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History of Telemedicine in Vermont

Vermont's experience with two-way interactive videoconferencing began in 1968 with the advent of the INTERACT network. This microwave system linked nine hospitals in Vermont and New Hampshire at its highpoint in the late seventies. This included: the Medical Center Hospital of Vermont in Burlington (now called Fletcher Allen Health Care), Central Vermont Hospital in Berlin, Rockingham Memorial Hospital in Bellows Falls (now defunct), the White River VA Hospital in White River Junction, the St. Albans Correctional Facility, the Brattleboro Retreat, Claremont Hospital in NH, and Dartmouth-Hitchcock Medical Center in Hanover, NH.

Like many programs of its time, when the grant money ran out for the project in about 1980, the subscribing organizations attempted to run it on their own with limited success. The end finally came in 1985. INTERACT joined the other sixteen or so pilot programs in the United States that died when soft money dried up.

The next serious effort to establish a telemedicine network began in 1993 when Julie McGowan, PhD, Director of the Dana Medical Library at the University of Vermont, and John Evans, PhD, Associate Dean of the UVM College of Medicine, established VTMEDNET. VTMEDNET was a text-based statewide system that actually began serious operations in 1995. All providers in the State of the Vermont had access to e-mail, text-based web browsing, the ability to do medLine searches, and other clinical information. It was one of the first, if not the first, statewide systems in the country. This was expanded to another attempt at two-way interactive video in 1994 when Dr. Kevin Leslie formed a small Pathology network linking Rutland Regional Medical Center, Central Vermont Hospital, and Fletcher Allen via T-1 lines with room-based systems. Microscope-mounted video cameras transmitted slide images from the remote pathologist as he moved the microscope stage as directed by the Fletcher Allen consulting physician. Rigorous evaluation indicated very good diagnostic accuracy and physician satisfaction. However these telecom systems were complicated to use and had inadequate reliability.

At the same time, Michael McKnight of the Media Services department at Fletcher Allen was experimenting with desktop videoconferencing using a single ISDN line. The following year the decision was made to use the triple ISDN (384 kbps) solution and form a network of nine distant sites (different from INTERACT's nine sites) to test out the effectiveness of desktop videoconferencing on a large scale. Fletcher Allen installed a multipoint bridge capable of handling six multipoint or simultaneous calls. Each external site a designated a telemedicine site coordinator who was responsible for arranging their site's teleconsults, assuring the equipment was in working order and coordinating the system continuing medical education (CME) for their local staff. This project put Fletcher Allen at the forefront of telemedicine systems nationwide, and placed Vermont squarely in the future as well as the past history of this technology.

The Fletcher Allen/UVM Telemedicine Program was honored as one of the nation's top telemedicine programs as the first selection in Telemedicine and Telehealth Network magazine's Hall of Fame. This followed selection two years in a row as a Top Ten Telemedicine Program in December 1996, and again in December 1997. Selection was based upon demonstrated organizational support, sustainable funding, provider acceptance, fulfillment of regional needs, and the monitoring of results. In addition, on October 8, 1996, the Fletcher Allen Telemedicine Project was featured on the CBS Evening News with Dan Rather in a special segment by Health Correspondent, Dr. Bob Arnot.

In 1998, Fletcher Allen's Telemedicine Program and the University of Vermont co-sponsored the "Information Connection" in Burlington, a conference that has featured multiple specialty presentations and a full day of continuous telemedicine demonstrations from Fletcher Allen as well as a link to a US Navy vessel patrolling in the Persian Gulf.

For the next several years, under the leadership of Michael Ricci, M.D., a vascular surgeon and Clinical Director of the Telemedicine Program, and Michael Caputo, Director of Information Systems for UVM College of Medicine and Telemedicine Operations Director, the Fletcher Allen Telemedicine Program expanded significantly to other area rural hospitals, clinics, dialysis centers. They also developed a cutting-edge feasibility project, FAST STAR (Fletcher Allen Specialized Telemedicine for Supporting Transport And Rescue), which tested the use of interactive video from a moving ambulance. This allowed our Level 1 Trauma Center specialists to consult with emergency medical technicians and paramedics in an ambulance enroute to the hospital. Dr. Ricci and Mike Caputo produced and hosted a series of "How To Build" training symposiums and other conferences to teach and provide hands-on demonstrations to national and international attendees.

Symposiums /Conferences included:

  • Oct 12-15, 1997 -   How to Build a Telemedicine Program
  • May 31-June 3, 1998 - How to Build a Telemedicine Program
  • Oct. 24-26, 1999  - How to Build a Telemedicine Program
  • Oct. 15-17, 2000  - How to Build a Telemedicine Program
  • Nov. 8-9, 2002 - Teletrauma: An In-depth View
  • Aug 14-15, 2005  - How to Build a Teletrauma Program

More recent conferences, developed under the leadership of Terry Rabinowitz, M.D., Medical Director, Division of Consultation Psychiatry and Psychosomatic Medicine and current Medical Director of Telemedicine, and Michael Wehner, current Telemedicine Operations Manager, have included:

  • Sept. 17, 2007 - Trauma and Emergency Care From a Distance: A Telehealth Approach to Delivering Quality Critical Care
  • August 15, 2008 - Home Telecare Vendor Fair
  • June 23, 2009 - Collaborating From a Distance, (hosted in Malone, NY for convenience of our Upstate NY rural partners)