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A rural managed care program development project funded by ´óÏóÊÓƵhas helped create a thriving statewide collaborative telemedicine network. Maine Telehealth Network, in operation since 1998, has made health care-especially chronic care, mental health treatment, and specialty physicians' services-much more accessible in remote areas throughout the state.

Of Maine's 42 hospitals, 37 participate in the network. In addition, rural health centers, mental health agencies, and health services centers for Native Americans participate. Some 250 telemedicine sites have been established around the state, with interactive, Integrated Service Digital Network (ISDN)-based video equipment that allows physicians to see patients from a distance and "home telehealth technology" that enables health data to be transmitted from patients' homes over standard telephone lines. To reach even more remote locations, a mobile telemedicine boat serves small islands off mid-coastal Maine.

´óÏóÊÓƵsponsored the Maine Rural Managed Care Center (RMCC), which was launched in 1994 in anticipation of State and Federal health reform. The RMCC was a consortium of academic health science and State health policy organizations, whose goal was to help underserved communities to develop vertically integrated health care networks and appropriate health information systems. Through the RMCC, the ´óÏóÊÓƵgrant supported several regional networks, including the Sunrise Healthcare Coalition.

According to RMCC's Principal Investigator, David Hartley, PhD, Professor at the Muskie School of Public Service at the University of Southern Maine, the Sunrise Healthcare Coalition gave seed money to a rural community health center, the Regional Medical Center at Lubec (RMCL), to design a telemedicine network. RMCL obtained additional funding for the network from the Health Resources and Services Administration's Office for the Advancement of Telehealth. Initially, two regional networks were established; the Maine Telehealth Network now serves the entire state.

Between 300 and 500 patients receive clinical services each month. In addition, the network helps provide social services such as discharge planning. It also offers participants administrative services, such as the transmission of information for billing purposes. Furthermore, the network operates programs of continuing education for health professionals through an interactive video system.

Ron Emerson, Maine Telehealth Network's director, describes a typical telemedicine physical examination, where a nurse might be present in the examining room. Using a hand-held camera, a stethoscope, or an otoscope, the nurse can transmit information to a physician many miles away, over the ISDN cables.

Home care has proven particularly cost-effective, Emerson explains. For example, daily home monitoring for congestive heart failure can be done from a distance, eliminating the need for home nursing visits simply to gather data. Each morning, the patient transmits weight, blood pressure, pulse, and temperature information to the home health agency. Dramatic sudden changes in the numbers might indicate a need for immediate medical attention or a prescription change; otherwise, the patient simply keeps in touch with a home care nurse by telephone.

Barriers to wider use of telemedicine include hospital credentialing requirements. To meet Medicare, Medicaid, and JCAHO requirements, physicians must have admitting privileges at each hospital where a patient is seen. Rural health centers, which are not subject to such hospital regulations, can more easily serve as telemedicine sites.

There are also financial barriers to the expansion of services, says Emerson. Currently, insurers reimburse for physicians' services, but not for the participation of the facilities where patients are seen.

Nevertheless, it is hoped that the Maine Telemedicine Network will expand. One of Emerson's goals is to create a regional telemedicine collaborative with neighboring Massachusetts, New Hampshire, and Vermont.