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Alabama Telehealth Project Focuses on Home Dialysis Patients

In a state where telehealth has been slow to catch on (or be reimbursed), a video visit platform could open the doors to expanded services and support.

- Roughly a dozen home dialysis patients in Alabama now have their monthly checkups via telehealth, thanks to a partnership between the University of Alabama at Birmingham School of Medicine and the Alabama Department of Public Health.

The pilot program, launched in March and funded by Baxter Healthcare, hopes to eventually serve 40 patients through community health clinics scattered across the state. It’s an important project in a state that – unlike most of its neighbors – doesn’t have a health insurance parity law in place, thus severely limiting reimbursable telehealth services.

Via a telemedicine cart, nephrologists can have a face-to-face visit with a patient via video feed, checking for signs of infection, dehydration or swelling. There’s a Bluetooth-enabled stethoscope available to listen to the patient’s lungs and heart, and an on-site nurse can draw blood samples.

The ADHP began laying the groundwork for a telehealth system in 2015, working with UAB to connect county health clinics around the decidedly rural state. Roughly half a dozen clinics now have access to telemedicine carts, and 10 clinics are telemedicine-ready, with 15 more scheduled to come online by the end of this year.

“We want our county health departments to be a neutral point of entry so patients can come into our facilities and receive services via telehealth facilitated by our nurse and social work staff with specialists around the state,” Michael Smith, the ADHP’s director of telemedicine, said in a story supplied by UAB. “We are breaking new ground in supporting those who are interested and have the support system for home dialysis. Our cooperative agreement with UAB’s School of Medicine is a great partnership to further develop our telemedicine network. It’s actually a model that’s been well-established nationwide.” 

The UAB project is reportedly the first in the country to focus on home dialysis patients, many of whom live hundreds of miles from their nephrologists.

“This pilot program … is really three years in the making,” said Eric Wallace, MD, an assistant professor of medicine at UAB and one of the nephrologists providing telehealth services. “(W)hat these dialysis visits mean for Alabama is what I’m most excited about. If I can provide a fully comprehensive telehealth visit for a home dialysis patient — which is one of the most complicated visits to do — then I can do this for any patient and virtually any disease. It means that the subspecialty and super subspecialty care that may only be available in a university setting, such as rare diseases, can now be extended to every corner of Alabama, thus increasing the quality of care of patients in Alabama. The gaps in care and education that telehealth can bridge are tremendous and incredibly needed in Alabama.” 

“There are so many patients in our state who have little to no access to subspecialty care like nephrology and have limited access to home dialysis care, and that’s the reason we are doing this,” said Wallace, who estimates a quarter of his patients have to drive an hour or more to see him. “As soon as telehealth carts are deployed, UAB physicians could get to any county in the state. My goal is to have some traditional clinics where I’m in my clinic office, and then connect to ‘be in’ several county health departments seeing other patients with telehealth. You could be in multiple places within a normal half day of clinic.” 

While Alabama has traditionally lagged behind much of the country in telehealth resources, according to report cards issued by the American Telemedicine Association, that’s slowly changing. In December 2015, Blue Cross Blue Shield of Alabama opened the doors to reimbursement for telehealth services in behavioral health, infectious diseases, neurological conditions (such as stroke), cardiology and dermatology.

State and UAB officials are hoping this partnership will expand those options.

“With UAB and the ADPH, you have two of the largest healthcare providers in the state working together for one common goal — to improve the health of the residents of Alabama,” UAB Health System CEO Will Ferniany said in the press release. “The examples of what telehealth can achieve for Alabamians are limitless. The real question is how we organize it in Alabama so it can be successful.” 

Early on, the telemedicine carts were used to provide care for HIV and AIDS patients and those needing behavioral health services. Smith, of the ADPH, sees those services expanding.

“With a counseling visit, you don’t need any peripheral clinical equipment like a stethoscope, handheld exam camera or ultrasound,” he said. “And counseling on a broad spectrum is possible — not just mental health counseling. Genetic counseling, diabetes education, weight management and other routine consultations are all possible. And clinical services including maternity care, diabetic retinopathy screening, oral health screenings — there are many, many healthcare services that can be facilitated and provided with telemedicine that would provide opportunities for those that wouldn’t otherwise see a doctor or a specialist.” 

Dig Deeper:

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