Only a call away

Telemedicine changes office visits

Like self-driving cars and colonies on the moon, the idea of physicians treating patients from miles away has long been considered science fiction. In 1925, inventor Hugo Gernsback floated the idea of the “teledactyl,” a way doctors could use remote controls and yet-to-be invented television imagery to diagnose ailments on distant patients. While Gernsback’s prediction is yet to be completely true, telemedicine has become both a reality and staple of modern health care.

Technically, the concept of telemedicine encompasses a wide range of electronic communications, equipment and software to provide clinical care to patients without an in-person visit to the doctor or specialist.

“In layman’s terms, telemedicine is the opportunity to connect with your provider in ways other than the traditional format of interacting in person at their office,” explains Trina Casner, president and CEO of Pana Community Hospital. She serves as president of the Illinois Critical Access Hospital Network and chairs the Illinois Telehealth Network. “Telemedicine expands the opportunity to have access, especially in rural areas, to specialty physicians whom otherwise would not be available locally.”

Robin Rose, chief operating officer and chief clinician of Gibson Area Hospital & Health Services in Ford County, says telemedicine is all about making medical care more readily available, ranging from a simple telephone call with a family physician to high-tech medical consultations from specialists and remote monitoring.

“One of the keys to health care and to maintain a good health care system is accessibility,” she explains. This includes if transportation isn’t available to visit the doctor or if there is inclement weather that prevents people from seeing their physician. “Telemedicine is definitely an answer to how we are able to provide care while dealing with these challenges.”

In each telemedicine application, most of which rely on cellular telephone signals or internet connections, health care providers must be certain that transmissions and patient information remain secure. With the exception of actual procedures and surgeries, many medical visits can be completed remotely through telemedicine. In some cases, telemedicine appointments are simply a telephone or video conference call between a patient and his or her physician, but the technology can be utilized in a variety of ways.

Heather Ruhe, system director for telehealth and virtual care at SIH, a three-hospital system which serves 16 southern Illinois counties, says telemedicine often works with a hub-and-spoke model where outlying health centers and clinics are provided with telemedicine equipment which connects to the larger “hub” locations.

“Using a stroke as an example, you have the stroke-certified neurologists at the SIH Brain and Spine Institute which is the hub that provides specialty expertise to the emergency rooms of eight total hospitals – those are the spokes,” she explains. Ruhe says in some cases the SIH locations also serve as the spoke, helping to connect patients with highly specialized medical providers at other locations, such as St. Louis Children’s Hospital.

“We are in a health provider-shortage area and have limited access to certain specialties. If we want to provide access to sub-specialties that our communities need in these situations, we must be prepared to facilitate the delivery of this clinical care virtually,” she says.

The technology has allowed rural health care centers to better serve their patients.

“Telemedicine has allowed small hospitals with intensive care units to work with more highly-specialized or tertiary care centers to monitor patients and provide support,” explains Pat Schou, executive director of the Illinois Critical Access Hospital Network as well as the Illinois Rural Community Care Organization. “It opens the door for rural communities to keep patients more local because they can access specialists and the patient may not have to be transported.”

Julie Casper agrees. As coordinator of the Illinois Dept. of Public Health’s Center for Rural Health, she understands the importance of providing rural residents access to care. “It is critically important to keep patients close to home not only for their care, but to be close to family,” she says. “They don’t have to take time off of work or find transportation or childcare. It also helps keep the no-show rates down for providers.”

She continues, “Instead of trying to decide whether to drive 30 miles to see a dermatologist, a patient can just take a half hour over their lunch break to be seen and then go back to work. It takes a lot of pressure off of the patient.”

Even the inspection of skin abnormalities can be done remotely, explains Casper. “A dermatologist can zoom in on a mole and analyze it right away,” she says. “Many of these specialties, which are not available in rural areas, can be done with telemedicine. With a camera, a provider can let the patient know if it’s something that needs to be seen in person. Telemedicine simply provides greater access to more providers.”

Rose explains that in some cases a patient can visit a rural health clinic or office in their own community and be seen by a nurse or other provider in person as well as a physician who “dials in” from another location.

Team members with the Acute COVID at Home program perform twice-daily touchpoints and symptom checks with patients testing positive for COVID-19, enabling them to recover at home.

“Everything is like a regular visit,” she says. “You can have a discussion with your physician just like you’re both in the office.”

