It is usually people who live in underserved rural communities who stand to benefit from telemedicine.
But now it's not just remote areas and unincorporated hamlets hooking up stethoscopes to computers and connecting doctors to their distant patients -- at least one big city is also joining the charge.
As phone lines get thick enough to transport data-rich medical images and carry real-time video conversations, a growing number of healthcare organizations are using technology to bridge the geographic -- or economic -- gaps that can separate doctor from patient.
In most cases, telemedicine (also referred to as telehealth) employs high-speed data connections and videoconferencing technology to bring small-town residents the same access to specialists as city-dwellers.
In the latest twist on that concept, Charles R. Drew University of Medicine and Science in Los Angeles opened its third urban telemedicine site in December, using a transported Brentwood house as a clinic to serve one of the nation's largest population centers.
Charles Flowers, M.D., heads up the program, which he said he believes is one of the nation's first telemedicine networks designed to serve a large city.
An ophthalmologist by trade and an admitted "techie by nature," Flowers has been working since 1996 to help reach Los Angeles residents for whom accessing healthcare is not always convenient, or even possible.
"Our studies revealed that pediatric care was a major unmet medical need in south central Los Angeles," says Flowers, director of telemedicine and assistant professor of ophthalmology at Drew. "This unique center will bring pediatric services closer to the people."
The third in a series of five planned telemedicine clinics throughout L.A., the Mary Henry Telemedicine Center will be the first in the network to provide pediatric care. The other two clinics -- which are in public housing developments in east L.A. and Long Beach -- provided eye care to some 2,000 patients last year but have yet to venture outside of ophthalmology.
Drew and Los Angeles County have absorbed the costs of treating those patients, Flowers said. He and colleagues are developing a billing mechanism they hope to have in place next spring.
The Mary Henry facility is located in a house from the upper-class L.A. neighborhood of Brentwood that was donated by Peter Zeegan, an area physician, and subsequently moved from Brentwood to Vermont Avenue near downtown L.A. about 10 miles away.
To support its telemedicine network -- which is run from a central operations center at Drew -- the medical center has drawn from a number of funding sources, and it hasn't always been easy.
"I ran up against a wall of no funding," Flowers says of the first three years he attempted to secure grants and other assistance to grow his network. "After all the effort, in the past year and a half, I got an explosion of funding."
Among contributors to the network have been HHS, which gave $800,000, and the Sacramento-based California Telehealth and Telemedicine Center, which chipped in $500,000.
The most substantial cash infusion -- $2 million -- has come from the Los Angeles County Development Commission, without which the initiative would never have gotten off the ground, Flowers said.
"The partnership between Drew University and the county is a technological lifeline for the community," Los Angeles County Supervisor Yvonne Brathwaite Burke said in a written statement.
As Drew moves forward on telemedicine, others in the country also are attempting to join the movement.
The Behavioral Health and Wellness Network of Northwest Michigan, a Big Rapids-based network of state and county organizations that provide behavioral health services, was awarded a $760,000 grant in December from the Health Resources Services Administration's office of rural health.
The Behavioral Health and Wellness Network will use that money to deliver psychiatric services over the Internet to 10 counties in northwest Michigan, according to Patrick McFarlane, Behavioral Health's executive director and a practicing therapist.
Behavioral Health's network will enable rural primary-care physicians without training in psychology to consult with specialists when a patient needs more than basic mental healthcare, McFarlane says.
"There is a notorious avoidance of behavioral health in rural areas," McFarlane says. Although he believes telemedicine technology can help solve that problem, there are still obstacles to overcome.
"The question comes down to how close can you get to real time with the Internet and how much of the consultation is going to be so broken up that (physicians) say we can't even do this. That's the scary part," McFarlane says.