Telehealth Expands Health Care in Rural Areas

Tele-ed example

Providing patients access to care in rural or understaffed areas of New Hampshire and Vermont can be challenging, but D-HH’s commitment to telehealth services is helping to address that challenge. Telehealth services are improving patient access and outcomes, while keeping patient care local. Mary Oseid, vice president of Regional and System Integration, and Kevin Curtis, MD, MS, medical director of Connected Care, are working in partnership to lead D-HH’s telehealth services. D-HH Connections spoke with them about telehealth and the impact it is having on the future of health care.

What is telehealth?

Mary Oseid: Telehealth is a group of services where a clinician is providing clinical care to a patient in a remote location, either through video, text, voice, or email. This can be very simple or very complex, from iPads on a stand to computer carts to the more complex system in TeleICU, where every bed in a remote location is wired to provide both video and monitoring capability.

Dr. Kevin Curtis: There are varying opinions about the difference between telehealth and telemedicine. In my mind, telemedicine is a live, interactive audio visual interaction that includes elements of consultation, diagnosis and/or care over a secure platform. Telehealth is that and more, and can include remote patient monitoring, store-and-forward image review and consultation, education such as Project ECHO, which links expert specialist teams at an academic hub with primary care clinicians in local communities, and mHealth smart phone and smart watch apps that can involve a clinician or be self-directed.

Can you provide an example of D-HH’s telehealth services in action?

Oseid: In TeleED, if a patient is in crisis, the bedside team requests assistance by pressing a button, and a board-certified physician or nurse is connected remotely to provide consultation. This gives the bedside team an extra set of hands to do things like documenting for nurses or assigning tasks. It also provides an extra set of eyes. For example, with TeleICU, we are monitoring patients 24/7 and notifying the bedside team when needed. We can keep that patient in their local hospital, and it also helps hospitals address the rural health crisis, because patients can stay in their own community for care.

Curtis: For TeleNeurology, from the patient’s standpoint, if you come into an Emergency Department with signs and symptoms that suggest a stroke, the local team can immediately bring a telehealth cart into the room and contact a tele-neurologist. CT scan results can be sent to the neurologist for review, and the neurologist can be involved in the decision about whether to administer tPA (the clot busting medication used for some stroke patients). Because of this, we are seeing community hospitals that are using tele-neurologists to administer tPA at the same rate as stroke specialty centers.

How do patients react to telehealth services? 

Oseid: Appointments go much like they do in person, except that they are handled remotely. Data shows that patients nationally are accepting of the concept and like remote care. Once they experience it, they want to do it more, because it is convenient and they have greater access to care.

Curtis: Telemedicine is at an exponential growth point.The technology has caught up and there is such a familiarity with things like FaceTime (a video product that allows people to talk face-to-face via computers or smartphones) that to mimic it now in the medical space is making sense to both patients and providers. As one example, at Cedarcrest Center in Keene, children with a variety of medical and developmental conditions visit with pediatric specialists via our TeleSpeciality service. Without telemedicine, a child at Cedarcrest has to take a long van ride up to DHMC, which is quite stressful for the child and takes two staff members away from the facility. TeleSpecialty also allows the clinicians to evaluate children in their normal environment. The Cedarcrest staff have been incredibly positive about the experience.

How is telehealth impacting the future of health care?

Mary Oseid
Mary Oseid

Oseid: I think we are increasingly going to see that there is growth in remote care. Patients will be expecting care in their homes and communities. There will be a continuum of care where you can see your doctor in a clinic, a hospital, in surgery or remotely on your phone or computer. This will continue to drive down costs and improve outcomes. Once people adopt it and accept it, it could become part of our standard of care.

Curtis: I believe telehealth will be such an integral part of achieving the right care for patients that it will no longer be thought of as unique. Patients will access optimal care independent of location, and it may outpace traditional care. We pay a lot of attention to how we are achieving the health outcomes that matter to patients, and how we can get the same outcomes at the same or lower cost.

How will it improve health care delivery to rural populations?

Oseid: First, I think telehealth allows patients to stay local and get their care closer to home. This improves outcomes. For example, stroke victims can get immediate care, and have a shorter hospital stay. It also helps support infrastructure for hospitals that have difficulty in recruiting doctors. So, telehealth keeps patients local, improves outcomes, drives down costs and improves access and convenience for patients.

Kevin Curtis
Kevin Curtis, MD

Curtis: Fifty percent of the hospitals in northern New England are critical access hospitals. They provide truly outstanding care but tend to be smaller, rural and under-resourced. We partner with them in the telehealth space, and have our specialists bring their expertise to those communities enhancing the experience for patients, families and local clinicians.

What are the most important reasons for supporting and expanding telehealth services?

Oseid: Part of our D-HH Strategic Plan is our commitment to rural health. Telehealth absolutely supports that and is a big part of what we are accomplishing. We are also committed to improving access, and this is another way to provide patients with more convenient care and access. We are focused on workforce development, and this provides a mechanism to make the best use of our workforce. And as always, we are committed to improving quality, improving outcomes and reducing the time patients are in the hospital. This is really the underpinning of what we are trying to accomplish—getting patients the best care possible.

Curtis: Access and convenience are huge benefits. Telehealth also meets all three aspects of Triple Aim: of improving the quality of health care, enhancing the patient and family experience and reducing costs. Our approach is to focus on the care first and the technology later. We first ask about what gaps in care delivery exist, then we identify which of those gaps telemedicine might help solve, we design the approach and then we wrap technology around it. If we are successful, patients are not even focused on the telehealth piece, they just see it as part of their care.