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No sooner had ear surgeon Moises Arriaga moved to New Orleans after working in Pittsburgh than he evacuated ahead of Hurricane Katrina. “I hadn’t even unpacked all my boxes,” he says. “We ended up in the hill country in Texas for about a week or so.” Fortunately, he still had a practice to return to up north, but the New Orleans native was committed to resettling.

Thanks to the growth of the Internet in the past 15 or so years, Arriaga didn’t have to sacrifice seeing patients through the LSU Health Sciences Center, where he is now director of the Hearing and Balance Center at Our Lady of the Lake Regional Medical Center, formed in partnership with LSU after Katrina.

While still occasionally working in Pennsylvania, Arriaga can consult with sufferers of eardrum cancers, balance problems related to the inner ear and similar neurotology maladies in Baton Rouge and elsewhere in south Louisiana through the growing use of telemedicine.

Visiting a physician without actually being in the same room is an increasing reality. Although dial-a-doctor has a nice ring to it, the term telemedicine has become descriptive of how the medical world is embracing online access to specialists who do not necessarily have offices near their patients. That means faraway doctors can consult in real time through high-definition videoconferencing, even performing tests and operating diagnostic equipment remotely.

At his clinic on the seventh floor of OLOL’s Medical Plaza 1, Arriaga shows off several pieces of high-tech gear, including a Carl Zeiss binocular microscope and a handheld “video otoscope,” which a technician aims into a patient’s ear to reveal a closeup of all that transpires in there.

A large Lenovo panel monitor shows the workings of the ear canal, while a picture-in-a-picture shows an image of the doctor in the office being broadcast by a Polycom camera sitting atop the screen. Central to the whole system is a codec: a coder-decoder device that converts analog image signals to digital data for transmission.

After modeling a set of infrared goggles he gives patients to wear to monitor their eye movements—a common indicator of a balance problem related to the inner ear’s gyroscope—Arriaga says: “Can I take this off now? I feel a little like the Borg from Star Trek.”

As with so many innovations, necessity is the mother of invention, says Arriaga, who also sees patients at Earl K. Long Medical Center in Baton Rouge and at Lafayette and New Orleans hospitals, either in person or by telemedicine.

“As it turns out, it was really very fortunate for the department and for us that I went temporarily back to Pittsburgh,” he says, noting that his LSU ear, nose and throat residents initially were rotated there but soon were serving their duties locally, with Arriaga guiding them by videoconferencing.

That’s how it all began for Tom Winchell, LSU HSC’s telemedicine program coordinator, based in Baton Rouge. Starting in the mid-1990s, he says the university linked its local, Lafayette and New Orleans students to participate remotely in lectures. “That was the starting point for telehealth,” he says.

Early on, a low-resolution setup might have cost $100,000 and run on expensive data networks, but he says a location now can be equipped for high-def telemedicine for $20,000 to $25,000 and runs on connections with 20 times the capacity of the “regional networks” in place 15 years ago. The normal bandwidth today, running from local LANs to LSU’s WAN and back through leased circuits from AT&T and BellSouth, is about 1 megabit per second.

OLOL’s hearing clinic is just one of LSU’s 75-plus telemed locations. “We’ve done in excess of 15,000 telemedicine patient encounters,” Winchell says, from cardiology consults to dermatology exams. Although EKL has a telemedicine setup, LSU’s work there is mainly hands on with prisoners, so the video system is used for staff meetings. “The clinic vision is still in development, how that fits in the core mission,” Winchell says.

One of his ongoing tasks is to explore providing telemedicine care to southwest Louisiana, an initiative similar to the Louisiana Rural Health Information Exchange, which will provide specialty care in north Louisiana centering on the LSU HSC in Shreveport.

Another example of OLOL’s telemed work is equipping ambulances with the gear. Med-Connect lets an ER doctor get a head start with first responders by guiding them through procedures that otherwise would wait until the patient’s arrival at the hospital.

The pilot program began last year with one ambulance and now has two fully outfitted for video, audio and data transmission, while equipment has been purchased to connect them with Baton Rouge General Medical Center’s Mid City and Bluebonnet campuses, possibly by the end of March.

Chad Guillot, EMS assistant administrator for East Baton Rouge Parish Emergency Medical Services, says tentative grant funding could connect all seven parish hospitals with the ambulances to let them send data, such as EKG tests, ahead of patient arrivals.

Yet similar local examples seem hard to come by. Ochsner Medical Center announced last year that it would implement a “telestroke and telehealth service,” in which neurologists at its New Orleans hub would consult with remote community hospitals, including Ochsner Medical Center Baton Rouge.

So far, though, local spokeswoman Amy Delaney says, “This is live at all Ochsner hospitals in New Orleans and Ochsner St. Anne in Raceland.” Spokesmen and executives with other area medical centers expressed little familiarity with telemedicine, meaning LSU is leading the rollout of the technology in the Capital Region.

Some procedures must be by hand, including cochlear implant surgery, which Arriaga performs to allow the deaf to hear with a prosthetic. But with telemedicine, much preliminary exam work can be done before he even meets a surgical patient in person. He notes that in his experience with telemedicine, patients actually tend to give higher marks for care involving an apparitional doctor seen on the Internet.

“Forty percent of patients, the first time I shake their hand is in the holding area for surgery,” he says, noting that their reaction often is, “‘Gosh, you really do look like your TV image.’”

He says a patient’s family can sit in and watch an exam on the large PC monitor while the doctor walks everyone through what is happening during a test and what the results show. Scanning through MRI frames of the head of a patient while he or she watches the display gives a visceral understanding of physical conditions and their cures, Arriaga says.

“The sky is the limit,” he says. “If they’re doing da Vinci surgery, where the surgeon is across the room operating robotically, why not across the city or across the country or across the world?”

Consultant Elona Sharbaugh helped facilitate the LSU-OLOL partnership that allowed Arriaga to set up practice in Baton Rouge. The interim director of specialty group two for OLOL says physicians she helped situate there provide “super-specialty” care that the institution had never offered before.

“There were a lot of contractual agreements, then just the whole setting up of the practices,” she says. “We had to build them from the ground up.”

Arriaga says it took $400,000 to $500,000 to staff and equip the local hearing center, while Sharbaugh says Arriaga provided high-end audiology equipment for testing. The telemedicine idea was his priority, she says.

“It just works beautifully,” she says. “[Patients] feel like they’re getting just as good a service as if he’s standing in front of them. We’re probably on the front end, but I think you’re going to see a lot more of this to come.”