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

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.

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.”