Telemedicine’s Increasing Role in Rural Healthcare on Arkansas Medical News Inc.

Telemedicine’s Increasing Role in Rural Healthcare

By: BECKY GILLETTE

Dr. Curtis Lowery, who heads the UAMS Center for Distance Medicine, is shown providing virtual consultation on an ultrasound being administered by nurse Mandi Dixon to an OB\GYN patient while her husband watches.

The rural nature of much of Arkansas means that specialists are out of physical reach for many residents, particularly in emergencies. But now telemedicine programs that provide “virtual” consultations using computers with two-way video cameras for the specialists to talk with patients and healthcare providers at rural hospitals are helping provide better medical care that can save lives.

Telemedicine in Arkansas has gotten a huge boost this year with a $102 million stimulus act grant to the University of Arkansas for Medical Sciences (UAMS) to establish or upgrade broadband connections at 474 healthcare and education sites. The grant, one of the largest ever received by an Arkansas institution, will be matched by $26 million provided by UAMS and its partners.

“Arkansas is about to have one of the most connected healthcare systems in the nation,” said Rick Wade, senior advisor and deputy chief of staff at the U.S. Department of Commerce. “This grant represents an investment that will pay dividends for generations, but there’s no dollar figure for the lives saved, the new educational opportunities and the overall quality-of-life benefits this will bring to the people of Arkansas.”

The grant will extend broadband to all two-year colleges and some libraries in the state, as well as 81 hospitals, all state human development centers, the state’s trauma network, community health centers, mental health clinics and home health agencies.

Curtis Lowery, MD, director of the UAMS Center for Distance Health, said they have been doing telemedicine consultations in Arkansas now for six years. The consultations are done over T1 lines, a fiber optic line that can carry about 60 times more data than a normal residential line.

Lowery, who is also chairman of the OB\GYN department at UAMS, said the larger data capacity is necessary for telemedicine because the Internet goes up and down in terms of bandwidth utilization. The T1 lines guarantee the quality of service needed for large bandwidth utilization needs such as real-time ultrasound tests.

Through the Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS) program, specialists provide OB\GYN virtual exams to high-risk pregnant women in rural areas, often allowing the women to deliver where they live rather than coming to UAMS in Little Rock.

“If mothers who have health problems deteriorate, or if the fetus needs surgery, we bring them here,” Lowery said. “But, in many cases, they never come to the university.”

UAMS is expanding the telemedicine model to include many disciplines. Lowery said the most important services to deliver involve critical, acute needs where decisions have to be made rapidly such as with strokes. Arkansas SAVES (Stroke Assistance Through Virtual Emergency Support) provides stroke specialists for consultation 24 hours per day, seven days a week. Real-time video communication, combined with the ability to view diagnostic tools like CAT scans, enables a neurologist to quickly determine such measures as administering tPA within the critical window of time after a stroke.
Treatment can prevent death and improve the odds for stroke recovery, which is particularly important because Arkansas leads the nation in stroke mortality.

“I strongly believe Arkansas SAVES has accomplished a lot of things since its inception,” said Salah Keyrouz, MD, a UAMS stroke neurologist and neurointensivist, and the Arkansas SAVES medical director. “We started November 2008, and are coming up on the two-year anniversary. Before we had this program, a lot of patients were not receiving tPA when it could have been of benefit. Very few hospitals had stroke neurologists willing to give tPA…. What the program did was extend the services of the few state’s stroke neurologists through live video conferencing to those patients.”

Keyrouz estimates 70 patients have received tPA since the program began. Currently 22 hospitals have a “virtual” stroke neurologist on hand for timely consultations.

“We examine patients with the help of the nurse or physician at other end,” he said. “I can talk to the patient live through a camera and see them on the screen. The diagnosis of stroke is made clinically. A lot of time they can speak, and contribute to their health history. Administering the drug can have huge consequences down the road with those who receive treatment being much more likely to regain mobility and be able to go back to being productive citizens.”

Iva Sikes, 89, Mena, had a stroke this past summer that resulted in paralysis on the left side of her body. Keyrouz provided a virtual consultation that determined Sikes was a good candidate for tPA.

“This is a lady who was independent, going about her activities and enjoying life,” Keyrouz said. "Without the medication, there was a very big possibility that she would live the rest of her life paralyzed, not feeling anything on her left side and with slurred speech.”

Sikes had a remarkable recovery that probably wouldn’t have been possible without SAVES. Sikes was surprised by her recovery and grateful for the technology that helped save her.

“It's just so wonderful, I'd like to tell the world,” she said.

Similar telemedicine procedures are being used around the state in other areas such as emergency care and intensive care.
UAMS has also received a $300,000 grant to support ANGELS program for long-distance, continuing education for rural healthcare professionals who treat high-risk pregnant mothers and newborns.

“We are excited to partner with physicians and nurses at rural hospitals throughout the Delta region,” said UAMS Assistant Professor Sarah Rhoads, a doctor of nursing practice and advanced practice nurse in the College of Medicine’s Department of Obstetrics and Gynecology.

UAMS has also received a $735,000 federal grant to expand its research into the use of telemedicine for cervical colposcopies and biopsies. An estimated 4,500 women over three years will have access to the cervical cancer tests who otherwise would have had difficulty obtaining the services due to travel distance and cost. The telemedicine program enables an OB/GYN at UAMS in Little Rock to oversee the exams and biopsies administered by an advance practice nurse at the remote clinics.

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Secure-Messages Saves Time and Worry

Ever had to wait days to get medical test results that were critically important to you? That can cause stress and anxiety, and it also can be time consuming for physicians and their staff to get in touch with patients to deliver the test results. Confidential information can’t be left as a message on an answering machine or even sent as an e-mail.

A telemedicine company in Little Rock called Secure-Messages has come up with a solution that patients and physicians both find very helpful. When a patient has a test run, they get a phone number to call to get the test results. Staff doesn’t have to waste time playing phone tag with patients, and patients get the test results quickly.

Secure-Messages saves a lot of time and worry, said Secure-Messages co-owner Debra Miller.

“Physicians leave a message patients can retrieve 24 hours per day seven days per week,” Miller said. “It has totally eliminated phone tag. Patients can listen to messages as many times as they want to. If we leave a message for an elderly person, they can have their son or daughter listen and help decipher the information.”

For a major issue, physicians will still talk to patients to give more information. But for routine things like cholesterol and Pap smear test results, the message service is handy for all involved. And it may seem more personal that having the message delivered by a nurse.

“I feel that Secure-Messages gives me the ability to give my patients a personal touch by recording the lab results in my own voice,” said Beth Milligan, MD, Baptist Health Family Clinic, Lakewood.

For more information call 501.831.4514 or visit the website www.veniapartners.com.