Telemedicine, the use of telecommunication to provide healthcare at a distance, is one of the fastest growing areas of medicine in the country, and Arizona is a leader in the nation for the number and variety of national awards for telemedicine programs. Changing economic incentives for care value, rather than volume, are driving more investment in these programs that provide patient care without the cost and risk of travel and hospital admissions.
Remote healthcare is particularly well suited to serve Northern Arizona’s vast rural expanses. Flagstaff Medical Center (FMC) serves close to 50,000 square miles, much of it rural. Even for individuals not living in remote areas, mobile health will soon be part of their everyday healthcare experience.
Telemedicine in Flagstaff
North Country HealthCare’s telemedicine program is four-and-a-half years old and was initially used to connect providers between its 12 satellite locations. According to Greg Hales, telehealth manager at North Country, they currently have more than 20 telemedicine units in rural clinics, which support telemedicine programs in Hepatitis C, HIV/AIDS and dermatology. Primary care, tele-nutrition and tele-cardiology programs are currently in development.
Hales has been with North Country for three-and-a-half years and he is an evangelist for telemedicine. “These programs save time and huge amounts of money for patients, doctors and the state, and are kinder to the environment. We use the best technology available to support the highest level of care.”
FMC’s Care Beyond Walls and Wires groundbreaking program uses advanced 3G wireless technology, smartphones and health-monitoring devices to enhance the care of heart failure patients by putting health monitoring and reporting at their fingertips. “This kind of mobile technology can play an important role in healthcare,” said Gigi Sorenson, M.S.N., director of telemedicine at FMC, “particularly for the constant management chronic diseases require.”
Access to Specialists
FMC also has tele-stroke and tele-neurology programs, which allow their physicians to have 24-hour access to stroke and neurology specialists at the Mayo Clinic in Phoenix. “These are super-specialists,” said Sorenson. “We have expert doctors at FMC, but it’s great for our doctors to have super–specialty validation in these areas.” Sorenson said it takes FMC an average of only five minutes to have one of these specialists on the line. “Our physicians are very supportive of these programs,” she said.
Mobile Healthcare and Patient Investment
Apple’s App Store currently has more than 350,000 health applications available to download. Joan Moss, leader of future-focused planning and strategic operations at Sg2, a healthcare intelligence firm, claimed that healthcare applications for smartphones like those developed by WellDoc, a firm which creates mobile apps including DiabetesManager, will be even more common in the future. “Patients as well as care providers will be using mobile technology applications more and more,” Moss said.
“Patient engagement is key in the new healthcare climate, which puts a premium on value-based care,” said Moss. “Mobile care promotes patient investment in their own healthcare, which is cost efficient and promotes better outcomes.”
In relation to FMC’s Care Beyond Walls and Wires program, Sorenson explained “mobile medicine can bring patients closer to their healthcare providers while empowering them to have better control over their well being. Care Beyond Walls and Wires is just a jumping off point to what we hope to accomplish in the future with mobile healthcare.”
Telemedicine and Behavioral Health
Nancy Rowe, director of telemedicine for Northern Arizona Regional Behavioral Health Authority (NARBHA), said they have been serving seriously mentally ill patients and AHCCCS patients in five Northern Arizona counties since 1996. NARBHA is a member of the Arizona Telemedicine Program (ATP), based out of the University of Arizona College of Medicine and partnering with many healthcare organizations statewide. North Country and FMC are also members of ATP.
“We have provided more than 75,000 doctor-to-patient sessions,” said Rowe. “Tele-psychiatry is very sustainable. We save taxpayer dollars while helping more patients.” Both Rowe and Hales reported tele-psychiatry has very high levels of patient satisfaction and that many patients prefer tele-sessions to in-person visits. Rowe explained that the technology also makes it possible for rural patients to get crisis consults almost instantly.
On the Horizon
North Country HealthCare is currently building a mobile medical unit (MMU) that will staff a nurse practitioner. This MMU will have two exam rooms and be equipped with wireless telemedicine technology for consults with physicians. For now, the unit will provide school-based health services to four FUSD schools, including Killip, Kinsey, Project New Start and Thomas. North Country is scheduled to take possession of this unit on July 1 with the hope of debuting it in the downtown 4th of July Parade this year.
FMC also has a behavioral health telemedicine program that’s about to go live by the end of June. “We’ll soon be offering tele-conferences with some of our rural patients’ families and caregivers before they are discharged from in-patient care at FMC,” said Sorenson.
FMC was excited to report that they recently received a $124,000 grant from the USDA to supply five rural sites, including Supai, located at the bottom of the Grand Canyon, with state-of-the-art telemedicine carts. These carts will allow FMC’s cardiologists and pulmonologists to partner with providers in the rural locations to provide specialty care.
“FMC, North Country HealthCare and NAHRBA all collaborate about telemedicine to share information and provide support,” said Sorenson. Although not all of them could be discussed yet, Sorenson, Hales and Rowe all reported many exciting new telemedicine programs are currently in development. Sometime soon, many Northern Arizonans will use technologies like two-way video for health consults, tele-health monitoring devices after a hospital discharge and smartphone apps to track chronic diseases.