ONE day last summer, Charlie Martin felt a sharp pain in his lower back. But he couldn't jump into his car and rush to the doctor's office or the emergency room: Mr. Martin, a crane operator, was working on an oil rig in the South China Sea off Malaysia.
He could, though, get in touch with a doctor thousands of miles away, via two-way video. Using an electronic stethoscope that a paramedic on the rig held in place, Dr. Oscar W. Boultinghouse, an emergency medicine physician in Houston, listened to Mr. Martin's heart.
"The extreme pain strongly suggested a kidney stone," Dr. Boultinghouse said later. A urinalysis on the rig confirmed the diagnosis, and Mr. Martin flew to his home in Mississippi for treatment.
Mr. Martin, 32, is now back at work on the same rig, the Courageous, leased by Shell Oil. He says he is grateful he could discuss his pain by video with the doctor. "It's a lot better than trying to describe it on a phone," Mr. Martin says.
Dr. Boultinghouse and two colleagues — Michael J. Davis and Glenn G. Hammack— run NuPhysicia, a start-up company they spun out from the University of Texas in 2007 that specializes in face-to-face telemedicine, connecting doctors and patients by two-way video.
Spurred by health care trends and technological advances, telemedicine is growing into a mainstream industry. A fifth of Americans live in places where primary care physicians are scarce, according to government statistics. That need is converging with advances that include lower costs for video-conferencing equipment, more high-speed communications links by satellite, and greater ability to work securely and dependably over the Internet.
"The technology has improved to the point where the experience of both the doctor and patient are close to the same as in-person visits, and in some cases better," says Dr. Kaveh Safavi, head of global health care for Cisco Systems, which is supporting trials of its own high-definition video version of telemedicine in California, Colorado and New Mexico.
The interactive telemedicine business has been growing by almost 10 percent annually, to more than $500 million in revenue in North America this year, according to Datamonitor, the market research firm. It is part of the $3.9 billion telemedicine category that includes monitoring devices in homes and hundreds of health care applications for smartphones.
Christine Chang, a health care technology analyst at Datamonitor's Ovum unit, says telemedicine will allow doctors to take better care of larger numbers of patients. "Some patients will be seen by teleconferencing, some will send questions by e-mail, others will be monitored" using digitized data on symptoms or indicators like glucose levels, she says.
Eventually, she predicts, "one patient a day might come into a doctor's office, in person."
Although telemedicine has been around for years, it is gaining traction as never before. Medicare, Medicaid and other government health programs have been reimbursing doctors and hospitalsthat provide care remotely to rural and underserved areas. Now a growing number of big insurance companies, like the UnitedHealth Group and several Blue Cross plans, are starting to market interactive video to large employers. The new federal health care law provides $1 billion a year to study telemedicine and other innovations.
With the expansion of reimbursement, Americans are on the brink of "a gold rush of new investment in telemedicine," says Dr. Bernard A. Harris Jr., managing partner at Vesalius Ventures, aventure capital firm based in Houston. He has worked on telemedicine projects since he helped build medical systems for NASA during his days as an astronaut in the 1990s.
Face-to-face telemedicine technology can be as elaborate as a high-definition video system, like Cisco's, that can cost up to hundreds of thousands of dollars. Or it can be as simple as the Webcams available on many laptops.
NuPhysicia uses equipment in the middle of that range — standard videoconferencing hookups made by Polycom, a video conferencing company based in Pleasanton, Calif. Analysts say the setup may cost $30,000 to $45,000 at the patient's end — with a suitcase or cart containing scopes and other special equipment — plus a setup for the doctor that costs far less.
Telemedicine has its skeptics. State regulators at the Texas Medical Board have raised concerns that doctors might miss an opportunity to pick up subtle medical indicators when they cannot touch a patient. And while it does not oppose telemedicine, the American Academy of Family Physicians says patients should keep in contact with a primary physician who can keep tabs on their health needs, whether in the virtual or the real world.
"Telemedicine can improve access to care in remote sites and rural areas," says Dr. Lori J. Heim, the academy's president. "But not all visits will take place between a patient and their primary-care doctor."
Dr. Boultinghouse dismisses such concerns. "In today's world, the physical exam plays less and less of a role," he says. "We live in the age of imaging."
ON the rig Courageous, Mr. Martin is part of a crew of 100. Travis G. Fitts Jr., vice president for human resources, health, safety and environment at Scorpion Offshore, which owns the rig, says that examining a worker via two-way video can be far cheaper in a remote location than flying him to a hospital by helicopter at $10,000 a trip.
Some rigs have saved $500,000 or more a year, according to NuPhysicia, which has contracts with 19 oil rigs around the world, including one off Iraq. Dr. Boultinghouse says the Deepwater Horizon drilling disaster in the Gulf of Mexico may slow or block new drilling in United States waters, driving the rigs to more remote locations and adding to demand for telemedicine.
NuPhysicia also offers video medical services to land-based employers with 500 or more workers at a site. The camera connection is an alternative to an employer's on-site clinics, typically staffed by a nurse or a physician assistant.