Feature Story

DOCTOR MAKES LONG-DISTANCE DIAGNOSES

You've heard of the global economy; now enter the global doctor's office. It's a room where a doctor in, say, Cairo, Egypt, can place a patient in front of a television camera and have him examined by a more-qualified specialist sitting in, say, St. Louis.

Dr. Keith Vrbicky projects an image of his eyeball on the TV screen behind to illustrate the detail of the images that can be transmitted to doctors around the globe.

It's also a place - not necessarily an office, but a huge auditorium in a Cairo hotel - where 2,500 physicians can gather and watch physicians in an Omaha hospital insert a stent, a wire mesh tube, inside a patient's artery. And they can listen while a cardiologist at the Creighton University School of Medicine describes the procedure.

To Dr. Keith W. Vrbicky, a Norfolk obstetrician, the global doctor's office is all those things and more, and they're the basis for a company he started in 1997.

American Educational Telecommunications, a limited liability company, grew out of Vrbicky's realization that physicians in rural areas like Norfolk, with a population of 23,516, are isolated in some ways. There's a continuing need for physicians to learn and update their skills, Vrbicky said, but "when you live in small towns, you don't have access immediately to that education.

"By education, I also mean second opinions for difficult medical cases, consultations with specialists that we won't ever have living in communities this size. That becomes a disadvantage to our patients because they have to travel distances to be able to see specialists."

With that in mind, Vrbicky said he started looking into the feasibility of starting a company that would not only provide the communication link between small and large communities, but would supply the content.

While some barriers stood in the way of a company's domestic operation - that is, there are questions about whether a doctor at a place like the Mayo Clinic in Minnesota would need a license to practice, even via television, in Nebraska - the rules governing operations in foreign countries were less rigid.

An Egyptian-born employee of Vrbicky's Midwest Health Partners clinic in Norfolk directed his attention toward that nation. With help from Nebraska Sen. Chuck Hagel's office, Vrbicky was able to pitch a proposal to the Egyptian minister of health. The minister, Vrbicky said, "saw the need for developing this type of concept, where physicians in (Egypt) could gain access to education content and the expertise from our universities."

As a result, AET was able to acquire the first international data transmission license granted to a private American company by Egypt. The license basically permits a company like AET to transmit data in and out of the country.

The company has signed an agreement with a university in Cairo, which built a telemedicine studio that has already been used for consultation and diagnosis sessions. Using technology from Cisco Systems Inc., a supplier of data networking products, and SBC Communications Inc., based in San Antonio, AET and its three American offices - Norfolk, Omaha and the St. Louis headquarters - are linked to Cairo by fiber optics lines and satellite.

AET calls its communications network I*Net.

Because AET is a privately owned company - whose first $750,000 in capital was furnished by Vrbicky and his family - officials won't disclose much about the firm's finances.

Donald A. LaPoint, executive vice president and chief operating officer of AET, said the company has signed up more than 100 American doctors to participate. LaPoint said physicians associated with the company have done consulting work in 25 medical disciplines, such as those involving infectious diseases and oncology.

The company has attracted about $2.1 million from investors and is negotiating with what LaPoint calls "venture funds, money firms."

Very few other American companies are involved in the same kind of telemedicine activity in foreign countries as AET, he said. The American Telemedicine Association's Web site lists two companies that provide video conferencing and telemedicine technology in Australia and New Zealand, one in India and two efforts under way in Africa.

Frost & Sullivan, a New York City-based market research firm, has estimated that the telemedicine industry could have revenues of $1.6 billion by 2004.

AET, which is the first American company to offer an extensive telemedicine service, also plans to offer its services in a number of other Middle East countries, LaPoint said. "Since we are using Egypt as the gateway, it does open the opportunity for us to move into other Arab countries, which has been requested," he said.

While AET officials won't disclose past and current sales figures, LaPoint said AET expects revenue to reach $74 million by 2004, as it expands its services to other areas and other countries. The company's revenue comes from fees charged for consultations and such things as seminars and classes, for which the company could charge $400 per credit hour.

Part of AET's strategy is to offer stock to the public, although no date has been set for that, LaPoint said.

Another area the company is involved in has nothing to do with telemedicine. The company will soon sign an agreement with the Arab League of Nations, comprising 22 Arab countries, to act as an information service for the Arab Lawyers Union. The Arab league was attracted to AET because of the American company's work with the Cairo hospital and university, LaPoint said.

AET will provide the lawyers union with, among other services, a catalog of laws in all 22 nations, he said. The agreement promises to be lucrative for AET, LaPoint said. He said AET plans to charge a person subscribing to the service $360 a year.

"There are 2 million lawyers in the Arab League," Vrbicky said. "They estimate a tremendous number of lawyers signing up to the network."

While the service to the lawyers may be a revenue producer, to Vrbicky the significance of AET's venture lies in what it can do for countries that he says are starved for medical knowledge.

"Because of the global economy that we're in and the telecommunications infrastructure now available, we should all be sharing knowledge with each other," he said.

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