Monday, Aug. 17, 2015 | 2 a.m.
Keeping patients local
The law requires doctors who use telehealth to have a Nevada license if they manage or direct a patient’s care. If they don’t, they may consult on cases, but they can’t order treatments or prescribe medications. Physicians had worried a telehealth expansion would allow people to bypass local doctors, said Bell Welch, president and CEO of the Nevada Hospital Association.
Once a year, Bell Welch would pile his family of four into the car, drive four-plus hours west from Reno and spend the night in the Bay Area. It was the only way his young son, who’d had a brain tumor surgically removed, could be treated for his ongoing seizures.
The sole purpose of the two-day trip, which cost the family upwards of $800 with a hotel, food and gas, was a 30-minute appointment with a specialist at Stanford Medical Center. But it was necessary because Reno didn’t have a doctor who specialized in the care Welch’s son needed.
“It was a big hassle,” said Welch, president and CEO of the Nevada Hospital Association.
Welch’s son, now 19, attends college in the Bay Area, which has minimized some of the logistical challenges, but countless other Nevadans still travel long distances to visit medical specialists. That may begin to change.
A bill signed into law by Gov. Brian Sandoval aims to expand telehealth, a method of delivering medical care that connects doctors and patients electronically. The law mandates that insurance companies and government programs offer parity in funding between traditional modes of delivering medicine and health care delivered electronically. Although it’s most widely used to improve health care in rural areas, health officials say the technology could be leveraged to reduce local inefficiencies, provide care to prisoners and prevent residents from traveling out of state for care.
Telehealth consultations typically occur through two-way video systems — one set up in a physician’s office, the other in a remote clinic, where nurses or other medical professionals assist patients. Telemedicine also is growing rapidly to include smartphones and other wireless tools that can communicate health information, such as vital signs and patient records.
The American Telemedicine Association estimates there are 200 telehealth networks and 3,500 service sites nationally. Experts say Nevada is a perfect landscape for the technology because of the state’s physician shortage and its vast, unpopulated areas.
“Telehealth is a vehicle to address the medical needs of the state,” Welch said.
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Renown Health, a health system in Reno that includes a hospital, was one of the state pioneers in adopting telehealth. The service began three years ago to improve care while keeping costs down, said Kirk Gillis, vice president for accountable care. Renown’s telehealth network now offers primary, specialty, acute and transitional care, in addition to health and wellness programs such as support groups and remote monitoring, one of the fastest-growing telehealth applications. Patients with congestive heart failure, chronic obstructive pulmonary disease and diabetes can take home digital scales connected to a Bluetooth device and transmit their vital signs and weight without multiple in-person appointments.
“You’ll never hear me say telehealth is as good as an in-person visit, but if you don’t have access to health care services, then it’s a heck of a lot better than going without those services,” Gillis said.
Though the scale of telehealth is new, the system has deep roots in the state.
The Nevada Office of Rural Health developed a telehealth program more than 20 years ago to connect rural sites using telephones, mail and fax machines. The program grew to include video conferencing between specialists and rural patients.
Four years ago, the VA Southern Nevada Healthcare System launched “teleretinal” medicine at four primary-care clinics. Technicians take photos of patients’ eyes and forward them to the optometry department, streamlining the process in hopes of early detection.
The Cleveland Clinic Lou Ruvo Center for Brain Health uses telehealth technology to serve patients in rural parts of the state.
“We’re a tremendous proponent of it,” Associate Director Charles Bernick said. “We’re so glad the state has an interest in it.”
And Southwest Medical Associates operates “NowClinic,” which allows patients insured by Health Plan of Nevada and Sierra Health and Life to participate in virtual appointments for nonemergency conditions such as allergies, urinary tract infections and bronchitis.
Launched in January 2014, NowClinic logged 5,000 virtual appointments in its first year; this year, the virtual clinic is on track to more than double that, said Dr. Robert McBeath, president of Optum Care Nevada, the parent company of Southwest Medical Associates.
The average wait time at NowClinic is four minutes, and most virtual visits are completed within eight minutes, McBeath said. If a prescription is needed, the doctor can send it electronically to the patient’s pharmacy.
“We view it as another access point to medical care,” he said. “It promises to be highly effective.”
The company also expects to end the year with more than 80,000 e-visits, secure email exchanges between physicians and patients.
Telehealth technology — once considered a challenge — improves every year, making virtual care even more feasible. Basic telehealth systems require a high-speed Internet connection and computer and video equipment that cost about $25,000, Welch said.
The Nevada Hospital Association received a federal grant to connect Elko, Ely, Reno and Las Vegas with broadband, Welch said. About two-thirds of the work is done, with the full project slated for completion by Aug. 31.
“There’s a lot going on,” Gillis said. “It’s exciting.”
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Telehealth also can help populations that are difficult to treat.
Renown Health partners with the Nevada Department of Corrections to use telehealth for HIV and hepatitis C programs in state prisons. A nurse in a remote prison presents the patient via video feed to a physician in Reno, who can review lab work, talk to the inmate and prescribe medication. The setup prevents prison officials from having to make costly trips transporting inmates to hospitals several hours away.
Renown also has found telehealth technology useful with mentally ill patients who wind up in hospitals temporarily because they are deemed a risk to themselves or others. The technology can connect the patients with psychiatrists and judges quickly, eliminating delays, unnecessary transports and duplicate evaluations, Gillis said.
As it becomes more widespread, telehealth could transform medicine in Nevada and the rest of the nation. Gillis envisions telehealth eventually being the conduit for patients, physicians, pharmacists, social workers and case managers to stay in touch.
“As telehealth technology gets faster, better and cheaper, this is going to be the way the entire care team interacts with patients,” Gillis said.