Rural health: One way around health provider shortage is audio-video hookup
ELY, Minn. — Angie Lundsten was thrilled.
The Hayward, Wis., woman sat in her local medical clinic telling Dr. Stephen Park she had lost 15 pounds in the past month.
"I have struggled with my weight a lot," she said, but after trying two other doctors, she said she is on the right track with Park.
"It was a rough first two weeks because I was getting headaches almost every day," Lundsten told Park. "I kind of tweaked what I was doing and now I feel fine."
Lundsten was 174 miles from Park, who was at a table in the lower level of his rural Ely, Minn., home. If he looked up, he would see a lake surrounded by trees.
But Park was not admiring the view, instead concentrating on one laptop computer showing Lundsten and another with her medical records.
The 42-year-old Lundsten said the video and audio connection worked well for her to visit Park without ether spending hours on the road.
"I wish I had known about this years ago," she said.
Experts say telehealth like Park practices helps fill the need for specialists in rural areas, where medical specialists are in short supply.
Each day, Park sees 12 to 15 patients from Wisconsin to North Dakota while sitting in his Ely home.
Few doctors see practically all patients remotely like Park, but he is in demand in dealing with obesity, one of the country's fastest-growing medical problems.
A report Grand Forks, N.D.-based Altru Health System gave to a June rural health meeting showed that telehealth cut deaths by 45 percent, reduced days in the hospital 25 percent and shrank emergency room admissions 20 percent.
Maureen Ideker, director of Telehealth at Essentia Health who involved in the issue when in the mid-1990s, said little is lost in a video visit.
If a remote provider needs to look into a patient's ear, for example, Ideker said that a worker with the patient can put a scope in the ear and a high definition picture shows up on the remote monitor. A digital stethoscope can be hooked into the system to provide the doctor with the patient's heart sounds, she added.
In dermatology, a scope can look through multiple skin layers, Ideker said. "It is better than the human eye."
A general surgeon in a rural hospital can be in communication with a specialized one elsewhere, getting guidance and reducing the need to ship a patient out of the local hospital.
The emergency room was one of the first places Essentia opted to use telehealth, Ideker said.
With video-aided stroke treatment, she said, it is possible to have a "clot-busting drug administered, if it is appropriate." Sending a patient to a bigger hospital by helicopter could take two hours.
"In stroke care, we say that minutes are brain," Ideker said.
Barb Andreasen of Allina Health said rural residents have a 12 percent higher risk of stroke death than their urban cousins. More than a third of rural Minnesotans live at least an hour away from hospitals designated primary stroke care centers, a time that adds up a death sentence for some.
Most rural areas never have had neurologists who specialize in stroke care, but programs known as telestroke quickly are spreading to rural emergency rooms and intensive care units.
Dr. Sandra Hanon, a stroke neurologist who works for the Allina system in the Twin Cities, is available to 15 hospitals, a number that she expects to grow. Neurologists are available day and night at a moment's notice.
In an interview on the telestroke equipment in Essentia Health-St. Joseph's Medical Center in Brainerd, Hanon said "there was such a huge need. ... It is so time critical."
"This is the only way you can do it right," Hanon said about low-stroke-volume rural hospitals.
Last year, the Brainerd hospital alone treated nearly 200 strokes, according to Nicole Anderson, who directs the facility's telestroke program. With telestroke, patients often are able to go home quicker.
Before telestroke, most stroke patients would be moved elsewhere. Now, Anderson said, only about 20 percent are transferred.
Telehealth is used to some extent by most hospitals and clinics in rural Minnesota, as well as some in urban areas. While most patients must be in a hospital or clinic to use telehealth today, Ideker predicted that before long many will be able to stay at home and use their own computers to connect with remote doctors.
Video is for many
Doctors are far from the only professionals conducting telehealth, also known as telemedicine.
The Minnesota Health Department reports that among those doing the two-way interactive video work are physicians, nurse practitioners, physician assistants, nurse midwives, clinical nurse specialists, registered dietitians, nutrition professionals, dentists, dental hygienists, dental therapists, advanced dental therapists, mental health professionals, pharmacists, certified genetic counselors, podiatrists, speech therapists, physical therapists, occupational therapists and audiologists.
Some emergency rooms have professionals such as nurse practitioners on duty, while connected to emergency doctors elsewhere.
"Health coaches" are seen as an area the telehealth will be used more and more.
Can you hear me?
A fairly new state law requires infants to have a hearing test.
However, audiologists for children are very scarce. So, Maureen Ideker of Essentia Health said, audio-video hookups are an increasingly popular way to do the hearing checks.
"It is the same exact equipment they use if the infant was right in front of the audiologist," she said.