Telemedicine gives rural doctors immediate access to help

Nursing Director Patty Frohreich
Nursing Director Patty Frohreich stands in the emergency room of Lakewood Health Center in Baudette. She's talking with Dr. Garrett Taylor, left on the television screen, and registered nurse Becky Vandekeift, who work at Avera Health system's e-Emergency center in Sioux Falls, SD. The telemedicine service provides assistance to the hospital's small staff.
MPR Photo/Tom Robertson

Advances in technology and changes in public policy are paving the way for an explosion of growth in the telemedicine industry, delivering health care to rural Minnesota.

One example is in the small Minnesota town of Baudette on the Canadian border. The emergency room staffers there now have immediate access to a roster of medical specialists who can help from hundreds of miles away.

Lakewood Health Center in Baudette is the city's only access to emergency care. It's small, with only two doctors and a nurse practitioner on staff. They and a team of on-call nurses respond to emergencies as they arise.

But for the past year, the Lakewood Health Center has had many more medical experts at its disposal. Nursing Director Patty Frohreich said when things get hectic in the emergency room, staff can tap the help of experienced doctors and nurses at a call center in Sioux Falls, S.D.

"All I have to do is push this button on the red emergency box," Frohreich said.

The service called e-Emergency is part of a range of telemedicine services provided by the Sioux Falls-based Avera Health system. When the call is answered, a high-definition television screen pops on above one of the emergency bays. Registered Nurse Becky Vandekeift in Sioux Falls can remotely control a wall-mounted camera, capable of zooming in on patients, as well as IV pumps, cardiac machines and other monitoring equipment.

The connection to Baudette's ER means doctors in Sioux Falls can assist with diagnosing and treating patients. Sioux Falls nurses can keep track of the time between certain medications, or can arrange transport to a larger hospital, if needed.

"A lot of these small facilities may not even have a physician working. It might be a nurse practitioner right out of school..."

Avera Health officials say their eEmergency Service costs subscribers between $40,000 and $80,000 annually, depending on volume. The service has been used by the hospital in Baudette only 14 times in the past year, but it has provided critical help in a few life-saving situations. Frohreich said on several occasions it has eliminated the need to transfer patients to larger hospitals hundreds of miles away.

"If we can keep a couple of patients at home per month and avoid an unnecessary transfer, that's going to support the ongoing program," Frohreich said. "It's a service that we welcome in our emergency room.*"*

Avera's e-Emergency Service is now in 62 hospitals across the upper Midwest. By next month there will be 16 Minnesota hospitals connected.

Dr. Garrett Taylor, at the hub in Sioux Falls, said e-Emergency means small hospitals can provide better medical care without hiring more staff.

"A lot of these small facilities may not even have a physician working. It might be a nurse practitioner right out of school, for example," Taylor said. "They can use my expertise working in a busy ER and busy trauma center, where I see things quite frequently that somebody in a smaller community might not see more than once a year."

Avera's telemedicine reach into Minnesota has grown since it began in 2007. In Minnesota alone, Avera now has nine ePharmacy sites. In addition to supporting emergency room service, there are three Minnesota health facilities that use Avera to support their intensive care units. The not-for-profit company will soon launch a similar service for long-term care facilities.

Dr. Donald Kosiak, who directs all of Avera's telemedicine services, said increasing use of technology fits well with national health reform goals. For example, he says, data show that in just over three years, the e-Emergency service has saved nearly $4 million by reducing medical transfer costs.

"Telemedicine across the country and across the world is really hitting its tipping point," Kosiak said. "This will be the way that rural medicine is practiced 10 years from now. It will be, I think, a standard that you'll see across the country and across the world."


Industry analysts project rapid growth in the multibillion-dollar telemedicine industry, partly fueled by advancements in mobile devices like smartphones and tablets.

Dr. Douglas Smith, a family physician in Plymouth, Minn., is the chief medical officer for a growing Miami-based company called Consult A Doctor. The company operates a network of more than 300 physicians available around the clock for medical consultations over telephone or via videoconference on a computer or handheld device. Those doctors can even write basic prescriptions for patients, Smith said.

"The mobile revolution has changed how this can be delivered," Smith said.

He said there have been more than 200,000 consultations since the program was launched in 2006. Most of Consult A Doctor's business comes from about 1,500 companies that use it as a way to reduce costs for self-insured health plans. But some group health plans, hospitals and insurance companies are also signing on.

New services like Consult A Doctor allow people to skip an office visit and connect directly to a doctor for routine ailments like sore throats, sinus infections and others that don't require a face-to-face diagnosis. Smart devices make that much easier, Smith said.

"The idea that you can get an almost-crystal clear image of someone's rash when they're sitting up at their cabin and you're sitting up at your cabin — and you can make a medical diagnosis based on that — is a revolution," Smith said.

Skeptics of online consultation worry that doctors could misdiagnose illnesses by not seeing patients face-to-face. Supporters of the service say telemedicine works well for routine cases and gives consumers broader access to health care.

Jon Linkous, CEO of the Washington, D.C.-based American Telemedicine Association, said said some people oppose online consultation because it's new.

"I think there's a lot of fear. There's fear of the unknown for the folks who just don't want to do something different. And yes, there is fear of competition, because telemedicine could provide competition," Linkous said. "And by the way, I think it's a great thing for consumers, because you're not limited to just seeing one doctor. You could choose from many different doctors and many different specialists, no matter where you're located."

The industry is waiting for public policy to catch up to technology, so that telemed doctors can get fully reimbursed for remote care, Linkous said.

Minnesota is among at least 13 states in the country that have passed laws requiring that providers get paid the same for virtual consultations as they do for in-office visits.