By Jennifer Parks
Access to health care has traditionally been a problem for rural areas where specialists, or even primary care doctors, are harder to find than in urban areas. Some living outside major cities may rarely see a doctor.
To help close in the gap, there is a concept gaining ground in the health care industry that is meant to, in the long-run, reduce costs and provide more convenience and greater access — telemedicine.
Telemedicine, or telehealth, is considered to be a growing part of the national health care landscape. It may be of particular benefit in Georgia, which ranks 40th in the nation when it comes to an ideal spread of physicians by specialty and geographic location.
Phoebe Putney Health System is starting to a platform for telemedicine. At the employee health clinic at Phoebe Putney Memorial Hospital, officials are planning to go live with a pilot program this week to offer acute care to employees and their families at Phoebe Worth Medical Center and Phoebe Sumter Medical Center facilities via telehealth.
After the six-month pilot is over, the plan is to establish a presence in various medical specialties that ultimately serves the entire region so that the rural area the health system serves can have better overall access to care.
One example of that might be a family who needs access to a pediatric specialist based in Atlanta. “An individual can come into the Phoebe Putney site and (see) a specialist in Atlanta,” said Will Peterson, assistant vice president of human resources at Phoebe Putney Memorial Hospital.
Phoebe Putney Memorial Hospital will be the sole site initially, with others to possibly follow later. Meanwhile, officials at Phoebe are looking at how to mirror a paramedicine initiative Georgia Partnership for Telehealth (GPT) is involved with that allows an emergency medical technician to go to a patient and connect with a provider while still on-site.
The idea behind the GPT intiative is to help patients while also avoiding a trip to the hospital that might not be needed, thereby cutting cuts and wait times.
“We can use the ER as it was originally intended,” said Michelle Collins, family nurse practitioner and manager of the Phoebe Employee Health Acute Care Clinic.
Systems can be taken in the home for those too sick to leave, making health care more mobile.
“In general, it makes for a more healthy community … a more productive society in general,” Collins said.
An added benefit is economic in nature, since increased access to care means more work productivity. Major employers in the area might benefit from having a set-up on-site, both Collins and Peterson said.
“In terms of being underserved, it provides us a platform to pull us out of that,” Peterson said. “The community concept is untapped opportunity. I can see telehealth set up in every school in the region.
“There is no resource that is inaccessible. There is really no limit to how far this thing can reach … The overarching goal is quality of life.”
On the note of how it could change the health care landscape, Collins said, “It’s just a different way of seeing your doctor. It’s just a different way of getting the care you need.”
The value comes in a number of different forms. “There is access, quality and cost, all of which are positively impacted,” Peterson said.
While not meant to treat everything, it is considered a good tool. The equipment Collins said she gets to use will allow her to see a lesion better than if she looked at it in person. She will get to hear heart and lung sounds, and will even be able to see a heart rhythm.
“It is forever evolving, and only going to get better,” she said.
Another telehealth platform is active through Blue Cross Blue Shield of Georgia (BCBSGa), which is offering a program known as LiveHealth Online that allows plan members to access doctors using their smart phone, tablet or computer and have a live video visit with a U.S.-based, board certified doctor of their choice — based on gender and/or educational background who are licensed to practice in the state the patient is in — to discuss non-emergency health issues from wherever they happen to be with internet access.
Doctors using LiveHealth Online can provide a diagnosis, treatment and a prescription if needed.
Dr. Mia Finkelston, based out of Maryland, uses the system to serve patients from most areas on the East Coast — including Georgia — and part of the Midwest who, for one reason or another, do not have immediate access to a brick-and-mortar health care setting.
“It helps to get their questions answered,” she said. “They may just need to ask questions. Access is a big benefit of telemedicine.
“If we make people realize it is available … it would be a convenience for them.”
Coming from a rural area, Finkelston was able to empathize with those who feel like it would be cumbersome to travel a distance from their home to see a doctor. If a telemedicine system is usable, she said a patient living in a rural area can call from home or get assistance from a family member in establishing a connection.
During those visits, there is often more to offer than a diagnosis. It might also be a good time, or perhaps the only time, to discuss preventative measures, such as immunizations and mammograms.
“It’s an opportunity for a doctor to give patient education … I try to add a patient education tidbit in every visit,” the Maryland doctor said.
Finkelston said when she is going into a session with a patient, she attempts to connect immediately and read through the information the patient has provided. she looks at any previous sessions the patient has had before meeting face-to-face and works in an icebreaker before her opening questions.
“All the time, I am observing them,” she said. “Where are they? How do they look? It’s important to know how the patient feels. I ask about medical allergies, past medical history and if they have a doctor.
“I don’t want to replace their doctor. I want to work with the medical team.”
Depending on the complaint, Finkelston may ask the patient to move closer to the microphone or camera to see or hear something better. She may also walk through how to feel for a lymph node that is swollen. If a prescription is necessary, the patient can get connected to a pharmacy nearby — and the doctor can generate a sick note.
Lori McLaughlin, spokeswoman for LiveHealth Online, said as people become more aware of the quality and benefits involved, more may come on board.
“The year 2014 was the year of awareness, and 2015 is the year of adoption,” she said. “We are seeing a huge uptick of telemedicine in all states.”
Finkelston went so far as to say that there was not much point in not embracing it, also adding that it is not meant to take away from the physical setting of a doctor’s office.
“Doctors who use this service are going to get better and better,” she said. “There are elderly who have caretakers who work. So may have smartphones that it’s like having a doctor in your back pocket. They can call on their lunch break or in the car.
“It will never replace doctors’ offices. Nobody in the service would underscore (physical offices). It is really part of the medical home. It is no different than what I did in the brick and mortar world.”
She encourages those hesitant to try it to give it a chance once.
“Try it … go ahead and try it and see if you find it useful,” she said. “See for yourself.”
LiveHealth Online has expanded to the majority of BCBSGa health plan customers, including health exchange members. For eligible members, a LiveHealth Online visit costs the same or less than a primary care office visit. Consumers who do not have BCBSGa as a health plan can also use LiveHealth Online by signing up and paying for the visit with a credit card.
As part of the effort to continue building on the presence of telehealth, GPT announced last month the offering of telehealth training via three web-based telemedicine certification courses through the National School of Applied Telehealth (NSAT), which GPT officials say was formed as part of an educational outreach program between GPT, the Southeastern Telehealth Resource Center, HomeTown Health University and the California Telehealth Resource Center.
The goal is to prepare individuals to become valuable members of their telehealth team. The specialty courses include Certified Telemedicine Clinical Presenter, Certified Telehealth Coordinator and Certified Telehealth Liaison.
“GPT is proud to contribute to the curriculums for these comprehensive certification courses,” said Sherrie Williams, executive director of GPT in a statement following the announcement. “There is a need for more telehealth professionals right now and that need is only going to increase as new technology and awareness of telemedicine’s effectiveness continues to grow. We are confident that these courses will adequately prepare students for a career in a telemedicine support role.”
Each certification program costs $249 to enroll. Interested parties can begin the certification by visiting www.nationalschoolofappliedtelehealth.org.
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