"Novelties we used to see in Dick Tracy and Star Trek are becoming realities," said Dr. Michael Weiner, an investigator into the feasibility and impact of "telemedicine" on health care. He and colleagues at the Regenstrief Institute for Health Care and the IU Center for Aging Research, both housed at the IU School of Medicine at IUPUI, are launching a project to use video-based teleconferencing to connect on-call clinicians with patients in a long-term nursing facility.

"We are applying the technology locally for clinicians who are not always physically present in the nursing home but might need to learn more about a patient with an acute illness," said Weiner. "They are primary-care providers who share a call schedule and might or might not have previously known the particular patient of interest. Through this application, an off-site clinician will be able to see and hear a patient with an acute problem, to provide a more detailed assessment of the patient than he or she would otherwise make through a telephone call from a nurse in the facility."

The project will employ relatively new, high-speed, "next-generation" Internet technology. Numerous questions to be answered also reflect challenges–among them, issues of data transmission security, costs efficiency and effectiveness.

How will telemedicine affect clinicians’ abilities to make medical decisions, and what will outcomes be on patient satisfaction, hospitalization and referrals to the hospital emergency department? Will physicians, nurses and patients accept the presence and use of the technology itself?

And, telemedicine suggests a whole new angle on patient-doctor trust issues. "The factor of distance in these applications may serve to accentuate existing problems with trust," said Weiner. "On the other hand, patients who are anti-social, dangerous or reluctant to interact directly with a clinician may uniquely benefit from this alternative mode of communication. We may discover completely new ways to treat some diseases. This might become useful for understanding psychiatric or behavior disorders."

According to Weiner, telemedicine applications elsewhere in the country have been useful in providing consultations among clinicians and other health-care providers, especially for patients in rural areas where access to medical care is often not ideal. "New applications," said Weiner, "could be developed.

"There is currently work on virtual surgery systems that could let a surgeon use robots to perform surgery on patients in remote locations. This could have applications in rural areas, developing countries and warfare. We can hear cardiopulmonary sounds and peer into eyes and ears using this technology. We can review radiologic images with great detail and resolution.

"In a sense," he said, "our nursing home application sparks the traditional notion of the doctor’s house call, with a new twist."