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Telemedicine Supports Rural Patients at Providence Valdez Medical Center

March 20, 2017, by Tabitha Gregory, Chief Customer Relations Officer, Copper Valley Telecom

I set out on a frigid day in mid-December to discover the extent to which telemedical resources are available and in use in our region. For the past year, as I've attended telecommunications industry meetings, the word "telemedicine" keeps surfacing. I've learned about various types of equipment, devices, software, and web-based services that have been popping up around the U.S. In some cases, these services are deployed directly to individuals and at other times, doctors equip their patients with devices. In other situations, doctors themselves use technology to communicate or send data to other doctors for advice and collaboration. The plethora of examples are wide-ranging and seem endless, and I was curious to learn how far telemedicine has penetrated rural Alaska – especially this corner of Alaska where Copper Valley Telecom does business.

To help me answer this question, Jeremy O'Neil agreed to meet me at his office in the Providence Valdez Medical Center. O'Neil, the hospital's administrator, is a native Alaskan from Fairbanks with a law degree, an MBA, and a CPA. His hospital focusses on emergency and secondary care and is operated by the Providence Health & Services system. It is one of several remote Alaska hospitals connected operationally and virtually to Anchorage's Providence Alaska Medical Center. The Anchorage location is home to numerous specialties including a neonatal unit, heart and cancer centers, surgical and diagnostics, imaging, and mental health and substance abuse counseling.

I joined O'Neil in his office and explained my interest in telemedicine. Immediately, he began sharing with me the varied ways in which Providence Valdez is using tech to improve and expand options for people who live in Valdez. Did I want to see some of these tools, he queried? Of course I did! He guided me down the hall and into the counseling center, then into a bright room decorated with attractive artwork and furnished with an overstuffed easy chair facing a flat screen television. Upon closer examination, I saw that the television was equipped with a webcam and speakers. O'Neil told me that this equipment enables a client to meet via video conference with a counselor in Anchorage. He said some residents prefer to work with staff who are less known than, say, a counselor who might live in Valdez. This option has proven valuable and gives residents additional ways to secure mental health service. O'Neil expects that his institution will soon offer services of a remote psychiatrist who could potentially prescribe medications and make diagnoses in this new virtual setting.

According to numerous sources, mental health care readily lends itself to tele-delivery. In a study conducted on this subject by the law firm Epstein, Becker, and Green[1], the authors report that one reason is that providers rely on verbal interactions and visual cues – perfect for video calls. Additionally, the authors state that the stigma of seeking this type of care is partially mitigated by distance and anonymity. As I considered the set up at Providence, it occurred to me that another reason remote mental health service is such a natural fit for rural locations is that the technology is low tech – most people use televisions and video cameras in their own homes and this type of gear requires little IT support.

We left the counseling center and walked down a corridor to the busy nursing station. Staff members buzzed around reviewing charts and coordinating schedules. O'Neil pointed out a monitor that, he said, churns out real-time vitals data from patients currently inhabiting the hospital beds and then transmits the data via a high speed broadband pipe to an Anchorage data center where a trained medical technologist monitors patients for alarming events or trends. This frees up local staff to provide direct patient care.

This type of provider-to-provider support is a key trend within the telemedicine field. The American Telemedicine Association reports that, currently, telemedicine is more often implemented in this type of setting[2] than administered directly to patients. Across the country in rural areas, it is difficult for medical providers to hire enough staff, let alone specialized staff, to perform all levels and types of care. Sharing knowledge and a central data center among several remote locations – Seward, Valdez, Kodiak – makes sense to me. It could enable quicker and earlier detection of issues, and thus, one might extrapolate – an improvement in the quality of healthcare available way out here in an isolated oceanfront town nestled among towering mountains.

I saw another example of similar remote monitoring capabilities in a vacant patient room. A neat white cart stood on high alert at the foot of the hospital bed. It was the E-ICU (Electronic Intensive Care Unit) cart, O'Neil informed me. This cart is a high tech all-in-one monitoring, video-conferencing, data transmission machine. Sensors transmit heart, lung, and other physical activity to providers in Anchorage. When needed, a local nurse or doctor may connect directly via video conference to a provider in Anchorage who can see and speak with the patient and on-site healthcare provider, evaluate the patient's vital signs, and help provide care.

The stroke cart is another highly specialized piece of connected medical equipment. O'Neil told me that stroke care is extremely time sensitive and quick diagnosis can make a big difference in the patient's recovery. The stroke cart is used when a patient exhibits stroke-like symptoms. Using the cart's technological tools, the local healthcare provider and the patient may interact directly through video with a stroke specialist in Anchorage. Records and notes may be exchanged and a treatment plan established. According to the American Telemedicine Association, "telestroke" units like this are being used in many hospitals across the country and are showing much promise for preventing long term disability[3].

In 2016, I heard Jennifer Dittes, CEO of Hope Family Health in rural Tennessee, speak to an audience attending a national broadband carrier conference. She told us that, as a whole, rural Americans have higher mortality rates, lower life expectancy, more difficulty accessing healthcare, and higher levels of certain chronic medical conditions. She emphasized the value of and potential for telemedical delivery to help reverse these trends. From what I saw on my visit to Providence Valdez, our community is moving forward along that path to more immediate and accessible care, and thus, possibly toward improved health.

  1. [1] 50-State Survey of Telmental/Telebehavioral Health (2016). Epstein Becker Green. Quashie, Rene Y and Lerman, Amy F. http://psychology.ohio.gov/Portals/0/MISC%20PDFs/EPSTEIN-BECKER-GREEN-50-STATE-TELEMENTAL-HEALTH-SURVEY.pdf.
  2. [2] Jonathan Linkouse, CEO, American Telemedicine Association. Presentation during ATA Fall Forum, September 16, 2015.
  3. [3] Jonathan Linkouse, CEO, American Telemedicine Association. Presentation during ATA Fall Forum, September 16, 2015.

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