Big-city medicine, small-town life

Dr.

Paul Katz, medical director of the Washoe Stroke Center in Reno, thinks a lot about stroke victims in rural areas of the state.

He knows that stroke victims benefit greatly when they're treated, often with clotbusting drugs, within three hours.

And he knows that many stroke victims in Nevada live and work far more than three hours from big-city medical care.

"Stroke demands timely emergency care," he says."We can't have two standards of care in Nevada."

The answer, Katz believes, is upgraded telemedicine systems that would allow rural physicians and their patients to easily the key word is "easily" consult with bigcity specialists during that critical three-hour window.

Executives of Washoe Medical Center don't disagree with Katz' hopes for an upgraded telemedicine network to serve the stroke center and other specialists, but they want to move cautiously to make sure that new technology works and actually meets a need in rural areas.

Washoe Medical Center in Reno currently is linked to most of the health-care facilities, hospitals and clinics alike, throughout rural Nevada, says Karen Holcher, rural services coordinator for Washoe Medical Center.

At its heart is a teleconferencing system much like those found in some business conference rooms.

Additional features allow physicians in Reno to use remote devices such as stethoscopes to check the condition of patients in rural areas.

A recent $8,300 donation by SBC Foundation, the philanthropic arm of the communications giant, provided more flexibility, allowing the telemedicine network to be moved away from limited teleconferencing centers at Washoe Medical Center to anyplace that has an Internet connection.

While the system is used by physicians with cases in fields such as neurology and psychiatry and has been used even more commonly for educational sessions, Holcher says telemedicine isn't yet a major piece of health-care systems in rural areas.

The reason, Katz and Holcher agree, is that the current system miraculous as it might have appeared a decade ago remains inconvenient.

While Yerington patients examined in a telemedicine consulting session may not need to drive more than hour to Reno, the specialist in Reno still will need to leave his office and waiting patients for a location set up for telemedicine.

Ditto for the physician in Yerington.

Katz says, too, the system remains cumbersome.

A physician may visit with the patient in a teleconferencing facility, for instance, while medical data is sent to a computer in another room and results from a scanning device are sent to yet another location.

That's particularly daunting in emergency cases such as strokes when no one has time to deal with cumbersome systems.

And the widespread use of telemedicine in the past sometimes has been hung up on procedural issues such as billing and liability.

Those issues, however, have been laid to rest, Katz says, leaving inconvenience as the biggest remaining hurdle.

He wants Washoe Medical Center to move fairly quickly like within the next couple of years to upgrade to new telemedicine systems that allow physicians to work from their offices or homes and provide images and data efficiently.

Along with champions of the technology such as Katz,much of the support for upgraded technology comes from nurse practitioners and other paraprofessionals in rural areas who see the possibilities, Holcher says.

And Katz says that community groups in rural communities also have been strong voices in support of upgraded systems.

Holcher cautions, however, that Washoe Medical Center officials want to study new systems carefully, both to make sure they work and to make sure physicians will use them, before they make hefty investments.