California's excellent health care resources and highly trained medical experts are poorly distributed across the state. Many urban centers have state-of-the-art medical technologies and specialty resources, but in sparsely populated and economically depressed areas (urban as well as rural), specialists are a rarity.

In some areas, primary care physicians are unwilling to work without specialty backup nearby after experiencing the frustration of practicing on the frontlines without their own safety net of experts. And it is not just the rural and poor who have difficulty getting care; increasingly, the isolated elderly face the same challenge, as do ethnic populations whose languages and cultural norms are too often not understood in health care settings.

One proven way to bridge the gaps in time, distance, and quality is the application of telehealth. It has been in use for a long time in demonstration projects across the state and around the globe. I believe the tipping point has arrived and telehealth is ready for prime time in California.

These real-life examples illustrate the promise of telehealth:

• Live from the ER, a rural provider consults with a neurologist at an urban medical center as he treats a patient with acute head trauma. The neurologist can see what is happening via video conferencing and advises the provider in real time.
• A remote provider keeps up on best practices and the latest advances in care through virtual attendance at grand rounds at a world-class medical center.
• A patient in an urban clinic has a persistent rash. Her primary care provider takes a picture and sends the image to a dermatologist via a "store and forward" system. The dermatologist reads the patient notes and views the image the next evening and provides interpretation and treatment advice to the primary care provider. The patient is treated in a week instead of waiting months for an appointment with a dermatologist.
• A rural practitioner in Humboldt downloads diabetes educational materials in Spanish from the UC Medical Center in Los Angeles to give to her Spanish-speaking patient.

One might imagine such successes would have led to broad adoption of telehealth. Yet in more than 15 years of working to eliminate disparities in care, I have often been frustrated that so few patients have been able to access care in this way. Telehealth works best not as a demonstration project grafted onto a broken health care system, but when it is accepted as a way to leverage new technologies to create new models of care that were formerly impossible.

Now in 2008, at long last, the prospects in California are improving. Recent investments in telecommunications infrastructure by the Federal Communications Commission, the California Emerging Technology Fund, California Public Utilities Commission, and the State of California, through Proposition 1D bonds, are all potential game changers. I believe the time has finally come for telehealth to thrive.