Telemedicine soothes rural aches – EMS class, prison-care, pharmacy programs seek to improve care

Sacred Heart Medical Center pharmacist Cliff Richards can discuss prescriptions with Othelllo Community Hospital nurse Rhonda Golladay via the TelePharmacy videoconferencing network.
Sacred Heart Medical Center pharmacist Cliff Richards can discuss prescriptions with Othelllo Community Hospital nurse Rhonda Golladay via the TelePharmacy videoconferencing network.

By Jennifer Hesse

http://spokanejournal.com/spokane_id=article&sub=1966

Northwest TeleHealth, a nonprofit subsidiary of Spokane-based Inland Northwest Health Services, has launched several initiatives aimed at helping rural hospitals and other medical facilities save money and lives with a few clicks of a computer mouse.

INHS, with money from a number of federal grants and a settlement, has spent at least $10 million so far on equipment, technology, and training for its videoconferencing network since launching it in late 1996, says Denny Lordan, a senior TeleHealth consultant. The network, which at first only connected Deaconess Medical Center, Holy Family Hospital, Sacred Heart Medical Center, Valley Hospital & Medical Center, and three rural clinics, now links 51 facilities in Eastern Washington and North Idaho, he says.

INHS handles the collaborative activities of Spokane-based Providence Health Care, which operates Sacred Heart and Holy Family, and Empire Health Services, which runs Deaconess and Valley Hospital.

Three up-and-coming applications of the Northwest TeleHealth network are creating more ways for health-care professionals here to provide specialized care and training to residents and health-care providers in outlying areas, Lordan says.

Those applications include programs that connect corrections facilities, rural Emergency Medical Service providers, and rural hospitals with physicians, educators, and pharmacists here.

“This is providing a way to level the playing field between urban and rural disparities in health care,” Lordan says.

Northwest TeleHealth provides free videoconferencing equipment to medical facilities, which pay only the monthly cost of a high-speed T1 connection. The network links computerized video cameras in hospitals here with those in rural areas, and sends images over the T1 line.

The network can connect up to 46 sites at a time, and dial out to any network that has compatible equipment, Lordan says. Communities linked to the network include Deer Park, Colfax, Colville, Chewelah, Newport, Davenport, Ione, Walla Walla, Wenatchee, Ellensburg, and Clarkston, Wash., and others across the state and in North Idaho.

Northwest TeleHealth has used grant money from federal agencies, including the Office for the Advancement of Telehealth and the Rural Utilities Service, to fund the network’s implementation, he says. In 2000, the nonprofit organization also received a $2.7 million grant from Denver-based Qwest Communications International Inc. as part of a settlement between Qwest and the Washington state Utilities and Transportation Commission over alleged telecommunications overcharges.

Providing care to prisons

Last year, Northwest Telehealth used $50,000 of that Qwest grant money to set up videoconferencing equipment at the Washington State Penitentiary in Walla Walla and at the Coyote Ridge Correction Center, in Connell, Wash., Lordan says. That pilot project, called TeleMedicine, connects medical units at those two correctional facilities with the hospitals in the network to provide inmates with specialized health care, he says.

Darren Chlipala, health-care manager for the penitentiary’s medical unit, says TeleMedicine has helped ease budget constraints for the state Department of Corrections by often eliminating the need to pay for specialists to travel there.

With TeleMedicine, inmates there can talk with doctors in Spokane, including dermatologists who can use the camera to zoom in on the patients’ skin, diagnose an ailment, and prescribe a treatment without having to leave the hospital here, he says.

The network also saves the Department of Corrections money by reducing the need to transport inmates out of the prison for health-care visits in downtown Walla Walla or elsewhere, which can be expensive and increase the potential for escapes, Chlipala says.

Because federal law demands that inmates receive health care, they can sue correctional facilities if they don’t receive it, Lordan says. Since TeleMedicine helps the state provide medical attention in a timely manner, it has the potential to reduce lawsuits, he says.

Chlipala says the penitentiary still must transport some inmates for surgical procedures that only can be performed outside of the prison.

Routine checkups through TeleMedicine, for example, are helping the Walla Walla penitentiary health unit care for the 26 individuals out of the roughly 2,000-inmate prison population who have diabetes, Chlipala says.

The penitentiary health unit recently set up a three-week TeleMedicine class for those inmates to teach them about diabetes and how it can be managed, Chlipala says. The class should help potential diabetic complications that could arise without proper medical attention, he says.

Such an educational approach also could help a large number of inmates who have Hepatitis C, hypertension, or other chronic illnesses in addition to problems stemming from their drug addictions and unhealthy past lifestyles, Chlipala says. Improving chronic conditions might save money for the penitentiary and ultimately, the taxpayers, who pay for inmates’ health care, he says.

Other correctional facilities throughout the country also are using videoconferencing technology to provide inmates with health care, and the U.S. military similarly is linking troops stationed abroad with physicians at naval medical centers in the U.S., he says.

After examining the results from the pilot projects at Walla Walla and Coyote Ridge, Northwest TeleHealth might expand TeleMedicine to correctional facilities statewide, Chlipala says. Also, the penitentiary health unit soon could use the network to connect inmates with mental-health professionals in Spokane because of the hefty demand for mental-health services among the inmate population, he says.

Chlipala says he hopes the videoconferencing technology will become an integral part of correctional facilities’ daily operations.

