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Doctors' house calls, a common practice of a bygone era, are poised to make a modern-day comeback, thanks to much of the same mobile and handheld technology that has transformed the phone call.

Telemedicine, which lets doctors see patients remotely via technology similar to popular apps such as Skype and Face Time, has been around for decades but is undergoing a rapid evolution as handheld devices become more powerful and broadband communications networks become standard.

Modern telemedicine, like the telephone, has been around for a long time — at least since NASA scientists first began monitoring the heartbeats of astronauts in space.

And just as mobile technology and handheld computing has put a powerful computer in many people's pockets, telemedicine is maturing itself, bringing teleconferences out of the board room and into the doctor's office.

On the North Coast, the use of telemedicine is no longer the domain of big players like Sutter Medical Center or Santa Rosa Memorial Hospital. Smaller district hospitals such as Healdsburg and Palm Drive have been linking their patients with distant specialists for a few years, while the area's community clinics have recently begun to take advantage of more affordable technology.

At Sebastopol Community Health Center, operated by the West County Health Centers, doctors and nurses are using inexpensive desktop Web cameras and iPads not only to connect their patients to specialists but to participate in these medical consultations.

"I get to participate with the specialist and patient," said Dr. Jason Cunningham, medical director of West County Health Centers. "It's more of a collaborative visit, rather than just a single specialist visit. It's a dialogue."

The new portability of telemedicine could allow people and health care professionals to link to each other from wherever they are.

Cunningham said the health centers had previously used a substantial federal grant to purchase an expensive telemonitor unit. But advances in consumer digital technology have dramatically reduced the price of telemedicine.

"The software that's now available allows for very meaningful video connection without an expensive Polycom unit," he said.

Long-distance telemedicine can be traced back to the Civil War, when casualty figures and medicine supply orders were reported via telegraph, according to a 1996 article in the Bulletin of the Medical Library Association. But the first modern telemedicine systems were developed by NASA scientists who sought to monitor physiological functions such as heart rates, blood pressure and respiration during the first manned space flights.

One of telemedicine's earliest goals of telemedicine has been to connect top-notch medical professionals to patients in remote geographic areas. It's an enduring objective that has driven much of its use in the North Coast.

When Dr. Javeed Siddiqui, an infectious disease specialist, first began providing telemedicine services to Sonoma Valley Hospital in 2007, telemedicine units and broadband services such as T1 lines were extremely expensive.

Siddiqui provides infectious disease consultations to Sonoma Valley Hospital. The hospital also links up to a UC Davis specialist for pediatric emergency care and an acute stroke specialist at Sutter Health's California Pacific Medical Center in San Francisco.

Siddiqui, who later co-founded TeleMed2U, said telemedicine became less cost prohibitive once it freed itself from expensive telemonitors and other "legacy units." Also, he said, the adoption of telemedicine platforms that can run on any computer operating system made it possible to use devices such as laptops, tablets and even cellphones for medical consultations.

"It's not about the device," Siddiqui said.

The platform that allows this type of connectivity is provided by the nonprofit California Telehealth Network, which recently teamed up with video conferencing firms Arkadin and Vidyo. The joint effort allows network members, which include community clinics and critical-access hospitals such as Sonoma Valley Hospital, to connect patients and providers using a standard wired or wireless Internet connection.

"We bring them things that allow them to connect to resources in Northern California that are not easily accessible. We help save them money, leveraging economies of scale," said Eric Brown, the California Telehealth Network's president and CEO.

Mark Noble, senior director of product marketing for Vidyo, said that nationally there has been a "perfect storm brewing" for rapid adoption of telemedicine. Politicians in Washington eager to grapple with the skyrocketing costs of health care are turning to telemedicine, he said.

"The political climate has become right," Noble said. "The cost of health care has to be brought under control."

Meanwhile, the North Coast's largest health care providers, Kaiser Permanente and Sutter Health, continue to adopt telemedicine in new ways.

At Kaiser, the "video visit" is directly integrated with the provider's system of electronic medical records. In the near future, some Kaiser members will be able to conduct video visits using mobile devices that use either Apple's iOS or Google's Android operating system.

"This is a huge deal. From a technology standpoint, this is one of our biggest operational improvements to our members," said Dr. Hari Lakshmanan, a physical medicine specialist and Kaiser's assistant physician in chief for technology.

Lakshmanan said Kaiser is working to ensure the service has a secure firewall and other safety features before "we roll it out to all our members."

Sutter Medical Center in Santa Rosa, which was one of the North Coast's early adopters of telemedicine in the intensive-care setting, has begun using the technology for acute stroke care.

Dr. John Stein, chairman of the medical center's emergency department, said ER doctors now have instantaneous access to neurologists based at California Pacific Medical Center.

The rapid consultations are a crucial part of treating stroke patients with new life-saving "clot buster medications," Stein said. But he said these medications can be difficult to use "without the help of real-time neurological guidance."

The future of telemedicine is currently being developed by companies like OffSiteCare in Sebastopol that are tying to expand the practice beyond its commonplace use as a telemonitoring tool.

The company, which was founded by Sebastopol's Dr. Jim Gude, who used to be the director of Sutter Medical Center's electronic ICU, is currently moving into areas of medicine that do not typically use telemedicine.

OffSiteCare CEO Jeff Dunbar said the company is providing dialysis consultation at St. Joseph Health Hospital in Eureka, where a nephrologist either in Petaluma or on the East Coast provides the vital guidance to prescribe the "cocktail" that runs through a patient's blood during dialysis.

"As far as we know, nobody else is doing dialysis by telemedicine," Dunbar said.

Dunbar said that the same economic forces that are driving health care away from the costly hospital setting are pushing telemedicine into new models of health care, such as the patient-centered medical home, and patients' homes as well.

Dunbar said telemedicine is catching up to the simplicity of consumer devices like the Kindle or the iPhone, where "you a press button and a gal comes on and says, 'I'm here to help you.' Why can't that be a physician?"

Using inexpensive peripheral medical devices that connect to consumer mobile products revives an old practice could soon return to the medical industry, he said.

"It's a house-call without the doctor getting in the car and driving to someone's house," Dunbar said.

You can reach Staff Writer Martin Espinoza at 521-5213 or martin.espinoza@pressdemocrat.com.