'Healing Touch' over the Internet

Reported by Brad Penner, STATEWIDE Correspondent

Last week we told you about some of the obstacles facing rural hospitals. Tonight, telemedicine is a new way of connecting small hospitals with larger ones and the doctors who work there. Cameras and computers bring specialized care to small towns who often have trouble keeping a general practitioner in town. Now telemedicine networks based in Norfolk and Kearney are giving patients another option.
Shari Wolken is getting ready to see her doctor, a specialist in rheumatoid arthritis. The specialist is Dr. Kelly Sems. She can walk from her office to Good Samaritan Hospital in Kearney. Dr. Sems has treated Shari before, but this exam is different. The doctor is in Kearney, but the patient is in Callaway, over 60 miles away.

[Chris Myers, nurse in Callaway] "It's a little bit strange to get used to right at first but they seem to really like it."
Nurse Chris Myers has been through this before. She knows how to put Shari at ease.
[Myers] "We have the ability to take the camera and zoom in on a certain site if you want some certain thing looked at. We can show X-rays if we ever need to."
Sixty miles separate doctor and patient, but they're connected by phone lines, video cameras, and computers.
[Dr. Sems] "Well, shoot, Shari, tell me what's going on."
[Shari] "My hands, the joints have really gotten a lot bigger this summer and this kind of concerns me a little bit."
The hospital in Callaway and the five other rural hospitals and clinics are connected to Good Samaritan Hospital by the Telemedicine network.
[Dr. Sems] "We haven't done this before over Telemedicine."
What she's trying is an examination via video.
[Dr. Sems] "Hey, Shari, can you open and close your hands pretty good?"
A small camera gives Dr. Sems a closeup view of Shari's hands and feet.
[Dr. Sems] "Just like that. Squeeze them together. Does that hurt?"
[Shari] "Yeah."
Good Samaritan's Telemedicine network went on-line in December of 1995. Since then the system has been used to serve patients more than a thousand times. In recent months they've averaged around 80 consultations a month. Donna Hammack is the director of Grants and Special Projects at Good Samaritan. She helped get the federal grant to pay for the demonstration project.
[Donna Hammack, Good Samaritan Hospital] "I guess it's proven that our rural neighbors like using this kind of technology and our patients are very satisfied as are providers in using the technology. We weren't quite sure at that point how it would work, but we wanted to be a part of that demonstration project and see just how we might effectively work with our partners here in Nebraska."
Hammack says they were surprised to find nearly half of the Telemedicine appointments were for mental health counseling.
[Ramona Schroeder, Mental Health Coordinator] "The first day that I used it, it was difficult, you know, different. But I fast became very encouraged by what I could see was happening with the patients I was working with."
Schroeder used to travel rural roads to visit patients. She learned that there was a need for counseling in rural Nebraska, but miles of highway kept patients away, especially the elderly.
[Schroeder] "Many of them, it's a distance for them and they're afraid to drive in Kearney or any other larger area."
With Telemedicine, patients don't have to leave the comforts of home. They can visit their local hospital complete with familiar faces.
[Marvin Neth, Callaway Hospital Administrator] "There's a huge advantage for our patients, because they can access any specialty services that Good Sam would have available in Kearney. That eliminates their need for travel, day off of work, or whatever. Plus they receive their services right here in our facility."
[Dr. Ron Sheppard, Callaway] "We've used it in a variety of patients. I think it's great, because the patients don't have to travel. Some of my patients, frankly, wouldn't travel, so I think we have not only improved access to care but we've improved the quality."
Dr. Charles Bascomb is an oncologist in Kearney, a cancer specialist. He supervised Eloise Phelps' chemotherapy over the Telemedicine network. Ron Sheppard was the local physician.
[Dr. Charles Bascomb, oncologist] "I think I saw Mrs. Phelps five or six times over the Telemedicine unit, otherwise she would have had to come to Kearney for those visits."
[Eloise Phelps, Callaway] "I took my first one in Kearney in case of an allergy or something. Other than that, I've taken all of them here."
Convenience is an obvious reason why patients like Telemedicine. In a survey done by Good Samaritan, 23% said they believe the quality of care was actually better than they would get in a face to face visit; 77% said it was the same. And nearly all of them said they'd recommend Telemedicine to friends and family.
