The calls may come in the middle of the night and from hospitals more than an hour away. Someone is having a stroke and is en route an emergency room in the Florida Keys, but there aren't any neurologists on call.
Within 15 minutes, a University of Miami neurologist pops onto a computer screen and can order an IV drug that should be given within three hours. It's that sort of potentially life-saving technology that some lawmakers say will drive down healthcare costs, while also addressing serious doctor shortages around the state.
A Senate bill would increase the use of telemedicine in Florida and establish requirements for health providers who treat patients remotely. A companion bill is also making its way through the House, but that bill doesn't require doctors to have a Florida license — only that they be licensed in their home state and registered in Florida.
"If we didn't have an access problem we wouldn't be here today ... everyone would rather see the doctor face to face, but when your mother is having a stroke in rural Florida and the choice is having a doctor via telehealth versus having no doctor," said Rep. Cary Pigman, an emergency room physician who supports the bill.
The Senate bill requires doctors providing telemedicine services to patients within the state to be licensed in Florida or meet an alternative requirement. For example, an insurer using a doctor that's in-network in another state would also be allowed to treat a Florida patient. The bill recently passed a Senate committee, but has two more stops before it's heard on the floor. Dozens of other states have passed legislation supporting telemedicine.
The Senate bill also would require Medicaid to reimburse for telemedicine services and allow doctors to negotiate payment rates with insurers. The House bill doesn't address payments.
"If you're a patient in Florida and you have a specific heart defect and the guru is a doctor in Philadelphia, you should be able to consult with her," said Republican Sen. Aaron Bean, who is championing the bill.
But critics worry that requirements for doctors in other states could compromise patient care. Some say that doctors practicing telemedicine in Florida should be licensed here.
"It may be the wave of the future, but I still think we need to concentrate on the patients and the bottom line is these (out of state) doctors are not licensed in Florida so they don't have the same accountability," said Sen. Dorothy Hukill, who voted against the bill.
Bean said they will be held accountable through the insurance company or the doctor's network they practice within.
Rep. Gayle Harrell, voted for the bill, but noted it still has problems.
"I also need to know what my recourse action should be should some malpractice incident take place," she said.
She also wants to see a website created where people can find information about the out-of-state doctors who may be treating them. After all, she noted, patients can't walk into the office of an out-of-state doctor and see medical degrees on the wall.
The Florida Chamber and several other groups, including ones representing nurse practitioners, physician assistants, nurses and pharmacists all support the bill.
But the powerful Florida Medical Association is strongly opposed, worrying it doesn't require treatment by a licensed Florida physician or mandate a review of the patient's medical history. The organization said such technology holds great promise, but does not support the bill in its current form.
"This will revert Florida back to the days of the Wild West where anyone with a bottle of whiskey, a pocket knife and Skype can practice medicine. That's what happens to the bill in its current form, said David Custin, a lobbyist for the group.
Several hospitals around the state have had success with telemedicine in recent years, helping patients in rural areas connect to specialists or getting multiple consultations conducted simultaneously for acute emergency cases. University of Miami neurologist Dr. Gustavo Ortiz has done more than 600 consultations since their program's inception in 2009.
Telemedicine saves money by reducing hospital and ER admissions and doesn't require medical transportation, supporters say.
Dr. Kim Landry, an emergency room physician and EMS medical director for four counties in the Panhandle, began a pilot program where 911 responders connect patients remotely to an ER doctor for a quick evaluation.
"Eight out of 10 times, they don't require transport to the hospital, so in a lot of cases, it's made life easier for a lot of sick patients," said Landry, who found those results after testing the program in nursing homes.
During a recent consultation, University of Miami dermatologist Dr. Anne Burdick asked an assistant at a Fort Pierce county health clinic to zoom the camera in on some scaly, white patches on a 10-year-old boy's legs. The boy is often kept indoors and complains of constant itching at night. Burdick, who diagnosed him with eczema, modified his prescriptions and added a monthly bleach bath to reduce bacteria. The boy was one of five pediatric patients seen remotely from her Miami office that day.
Burdick, who estimates 40 percent of her practice includes telemedicine patients, also does medical consultations for two cruise lines, the Indian Health Service and a weekly program for school children.
"For some areas in the state, it's going to be impossible to get specialists to that area and so telemedicine is really the best option, " said Burdick. "The bill will be a really good step forward for Florida."