for telemedicine ... to do two things. Help with some of the technical issues to provide more equipment, and then there's got to be a program phase."

Officials with the state, the University of Alaska and the Alaska Native Tribal Health Consortium, will hold a series of meetings this winter to map future plans, he said.

Small and efficient

A prime example of how telemedicine is evolving can be found south of Anchorage at the Girdwood Clinic, owned and operated by Dr. Kerry Dorius.

Situated in the heart of a ski resort community, Dorius's practice sees a lot of orthopedic cases, and she employs methods as simple as snapping digital photos of a patient's x-ray results, and e-mailing them to a specialist in Anchorage.

For patients with sore muscles and joints, Dorius has been known to draw dotted lines on the patient's skin to show distant physical therapists where it hurts.

Dorius and two other small-scale private health care providers in the state formed a group called Alaska Health Resources and received funding to help develop the technology a couple of years ago. She said it has helped her business, and is great for her clientele.

"I'm just far enough away from the medical community in Anchorage, that telemedicine is useful for me," Dorius said.

She said the system handles most non-emergency cases efficiently.

"I don't have to send the patient into town, and the patient doesn't have to wait three weeks," to see another physician, Dorius said. "It also keeps the specialists from being clogged up with cases that they really don't need to see."

The method is very affordable, she said, requiring only a decent PC workstation, encryption software and a modem. "I was lucky enough to get a digital otoscope. I can actually take pictures of eardrums and send them in to the ear, nose and throat people."

And patients love it when they get to see the pictures, she said.

Dorius said telemedicine techniques will become more mainstream for health practitioners when doctors look past the technical aspects, and consider the effects on their pocketbooks.

"People look at it and go, 'that's going to take me an extra 20 minutes, and I'm not going to get paid for it so why should I change the way I practice,'" she said. "I look at it a little bit differently. It may take me an extra 20 minutes, but I get to see that patient back here for a checkup next week, so that keeps business here for me."