Wednesday, September 20, 2017  

Telemedicine: The Bridge between Rural Life and Leading-edge Medicine


More than 2,500 years ago, Aesop wrote one of his enduring fables centering on the differences between urban and rural living. Called The City Mouse and the Country Mouse, Aesop’s simple but insightful tale set up the marked contrast between the two locales and lifestyles. It’s a distinction that continues to be discussed to this day.

Many prefer the rural lifestyle because of the more personal connection to most of the folks you see every day and the chance to get away from the traffic, the noise and the concrete landscape of large cities. If there’s a downside it would include, at least according to the urban dwellers, less access to certain services such as highly specialized care for complex medical conditions. For those of us who prefer the world of the Country Mouse, it’s good to know we can count on that particular disadvantage to decrease.

The rapidly evolving technology of telemedicine is an important part of the reason why the change is taking place
An Effective Alternative to Face-to-Face Clinical Services
In its most basic form, telemedicine is the real time, interactive communication between a patient and physician or care team at one location and a consulting physician or care team at a distant site. Telemedicine makes use of teleconferencing technology with, at a minimum, sophisticated audio and video capability. Increasingly, other specialized equipment, called medical peripherals, can be included to aid in the remote diagnosis or treatment plan.
As a result, clinicians at one facility can gain an extensive amount of information on a patient at another facility through the ability to record vital signs, along with heart and lung sounds and other electronic versions of standard examination tools. The peripherals also allow for the recording of EKGs as well as highly detailed images of the skin, the eyes, the ears and other areas.

Telemedicine has played an important role over the past decade providing care for armed services members who are situated in remote areas, far from required medical care. It’s also been used by NASA to create high resolution images, live video and sound and medical data in support of healthcare for crew members of space shuttle flights and International Space Station assignments.

In some cases, the specialized communication technologies developed for these long-distance remote applications have been transferred to the general public with the result that individuals and their care providers in rural areas now have access to specialists and subspecialists throughout the region and beyond.

Riverside’s Telemedicine Network

Riverside Health System’s telemedicine network is one of only a few collaborative programs in the state to offer both advanced outpatient care and emergency treatment for patients in smaller communities, including Tappahannock and the surrounding areas.

Through this program, patients being seen at Riverside Tappahannock Hospital can access hundreds of specialists who are part of Riverside Regional Medical Center in Newport News. Randy J. Ferrance, MD, a Tappahannock-based Hospitalist who is board certified in pediatrics, internal medicine and hospice and palliative care, has been utilizing telemedicine with very positive results.

“Telemedicine lets local physicians and their patients take advantage of the same kind of consultation with a specialist that once would have required a long drive. The communications technology is advanced to the point where you feel like you’re in the same room with the other physicians who are either in a special telemedicine suite at Riverside Regional Medical Center or simply in front of their laptop computers. For the patient, telemedicine is a very interactive process in which he or she, as well as family members, are an important part of the referral”.

“By having this kind of immediate and personalized access to leading-edge medicine we’re able to provide a higher level of care for patients on a local level. If patients have to be transferred, they’ve already had an introduction to the specialist who will be providing their care, so the whole experience is much more familiar.”

Riverside’s Telestroke Program
Along with consultations with specialists, telemedicine offers residents of smaller communities an important emergency capability. For example, neurologists and neurosurgeons at Riverside Regional Medical Center have joined with physicians at Riverside Tappahannock Hospital and Riverside Walter Reed Hospital to develop the first “telestroke” program in the Hampton Roads, Middle Peninsula, and Northern Neck communities.

As soon as a possible stroke patient arrives at either hospital, a Riverside neurologist in Newport News is alerted and quickly initiates a teleconferencing link to the emergency department in Tappahannock or Gloucester. Through the technology in place between the two locations, the neurologist can examine the patient remotely and then provide treatment recommendations.

Riverside’s Telehealth Program Manager, Christy Helsel, RN, BSN, views this aspect of telemedicine as a new and potentially life-saving resource in the battle against stroke.

“When individuals with signs and symptoms of stroke come to the emergency department at a smaller Riverside facility we immediately set in motion what we call a brain attack alert. The local physician and the remote specialist then work together to decide, after reviewing medical records and diagnostic tests, whether the patient can be treated on site or should be transported to Riverside Regional Medical Center, usually by our LifeEvac helicopter”.

“What telemedicine provides, particularly in a medical emergency like stroke where advanced care can mean a better patient outcome, is a major health benefit for people living in smaller communities. It also means that as a healthcare provider for a large geographic area of our state, Riverside can provide the same high level and evidence-based care for people across the entire health system”.

The Present and Future of Telemedicine
Although the future of telemedicine holds considerable promise, Wanda Miller, DNP, RN, CENP, the Director of Nursing and Patient Care Services at Riverside Tappahannock Hospital, is quick to point out that many of the technology’s benefits are available to the community right now.

We’re using telemedicine to improve patient care in such areas as neurology, dermatology, wound care and geriatric psychiatry, and we’re developing a program for pediatric trauma. We’re also using the technology for the transfers we make to The Orchard, our assisted living and specialized care facility in Warsaw.

“Historically, the transitions across the continuum of care, the ‘handoffs’ between departments and facilities, have been a challenging part of providing effective care. In the case of moving patients from acute care to skilled rehabilitation, telemedicine enables us to bring in all of the care providers remotely to help smooth out the transition”.

“Equally important it helps patients stay closely involved in their own care process. By creating a face-to-face environment between patients, families and care providers we provide an opportunity to ask and answer questions as well as a chance for patients to feel more familiar and confident in their new setting”.

“Regarding the future, we anticipate – and relatively shortly – an increased use of telemedicine in psychiatry and behavioral health and emergency services and critical care, as well as some areas that aren’t even on the radar at the present time. Our expectation is that the current applications for telemedicine will continue to expand over time and provide even more benefits in patient care”.

The Best of Both Worlds for Rural Living
Telemedicine has already demonstrated the ability to improve patient outcomes, increase access to care and even lower the costs of healthcare delivery, features that put it squarely in the realm of true healthcare reform.
As part of its commitment to telemedicine, its general role in the future of healthcare and its specific potential to improve health and quality of life for people living in rural areas, Riverside maintains 21 mobile telemedicine sites within the health system.

The realities of healthcare are such that certain physician specialists and subspecialists are far more likely to be practicing in geographic areas where the population is larger and more concentrated.

Simply put, telemedicine makes it possible to bring people to these specialists in a convenient, clinically effective and cost effective way. For people living in communities in the Middle Peninsula and Northern Neck, the result is the ability to enjoy the many features and amenities  of smaller-town life while still maintaining a viable and growing link to advanced medicine.

For more information about Riverside and its telemedicine services, visit riversideonline.com/telemedicine.