Telemedicine brings specialty care to rural patients

Rural hospitals, isolated and often hamstrung by a lack of physician specialists, are increasingly expanding their services through the use of telemedicine.

Telemedicine, broadly speaking, is “medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status,” according to the American Telemedicine Association in Washington, D.C.

That could be as simple as the secure sharing of a patient’s medical file electronically or the transfer of images or as complex as clinical assessments of patients done remotely using video conferencing over high-speed connections.

The latter allows rural facilities which cannot recruit or afford multiple specialties such as neurologists, cardiologists or psychiatrists to provide those services as needed so an emergency room patient suffering a stroke, for example, can be treated immediately rather than transported 100 miles or more to the closest big city hospital.

“If the emergency room can’t take a patient or it’s outside their scope than they’ll be shipped to Reno, Salt Lake City or Boise,” says Hope Cripps, director of business development at Northeastern Nevada Regional Hospital in Elko.

For at least the last five years, the hospital has tried unsuccessfully to recruit a neurologist, a not uncommon challenge for rural medical facilities. So now the facility is working with Specialists On Call Inc., a Reston, Va., company that provides what it calls teleneurology.

By mid-year, the Elko hospital plans to provide its emergency room personnel with round-the-clock access to neurologists from Specialists On Call, who will be contacted via a computer on the rolling technology carts now commonly used by hospital nurses to collect patient data.

Once the neurology practice is up and running, Northeastern Nevada Regional will look at expanding its telemedicine services outside the hospital and into its outpatient clinic. Again, the impetus is to provide its patients with specialists not on staff, including oncologists.

The Elko hospital started its foray into telemedicine on 2011 when it lost its staff psychiatrist and started remote inpatient behavioral assessments via TV screen in a private room with nurses present. In addition to diagnosis, the long-distance physician can prescribe medication.

Banner Churchill Community Hospital launched its telemedicine program eight months ago, also starting with behavioral assessments of patients conducted jointly by on-site staff therapists and remote psychiatrists.

A month ago, the 40-bed facility added Banner iCare after the intensive care service was well-tested by other hospitals in the Phoenix-based Banner Health system.

The program brings telemedicine to the Fallon facility’s four-bed ICU, after equipping each room with about $50,000 in video cameras, monitors and other devices. The service gives in-house staff and patients 24-hour access to intensivists, doctors specializing in intensive care, located in Phoenix, Colorado and Tel Aviv, Israel. The physicians can monitor all physiological signs remotely and initiate contact if and when needed as well as be called upon by patients or staff.

Physicians providing consultations or treatment via telemedicine, whether they’re located elsewhere in Nevada or outside the state, are required to be licensed here and to carry malpractice insurance. Previously, state law required examining doctors to be present but Banner was instrumental in getting Senate Bill 327 passed during the 2013 legislative session, which now allows patients to be examined telephonically.

John D’Angelo, Banner Churchill’s administrator and chief executive officer, says iCare helps to reduce the time a patient spends in the ICU, which improves health outcomes. And even for bigger hospitals that may have intensivists on staff, it provides back-up and shift relief.

“Staffing,” says D’Angelo, “is one of the more difficult challenges in hospital management.”

Carson Valley Medical Center is working with Renown Health, which provides an array of specialists via the Internet.

The Gardnerville facility uses it for consultations between local primary care physicians and specialists in Reno and is now starting to provide direct treatment from specialists who continue to track the patient without the assistance of the local doc.

Carson Valley Medical started up its program about a year ago to supplement weekly visits from a Renown oncologist, providing both additional consults during the week via videoconferencing or replacing the weekly appointment if the oncologist couldn’t out to the facility.

Now, the medical center has moved into endocrinology treatment via telemedicine and has access, if needed, to nearly 40 specialties offered by Renown.

Lori Salvador, Carson Valley Medical’s nurse manager for telemedicine, said the service is helpful for older residents who for various reasons cannot always travel even an hour to Reno.

The one challenge, she says, has been losing the human touch, especially for more serious health issues.

“Sometimes when you deal specifically with oncology patients, it does seem less personal on camera,” says Salvador. “It is harder to convey sympathy and empathy.”

But she says the equipment, which lets a physician hear heart and lung sounds via connected stethoscope or view nose, ear and wounds from uploaded images, is phenomenal.

“The technology is so incredible,” says Salvador. “On that level, it’s been amazing.”