Patient-Centered Care

Technology Helps Providers Go the Distance to Bring Care to Rural Patients

From Oregon and Idaho to Alabama and the Mississippi Delta, telehealth solutions and strategies expand treatment options.

Melissa Delaney

Melissa Delaney is a freelance journalist who specializes in business technology. She is a frequent contributor to the CDW family of technology magazines.

Rural patients are a high priority for St. Luke’s Health System, a Boise, Idaho-based not-for-profit care organization that treats patients located throughout the Gem State and eastern Oregon. Until recently, though, it lacked an efficient way to provide consistent care to that population. A few times a month, for instance, a nephrologist from the organization would drive two hours to meet with patients in one of the organization’s rural clinics for a day, then drive back home.

When the doctor replaced those road trips with telemedicine exams, he added 30 appointments to his monthly schedule. “Rural communities struggle to recruit and retain specialists,” says Krista Stadler, senior director of telehealth services at St. Luke’s, which in August opened a new 35,000-square-foot virtual care center. The goal of the care center is to centralize a medical team that leverages technologies, including two-way cameras and remote monitoring equipment, to provide around-the-clock care to patients at clinics, hospitals and homes that in many cases are hundreds of miles away.

“We now can better leverage our scarce resources, which are our specialists, to these communities by way of technology-enabled care,” Stadler says.

Urban areas have an average of 263 specialists per 100,000 people, compared with only 30 in rural areas, according to the National Rural Health Association. That demand is fueling transformation throughout the healthcare industry as organizations strategically deploy technology to reach those patients who might otherwise go underserved.

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UMMC Expands Rural Care Access with Telehealth

Technology has been at the heart of the University of Mississippi Medical Center’s rural care strategy for 15 years. The organization, which provides remote intensive-care consultations and critical-care monitoring as well as telemedicine specialty services, was named a 2017 Center of Excellence for Telehealth by the U.S. Department of Health and Human Services.

In 2014, UMMC conducted a yearlong study in the Mississippi Delta to determine the effectiveness of using digital tools to educate diabetics about how to manage their disease. Prior to the effort, patients taking part in the study had little access to technology or specialty care.

We now have the ability to better leverage our scarce resources, which are our specialists, to these communities by way of technology-enabled care."

Krista Stadler Senior Director of Telehealth Services, St. Luke's Health System

Photography by Glenn Oakley.

“They were pretty much getting all of their diabetes care in the ER,” says Michael Adcock, executive director of UMMC’s Center for Telehealth.

Participants were given tablets to educate them and monitor their symptoms at home. Providers would intervene in real time when necessary.

“It’s transformational,” Adcock says. “After six months, we had zero hospitalizations and ER visits related to diabetes.”

Savings from the reduction in hospital admissions through the first six months totaled $339,000. UMMC has since extended the program, which now uses iPad minis with cellular connectivity, to adult and pediatric diabetes, heart failure, chronic obstructive pulmonary disease, hypertension, adult and pediatric asthma and high-risk pregnancies. An iPad alarm alerts patients to take their measurements using Bluetooth-enabled glucometers, scales or blood pressure cuffs, and conduct brief health sessions to gauge symptoms. The data then is sent electronically to center staff.

St. Luke’s has a similar remote patient monitoring program that also disperses iPad minis and Bluetooth-enabled peripherals for patients with diabetes, hypertension, coronary artery disease, congestive heart failure and COPD. Data gathered through telehealth software is transmitted to the virtual care center, where a nurse receives alerts when patients answer questions or have aberrant vital signs.

The nurse can reach out to patients by phone, secure text message or a two-way audiovisual link in the home to then direct them to appropriate care.

“We knew there was an opportunity, but we didn’t recognize the magnitude of opportunity that the program would present to our patients,” Stadler says.

Customized Carts Optimize Urgent Care

Since fall 2017, MainStreet Family Urgent Care, which has 16 clinics in rural Alabama, has leveraged telemedicine tools to offer urgent-care services. After countless inquiries from its patients, the organization decided to add primary-care services last summer.

MainStreet’s business model, designed to address the challenge of recruiting providers to rural areas, is to employ small staffs (often a nurse practitioner and medical assistants) and connect with a cadre of remote physicians.

500,000

Number of telehealth encounters the UMMC has provided since beginning its telemedicine program in 2003

Source: University of Mississippi Medical Center

The organization built its own telemedicine cart, which comprises a computer on wheels, a keyboard, mouse, webcam and devices such as an otoscope, a general camera and a digital stethoscope. MainStreet also started a sister company to develop a browser-based telemedicine platform.

“What really sets our system apart from others is our ability to load-balance between clinics,” says Wendy Morell, MainStreet’s director of business development. MainStreet’s platform uses a bot to search which exam rooms in 13 clinics are occupied and automatically matches patients with the least busy.

UMMC also uses carts in its facilities with standardized devices on a Cisco network — including Dell computers with dual-monitor setups for clinicians, Logitech webcams, Cisco Unified Communications cameras, Cisco SX20 codecs, and digital stethoscopes and otoscopes — but each cart is customized based on need, Adcock says.

Virtual Care Grows Rapidly as Tech Expands

The providers in St. Luke’s remote specialty clinics use monitors, webcams, headsets, electronic health records and a stand-alone Vidyo virtual video infrastructure to deliver care to remote patients. Clinicians in the virtual care center, which utilizes 49-inch curved Samsung monitors, log in to the telehealth software platform and select the room they’re scheduled for; the camera in the patient’s room turns on, and the physician’s face appears on the screen.

Through the software, the provider can move left, right, up, down and zoom in to see granular detail, such as wounds, pupils or rashes. When necessary, a nurse trained as a telepresenter is in the patient’s room to assist the provider with a more detailed assessment, such as removing a patient’s dressings.

St. Luke’s system was designed with redundant processes to ensure a reliable experience, and it’s scalable and standardized so that it can grow along with the demand for telemedicine.

“This space is rapidly evolving,” Stadler says. “Every year it changes, so we’re constantly having to morph.”

5 Tips for a Successful Telemedicine Launch

Looking to launch your own telemedicine program? UMMC Center for Telehealth Director Michael Adcock offers advice, whether you’re starting from scratch or expanding an existing effort.

Focus on problems you’re trying to solve. Does your community have a large population of diabetics or heart failure patients? Don’t build a telehealth program just to have one.
Develop the clinical solution first, then wrap the technology around it, not the other way around.
Find providers interested in telehealth. Programs thrive when they’re fueled by providers as opposed to top-down decrees.
Learn connectivity, licensure, insurance and regulatory requirements. There are nursing compacts and parity laws that have simplified telemedicine, but laws, regulations and licensing still vary by state.
Talk to a comparable hospital or clinic that has a successful telemedicine program “so that you don’t have to step on the same land mines that others have.”