Digital Medicine Comes to Urban Neighborhoods

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Doctors in South Central Los Angeles utilize technology to better service patient area

– Question: What does South Central Los Angeles and a tropical island have in common? Answer: In both places you can’t get to a medical specialist when you need one. Imagine you live on an island and you have a sick child who is desperately in need of specialty health care, such as a pediatric cardiologist. The good news is that there are hundreds of physicians nearby with the expertise your child needs. The bad news is that most of the doctors are either on a nearby island or on the other nice side of the island separated from you by challenging terrain. Millions of residents in the inner city live on medically isolated islands designated as health professional shortage areas. They are often surrounded by areas with high densities of specialist physicians residing in the same city, but virtually inaccessible to them. In the midst of plenty, they have none. The barriers they face are transportation, insurance, cost, childcare, competing resources needs, and even gang boundaries. A mother in the middle of South Central Los Angeles is faced with a daunting journey to reach the specialist physician that will agree to see her. Her trip, which could take up to several hours each way, might involve many buses and trains, and multiple transfers and delays through dense traffic, all this with a sick child and probably other young children in tow. Telemedicine is being implemented as an innovative solution to this dilemma. Historically telemedicine has been used to bring specialty care to remote and rural settings. Now this state of the art technology is being applied to the “remote inner city” where it represents a cost effective way to improve access to care for millions of urban residents.

Telemedicine is a means of electronically transferring and managing digitized patient health information (including sound, live video, data, and digital visual images) securely from one location to another. Until now, telemedicine has been used primarily in rural settings where great distances separate patients from their care providers and where the number of specialists is particularly small. This technology, first used by the space program and currently enabling the Mars probe to send crystal clear images back to earth, is now beginning to be applied where it is needed the most: in the underserved, impoverished urban communities of South Los Angeles. In comparison with relatively small populations in rural settings, telemedicine in the inner city has the potential to touch the lives of many millions of people.

At a typical, urban safety net hospital like King/Drew Medical Center in South Central Los Angeles, the wait for a specialty appointment can be many months. Even for a high-risk diabetic patient or pediatric cardiology patient, the wait could be six months or more. Hundreds of patients who fill the emergency rooms each day in these hospitals represent people who have waited for months to be seen and have simply given up. By the time they show up in the emergency department they are much sicker, and the cost for their care has skyrocketed. In fact, this lack of specialty access was a central precipitating factor in the civil unrest in Watts in 1965, which led to the creation of the King/Drew Medical Center.

In 1996, a group of five physicians based at the King/Drew Medical Center were faced with the challenge of providing services for an inner city area of 1.5 million people – a population equivalent to the city of Philadelphia. They decided that if the people couldn’t come to the clinic, they would find a way to bring the clinic to the people—delivering health care services to this area. To overcome the barriers limiting patient access to health care these physicians began using telemedicine as a health care delivery solution.

“Our research shows that people who live in urban areas face similar challenges to those who live in rural areas with respect to transportation and access to timely, high quality care,” says Dr. Richard S. Baker, executive director of the Los Angeles Urban Telemedicine Centers of Excellence. “We have long known that technology could assist in providing high quality care to people who would otherwise not have access. We are well positioned, with all the specialized equipment and communications systems in place, to apply this solution in an urban setting. Telemedicine technology makes it possible for a doctor or practitioner to examine, for example, the eye, ear, or heart at a local, community clinic and send this information digitally to specialists at another location. Specialist physicians at a remote office can actually listen to heart sounds, examine the inner ear or a skin rash, or directly review test results. They can make a diagnosis, provide consultation and advice on treatment, or even set up a live telemedicine visit with the patient. This can be done in a fraction of the time it would ordinarily take through conventional office visits.”

Urban telemedicine has already been instrumental in saving lives. A young female patient from the inner city came to a public housing telemedicine clinic complaining of vision problems and headaches. She was examined by a physician’s assistant, who was unable to provide a definitive diagnosis, but who did have direct access to a specialist via telemedicine. After videoconferencing with the patient and the physician’s assistant, an ophthalmologist at the King/Drew Medical Center recognized the need to make an immediate referral to a neuro-ophthalmologist, an even more highly specialized physician. Further tests showed that the patient had a brain tumor. In this situation, telemedicine enabled a medical provider without specialty expertise to provide immediate access to a specialist appropriate to the patient’s condition. Not only did this telemedicine interaction eliminate months of waiting time, it provided an instantaneous, life-saving triage and diagnosis.

Since 1999, the Los Angeles Urban Telemedicine Centers of Excellence has served over 12,000 patients while operating in only a limited capacity, and estimates that typical waiting time has been reduced from months to days, and in certain instances, mere hours.

In establishing itself as a leader in the telemedicine field, the Los Angeles Urban Telemedicine Centers of Excellence has received numerous awards for its service and commitment to patient care. In June, 2003 it was awarded “Best in Show” at Tavis Smiley’s “Building Inroads to Technology” Multicultural Summit. Additionally, it received the following accolades: HUD Best Practices Award national winner for “Efforts with the Telemedicine Program in Public Housing”; Computer World’s Smithsonian Institute Award “The Face of Innovation” for entry into the Smithsonian Institution’s Permanent Research Collection; commendation from the Los Angeles County Board of Supervisors for establishing the Carmelitos Teleophthalmology Project, a teleophthalmology preventive eye care clinic servicing a medically underserved urban public housing community; and the Innovator’s Award for Innovation in National Health Care Information Technology in Health Data Management Magazine.    

The Los Angeles Urban Telemedicine Centers of Excellence was created in 1996 in cooperation with the Los Angeles County Community Development Commission and the Los Angeles County Department of Health Services. Three telemedicine clinics were established in three CDC housing communities located across inner city areas of Los Angeles to improve access to medical subspecialty care. The first clinic was brought online in 1996 in the Carmelitos community, located in North Long Beach. In 1999, the Nueva Maravilla community telemedicine clinic opened in East Los Angeles, and in 2000 the doors of the Mary Henry

Telemedicine Clinic in South Central Los Angeles opened. Ophthalmology was the first specialty service delivered across the telemedicine network.

The addition of the Mary Henry Clinic represents the commitment to grow this program to include a broad range of specialty services – for example: cardiology, asthma/allergy, and dental – all accessible from local community clinics. Los Angeles County Supervisor Yvonne Brathwaite Burke, who represents the area said, “Mothers can sleep better knowing that their children will receive essential physician care that all people deserve. Telemedicine provides a technological lifeline for the community.” An additional facility, Hubert Humphrey Comprehensive Health Center is a high volume County Clinic which services over 200,000 patients a year and is the clinical hub for several long term telemedicine projects.

The Los Angeles Urban Telemedicine Centers of Excellence is one of several cutting-edge health research programs conducted by the Research Centers in Minority Institutions (RCMI). The RCMI program housed at the Charles R. Drew University of Medicine and Science

is one of 18 such research infrastructure programs nationwide, funded by the National Institutes of Health through the National Center for Research Resources (NCRR). The NCRR ensures that institutions such as Drew have the means to develop and access state-of-the art technologies, instrumentation, and facilities, thus enabling scientific collaborations and discoveries essential to the study and eradication of health disparities. For more information, call 323.563-5911 or visit our website at http://www.cdrewu.edu/rcmi and click on “Telemedicine”.

Media: Please call Ginger Campbell at 323-933-4155 to schedule and interview with Dr. Baker or to obtain more information on the Telemedicine Program.

1731 E. 120th Street        

Public Contact: 323.563.5911

Los Angeles, CA 90059

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ginger@snap-productions.com

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Ginger Campbell