TELEMEDICINE BRINGS SPECIALTY CARE TO HOMETOWN HEALTH CARE
The term ‘telemedicine’ may summon visions of R2D2 in an intergalactic operating room or Star Trek’s Dr. McCoy scanning Captain Kirk with his medical tricorder. Yet, you don’t have to be watching sci-fi to find many northern Michigan patients already benefitting from telemed – with the potential for much more looming on the horizon.
Women with high risk pregnancies in Alpena can now be monitored via real time scanning by a Grand Rapids-based specialist at a Munson Medical Center clinic. The Northern Regional Bleeding Disorder Center connects northern Michigan patients in 26 counties to services in Traverse City as well as hematology specialists in Lansing and Detroit. A Munson-based neonatologist can consult with superspecialists at Devos Children’s Hospital while caring for the region’s tiniest babies. Physicians regularly access radiology systems remotely to view and manipulate scans, while others participate in “skype-like” education and discussions of complex cases with downstate specialists. All are examples of telemedicine already at work in northern Michigan.
Telemedicine – sometimes referred to as telehealth, mHealth or eHealth – is defined as the remote delivery of health care services and clinical information using telecommunications technology. The term includes a wide variety of clinical services via internet, wireless, satellite and telephone media. According to the American Telemedicine Association, close to 15 million people will have care delivered by telemedicine this year.
The benefits are many. Local providers are linked with urban specialists. Patients and families aren’t forced to leave work or home to travel hundreds of miles for care. Rural communities retain access to sophisticated care. Institutions and individuals benefit from cost savings.
Regionally, telemedicine is still in its early stages but offers one more health link among northern Michigan health care providers, patients and community hospitals, regional tertiary hospitals such as Munson Medical Center, and quaternery centers including Spectrum Health System, University of Michigan Health System and other subspecialists and major teaching facilities. Here is a snapshot of telemedicine at work in northern Michigan and a glimpse to the future.
Mothers and Babies
“Our goal is to keep mothers and babies in their communities,” said Russell Jelsema, MD, medical director for maternal fetal medicine and regional service integration at Helen DeVos Children’s Hospital.
Dr. Jelsema began traveling to Traverse City in 1994 to treat local patients with, or at risk for, complicated pregnancies. The Munson-based clinic began when local obstetricians sought options for their high risk patients to receive the highly specialized care that so often required long trips downstate. He averages about four patients per month in Traverse City, but for the past several months has seen an additional three to four per month without leaving Grand Traverse County via new telemedicine services linking Alpena Regional Medical Center with Munson.
This technology allows real-time sharing of ultrasounds, scans and data across the miles, and the ability to communicate ‘skype like’ between Dr. Jelsema and Alpena-based patients and providers. Dr. Jelsema usually meets patients for their initial consultations in person in Traverse City, but then continues to monitor and followup throughout all stages of pregnancy via telemedicine. Local providers remain involved, using Dr. Jelsema’s recommendations and continued consultation to treat their high risk patients, while patients and their families benefit from early diagnosis and expertise without leaving family, homes, support systems and jobs to seek care.
“The system is working wonderfully,” Dr. Jelsema said, noting the cost savings of local care as well as accessibility and convenience.
An added benefit to linking via telemedicine has been the learning shared among staffs. Dr. Jelsema often teaches staff throughout the process. In the past, he has invited the Alpena sonographers to Munson to train with him on processes, procedures, points to watch for and why.
“Dr Jelsema’s presence in Traverse City allows the local OB/GYNs access to a subspecialist to help manage their high risk obstetrical patients,” said gynecologist and retired obstetrician David Wright, M.D. of Traverse City, who helped lead the effort to establish the clinic in 1994. “Before that, patients would have to drive 2 1/2 hours to Grand Rapids or four hours to Ann Arbor for a perinatal consult and local obstetricians would have access to a maternal fetal medicine specialist only through a phone call. He is an invaluable resource to the local OB/GYNss providing advice, recommendation, follow up and continuing education regarding the latest changes in the field of high risk obstetrics. The Alpena link extends access to his expertise even further.”
Rural Access for Blood Disorders
The Northern Regional Bleeding Disorders Center began using telemedicine as a “physician supported, rural hemophilia treatment center (HTC)” in 2010. According to director Michelle Witkop, the Munson-based program is one of approximately 135 federally-funded hemophilia centers in the country with a coverage area spanning 11,000 square miles and 26 counties across northern lower Michigan and the eastern upper peninsula.
Bleeding disorders may include hemophilia, Von Willebrand’s disease, and other inherited blood disorders. Due to the nature of the diseases, patients require care throughout their entire life.
The Northern Regional Center is one of nine collaborative treatment centers in Michigan and the only HTC in the United States that does not have an on-site physician. Instead, the center is led by nurse practitioners such Witkop who collaborate distantly with pediatric and adult hematology experts located in Detroit, East Lansing and Grand Rapids to treat the 225 patients the center follows. Daily medical management is done by nurse practitioners while the physician specialists provide patient planning and oversight via telemedicine.
It’s a business model – and a care model º that benefit local institutions as well as patients. Blood disorders are complex and rare, with estimates of only 100,000 people in the U.S diagnosed. Medical care requires expertise in bleeding disorders and is usually confined to large centers in urban areas. Utilizing telemedicine in northern Michigan extended access across a very large rural region and also allowed the center to remain open and sustainable.
During the past year, the center managed 60 surgeries and 10 childbirths, working with local hospitals, physicians and other caregivers in the 26-county service area.
“It has a tremendous impact,” Witkop said, noting impact on income, work and family life. “It’s a huge savings for our patients and a huge financial impact on our institutions.”
She estimated that for each mile regional patients travel for care via telemedicine, they save an additional seven miles they did not have to travel. A recent study showed the 48 bleeding disorders patients who utilized telemedicine saved eight 40-hour work weeks or the equivalent of one working month per year by not traveling to a downstate center to see a specialist.
“Our goal is to provide the best care we can locally,” said Witkop. “It’s very collaborative … and successful,” noting the study showed there have been no adverse outcomes experienced by patients utilizing the clinic’s telemedicine services.
Telemedicine is also attracting attention of funders. The Northern Regional Bleeding Disorders Center received a $217,629 grant from the United States Department of Agriculture late last year to help upgrade communication technology while Alpena Regional Medical Center received a $50,000 state grant to help fund the equipment needed for its fetal medicine telemed services with Munson and Dr. Jelsema.
Low Acuity Services Heading North
According to Joe Brennen, director of operations for Spectrum Health E-Care, past barriers to telemedicine have been reimbursement, technology and buy-in. Today, technology and acceptance is no longer an issue and reimbursement is improving as telemedicine is increasingly viewed as a viable way to deliver care.
Spectrum is incubating its telehealth services through the centralized E-Care team. In addition to extending access to specialists, it is also focusing on low acuity primary care where patients can monitor themselves or connect from their homes via smartphones. The low acuity services are currently offered only to members of Spectrum Care with less availablity in northern Michigan, but are slated to become available statewide by late fall.
“We’re establishing a foundation that can go anywhere in the state,” Brennen said. “We are using technology to open up access and keep care local.”