[Shari Wolken, patient] "This is my first time that I've done this and I'm very impressed. I think this is great. It's nice to be able to have this communication when you're having a problem. I wasn't aware that we had this up and running yet and so I'm very pleased."
Wanda Kjar is the Telemedicine coordinator at Good Samaritan. She says they have some other theories why patients like Telemedicine. For one thing their doctors are not usually delayed or distracted by other patients.
[Wanda Kjar, Telemedicine Nurse Coordinator] "We were very surprised. We wanted them to say it was close to the same, but we never expected them to say they got better care or they thought the quality of care was actually better on the Telemedicine. How often do you have your specialist and your family practitioner in the same room at the same time together discussing your case?"
The specialists in Kearney are less enthusiastic, but still like it. In the Good Samaritan survey, only 1% said they wouldn't use Telemedicine again.
[Dr. Bascomb] "I have mixed feelings. I would really rather be in the room with a patient and be able to shake their hand and lay hands on. But I'm also not the one having to drive 90 or 100 miles. Also I think it is better than say, visiting over the telephone."
[Dr. Kelly Sems, arthritis specialist] "A lot of times it's hard to do this over the Telemedicine, because you rely so much on how things feel, but there are certain aspects like follow-up visits and that sort of thing that you can use Telemedicine for, because I know how things looked last time, I can see how they look this time just by looking at it through the camera."
Doctors and nurses at remote sites play a key role in making Telemedicine work. The specialists in Kearney depend on them.
[Kjar] "They have to trust that of the person's eyes, ears, hands to tell us what they find on a physical exam."
[Hammack] "The human element, I think, is more important than the technology in a project like this, because you can hire a consultant or you can figure out how to do the technology, but if you don't have good working relationships with those sites, your project is not going to work."
Speech therapist Shirley McCammond was a little reluctant about using Telemedicine.
[Shirley McCammond, speech therapist] "I'm not these kids that have grown up with computers or even with television. My parents didn't have a television set until after I graduated from high school. This is beyond anything I ever dreamed of doing. It really smacks of the future."
For Shirley, technology is a tool. It might seem that cameras and cables would create a barrier, but Shirley still finds a way to forge a bond with the stroke patients she works with.
[McCammond] "Part of the therapy is the conversation, and after all that's the practical aspect. You want the patient to be able to speak in any conversation setting. As we fine tune her speech, we will be working on these really difficult combinations of consonants and then I think she will be ready to not come and see me anymore. I will miss seeing her. I will miss seeing her a lot because she is just a fun person."
It appears that with Telemedicine, care is less of an issue than cost. Good Samaritan's initial Telemedicine grant ran out in September, but they got a new grant that will provide close to $400,000 over the next year. The grant will likely be renewed for two years after that. A change in federal law will also reduce the costs of phone lines used to connect the network. Lower costs will help, but there are long term questions about who will pay the bills. Medicare recently approved Telemedicine payments for patients in the most isolated rural areas, but many still won't qualify. Private insurance companies are also reluctant. They want more information on costs and effectiveness.
[Neth] "There's a lot of issues with Telemedicine services about who should bill for those, who should pay for those services, and typically right now, we can't rely on insurance companies or Medicare to pay for those services."
Neth says attitude is a big barrier for insurers, but patients don't seem to mind, and Telemedicine might be one way to help keep hospitals and doctors in small town Nebraska.
[Neth] "If there's a sole physician in the community, he knows that he is not quite so isolated because he can at least by Telemedicine access specialty services and consultations. I think that could at least make a sole physician or his support staff like our physician assistants more comfortable in being in a rural area."
Telemedicine isn't a brand new idea. The reproduction of a magazine cover shows it was dreamed of back in the 1930's.
Now a phone call and a click of a mouse give rural patients and their doctors instant access to specialized care. The cost of new technology is coming down. And those who know believe Telemedicine will grow. If that happens, more patients like Eloise Phelps will have time to stop at the grocery store when they're done at the doctors.
Reporting for Statewide, I'm Brad Penner.