In the midst of chemotherapy last fall, Pat Ballek didn't feel like driving 260 miles roundtrip for checkups at her doctor's office. So she didn't.

Instead, the Sheridan, Wyo., woman met with Billings' Dr. Patrick Cobb over a video link. Ballek dialed in from Cobb's Sheridan clinic, where she was receiving chemotherapy, while Cobb logged on from the Billings office of Hematology-Oncology Centers of the Northern Rockies.

A decade ago, telehealth was still the stuff of science fiction. Cobb, who graduated from medical school in the mid-1980s, said remote health care was something he and his classmates figured they'd be more likely to encounter at Disneyland than in a hospital.

"They talked about it, but the technology wasn't there," he said. "That was before the Internet and personal computers.

"But, as anyone knows who's watched a new electronic gadget grow outdated almost as soon as it's been unboxed, technology is advancing at a furious pace.

In Montana, the medical community has managed to stay ahead of the curve and become a national leader in telemedicine. That's given patients in the far-flung reaches of the state, Northern Wyoming and even western North Dakota better access to care than ever before. "It's part of the fabric now. It's not surprising. People think about using it now."

Fifty medical sites across Montana are connected by a handful of telemedicine networks, and the menu of services that can be provided by video, over the phone or online is ever expanding.

"If one dreams about future possibilities, the possibilities of providing remote medical care are endless. In reality it is limited by the current technology and personal commitment of providers, said Cindy Leenknecht, a telehealth clinical nurse specialist at St. Vincent Healthcare. "It is those who will push the envelope that will provide the inspiration for tomorrow's technology development. It's only in our dreams where it will go. You can get a consultation from anywhere in the world if you can get a connection."

"The world is becoming a smaller place due to technology," Leenknecht said. "Our imaginations are the limitations."