On most days, associate director Eve Heemann Byrd sees geriatric patients in her office at the Fuqua Center for Late-Life Depression at Emory University's School of Medicine. On Monday afternoons, however, she sees patients on her computer screen.

Since its launch late in 2004, the Georgia Statewide Telemedicine Program has connected doctors and professionals from 45 medical specialties with patients who live in rural Georgia. This year, the program added psychiatric counseling to its services.

"Psychiatric services are so limited across the state, and the situation is particularly serious with our growing elderly population. They find it harder to drive long distances to see a specialist," Heemann Byrd said.

Thanks to Georgia's network of videoconferencing equipment in 37 hospitals and clinics, many patients are within a 30-minute drive of a facility where they can connect with specialists.

"We have known for a long time that our elderly patients were struggling to make their appointments and sometimes discontinued treatment because of the distance," said Dr. William McDonald, professor in Emory's department of psychiatry and behavioral sciences and director of the Fuqua Center.

"The client comes to the remote site and sits in an exam room with a nurse, nurse practitioner or physician's assistant and a family member who can help answer questions about the patient's history," said Heemann Byrd, MSN, APRN-BC, MPH. "We communicate via audio and video computer equipment in real time to make a diagnosis and prescribe a treatment plan."

The camera is movable, and, if a physical assessment is needed, an onsite health care professional conducts it.

"It is very important for us to actually see the patient," McDonald said. "You can tell a lot more about how patients are doing by their appearance and body language than you can determine from a phone conversation."

Patients don't have to operate the technology; they watch the onscreen doctor and respond. "Patients have reacted very positively to the experience. It's sort of like watching TV and talking back to it," Heemann Byrd said.

When new patients call the Fuqua Center, they are given a choice of onsite or telepsychiatry services.

"At the moment, we're seeing about four patients through telemedicine a week, but I expect that number to grow. In the future, I expect I'll be alternating seeing patients in my office and those in north or central Georgia on my computer screen," Heemann Byrd said.

The program also helps spread knowledge about psychiatric treatment.

"One of the really great components of telemedicine is that we're educating primary-care doctors and nurses as well as patients," she said. The Emory doctors may recognize certain conditions and side effects from psychiatric drugs, because of their day-to-day practices. Rural clinicians may not be as comfortable evaluating psychiatric conditions, because they haven't had as much experience in the field.

"Our goal is to make it a team effort, with everyone working from the same page," Heemann Byrd said. Once the specialist makes an evaluation, the findings are sent to the patient's primary physician.

"We can either follow up with the patient or make recommendations and turn the patient back to his [local] doctor," she said.

Georgia has the first statewide network for telemedicine, said Paula Guy, RN, manager of the Georgia Statewide Telemedicine Program. Patients who might not have access to dermatologists, endocrinologists, rheumatologists or prenatal specialists are now seeing some of the best practitioners from Emory Healthcare, Piedmont Medical Center, the Medical College of Georgia in Augusta and Memorial Health University Medical Center in Savannah.

"Uses for the network continue to grow. Recently, a rural patient underwent a stress test with his physician in the room and a remote cardiologist monitoring," Guy said.

Doctors involved in the program see its merit.

"Our physicians tell us that they feel very comfortable making a diagnosis using the technology," Guy said. "Our 'store-and-forward software' allows them to take close-up photos of something and have the pictures sent through encrypted e-mail to their office. They say that sometimes they can see things better that way than with the naked eye."

The network can also transfer X-ray and MRI images.

In January, the program logged 154 consults via telemedicine, and Guy expects that number to grow to 250 a month by this summer, as more specialties are added and more patients hear about the program.

"We're always learning lessons about how to better use the technology, but we feel like we've got the best network anywhere," Guy said.