Telemedicine – Bringing Medical Specialists to a Neighborhood Near You

by Marcia Simon, APR

Note: a version of this post originally appeared in Strategic Health Care Marketing.

Gundersen Health System is rooted in a main hospital campus in La Crosse, Wisconsin, even though most patients live at least 25 miles away in rural or suburban areas.

The potential of telemedicine was an exciting prospect for Gundersen well before participating physicians understood how it worked and how it enhanced the practice of medicine. We’re talking about provider-initiated telemedicine here. With this model, a physician, PA or APRN requiring further expertise connects digitally with a specialist or subspecialist who can consult, observe and diagnose remotely, and prepare for a patient’s arrival if transfer is necessary. R

Not surprisingly, many physicians were slow to get onboard with the concept. Not every doctor wanted to do it. Some were not comfortable with the technology; others were concerned that something might go wrong when clinical care was time-sensitive. Another concern was payment parity, allowing physicians to charge the same for telemedicine and in-person consultations. Even today, reimbursement varies state by state.

“There was a lack of understanding of what the technology can do,” said Kimberly Hable, BSN, RN, referral relations and outreach development representative at Gundersen Health System. “Neurologists and emergency physicians had the perception that telemedicine would slow the process of getting immediate medical care to an acute stroke patient. In fact, when a stroke occurs and the individual is taken to the closest facility, telemedicine allows that patient to be seen by a triage team for a full assessment at the receiving hospital and a top stroke neurologist remotely.” Transfer is not always necessary when a telemed stroke intervention is done at the receiving hospital.

“In the event that a patient does require transfer, the neurologist has already seen the patient once, has seen all the charts, and talked with the family, which is important, especially if the patient has become nonverbal and consent is required for procedures,” explained Jessica Easterday, BSN, RN, program manager for Telemedicine at Gundersen Health System. Using EMR (electronic medical records), such as Epic, a specialist can see a patient‘s records instantly, add information in real time, and share with other providers immediately.

Today’s New Comfort Level

When a snowstorm rapidly dumped 12 inches of snow across the region, patients started to call to cancel appointments. The physicians’ office knew it could easily take up to six months to reschedule all those cancellations. Telemedicine made it possible to keep a good amount of the originally scheduled appointments, which was a welcome arrangement to both the patients and the physician.

Today’s new generation of med school graduates is comfortable with digital health, and once “old-schoolers” have a positive experience with the system, they realize how beneficial it is to their practice.

Gundersen’s telemedicine program now connects 41 subspecialties to the hospital’s 27 regional community clinics, seven critical access partners plus post-acute care facilities. Staffing all these locations with specialists and subspecialists 24/7 is not possible, but around-the-clock access is enabled through Gundersen’s telemedicine strategy for delivering care close to home for patients and their families.

The most active specialties in the program are Behavioral Health, Psychiatry, Hematology/Oncology, Nephrology and Cardiology. This may seem surprising, but it makes sense because telemedicine is most heavily used by patients who require management of chronic diseases, and by individuals who need frequent and routine follow-up appointments with a specialist and don’t have one nearby. Many routine follow up visits to review blood work, for example, can easily be very effective using using a telehealth platform.

Why Patients Like It

Think about a palliative care patient who has to travel a long distance to see a doctor, or a patient with COPD who gets winded just walking to her car. Some patients are simply too sick to make a two-hour car ride to see a specialist for a follow-up visit.

“It’s not unusual for someone with a chronic illness to see as many as four different specialists every month. Missing work or school to travel 100 miles for a follow-up visit with a subspecialist increases both financial and emotional stress. As an example, with telemedicine we can gather an interpreter, gastroenterologist and nutritionist to consult with a patient close to home,” explained Easterday.

Preparing Physicians and Inviting Communities

“Some specialists who join our system come from academic environments and are not familiar with working in rural areas,” said Hable. “Some are not comfortable being on-camera, or without the physical touch of an assessment. We train new doctors in face-to-face contact and how to address the camera.” Telemedicine etiquette is important and has become part of Gundersen’s physician training, according to Easterday.

The hospital’s seamless procedure for new physicians who want to participate in the program begins with initial orientation, one-on-one training, mock sessions, and then shoulder-side support when the doctor is ready for the first actual patient sessions.A

Among the earliest stages of preparation was choosing a HIPAA-compliant software platform and justifying the initial investment of the telemedicine “cart.” This cart supplies the transmitting location with a high-resolution screen, camera and a myriad of peripheral devices and attachments including a hand camera, stethoscope and monitoring equipment to share vital information about conditions such as cardiac irregularities, edema in lower extremities and skin lesions. Physicians can hear breath and lung sounds and observe use of specialty-specific diagnostic tools. Although the majority of Gundersen’s telemedicine visits are for follow up visits, the Emergency Department and hospital-based programs see many new patients as well.

Both Easterday and Hable are registered nurses with acute care and ambulatory care clinical experience. They view telemedicine as one more tool that allows hospitals to provide a high level of patient care – as close to home as possible.

Telemedicine has paid off for Gundersen Health System and its patients, the majority of which live in suburban and rural areas bordering the three-state service area. It allows providers to expand their services beyond the system’s traditional geographic area; the capability positions Gundersen as a healthcare system embracing technology for excellence in patient care.

Marcia Simon, APR, writes about health care, medical issues and wellness. As principal of MSE Public Relations, she manages content, strategic communication and media relations for hospitals and digital health clients. Connect at marcia@mseusa.com or LinkedIn.com/in/marciasimon.