[nursebedlam]

Sun, May 30, 2004

Patients dial up doctors from afar

By Kyle Gearhart
Wausau Daily Herald
kgearhar@wdhprint.com

Patients in rural communities don't need to travel to neighboring cities to receive specialty health care. Marshfield Clinic has technology that does the traveling for them.

When 36-year-old diabetes patient Mary Hall of the town of Weyerhaeuser visits her physician every three months, she heads to the Ladysmith Center 15 miles away. Sixty miles south, her endocrinologist heads to his office at the Eau Claire clinic, sits down at his computer and dials up Ladysmith over a secure, internal high-speed Internet connection.
Hall is able to see and hear her physician through a television monitor. Through video cameras, microphones, digital medical equipment and Marshfield Clinic's electronic records, the physician has access to Hall's medical records, any tests she's been given, and the help of a nurse in Ladysmith to do the face-to-face and hands-on examinations that are needed.

It's a convenience for Hall, who doesn't have to spend hours traveling to receive specialty care, and it improves care by allowing specialists to see patients who sometimes won't visit a doctor because of the distance and time it takes.

"I'm about a hour and a half from the clinic in Eau Claire," Hall said. "I have to take half-day off to go to Eau Claire. Here I can just zip over and be home in about an hour."
The Marshfield Clinic Telehealth Network started in late 1997 with a grant from the federal Office of Rural Health Policy. Since then, the program has expanded from seven clinical services and a few clinics and physicians to more than 35 services, 60 specialty physicians and at least 25 of Marshfield Clinic's 41 sites.
Telehealth has a broad definition, from a simple phone call to the more sophisticated interactions now being done by Marshfield Clinic.

The Ladysmith Center, where Hall goes to see her physician, has a separate exam room with a hand-held camera, video monitor on which the patient can see the physician, a digital stethoscope that transmits sound to the physician and an odoscope with a camera to examine a patient's ear, nose or mouth.
The Ladysmith Center, Marshfield Clinic's busiest telehealth center, serves between 60 to 100 patients a month. Patients in Ladysmith can receive specialty services that include burn management, psychiatry, dermatology, neurology, research oncology, occupational medicine and nutrition services.

"It's a question of how to get services out to them," said Nina Antoniotti, manager of the clinic's telehealth network. "If you can't get them out there in person, you can get them out there by telehealth. It's never intended to replace services already on site. It's to augment and strengthen services in those towns."
To help facilitate interaction between the patient and physician, a nurse is always present in the exam room during a telehealth visit. By handling the camera, the electronic stethoscope and odoscope, the nurse in some ways is the eyes and ears of the physician. If a physician needs to see a wound or lesion close up, the nurse uses the camera to get a close-up view. The physician can also create a still photo from the video exam to get a closer and steadier look at a patient's ear, throat or wound.

"It takes good communication and collaboration because I'm working with 10 physicians a day," said Anita Polecek, a registered nurse who handles most of the telehealth exams at Ladysmith Center. "Part of my role is to get all the ducks in a row - with the fax, phone and video equipment."
Polecek's role is instrumental for a successful examination. Physicians like Dr. Erik Stratman, a dermatologist at Marshfield Clinic-Marshfield Center, wouldn't be able to see as many patients without her or the telehealth equipment.
"There's definitely a patient population out there that deserves and needs subspecialty care that for some reason is unable to make the trip (to Marshfield)," Stratman said. "For some patients it's insurmountable. Whether they are old or blind, there are impediments to travel.
"That's where I see the role of teledermatology. I think that it allows access to care for patients who otherwise wouldn't get it."
Stratman sees between two and four patients a week by telehealth. His office, with six dermatologists, sets aside a few days each week for telemedicine patients. And he's confident in the care his patients receive.

"I've seen studies on how well a doctor diagnoses a condition first with teledermatology and then in person," Stratman said. "The concurrence of opinions is very high. If I see patient in person, I know I won't need to change my mind. For me that makes it good care."
Hall, the patient, agrees. She had her first telehealth visit with an OB/GYN about two years ago when she was pregnant with her son Sam. Those visits took place once every three weeks. She now uses telehealth once every three months to see her endocrinologist about her diabetes.

"The first time I did it, it was kind of weird because the doctor wasn't right there," she said. "You're a little nervous. But now I think it's great.

"I'm kind of in the boondocks where I'm at. If I have to travel to either Eau Claire or to Marshfield it makes for a long day."


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