Residents of the foothills and Northern San Joaquin Valley now can see more specialty doctors more often, thanks to the rise of telemedicine in the area.

Tuolumne County recently received a $9,000 grant, enabling patients at two sites to connect with more specialists such as dermatologists and neurologists without driving long distances or waiting months for appointments.

A Hughson clinic, which began tel- emedicine earlier this year, saw its telemedicine patient load more than double in the past few months. And a medical center in Livingston will start offering telemedicine in July.

Telemedicine allows patients to use computers, phone lines, cameras and microphones to have virtual office visits with specialists who might not be available locally.

"If it wasn't for telemedicine, a lot of the patients would not seek care," said Tina Dutra, telemedicine program coordinator for Tuolumne General Hospital in Sonora.

Seeing a specialist in Sacramento, Los Angeles or the Bay Area is all but impossible for some patients, especially those who are elderly and no longer drive long distances.

Others, like Lisa Duncan of Sonora, use wheelchairs and depend upon family or public transportation to get to medical appointments.

Duncan and her family doctor, Christina Tan, used telemedicine earlier this month to hook up with a thyroid specialist in Sacramento. Duncan, a mother of three, used to rely on her husband or brother to drive her to doctor appointments out of the county.

"This is a wonderful advantage for people who can't go the distance," Duncan said.

Some patients turn to telemedicine because of the shortage of specialists in the area.

Dermatologists are in short supply throughout the nation; there's one in Sonora, and his office is often booked months in advance. Rheumatologists, who treat arthritis, are also scarce, said Kathy Kohrman, an associate director with the Stanislaus County Health Services Agency, which runs the clinic offering telemedicine in Hughson.

Connecting patients with doctors via telemedicine has been happening for years, often in prisons where it's difficult to get an inmate to a specialist. In 1998, Tuolumne General started offering the appointments, hooking up patients with specialists at the University of California at Davis Medical Center.

Last year, thanks to a $1.8 million grant from the Rural Health Demonstration Project, Blue Cross of California set up a network of telemedicine sites, connecting rural clinics with medical centers that specialize in children's health.

Part of that money went to Sonora's two telemedicine sites, which now can network with more doctors from more hospitals. Foothill residents have access to specialists like pediatric rheumatologists and pediatric neurologists at several research hospitals, including Cedars-Sinai Medical Center and Children's Hospital in Los Angeles.

The clinic in Hughson, which also networks with these hospitals, began offering telemedicine as part of the Blue Cross grant in January. In February, the clinic had seven telemedicine visits. Nineteen appointments are scheduled for May.

"The word is out," Kohrman said.

Part of a second grant went to add telemedicine to the Livingston Medical Group center. It expects to begin seeing patients this summer.

While grant funding is helping telemedicine grow, a maze of federal regulations still prevents some patients from seeking telemedicine care. Medi-Cal and most private insurance plans cover telemedicine visits, but Medicare doesn't always reimburse patients, said Dutra, the Tuolumne General Hospital official.

The U.S. Senate is starting to debate legislation to ensure Medicare reimbursement for telemedicine. Dutra hopes that will happen soon.

"We hope as many people as possible will have access to care," Dutra said.

Reprinted by permission of Modesto Bee.