Video Dial-a-Doctor Seen Easing Shortage in Rural U.S.

Until recently, when children in Ware County, Georgia, needed to see a pediatrician or a specialist, getting to the nearest doctor could entail a four- hour drive up Interstate 75 to Atlanta.

Now, there’s another option. As part of a state-wide initiative, the rural county has installed videoconferencing equipment at all 10 of its schools to give its 5,782 students one-on-one access to physicians. Telemedicine sites for adults have also sprung in the area. Instead of taking a full day off from work or school, residents can now regularly see their specialist online.

The program places Georgia among a half-dozen U.S. states turning to telemedicine to address a shortage of doctors in rural areas, a gap the Obama administration has said is a serious health-care shortcoming. At the same time, it is allowing companies such as medical provider Sentara Healthcare and MDLive, a remote technology developer, to get a toehold in a new and growing market.

“As we’re looking toward the future, everybody knows the system is strained,” said Kenneth Krakaur, senior vice president of Norfolk, Virginia-based Sentara, which has joined with MDLive, of Sunrise, Florida, to provide remote care to more than 2 million people in the Southeast. “We live in a ‘there’s an app for that’ kind of society, so this fits well.”

Health Law
While about a quarter of Americans live in rural areas, only 9 percent of doctors work there, according to the nonprofit National Rural Health Association. And within just 16 months, the 2010 U.S. health-care law will start adding as many as 15 million more people to health insurance rolls, further taxing already spotty care.

That’s important in rural areas where residents are about 4 percentage points more likely to be uninsured than in cities, according to data compiled by the health association. They’re also more likely to carry higher rates of chronic diseases — including diabetes, arthritis and bronchitis — that are best handled by medical specialists, the group said.

The U.S. Department of Health and Human Services has determined that more than three-quarters of rural communities in the U.S. have fewer than one physician serving every 3,500 residents, a figure the agency has tagged as the minimum number for “adequate” care.

Those figures primarily focus on the availability of primary-care doctors, though they also reflect a shortage of medical specialists, said Maggie Elehwany, vice president of government affairs for the National Rural Health Association, based in Kansas City, Missouri.

‘Great Promise’
“There’s virtually little or no specialty care at all right now in many rural areas across the country,” Elehwany said in a telephone interview. While the U.S. is trying to increase the numbers of doctors by providing grants and programs designed to entice doctors to live in these communities, “we see great promise for telemedicine,” she said.

The market for telemedicine systems and software is expected to increase to $2.5 billion by 2018 from $736 million last year, according to WinterGreen Research.

While residents in places like Ware County, about 200 miles (321 kilometers) south of Atlanta, have access to nearby doctors and emergency care, it doesn’t always help them deal with medical issues that are more chronic, requiring regular visits with specialists, said Jeffrey Kesler, chief operations officer with the Georgia Partnership for TeleHealth.

Now, with the advent of of telemedicine, “a child can be seen, assessed, diagnosed and treated within 30 minutes” by a specialist, Kesler said in a telephone interview.

Statewide System
The Georgia initiative is also placing telemedicine equipment in clinics, prisons and churches across the state to provide help to adults. Similar programs exist in Alaska, Hawaii and North and South Dakota.

One use is evaluating stroke patients, Kesler said. A neurologist must determine if someone suffering from a stroke needs medicine within the first few hours of the event to prevent long-term disability. Without the telemedicine centers that have been placed at many local emergency clinics, rural patients wouldn’t be able to have the evaluation, he said.

“It’s life changing — you’re looking at a person who could live the rest of their life in a nursing home, or skilled nursing, versus somebody who will live a functional life,” Kesler said.

Companies see opportunities as well. Sentara announced on Aug. 20 that it will work with the technology company MDLive to market telemedicine services from the nonprofit health group’s 10 acute-care hospitals and other facilities in Virginia.

Service Fee
Patients can access doctors to diagnose non-severe issues, such as allergies, pink eye and urinary tract infections through the Internet, according to MDLive’s website. The system then will pass prescriptions along electronically to a pharmacy.

The program can provide medical care to those without a doctor nearby and, at the same time, be a time saver for other patients, said Sentara’s Krakaur in a telephone interview.

“We have an aging population, and each physician visit is a little longer than when they were younger,” he said. “There are a wide range of conditions that don’t require hands-on care from a physician.”

No one suggests doing away with doctor visits. Telemedicine advocates say the systems offer a level of convenience that often helps patients and doctors, said Seth Bokser, health sciences associate clinical professor at the University of California, San Francisco.

Skype for Doctors
“In many cases, virtual interaction doesn’t substitute for personal interaction,” Bokser said in an interview. “But in the same way a grandparent keeps up with their grandchild on Skype, virtual interaction can be a real enhancement to a patient-doctor relationship.”

For patients, this can mean avoiding waiting months to see a specialist, and for doctors, it could let them check in more frequently on a home-bound client, he said.

“More and more, patients are become consumers, and I think that convenience for patients matters in many cases,” Bokser said. “We can meet consumer demand and also provide the right level of care at the right time, which often is the most efficient and effective way to provide care.”

Georgia patients have interacted with doctors remotely through the system about 40,000 times so far, a number that’s expected to quadruple next year, according to Paula Guy, chief executive officer for the Georgia Partnership.

Video Visit
Patients using the system sit in front of mobile carts that are fitted with screens and speakers, Guy said in a telephone interview. The carts also carry stethoscopes and other devices for examinations that are carried out by local nurses. More than 185 doctors in the state work with the system, providing consultations on 40 different specialties.

The growth of these systems have been spurred by an increase in broadband availability, a reduction in cost for the technology and supportive insurance reimbursement rules for doctors, according to Thomas Nesbitt, the associate vice chancellor for strategic technologies and alliances at the University of California, Davis.

In 1996, the school’s first telemedicine unit cost about $100,000. “Now you can get the same quality for $5,000 to $7,000,” Nesbitt said.

Putting telemedicine in schools and walk-in clinics makes perfect sense, said Debra Lister, 61, medical director of the Coffee Regional Medical Center in Douglas, Georgia.

“In the very beginning most of the ones we did, oddly enough, involved dermatology,” said Lister, whose clinic began offering telemedicine about six years ago. “Now, most of what we do is child psychiatry.”

Lynn Rivers, the nursing coordinator for the Ware County Board of Education, says telemedicine offers a double benefit. Students get the medical care they need, and they don’t miss school to do it, she said.

An added bonus is that the students can see themselves on the screens, along with their doctors. “They love it,” Rivers said. “To see themselves on TV? Oh wow.”

This article originally appeared in the September 5, 2012 online edition of Bloomberg.

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