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Taking Telehealth to Rural America

Telehealth programs in remote parts of Georgia, where the only medical care may be found in ambulances and small clinics, show the true value of mobile health platforms.

By Eric Wicklund

- In a remote part of Georgia where healthcare is only found in the local ambulance service or community center, a new telehealth project is looking to take hold.

The Hancock County Healthcare Access Initiative aims to equip staff at the Community Health Systems clinic in Sparta with telehealth kits. Residents would then be able to dial a toll-free number, and a nurse would visit the caller’s home in a WiFi-enabled van to conduct a virtual visit.

“It’s a way to bring some healthcare to people who don’t often see it, but who do need it” says Dr. Jean Sumner, dean of the Mercer University School of Medicine in Macon and a doctor for more than 25 years in some of the most rural communities in the state.

Sumner, who’s spearheading this project with help from Navicent Health and Putnam General Hospital, is also using a USDA grant to launch a second telehealth project in neighboring Twiggs County, where the local ambulance is the only point of healthcare contact for many residents. That project would equip EMTs with telehealth kits.

“It’s little bitty steps, but we’re chipping away at the big block,” says Mercer, a telehealth advocate for more than two decades and frequent collaborator with the nationally recognized Georgia Partnership for Telehealth. “In these areas, you need to figure out what you have, and then work with it.”

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Developed roughly one year ago, the Hancock County plan originally envisioned equipping ambulance personnel with telehealth kits, and even allowing them to make house calls when requested. But Sumner said disputes between the ambulance company and county officials scuttled that plan.

Officials are now working with the Community Health Care Systems clinic – a federally qualified health center and one of 12 clinics run by CHCS in 12 Georgia counties – to create a sort of telehealth center, equipped with what the local newspaper calls “whiz-bang medical technology.”

“We’ve already kind of tested it on a small scale, but I expect it will roll out to some of our other communities,” Carla Belcher, the organization’s CEO, recently told the Macon Telegraph. “We just have to find a way to extend access in rural areas.”

That access is crucial in rural Georgia, where the nearest hospital may be 50 miles away, health clinics offer limited hours and many residents are poor, dealing with chronic health concerns and have limited access to transportation – taxis are rare, and it might take a few weeks to arrange a ride to a health center. That puts the pressure on ambulance services, who have found that almost 70 percent of the 911 calls they receive are for non-emergency health concerns.

Ironically, Georgia is one of the shining stars in the national telehealth movement, thanks in no small part to the Atlanta-based GPT and the Southeastern Telehealth Resource Center. Telehealth programs around the state and in partnerships with neighboring states bring the platform into schools and senior and assisted living complexes and create “hub and spoke” models of delivery that enable smaller, more rural hospitals to access telestroke, ICU and specialist services from larger institutions.

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In addition, recognizing that in some remote regions the only form of healthcare comes in the ambulance, state officials this past April enacted legislation that designates the ambulance a telehealth delivery site, enabling those services to bill Medicaid for telehealth services.

But not all projects have been successful. Sumner said she was once part of a $500,000 rural telehealth project that placed a telehealth cart – “like a Coke machine with a TV screen” – in the middle of one of the state’s most remote counties.

“We spent a lot of money on technology that was a nice idea,’ she recalls, “but I needed help. This wasn’t giving us the quality healthcare we needed.”

Sumner says too many telehealth projects fail because they substitute technology for quality, and expect clinicians and patients to adapt to processes and platforms that they’ve never seen or used before. Sometimes the simplest tools – like a small tablet or laptop that offer a video link to a doctor – offer the best results.

They’re also the least expensive, an important consideration in a poor region with few resources to spare.

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These communities have “got to be willing to accept the healthcare that can be provided to them,” State Sen. David Lucas, D-Macon, a supporter of the Hancock County program, told the Macon Telegraph. “Because in most rural communities, they don’t have the sales tax base or the businesses to support having a hospital.”

Sumner is a passionate advocate for telehealth, and hopes to incorporate the platform into clinical skills training at Mercer. She expects big things from the technology and the future, and a change in how the nation sees it.

“In the future, I feel you’re going to have (a telehealth platform) in your kitchen,” she says. “And we’re going to change the way we define it. It will just be healthcare.”

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