I was offered the opportunity recently to observe a medical examination of a child in Guatemala, and I was able to accept because I didn’t have to leave home. The U.S.-based doctor examined the patient with the help of medical personnel in Guatemala, special instruments designed to transmit high-resolution images, and a high-speed internet connection.
Of course, I had heard about advances in telehealth, but until I saw the clarity of the images on the screen and heard the detail in the sound transmission, I really had no idea how much the field had progressed. We could see inside the child’s ear with detail that rivaled an in-person exam. Her heartbeat was loud and distinct. It was as if we were sitting in her local doctor’s office, conferring with a specialist – which, in a way, we were.
Watching both the ease with which the medical professionals communicated to each other via the internet and the high quality of the data they shared reinforced my interest in telehealth. Granted the terms “telehealth” or “cybermedicine” cover a wide array of initiatives from transmitting images of tissue samples from lab to lab to seeing a doctor via your smartphone. I am particularly interested in how telehealth may have a positive impact on rural hospitals.
Small, rural hospitals have been under financial stress for a number of years, and we have seen them close across the country, sometimes leaving their communities without a local emergency or acute care provider. Of course, rural hospitals are not the only ones challenged by the changing healthcare environment, but in urban areas patients have more options within a short distance when financially distressed hospitals close. Rural hospitals are often the only medical facility in a community and, in an emergency, time and distance matter.
This is where telehealth can play a vital role. Remote access allows doctors and nurses to monitor patients, sometimes across great distances, and supplement in-person staff members with 24-hour, detailed care.
National Public Radio recently did a feature on telehealth and spotlighted a Carolinas HealthCare System hospital in Lincolnton, N.C. The hospital’s intensive care unit is staffed by a combination of on-site and remote medical staff. Doctors and nurses working from 45 miles away communicate on a regular schedule with ICU patients via monitors in the patient’s room.
At the remote center, seven to nine critical-care specialists are on duty. Nurses and doctors work day and night shifts, as well as spending time physically in the hospital. Doctors cite the calm of the remote center as a plus to the job. Without the noise and bustle of an ICU, they say they are better able to monitor their patients’ progress. The remote system also provides ongoing vital signs and lab results that nurses say are key to monitoring critical-care patients. Nurses in Lincolnton credit the remote system with catching trends in a patient’s medical status that a bedside nurse might miss.
With an ICU that can handle complicated cases with the help of critical care telehealth specialists, more patients can stay in their communities. It is easier on families, better for patients and supports local jobs for nurses and lab technicians who might otherwise work in larger cities.
Statistics from the 10 Carolinas HealthCare hospitals engaged in telehealth show promise. Mortality is down 5 percent and length of stay is down 6 percent. The hospital has also instituted a program to better manage sepsis, a leading cause of death. Virtual care is a part of the sepsis program, and shares some of the credit for improved outcomes.
In South Dakota, Avera Health has estimated $70 million in savings during the past 10 years because of remote healthcare from one center. During that time, they have expanded their reach and today monitor patients as far away as Minnesota and Wyoming.
Of course, the technology doesn’t matter if doctors and hospitals cannot be reimbursed for telehealth services. To that end, Cigna, United Healthcare, WellPoint and Aetna have followed guidelines from CMS and have begun programs to reimburse for telehealth visits, albeit under specific circumstances with a specific population, generally Medicare and Medicaid recipients.
Is telehealth always the best route to take? Of course not. Nothing will replace the relationship between a doctor or nurse and the patient, but telehealth may make critical care possible in remote areas and may help many of our rural hospitals continue to operate.