Feature Story

NORFOLK DOCTOR USES TELEMEDICINE TO LINK THE WORLD

Years ago, Norfolk doctors needing university support might as well have been living in the Middle East. Rural doctors don't get much time off for vacations, let alone for distant training.

But communications technology is changing that. Telemedicine -- two-way video sessions or the transmission of X-rays -- makes it possible for rural physicians to keep up on the latest techniques. Rural doctors also can have patients demonstrate their problems to distant specialists over a private, two-way cable television connection.

For Norfolk OB/GYN physician Keith Vrbicky, it wasn't much of a leap from that capability to his dream of connecting American medical research centers to hospitals and clinics in the Middle East. His company, American Educational Telecommunications (AET), headquartered in Omaha, began transmitting medical information and consultations to Egypt last fall.

In December, a theater in Cairo, Egypt, filled with 700 doctors watched as a Nebraska cardiologist instructed them in how to put a stent -- a wire mesh tube -- inside a patient's artery. AET earns $300 for each 15-minute consultation. The price covers the phone bill and physician charges. Instruction on the stent took 45 minutes.

AET Chief Operating Officer Don LaPoint expects to conduct 1,200 similar medical consultations in the first quarter of this year. By 2004, he believes, AET's network will generate at least $70 million in annual revenue. He ultimately plans to move beyond Egypt, providing connections to 13 other countries.

The goals are realistic, Vrbicky insists. There is a tremendous need for medical training and consultations. "People, no matter where they are located, will pay to seek out the finest medical care possible."

LaPoint brings a background in international medical business to the project. In 1991, he went public with BioLase, a St. Louis dental and medical laser company.

Vrbicky grew up in northeast Nebraska and received his medical education at Creighton University. He became part of the Creighton faculty before relocating to Norfolk.

"One of the hesitations of leaving a university center was not having the access to consultations and continuing education that is so readily accessible to physicians in the city," Vrbicky said. His desire to maintain that connection led to an interest in the new technologies connecting medical professionals.

He brought that expertise with him a few years ago when a friend introduced him to the Egyptian minister of health. Egypt was then spending $80 million annually to send its people abroad for medical consultations. The minister believed video consultations and training would allow Egypt to redirect its money into providing better health care.

He had already been approached by several American universities then developing telemedicine. But he did not like their point-to-point approach. Many of Egypt's physicians trained at universities in America. Medical universities also have strengths and weaknesses. A system that could connect several of those centers would best suit Egypt's needs.

In 1998, AET demonstrated five simultaneous connection points. Since then it has made similar demonstrations for Egyptian President Hosni Mubarak and the prince of Japan. AET's technology can link up to 14 locations on a single call.

Providing a quality connection was the first hurdle. AET at first sought an intermediary to provide it, LaPoint said. But it ended up working with a consortium of telecommunications providers to craft its own.

The next major hurdle was international licensing. Large telecommunications companies had never been successful at gaining a license to transfer data into and out of Egypt, he said. "But because of our focus on health care and education, we were able to bring that to fruition."

AET uses high-speed fiber optics and satellite technology to make the international connection. About 80 percent of the time, the signals travel in both directions. It plans to add other wireless capabilities to connect Cairo to far-flung areas in the region.

Quality and simplicity are the keys, LaPoint said. The company has studied telemedicine models, looking at the successes and failures, he said. Physicians must be able to walk into a room, hit a button and instantly connect with the right location, he said.

Profits will comes from the training and education, he said.

"Most importantly," Vrbicky said, "it increases the quality of health-care services and makes it available to the population." Patients can get the latest in medical care close to home, where before they would have had to fly to the United States.

AET has so far signed up 100 U.S. doctors to provide consultations. "We're constantly developing content from the American College of Surgeons," LaPoint said. The company is looking to connect with Creighton and has proposed a partnership with the University of Nebraska, in addition to the universities with which it is already associated.

The company has invested $2.6 million. It is looking to raise an additional $3 million to $5 million from private investors. The ultimate goal is to take the company public.

AET has offices in Norfolk, Omaha, St. Louis and Cairo. It currently employs 14 people but expects to double that in 18 months. Most new jobs will be based abroad.

In addition to this project, AET is looking soon to deploy services that would monitor heart patients, LaPoint said. Patients will wear an AET cardiology device and periodically transmit data from it over a telephone. The company would then analyze the data to track the patient's condition.

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