Upstate News

March 17, 2000
Darryl Geddes 315 464-4828

SUNY Upstate and Columbia University partner on $28 million federal grant to use telemedicine to serve New York residents with diabetes

Columbia University College of Physicians & Surgeons at Columbia Presbyterian Medical Center and SUNY Upstate Medical University have received a $28 million grant from the Health Care Financing Administration (HCFA) to bring health care into the homes of underserved rural and inner-city residents with diabetes through the largest telemedicine effort ever funded by the federal government. Columbia and SUNY Upstate join five other sites in the effort, called the Informatics for Diabetes Education and Telemedicine (IDEATel), which will serve as test bed for the national use of internet technology and advanced networks to increase access to healthcare for all Americans. The demonstration project will be a model to develop more effective treatments for other diseases such as depression, obesity, asthma and heart failure.

Traditionally, Americans living in rural and impoverished inner-city areas have low levels of primary care and high levels of isolation from specialized, high-quality medical care. The project is led by Steven Shea, M.D., Hamilton Southworth Professor of Medicine in Public Health at Columbia University P&S and director of the division of general medicine at Columbia Presbyterian Medical Center of New York-Presbyterian Hospital, and Ruth Weinstock, M.D., Ph.D., professor of medicine, medical director of
SUNY Upstate’s Joslin Diabetes Center and chief of endocrinology, diabetes and metabolism at SUNY Upstate. Also participating in the project from SUNY Upstate are Paul Knudson, M.D., L. Thomas Wolff, M.D., Peter Beatty, Ph.D., David Thomson, M.D., and Teresa Wagner, SUNY Upstate chief information officer.

The diabetes telemedicine program is a collaborative effort among the Joslin Diabetes Center of SUNY Upstate, the American Diabetes Association (ADA), Harlem Hospital Center, the Harlem Renaissance Network, Arnot Ogden Hospital in Elmira, Olean General Hospital in Olean, Good Samaritan Hospital in Watertown and HCFA.

“While much has been made of the digital divide between rich and poor, rural and urban, I believe this technology will bring better, faster healthcare to all,” said U.S. Rep. Charles B. Rangel of Manhattan.

U.S. Rep. Amory Houghton of Corning added, “Telemedicine can reach beyond the limits to healthcare in rural New York to ensure quality care in any environment.”

U.S. Rep. James T. Walsh of Syracuse, chairman of the VA/HUD appropriations subcommittee, applauded the efforts of SUNY Upstate and Columbia University. “Rural healthcare benefits, the research community benefits and all New Yorkers benefit from this outstanding effort,” he said, “and I am excited about the prospects. Secondly, I am proud of the institutions involved and am happy to have played a role in supporting this project.”

U.S. Rep. John McHugh, whose congressional district spans more than 12,000 square miles in Northern New York, said: “One of the most important components of this project is the focus it places on the special needs of underserved patients in both rural and urban areas. Good Samaritan Medical Center in Watertown provides medical care to people from across New York’s northernmost counties. Lessons learned from their research will be relevant to virtually every region of the country.”

The IDEATel project will establish Web-based computing and telecommunications networks in both urban and rural economically disadvantaged areas in New York state.

Statewide, more than 970,000 people over age 40 suffer from diabetes. Complications from diabetes cost the U.S. economy $45 billion each year, with an additional $47 billion attributed to indirect costs from diabetes-related disabilities. It is estimated that the federal government can save $247 million per year through early intervention in diabetes treatment, which could rise to $457 million if telemedicine can expand the reach of that treatment.

Bridging the divide between urban and rural healthcare, the four-year grant will enable researchers to study the efficacy of telemedicine in improving patient quality-of life and reducing overall health care cost.

The four-year grant will enable researchers to study the efficacy of telemedicine in improving patient quality-of-life and reducing overall health care cost. Columbia’s Department of Medical Informatics pioneered the use of the Web in providing clinical care. Two million patient records are computerized at CPMC which are available for secure access on line by more than 4,000 clinicians. SUNY Upstate’s Joslin Center is preeminent in providing state-of-the-art diabetes care in urban and rural settings, and Columbia’s Naomi Berrie Diabetes Center is one of New York City’s leading centers for diabetes care and research.

“Diabetes, more than most other chronic diseases, requires daily self management. One cannot take a vacation from diabetes,” said Dr. Weinstock. “Education, frequent monitoring and medication adjustments in the home setting should help patients achieve better glucose and blood pressure control, thereby preventing or slowing the progression of diabetes’ dreaded complications, such as eye disease, nerve and kidney damage, heart attacks and strokes.”

Columbia University’s Dr. Steven Shea said: “In a doctor’s office, care of diabetes takes place every few months for a few minutes. But in a patient’s home, care of diabetes occurs every day. Telemedicine will give people the tools they need to take control of their diabetes. We will be reaching into patient’s homes and empowering them to take better care of themselves through monitoring, access to information and education. This ‘house call’ of the future will allow patients and clinicians to reach out across any distance for care.”

Initially, 1,500 patients from Northern Manhattan (Washington Heights, Inwood, and North and Central Harlem) ‹ and Central New York (Syracuse, Elmira, Watertown and Olean and rural areas in northern New York ) will be enrolled in the project, 750 as control subjects. Computers with devices to read blood sugar, take pictures of skin and feet, and check blood pressure will be placed in half of these patients’ homes and the other half will continue with the care they usually receive from their providers.

Participants will receive Internet service, training in equipment use and maintenance support. Patients will check their blood sugar, blood pressure and other factors that affect diabetes. They will be able to view their own medical information, learn more about diabetes and receive recommendations and instructions on how to manage their disease. Decision support systems will play a crucial role, an automated care guideline system will analyze the patient’s data, if information recorded on the computer varies from predetermined values an automated alert will be sent to the physician or nurse. The system will also provide alerts, suggestions, and reminders to inform patients about what steps they need to take to maintain good health.

“We will use the power of the Web to treat people with diabetes with more success than ever before,” according to David Liss, executive director of Columbia’s Center for Advanced Technology (CAT). The CAT coordinated the participation of companies including American Telecare Inc., which is providing the special home-based units and Bell Atlantic, which will serve as the telecommunications carrier.

New York’s 31st congressional district is the home of fiber optics and other advanced technology. This type of system would allow the technology to make a difference in people’s lives and physical well-being,” says Houghton. “It is difficult for diabetes patients residing in rural New York state to gain access to hospital care. This project would provide patients with the essential daily monitoring they need.”

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