Our History

Telehealth started at the University of Miami in 1973 with a National Science Foundation grant as part of a national program called RANN (Research Applied to National Needs). Dr. Jay Sanders, who was the UM Chair of Medicine at the time was the principal investigator on the grant, with Westinghouse Electric and Dade County as co-investigators. This was the first ever telemedicine program in Florida and one of only about a dozen in the country as a whole; the first Correctional telemedicine program in the country, and the first use of Nurse Practitioners (NP) with telemedicine in the country.

The program’s objectives were:

1. Evaluate the quality of care utilizing the NP with telemedicine as the experimental group vs. the traditional care system utilizing physicians;
2. Assess the technology from a functional standpoint;
3. Evaluate the system from a psychological/human factors standpoint, and
4. Compare the cost vs. the traditional system. The project involved Jackson Memorial Hospital as the hub, and the Dade County Jail, the Women's Detention Center and the Men's
   Stockade (near the Miami airport) as the spokes.

Dr. Sanders recalls:

This was when we learned that because of all the proprietary technology that existed in the fax industry, that one fax machine couldn't communicate with another unless it was exactly the same make and model. Also we learned that the color camera was terrible in terms of consistency - one day a person would look sunburned and the very next day that same person looked like he was jaundiced. The best way to assess a skin lesion, etc. was the "black and white" camera. Fascinatingly even though everyone agreed that the "black and white" technology was much better, when asked about how they would like to be viewed, they all wanted to be seen in "living color." [Personal communication, July 3, 2008]

The current UM telehealth program started nearly two decades later. In April 1993, the University of Miami School of Medicine/Jackson Memorial Hospital (JMH), Miami, Fla, established an interactive telemedicine program between JMH and the Martin Luther King, Jr., Clinica Campesina (MLK),Homestead, Fla. to provide medical care to migrant workers and their families. Between 10 and 15 patients were evaluated each session by the University of Miami School of Medicine faculty dermatologists.  Equipment was donated by AT&T, Hitachi, Telecom, Sony, Southern Bell and others.  The Medical Director presented patients to the dermatologists.  Adults made up 75% of the patients; and children 25% of the patients.  These patients were referred from 3 smaller clinics located in the Everglades, Redland and South Dade migrant worker camps.  With this video clinic, patients avoided the 6-hour round tripand lost wages and/or jobs due to their absence from work.  A description of this clinic is given in an article co-authored by Dr. Burdick in the Archives of Dermatology on Teledermatology, “Norton, SA, AE Burdick, B Berman and C Phillips, Teledermatology and Underserved Populations, Archives of Dermatology, 133(2):197-200, 1997. 

Equipment at the MLK and JMH dermatology clinics included video cameras, portable desktop monitors, and dedicated wiring using Integrated Services Digital Network (ISDN) lines.  The beneficiary patient population was medically underserved and has gained access to specialty care by the telemedical system.  An estimated 11,000 (during off season) and 18,700 (during peak season, October-May) migrant workers, seasonal farm workers, and their families received treatment at the local, publicly funded medical clinics (Primary Health Care Consortium of Dad County Inc., Miami, Fla., unpublished data, 1992).  The local clinic in Homestead (MLK) was the referral healthy center for 3 smaller clinics located in the Everglades, Redland, and South Dade migrant worker camps in Florida.

In 1993, 1530 patients with skin diseases were seen at MLK by primary care providers (general practitioners, pediatricians, nurse practitioners, and physician assistant).  Since there was no dermatologist on staff, approximately 25% of the dermatology patients were referred 40 miles north to JMH in Miami.  Approximately 40% of the referred patients failed to keep their appointments.  Several reasons may accounted for this, including lack of transportation or money to attend the clinic, the 6-hour roundtrip bus ride, fear of losing wages or jobs because of absence from work, and fear of the urban JMH system. The rationale for developing the teledermatology clinic was to enable those patients who would otherwise be unable to attend the dermatology clinic at JMH to receive specialty care. This endeavor improved access to care but conclusions were limited because of the small number of patients enrolled in the program.

The Teledermatology clinic became operational in October 1994.  During the first 5 months, 18 TMCs were conducted.  Their diagnoses included dermatophystosis, impetigo, contact dermatitis, alopecia, acne cosmetic, and pruritus.  Each patient is initially seen by a primary care provider at MLK.  If there were questions about diagnosis or treatment, the patient was scheduled for a TMC.  The clinic director completed the patient’s history and physical examination, including recent laboratory and skin biopsy results, medications, and allergies.  This information was sent on a facsimile transmittal form to be reviewed by the JMH dermatologist before the telemedicine session.  Prior to the session, each patient was given an educational handout on telemedicine and is patient, information and consent to participate form to sign.  The handout and form were available in English, Spanish, French, and Haitian Creole.  During the TMC, an MLK clinic physician and a translator were present. A technical support person operated the camera and lights.  At JMH, there was a technical assistant as well.  The dermatologist completed the consultant section of the facsimile transmittal form and sent it back to MLK to become part of the patient’s chart.  At the end of each TMC, the patient completed a patient satisfaction survey.  The MLK physician and the dermatology consultant completed the provider satisfaction survey forms.  Patients and providers were very satisfied.  No patients declined participation in a teledermatologic consultation.  A logbook was maintained, indicating the presumptive diagnosis of the referring physician and the diagnosis of the consultant dermatologist. The time to complete a patient evaluation decreased to an average of 10 to 15 minutes with increasing familiarity of the consultant with the equipment.

UM Radiologists were contracted to read abdominal X-rays of suspected drug smugglers by U.S. Customs in California, Florida, New Jersey, New York and Texas airports. The films were evaluated within 30 minutes and determined to be either positive, negative, or inconclusive. This contract was in existence for several years.  In 2002, 500 cases were evaluated.

In 2003, a contract was established with Humana Tricare for store-forward teledermatology consultations to Tyndall Air Force Base military personnel and their dependents in the Florida Panhandle.  Tyndall personnel included a physician’s assistant and two medical technicians who captured digital images of dermatologic conditions . UM faculty dermatologist provided consults to the referring Tyndall physicians with a 72 hour turnaround, TeleDerm Solutions, Inc. software.  This successful program was well received for 6 months of remote care.  With deployments to Iraq, this service contract was stopped.