HUGHSON -- Ear, nose and throat doctor Craig Senders peered into the ears of 12-year-old Billy Bates.

At one time, Billy experienced chronic ear infections. But scheduling an appointment with a specialist such as Dr. Senders often was difficult.

For patients enrolled in state and federally funded health programs such as Healthy Families and Medi-Cal, getting an appointment with a specialist can take weeks, even months because of the scarcity of specialists willing to take on those patients.

But Billy and his grandparents, Bill and Carol Wright, were able to confer with Dr. Senders while remaining in Hughson, saving them from having to make a four-hour round trip by car to the doctor's Sacramento office.

Dr. Senders didn't have to trek to Hughson to see Billy, either. He was able to conduct the examination while in Sacramento.

He did so using telemedicine, a technologically sophisticated method of bringing specialty care to rural communities.

"Telemedicine will help us improve access to specialty care," said Kathy Kohrman, associate director of ambulatory services for the Health Services Agency. "Many of our patients have to travel to Fresno, Sacramento and the Bay Area for those services."

With telemedicine, a doctor or doctors can consult with a patient in another location using a computer, telephone line, camera and microphone.

Cameras and computers are located in the office where the patient is and also the office of the specialist. The parties on each end can see and hear each other. Images the camera captures are displayed on the computer monitors.

In Billy's case, which was a demonstration to show how telemedicine works, a primary care physician was in the room with him. That doctor, David Narita, used a high-tech otoscope, an ear scope equipped with a tiny but powerful camera no bigger than the head of a finish nail. Images of Billy's inner ears were transmitted to Dr. Senders' computer.

Better than mere eyes

In some ways, telemedicine exceeds regular exams. The cameras can zoom in, making images appear much bigger than when looking with the naked eye. Some cameras are able to take snapshot images, so if the person handling a camera doesn't have a steady hand, the physician can analyze a motionless image.

Telemedicine can be used in a variety of specialties: dermatology, cardiology, pediatrics, orthopedics, oncology and psychiatry.

The Hughson Medical office, one of the Stanislaus County Health Service Agency's out- patient clinics, was chosen to become one of 41 telemedicine sites, forming a network throughout the state.

Blue Cross of California, the insurance company which is the largest health care provider of state programs such as Medi-Cal and Healthy Families, got a $1.8 million grant through the Rural Health Demonstration Project.

The insurance company will help establish 24 new telemedicine sites in 18 counties. Part of the grant, approximately $230,000 will go to 17 sites that already offer a form of telemedicine, such as the Primary Care Clinic in Sonora. The money will help those sites expand and upgrade equipment.

The program will eventually link the 41 telemedicine sites with six specialty sites throughout the state. The specialty sites include Childrens Hospital and Cedar-Sinai Medical Center in Los Angeles, pediatric centers in Humbolt and Ventura counties, a medical center in Shasta County and the University of California, Davis.

Besides buying telemedicine equipment, the grant money will be used to help train the clinics' doctors and staff to use the machinery.

The Hughson clinic expects to start using telemedicine early next year, says clinic manager Jim Austin.

Telemedicine on the rise

The concept of telemedicine isn't entirely new, says Kathleen Brown, Blue Cross' telemedicine coordinator. It started when astronauts first ventured into space.

But telemedicine didn't take off until the early to mid-1990s, as computer technology became faster, more powerful and affordable.

Five years ago, telemedicine equipment and its setup cost close to $300,000. Now the cost can be as low as $5,000.

The number of telemedicine programs has increased, too. A survey conducted by the Association of Telemedicine Service Providers and the magazine Telemedicine Today found 157 programs in the United States. In 1993, there were 10.

Some 58,000 telemedicine consultations were conducted in 1998, up from 1,750 in 1993.

There are limitations.

"It doesn't fix everything," Brown said. "There are times when physicians need to use their sense of touch when treating a patient."

And many private insurance companies don't pay doctors when they consult with patients through telemedicine. Blue Cross pays doctors for their consultations with Healthy Families and Medi-Cal recipients.

Communication improves

A benefit is that a patient's primary care doctor and specialist can communicate directly during a consultation. That way, both are involved in developing the treatment.

Doctors such as Jose Rodriguez, who practices in Hughson, says telemedicine is a plus for medical providers and patients.

"We'll be able to do things we haven't done before," he says. "And this will help a lot of people who haven't had access to specialists."