“As more institutions within the Department of Corrections come online, the greater the benefit in cost savings will be for the state as a whole,” he asserts.

In pursuit of other ways to reduce expenses, Northwest TeleHealth last year launched a program called EMS Live at Night, which offers rural EMS providers training from professionals here.

Northwest TeleHealth identified the need for the training sessions when rural EMS providers asked the Spokane County EMS & Trauma Care Council to give a presentation on methamphetamines, because they increasingly had been encountering problems associated with that drug, Lordan says.

Since Northwest TeleHealth already had established the videoconferencing equipment at a number of rural locations by then, it simply announced the date of the EMS training talk show and broadcasted the program, Lordan says. About 188 people at 21 different hospitals participated in that session, and nearly 900 people have participated in the monthly teleconference training sessions.

The free program potentially could save money for the emergency-care providers, more than 90 percent of whom are volunteers, Lordan says. Similar training provided through the network, such as an 8-hour basic emergency-nursing course for 10 nurses in Seattle, can save hospitals about $5,000 per session, he says.

Michael Day, one of the EMS Live at Night instructors, says the program gives EMS providers current training in an ever-changing field that requires updated education for EMS personnel to receive and keep their licenses.

“This is providing a regular, routine avenue for high-level education that otherwise would be difficult if not impossible for them to obtain,” he says.

Day is an outreach educator and clinical nurse specialist for Northwest MedStar, a Spokane-based division of INHS that offers critical-care air-transport service and operates satellite helicopter bases in Moses Lake and the Tri-Cities. He says that training from experienced professionals in Spokane helps make rural EMS providers more comfortable handling certain types of injuries.

The videoconferencing technology allows EMS Live at Night viewers and presenters to interact, Day says. Videoconferencing discussions have shown differences in medical problems throughout the state, such as blunt traumas arising primarily from farming accidents in Colfax as opposed to injuries in mining or logging accidents in Republic, he says.

Day says he and other presenters have discussed current information related to triage, hazardous-materials management, head and spine trauma, and other emergency-related topics.

“You need up-to-date information so that when a life-threatening emergency is in place, you do the proper thing to make sure the person stays alive,” he says.

Dr. James Nania, emergency room director at Deaconess and medical director of Spokane County EMS, says he hopes EMS Live at Night will gain enough participants to attract EMS product manufacturers as sponsors. Those manufacturers, who make and sell products such as defibrillators, might pay for commercial spots or other promotions to be aired during the training, which perhaps could make the courses self-sustaining, he says.

Nania oversees another TeleHealth program, called TeleER, which connects emergency rooms in Republic and Newport and the Mount Spokane ski patrol to the emergency room at Deaconess. That program, launched in 2002, has enabled physicians here to diagnose and initiate treatment for patients.

This June, Northwest TeleHealth plans to start a pilot project that will install video technology equipment in ambulances and critical-care aircraft here, connecting those transportation units with the ER at Deaconess, Nania says.

Filling pharmacist needs

Lordan says another Northwest TeleHealth program that recently received about $750,000 in federal money, TelePharmacy, also has started to take off.

TelePharmacy uses videoconferencing and other technology to connect hospitals in Othello, Chewelah, and Davenport with Sacred Heart’s pharmacy. The program enables those small hospitals, which don’t have enough money to hire pharmacists, to fill prescriptions for patients there by being in contact with Sacred Heart’s pharmacy, Lordan says.

Larry Bettesworth, director of Sacred Heart’s pharmacy, says that TelePharmacy models the Spokane hospital’s system for filling prescriptions.

In that system, a pharmacist at Sacred Heart compares a physician’s written prescription order with a copy of that prescription scanned by nurses when the order is made, and enters the prescription into the computer system to access the patient’s laboratory results and other information. The pharmacist then reviews the dosage and drug interactions, and completes the order entry in the computer.

After that, in the Sacred Heart system, a nurse accesses the approved prescription by swiping an identification card and typing a password into an ATM-like machine that dispenses medications. The nurse enters the patient’s name and selects the appropriate drug, which causes the machine to open the drawer containing that drug automatically.

TelePharmacy works the same way, except that the doctor who writes the prescription and the nurse who obtains the designated drug both are located in Othello, Chewelah, or Davenport, Bettesworth says.

TelePharmacy also enables the rural hospitals to refill the dispensing machines with medications, Bettesworth says. Through the videoconferencing network, pharmacists at Sacred Heart can watch nurses at those hospitals refill the drawers to ensure the accuracy of the drugs’ placement, he says.

The Washington state Board of Pharmacy approved that refill method in cases in which hospitals don’t have on-site access to pharmacists, he says.

That review process might help reduce medication errors at small rural hospitals, Bettesworth says. Those errors can be costly—about $4,700 per patient visit as indicated by some studies, he says.

TelePharmacy also eliminates the need to hire pharmacists at rural hospitals, which have difficulty recruiting pharmacists, Bettesworth says.

Covering a full-time pharmacy requires the equivalent of 3.5 pharmacists, who can earn about $100,000 a year, costing a hospital at least $350,000 a year, he says. Small rural hospitals can contract with Sacred Heart’s pharmacy through TelePharmacy for about one-fifth of that amount, he says.

TelePharmacy is one of the first such networks in the U.S., Bettesworth claims, and Northwest TeleHealth hopes to add two more hospitals to the network by mid-summer.