Telemedicine extends healthcare to rural patients

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SALEM, Ohio — A doctor’s appointment, particularly with a specialist, can mean long hours of driving and sitting in waiting rooms. But a new telemedicine program through the Butler Health System in western Pennsylvania is giving patients more free time and less wait time.

Telemedicine visits — where patients meet with doctors via a computer video connection instead of in person — allow patients to cut down on the lost time by staying closer to home.

Just getting started

First in Ohio
Marietta Memorial Hospital also received a $185,791 grant in 2016 to provide telemedicine services in southeastern Ohio and in northwestern West Virginia, the first telemedicine system in the region.

In September 2016, Butler Health System received a $137,755 grant from the U.S. Department of Agriculture’s rural development branch to begin a telemedicine program.

The grant, along with the hospital’s matching funds, were used to purchase telemedicine equipment and begin conducting telemedicine appointments.

Dr. David Schwartzman, a cardiologist who specializes in electrical disorders and had experience with telemedicine from his work at the University of Pittsburgh Medical Center, is the first doctor to use the program.

Schwartzman said an example of the type of patient he might see would be an elderly person with a pacemaker. The pacemaker needs to be checked regularly, but this checkup does not necessarily require a face-to-face visit. In many cases, through a telemedicine visit, he can conduct the same visit he would have in person.

Benefits

There are times when it can be difficult for patients to get in contact with a specialist. The hospital’s first telemedicine location, BHS Cardiovascular Center in Seneca, is over an hour-long drive north of Butler Memorial Hospital, where Schwartzman is located.

Patients who live close to Seneca can save more than two hours by using local telemedicine visits instead of driving to Butler to see Schwartzman. For rural patients who are even further from Butler, an in-person visit could take a whole day, between the travel time and the appointment.

According to Schwartzman, the cost for patients, which is largely based on copays, should be about equivalent for in-person and telemedicine visits.

However, due to potential savings on gas, and on the calculated lost productivity costs for patients and their relatives who have to take more time off work to drive to in-person visits, telemedicine could save patients quite a bit.

Nothing lost

Schwartzman feels there are no real down sides to conducting telemedicine visits.

“I don’t think anything substantial is missed by not having physical interaction,” he said.

Some patients do prefer face-to-face visits, and Schwartzman said the patients’ wishes will be respected, but the majority choose to stay close to home when given the opportunity.

“Once this gets out,” Schwartzman said, “it will be a widely subscribed service.”

Use. As of July 27, BHS Cardiovascular Center has hosted three patients for telemedicine visits with Schwartzman, and they are scheduling about one patient per week for future visits.

“I think people are quite satisfied with it, in no small part because they can stay close to home.”

Still, BHS will be tracking the patients’ reactions to the program.

After every visit, they send home an anonymous questionnaire that allows patients to be brutally honest about their experiences with their visits. Schwartzman said they will gauge the reaction to telemedicine visits by watching how telemedicine patients respond in the anonymous questionnaires and comparing that with responses to face-to-face services.

Equipment

The equipment includes mobile video carts, physician video units and educational carts, which allows the specialist and the patient to see and talk to each other from different locations.

Many of the telemedicine visits are centered around asking questions to understand what the patient is experiencing, Schwartzman said.

There are also digital stethoscopes and other medical instruments that allow Schwartzman to conduct physical exams digitally. A nurse or medical assistant helps with telemedicine visits on the patient’s side by controlling the digital stethoscopes and taking vital signs for the specialist and starting the video call.

Doctors

Schwartzman said the telemedicine visits allow him to do more “parallel activity.” He can work in the hospital and “see patients 100 miles away” without leaving the hospital, he said.

While good IT support is important to help with any technological issues, the equipment itself is not difficult to use, and no elaborate training is necessary for doctors to conduct telemedicine visits.

Telemedicine visits can take some getting used to, especially for older doctors who are used to face-to-face appointments, but they are not difficult to conduct, said Schwartzman.

Expanding

The hospital currently offers telemedicine for electrophysiology, Schwartzman’s field, and plans to offer neurosurgery, endocrinology and pulmonology telemedicine services.

BHS Cardiovascular Center is currently the program’s only site, but the hospital plans to expand the program to other sites to be as “close to the homes of as many patients as possible,” said Schwartzman.

According to Schwartzman, it takes courage for a hospital to start telemedicine programs because there are risks that go along with telemedicine, including hacking. But because they can offer more support to patients and help ensure rural patients will get the care they need, Schwartzman believes the benefits outweigh the risks.

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