Nantucket Hospital Uses Telemedicine as Bridge Cary Hazlegrove for The New York Times Dr. Peter Schalock, a dermatologist in Boston, saw a patient at Nantucket Cottage Hospital, which lacks some specialists. NANTUCKET, Mass. - When Sarah Cohen's acne drove her to visit a dermatologist in July, that's what she figured she'd be doing - visiting a dermatologist. But at the hospital on Nantucket, where her family spends summers, Ms. Cohen, 19, was perplexed. "I thought I was going to see a regular doctor," she said, but instead she saw "this giant screen." Suddenly, two doctors appeared on the video screen: dermatologists in Boston. A nurse in the room with Ms. Cohen held a magnifying camera to her face, and suggested she close her eyes. Why? she wondered - then understood. The camera transmitted images of her face on screen, so the doctors could eyeball every bump and crater. "Oh my God, I thought I was going to cry," Ms. Cohen recalled. Even if you've never seen that pimple before, it's there. That, she realized, was the point. Technology, like these cameras and screens, is making it affordable and effective for doctors to examine patients without actually being there. More hospitals and medical practices are adopting these techniques, finding they save money and for some patients work as well as flesh-and-blood visits. "There has been a shift in the belief that telemedicine can only be used for rural areas to a belief that it can be used anywhere," said Dr. Peter Yellowlees, director of the health informatics program at the University of California, Davis, and a board member of the American Telemedicine Association. Before, you had to make do with poor quality, or buy a very expensive system. Now, you can buy a $100 webcam and do high-quality videoconferencing. The technology is especially being embraced in professions like ophthalmology, psychiatry and dermatology, which face shortages of physicians. At Kaiser Permanente, dermatologists "sit in a suite in San Francisco" and tele-treat patients throughout Northern California, Dr. Yellowlees said. It's much more efficient than having 20 hospitals, each with a dermatologist. On Nantucket, an island 30 miles from the nearest spit of mainland, "telemedicine just makes a lot of sense," said Dr. Margot Hartmann, chief executive officer of Nantucket Cottage Hospital. "It allows us to meet the mission of the hospital better because we're offering more locally," and saves patients the cost and time of flying or ferrying off-island, then driving to Cape Cod or Boston hospitals. The island may be small, but it has strikingly diverse medical needs. Its year-round population of about 10,000 balloons to 50,000 in the summer. And while it is famous for wealthy visitors, its year-rounders are much less affluent. They include immigrants from many countries, and range from businesspeople to scallopers. Nantucket has all the ailments one would find anywhere, plus some exacerbated by island life: skin cancer, tick diseases, water accidents. "Most people are within an hour of some major hospital," said Joanne Bushong, the hospital's outpatient clinical coordinator. Not Nantucket. We're not practicing rural medicine; we're practicing island medicine. Nantucket's hospital has a handful of year-round doctors. While mainland specialists do visit, fog or storms can keep them from getting there. And specialists cost money. The hospital, millions in the red in recent years and now needing $60 million to replace its outmoded 1957 building, must pay for the specialists" travel and lodging. Telemedicine, done by doctors at Massachusetts General Hospital, saves some of those costs, and generates revenue because it means more tests are done on Nantucket. "If someone was going off-island to see a dermatologist, they would probably have their labs and X-rays done where that dermatologist was," Dr. Hartmann said. Instead, tele-dermatology saves nearly $29,000 a year because two dermatologists now visit only four times a year, but appear on screen six times a month and see 1,100 patients a year. Previously, dermatologists visited monthly, and always had "100 people on the waiting list," Ms. Bushong said. Nantucket also uses tele-radiology, having Boston radiologists, some specializing in certain body areas, read X-rays and scans. It has used tele-pediatrics twice, for a child in a car accident and one in diabetic crisis. Tele-stroke uses video neurologists to quickly determine if a patient's stroke type warrants a clot-busting drug, tPA, or if tPA could harm the patient. Tele-endocrinology, for thyroid problems and diabetes, is starting. And Nantucket hopes to have video sessions for autistic children "so parents would not have to take kids with autism off-island, since it's hard to travel with them and it upsets them," Ms. Bushong said. Pam Belluck is a Times health and science reporter and author of "Island Practice" (PublicAffairs, 2012), about Dr. Lepore's experiences. A photo caption with an earlier version of this article misspelled the last name of a dermatologist. It is Schalock, not Schlalock.