Providing Strong Solutions in Healthcare

Eight-year-old Ivan Quiñones was trying to hide his nervousness, his mother standing by for reassurance. A heart specialist got ready to read the boy’s EKG — from 15 miles away as she sat in front of a computer screen.

“Can you see that?” asked Dr. Lisa Gwynn, speaking to the heart specialist on the other end of the computer connection. She was seated next to Ivan in a motorcoach-turned-health clinic, her eyes on a graph on the laptop that was connected to the electrocardiogram (EKG) wires that are taking Ivan’s readings.

“Oh, wait,” said the cardiologist, Dr. Mary Sokoloski, over the computer hookup from her office in central Miami, “something happened. Better do it again.”

Dr. Sokolski watched by video camera as a nurse practitioner readjusted the electrodes. Another try. This time the graph came out full and clear.

“Perfect!” Dr. Sokoloski said. “EKG’s normal.”

As an infant Ivan had been diagnosed with a heart murmur. When he got a little older, doctors detected something slightly more serious, a mitral valve prolapse. Ivan needed the diagnosis checked out before he could enter school. But the family can’t afford to see a cardiologist, not on Ivan’s dad’s auto-mechanic pay.

Through a church, Ivan’s mother, Annia Quiñones, learned about the Pediatric Mobile Clinic, which travels to neighborhoods four days a week to dispense free medical services for children and young people up to age 21. It’s a project of the nationwide Children’s Health Fund, with medical services provided by the University of Miami.

Since the 1990s, the mobile clinic, a converted motorcoach, has offered the basics of health care — physicals, vaccines, blood work, vision and hearing screenings — to waves of Miami’s poor children. It roams an area that’s 75 percent Latino, a group for whom heart disease is the number-two killer. Lately, the mobile clinic has been able to offer an even more vital benefit for this vulnerable population: access to specialists such as cardiologists and dermatologists.

In a partnership with the Verizon Foundation, the Children’s Health Fund in Miami is using Verizon’s wireless network to enable specialists, working in their downtown offices, to examine patients who would otherwise be hard pressed to afford a specialist or to travel to one.

This is a new use for telemedicine, which has been linking patients and doctors in the rural West and Midwest for a couple of decades. Now, instead of bridging geographic distances, the Miami project is bridging social and economic distances. It’s making sophisticated medical services available to the poor and disadvantaged.

“This is awesome, being able to transmit patient information by video communications,” said Brenda Owusu, an assistant professor at UM’s School of Nursing and Health Studies. “You don’t have to be there [in person] and still get a result.”

After verifying that the EKG is normal, it was time for the cardiologist to listen to Ivan’s breathing and heartbeat. In her office 15 miles away, Dr. Sokoloski put on a pair of headphones. Owusu pressed a stethoscope onto Ivan’s back. The sound traveled through the computer through the wireless network to Sokoloski’s ears.

“Now let’s get his side,” Sokoloski said, watching through the video camera as Owusu pressed the stethoscope above Ivan’s waist. “No, a little higher.” The nurse inched the stethoscope up.

And then: “OK! Sounds great! Thank you!”

“I don’t hear anything abnormal — which is good,” Dr. Sokoloksi said to Dr. Gwynn.

“I’m going to tell the mother he’s OK.” And Dr. Gwynn, who is the Pediatric Mobile Clinic’s medical director, turned to Mrs. Quiñones to explain, in Spanish, that despite previous diagnoses, there is no reason to worry about Ivan’s heart. Afterward, Mrs. Quiñones said through an interpreter she was grateful for the medical service her son just received.