“There were questions about security. How
secure was the technology?” recalls Mariposa
CEO Jim Welden, who has been with the clinic
since 1980. “We explored that, and we also
wondered how patients would experience this
technology. Would they feel this was less than
an in-person visit? It also meant having to
coordinate the UA specialists’ schedules with
our primary care physicians’ schedules.”
Eladio Pereira, MD, an internist and Mariposa’s
medical director, remembers that doctors
wondered if they could achieve comparable
results with telemedicine. “The question was,
do we need to be able to examine and touch
the patient to make the right decision? At the
same time, there was a lot of comment that this
will help us move forward.”
The final decision was pivotal. “It was really
the first time that we had access for some of
our patients to see specialists in Tucson,” Mr.
Welden says. “It was the first time we could
meet the needs of some of our patients who
couldn’t get to Tucson.”
A top priority has been connecting patients
with University of Arizona rheumatologists, in
part because of the longstanding shortage
of rheumatologists in Arizona. More recently,
Tucson community rheumatologists have joined
highly specialized, and carry significant risk,
such as making patients more susceptible to
infection. “Only an expert should prescribe
them,” Dr. Pereira says.
with a Mariposa physician who was caring for a
5-year-old girl who was born with HIV. She and
her family were living in Nogales, and traveling
to Tucson to see a specialist was difficult.
“Working with the UA and Tucson community
doctors has been really, really helpful to us.
We’ve been able to get our patients seen
quickly. And that is so important, because we
now know that the earlier you treat rheumatoid
arthritis, the lower the risk of deformities.
At the end of his videoconference visit with the
girl and her pediatrician, Dr. Shehab said to her,
“I’m so sorry I can’t give you a hug.”
“The relationship between primary care
physician and specialist is significantly
enhanced by the fact that they can see the
patient at the same time,” Dr. Pereira says.
In response, the child walked over to the
telemedicine monitor, with Dr. Shehab on its
screen, and gave it a big hug.
“Also, we, the primary care physicians, have
our limitations, and I think it’s really healthy to
bring that up in front of the patient,” he says.
“The patient realizes you are not an expert in
everything, but you’re seeking help for that
The girl is now an adult – a tribute to the
advances in HIV care, and to the importance of
being able to be seen by a specialist, once the
transportation barrier is removed.
Dr. Pereira and Mr. Welden agree that
telemedicine is moving toward greater mobility,
with smart phones, Skype and tablets having a
Mr. Welden and Dr. Pereira will never forget one
consult that had a surprise ending.
“We are moving toward doing consults with the
patient at home,” Mr. Welden says. “We have
patient navigators who are out visiting patients
in their homes, which is a big plus for someone
who is elderly or chronically ill.
Ziad Shehab, MD, is a University of Arizona
pediatric infectious-disease expert who has
been caring for children with HIV and AIDS for
30 years. About 15 years ago, he consulted
“But regardless of how the technology changes
in the future, historically telemedicine has
meant a lot to our providers and to the patients.
It was absolutely a win-win.”
“Rheumatology is a very challenging field,” Dr.
Pereira says, because many of the new drugs
– called biological res