Deepak Chandrasekar gets his eye examined by internist Seema Sangwan (on screen). Nurse Xenia Khesin assists. | Photograph by Cody Pickens

Cisco's Virtual Doctor Will See You Now

Cisco's new health-networking systems could transform health care.

DEEPAK CHANDRASEKAR has been wondering why his right eye has been so red recently, which is what brought him to see the doctor today. Internist Seema Sangwan examines his eye and inquires about whether he also has an itchy throat. "Look up, please," she asks her patient, peering closely at the eye, finally determining that his symptoms are consistent with allergies. She prescribes some antihistamine eyedrops and recommends scheduling a follow-up appointment. It's a pretty routine medical exam. Except that Sangwan isn't in the same room with her patient—she appears in front of him on a giant home-theater-esque display.

Thanks to a new Cisco telemedicine initiative called HealthPresence, Chandrasekar was diagnosed remotely with the aid of videoconferencing and high-tech medical equipment that transmitted images, blood-pressure readings, and heart-rate data to Sangwan. Xenia Khesin, the on-site nurse, focused a high-resolution video camera on Chandrasekar's eye and instantly a magnified image of his eye appeared on a smaller monitor next to the main video display in their location. Sangwan saw the same image on her computer screen, which was how she was able to diagnose Chandrasekar's problem. Patient and doctor were conversing face-to-face, though they weren't in the same room. The entire episode took no more than 10 minutes, and Cisco hopes it is the future of health care.

Cisco launched its HealthPresence initiative in 2006. Executives realized teleconferencing could potentially solve a growing problem in the health-care field: Many Americans live in areas where doctors, particularly specialists, are far away. So the company devised a network of exam stations that would supply specialized health care to patients regardless of their location. The HealthPresence system includes not only virtual-chat capabilities but also medical devices such as pulse oximeters, blood-pressure cuffs, and ear-nose-throat scopes that transmit patient information electronically to doctors anywhere around the globe, who are also equipped with Cisco's technology. Exam kiosks can be installed in all kinds of places, from 18-wheeler mobile clinics to office parks. The company already has 33 kiosks up and running, including the one at the Cisco campus in San Jose, which is where Cisco consultant Chandrasekar was able to have his eye checked.

Sangwan thinks users enjoy the participatory aspects of their virtual doctor visit—getting to see an on-screen close-up of an inflamed eye, for example, or to listen to a chest noise recorded by the telephonic stethoscope. "People get amazed," she says. "They say, 'Yes, it does look red,' or 'Yes, I hear a whistling.' " Sangwan cannot use the system to diagnose conditions that call for palpation, such as appendicitis, but she says these situations arise rarely.

Demographic trends suggest Cisco has timed its entry into the telehealth realm perfectly. The ratio of health-care staff to U.S. citizens is already about 40% lower than ideal, according to research firm Frost & Sullivan, and it's going to get worse; health-staffing needs are projected to triple over the next quarter-century. Telehealth systems may be our best shot at extending the reach of the specialized providers we do have. Other companies are beginning to get in on the action: GE Healthcare and Intel joined forces this year in a telehealth venture called Care Innovations, and HP has teamed up with Lifebot to develop a telehealth system for emergency care. But Cisco maintains an edge deployment-wise. Its HealthPresence system is already being used by a variety of health-care providers, including a Tennessee not-for-profit that houses its kiosk in a truck. The truck drives around rural parts of the state where specialists are scarce, and heart patients are able to see their cardiologists on a monthly basis without ever leaving their driveways. "The more people are exposed to this, the more they're going to become comfortable," says Gloria Calderon, vice president of clinic operations at California-based Molina Healthcare.

A variety of logistical challenges remain, such as persuading government programs like Medicare to reimburse doctors for telehealth visits, convincing HMOs that they should jump on the bandwagon, and—the biggest one—getting patients truly comfortable with seeing their doctors on a video screen. The Cisco team, convinced that these are just temporary obstacles, remains committed to its goal of installing the system widely. "Jails, corporate campuses," says Kathy English, Cisco's director of global health-care marketing, "you could have patients go to a Walgreens or CVS to see a physician." Will HealthPresence kiosks someday be as common as Starbucks? It's possible—as long as patients decide the technology is seamless enough that they can forget it even exists.

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  • Roger Downey

    I'm wondering.  How does the nurse know she's providing the doctor with a stable image when the monitor is behind her and that camera "prong" is dangerously close to the patient's bad eye?  Someone from Cisco got a "C" in ergonomics class.  BTW, everyone in the photo is looking in a different direction.

  • Michael Helmbrecht

    LifeSize agrees
    that telemedicine is the way of the future especially in rural areas—as pointed
    out above. However, it’s important to note the cost of this equipment may be a
    bigger factor in these types of places. While Cisco has showcased this kiosk
    setup, this offering is much bigger and bulkier than what some
    physicians/medical centers need or can house. The price is also greater.
    Offering the best quality is mandatory—especially when used in these cases—but
    implementing tools that are less expensive and more portable are sure to be an
    even greater selling point.

  • Ally Stoeger

    Cisco may have a great idea for virtual medicine. But using a "red eye" as an example shows that whoever designed this program, knows very little about eye care. A red eye can be caused by iritis, viral conjunctivitis, bacterial conjunctivitis, contact lens related red eye and solution sensitivity, acute glaucoma, herpes keratitis, corneal infiltrates, dry eye, ocular allergy or even a foreign body in the eye. Each of these is treated with different medications which can include anti-virals, antibiotics, steroids, lubricants, anti-histamines, anti-inflammatory medications, medications to lower eye pressure. Optometrists and Ophthalmologists use a biomicroscope (slit lamp microscope) to properly diagnose and treat the various causes of red eyes. A photograph of a red eye is not an example of virtual medicine--it is an example of virtually useless. It should be noted that in some cases of red eye, improper diagnosis or delayed treatment can result in permanent loss of vision. Until Cisco can send images of cross sections of biomicroscopic views along with sodium fluorescein staining of the cornea and photos of everted eyelids, this technology is no better than a phone call from a patient who says they have a red eye.

  • Ddt

    I agree with your comments; but altho Cisco don't know what they are doing could a consultant ophthalmologist make the above possible with the equipment and technology available today?

    David Thomas

  • Thomas B. Albright

    This medical approach was copyright registered as TXu 539 002 Video Pharmacy Medical Effectiveness
    on 9-29-92 (1992). Notification was made to CVS Pharmacy in 2006. An Internet Search showed the
    name in 1994 - 2 years later than the registrateion.

    It is also highly effective for a medical practitioner to visit the many assisted living places.

  • Digger

    The story refers to "nurse Xenia Khesin" and again as the "on-site nurse" in San Jose, CA. In that state, "nurse" is a protected title. AB 1439 (chaptered 98-1013) prohibits the use of the title “nurse” by any individual except RNs or licensed vocational nurses. I have checked the database of California RNs and licensed vocational nurses; Xenia Khesin is not listed. Therefore, the writer of this article should correct the on line version, at least, to read "medical assistant" or whatever title Ms. Khesin is allowed to use legally.

  • Xenia K

    Dear Digger,
    Ms. Khesin is in fact a registered Nurse in the state of California, even though she has different legal first name. Therefore, she is legally allowed to use that title, if you don't mind :)
    Couldn't help but wonder what you do for a living? Must be something intriguing since you are checking databases to make sure random people use legal titles.
    Best regards,
    Xenia Khesin

  • Vikram

    You need to be a bit creative with your search...
    Start with the last name only and you will find her in the database of California RNs