Care at a Distance

Eric Wallace, MD

UAB First in the Nation to Use Telemedicine for Dialysis Visits

"How are you feeling today?" the doctor asks the dialysis patient.

"Everything's going good," she says.

"Are you having any belly pain? Shortness of breath?"

She answers no, and the doctor proceeds with a stethoscope exam, inspects her legs for swelling and her catheter site for any signs of drainage or infection. Then a nurse draws her blood for lab work.

It's a routine medical visit for UAB nephrologist Eric Wallace, MD with one exception: the patient is 100 miles away. The stethoscope at the distant exam site is Bluetooth-enabled, and the visual check is done with a handheld video-cam connected online.

The pilot program in which Wallace participates is thought to be the first in the country to replace an in-person dialysis visit with its telemedicine equivalent.

"Our aim is to bridge the subspecialty care available at UAB to areas that may not have it," Wallace says. "Alabama has one of the highest incidences of end-stage renal disease in the U.S., and it's a rural state so there are many patients who have little or no access to subspecialty care like nephrology and dialysis."

His patients have adjusted well to the new long-distance setups. One older lady told Wallace that her son, a NASA engineer, would be amazed by this.

The new program has been years in the making. "The only way it could have occurred was through the constellation of events that allowed me to meet up with Michael Smith, who is in charge of distance learning at the Alabama Department of Public Health (ADPH)," Wallace says. "They were already increasing their telemedicine network, and it evolved from there.

"If we did it with dialysis only it would probably be cost prohibitive, but ADPH developed a network that other programs can join. The more programs that use it, the lower the cost per visit becomes."

The Department started out with six telemedicine equipment carts at its facilities around the state, and has since added 15 more. "My goal," Wallace says, "is to have some traditional clinical exams in my office, and then connect to 'be in' several county health departments seeing other patients with telehealth. I could be in multiple places within a normal half day of clinic."

Wallace says that it's a simple process to set up a new location with a telehealth cart. "I drive to that county, meet all the nurses, and familiarize them with the equipment. After that, it's easy to catch on to. ADPH has access to a phenomenal group of nurses, and they've been nothing but supportive of this."

He looks forward to more counties joining the network, and says that nephrology is only one aspect of the impact telemedicine can have. "If I can provide a fully comprehensive telehealth visit for a home dialysis visit--which is one of the most complicated visits to do--then we can do this for any patient and any disease. There are many clinics here that deliver subspecialty care that can only be available in a university setting, such as rare diseases. Now that can be extended to every corner of Alabama and thus increase the quality of patient care. The gaps in care and education that telehealth can bridge are tremendous."

Will Ferniany, CEO of the UAB Health System, agrees. "With UAB and the ADPH, you have two of the largest health care providers in the state working together for one common goal, to improve the health of the residents of Alabama," he says. "The examples of what telehealth can achieve for Alabamians are limitless. The real question is how we organize it so that it can be successful."

Wallace envisions a wide range of refinements in the future. "There are companies whose customer service departments let you leave a phone number and a person calls you when they're ready. There's no reason that couldn't work. You're at home and when it's your turn for a clinic appointment somebody calls you. The point is to maximize care and minimize the time patients spend in receiving this care.

"Life is changing so much due to technology, and medicine has been relatively slow in catching up, so it's time. And so much more is possible. We can have a telehealth network to service both the adult and pediatric populations to help ease the burden on patients and their families. I hope this is just the beginning of telehealth in our state."


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ADPH, Alabama Department of Public Health, Dr. Eric Wallace, Nephrology, Telehealth, Telemedicine, UAB


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