Telemedicine is not only more convenient, it can also save lives. Using the example of a stroke in a rural part of southern Illinois again, Ruhe shares a scenario:

“Imagine if a person presents with the signs and symptoms of a stroke at a rural hospital. That hospital immediately activates a ‘Code Stroke’ page to our system, which is answered by an on-call neurologist. The doctor receives a summation of the signs and symptoms and then determines if the case is appropriate for a telehealth consult. If that is the case, the hospital would already have a telehealth cart in the room. The doctor would use a laptop computer he carries with him for this purpose to dial in to the cart. He’s connected within 10 seconds and he’s able to get audio, video and data from the other equipment in the room.”

Ruhe continues, “The doctor can control the camera in the emergency department with a computer mouse and talk with the medical team and patient. This allows for immediate care. Without it, the patient would have had to be transported to another facility for evaluation and care, taking 45 minutes or an hour. With stroke, every minute is critical.”

At long-term care facilities, telemedicine also can be beneficial.

“In nursing homes or skilled care units, one of the first considerations with a patient who is not feeling well is to transfer them to a hospital. insert spaceIf we can do virtual visits, it might be possible to eliminate moving them five or 10 miles to the hospital emergency department and then transported back again in 2 hours. It’s more efficient and better for the patient,” Schou says.

Telemedicine also has some unintended benefits including giving doctors insight into their patients’ lives.

“Maybe there’s a patient who probably spends a lot of time in her favorite chair in her family room,” explains Charles James Jr., president-elect of the Illinois Rural Health Association. “When you make a video connection with her in that chair, providers get a lot of clues about her living environment from being able to see her in her home. They get a lot of really important socio-economic diagnostic indicators and that’s something they wouldn’t get in person; things like ‘Do they have a secure environment?’ and ‘How ambulatory is my patient?’ Things like that.”

Even non-face-to-face health monitoring can be done remotely. Health care systems can provide patients with a variety of devices ranging from scales to pulse oximeters and heart monitors and blood sucrose meters, all of which send data to the physician’s office.

“All of these things can be shared by the patient without having to visit the doctor’s office,” Casner says. “It really can improve quality of life.”

If a pandemic can have a plus side, the adoption of telemedicine is it. The COVID-19 public health emergency has expanded the adoption of telemedicine initiatives, changed the way providers are paid for practicing medicine remotely and made the public more comfortable with telemedicine.

Andrea Nicolaides RN BSN, an ICU charge nurse at SIH Memorial Hospital of Carbondale discusses an EKO Bluetooth stethoscope with hospitalist Dr. Sonal Shah. Equipment such as this stethoscope is key to telemedicine consultations.

The use of telemedicine grew exponentially because of the pandemic, with remote visits becoming the norm for many patients and their medical providers. A federal report found that nearly half of all Medicare primary care visits in Illinois during April 2020 were provided through telemedicine as opposed to less than 1 percent before the public health emergency. Even as some in-person visits have resumed, telemedicine still accounts for nearly one-fifth of all interactions with physicians.

“Overnight, COVID changed the urgency of adoption because all of a sudden, we found out that this was our only way to see patients,” James explains. “It really has magnified the value of telemedicine.”

Since the inception of telehealth, many insurance reimbursement programs including Medicaid did not pay providers for telehealth visits or didn’t pay as much as they did for in-person visits. That changed with the onset of the COVID-19 pandemic, when telehealth was about the only way for patients to see their doctors. During this time, many of the reimbursement discrepancies were eliminated and there are efforts underway to make these changes permanent.

Casner says the pandemic forced many health care providers to quickly move to virtual visits and expand their telemedicine programs. Ruhe says the situation sped up her system’s telehealth efforts, completing a three-year plan in just 12 months.

It also has brought to life one problem – the lack of high-speed internet access in many areas.

“The number one challenge we have is broadband,” James says. “There are still patients in some rural areas that do not have access to a computer or broadband internet access at home.”

That’s one of the reasons groups like the Illinois Rural Health Network and the Illinois Telehealth Network are spearheading efforts to increase broadband internet access throughout the state.

“We need that sort of infrastructure to medical facilities and even into homes so this can all happen,” Casner adds.

James agrees. “As the future unfolds, what we hope to do is utilize all of these mechanisms to keep in contact with our patients, especially for follow-up visits with the goal of keeping them out of the hospital,” James says. “I think the takeaway is there is no going back. Telemedicine is a really important tool to care for our patients and to help them live healthy lives. It is the new normal.”

Although telemedicine’s time has come, Gernsback’s vision of a teledactyl may never come to reality. There will still be times a visit to the clinic, doctor’s office or hospital will be necessary, but perhaps they won’t be as frequent.

“There are just certain things we can’t do with telemedicine,” says Casner. “Telemedicine will not replace traditional medicine, but it will enhance it.”