Dr. Kyle John is riding on a wave he calls the future.
His wave began nearly three years ago during his seven-year stint with Mercy as a pediatric psychiatrist.
A boy’s group home in Rolla that lacked a psychiatrist was on his mind during a video teleconference between clinic staff across the state.
“We’re here, we’ve got Rolla on this screen and St. Louis on that screen, and I thought, ‘Wow, that works really slick. Why can’t we do that for these kids?’” said John of helping the boys who typically traveled more than two hours for care.
After communicating with his manager about the need and working out the nuts and bolts of the program, the Springfield-based psychiatrist began seeing patients in other Mercy clinics through face-to-face video chats, eliminating the need for the boy’s group home and other patients to make the trip to the Queen City.
Telemedicine, sometimes referred to as telehealth, is defined by the American Telemedicine Association as the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Currently, more than half of U.S. hospitals use some form of it to deliver clinical services. Area leaders say that number is growing.
John’s first telemedicine session was conducted in a board room, because the technology, though fairly simple and consisting of a computer, a webcam and a secure wireless connection fit for patient confidentiality, was not yet available in his office.
Now, John – who devotes each Tuesday to telemedicine – sits down in front of his computer with a patient on the other end every week. He gives the patients a tour of his personal office using his webcam and tries to make them comfortable enough to speak openly.
Virtual realityOpening in Springfield in 2006, Mercy’s Vice President of Telehealth Services Wendy Deibert said Mercy’s 100-bed teleICU started the telemedicine ball rolling for the health care provider.
“We began seeing the great opportunity of telehealth and how that can benefit our rural communities,” Deibert said, emphasizing the need in Missouri’s rural communities for accessibility. “We are really trying to give access to patients close to home and it is a more proactive approach to medicine.”
The Springfield teleICU, or eICU, which has round-the-clock monitoring of intensive care unit patients through the use of St. Louis-based SafeWatch, is one of Mercy’s high-tech telemedicine innovations.
Deibert said the eICU led Mercy to break ground in May on its newest telemedicine venture in Chesterfield, a $50 million, 120,000-sqaure-foot virtual-care center set to open by May 2015. Currently under construction, the building will serve as Mercy’s telemedicine hub for serve patients in a five-state area: Missouri, Kansas, Oklahoma, Arkansas and South Carolina.
Working outside the state has proved beneficial for Mercy, forming partnerships with companies such as NeuroCall, an international facility specializing in teleneurology.
The partnership helped solve Mercy’s neurologist shortage problem, Deibert said, with NeuroCall specialists licensed as attending physicians at Mercy and paid a service fee by the hospital serving patients at eight of 32 acute care hospitals.
“Very few neurologists want to do just stroke care, because it is so time consuming, but it is needed,” she said. “This partnership helps bridge the gap. They cover Monday through Friday. We cover nights and weekends.”
Mercy has about 30 clinics currently set up to use telehealth and every new clinic built is equipped with the hardware required for telehealth services, including equipment such as webcams, high-definition cameras and Bluetooth stethoscopes that allow a physician to hear a patient’s heartbeat or see detailed images of different parts of the body in real time, though not every clinic requires the same tools.
With different needs in different clinics, the cost of equipping Mercy facilities with telemedicine technology varies.
Deibert said a webcam cost about $100, and the telemedicine software installed on clinician’s computers is $50. Those costs are on the low end. Getting into high-tech gadgets, prices climb. Hardwiring patient rooms can cost anywhere from $8,000 to $12,000, and mobile carts that carry tools such as computers and cameras can range from $20,000 to $40,000.
Not alone Though it is on the forefront of bringing innovative telemedicine technologies to Missouri, Mercy is not the only Missouri health care facility sporting telemedicine in its programs. Joining Mercy in the pack are Ozarks Community Hospital Inc. and CoxHealth.
A pulmonologist at the OCH Evergreen Clinic, Dr. Brian Kim operates a sleep telemedicine practice, one of two telemedicine programs currently operating outside of OCH’s main facilities.
Getting its start in 2012, Kim’s sleep telemedicine program requires collaboration between the sleep lab at OCH Evergreen Clinic and smaller facilities such as the OCH of Gravette in northwest Arkansas.
This relationship, he said, is of the upmost importance.
“If something goes wrong, we are responsible for that patient,” Kim said, noting that as a reason some doctors may not be ready to dive headfirst into telemedicine.
Karen Stout, the clinic manager at OCH Evergreen Clinic, said she and Kim rely heavily on the nursing staff at other OCH clinics to remain up to date on a patient’s condition, noting sleep medicine is a perfect fit for telemedicine because it is often less hands on.
Kim said 90 to 95 percent of problems related to sleep medicine can be detected without touching a patient.
“The technology we use is so good,” Kim said. “The picture is clear. The voice is clear. It is just like a face-to-face visit.”
Dr. Lori MacPherson, a family physician at CoxHealth Center Mountain Grove, is on the other end of telemedicine. The small practice often needs the services of specialists at larger facilities, though it’s not her most common use. MacPherson said e-visits allow her to treat simple medical issues, such as urinary tract infections or upper respiratory infections, for a relatively low cost to the patient and save them a trip to her office.
An e-visit is requested by the patient and payment is submitted via credit card. If the patient has a CoxHealth plan, the cost is $10; other insurance or Medicaid is $30.
MacPherson said telemedicine is one of her most popular services.
“As technology advances, physicians and patients need to adapt and change their mindset that change is difficult,” she said. “It’s really not that hard. It is the way life is and in the end it will only be for the benefit of us all.”
Ups and downsWhile telemedicine may not be the future for everyone, John said it helps solve staff shortage issues in his field.
“Good or bad, our society has become the ‘I want it now, and I want it here,’ kind,” John said. “Telemedicine will never be the future of surgery, but it is part of the evolution of pediatric medicine, because there are simply not enough providers to see all these kids and there never will be.”
John and MacPherson said getting reimbursed from insurance companies has not been a problem, but Kim has experienced otherwise at OCH.
“Financially we are getting less reimbursement for this,” Kim said. “Insurance pays less, but we still spend the same time, so to us it is kind of a nuisance, but it’s about providing a needed service for the patient.”
MacPherson said while her clinic has not seen a financial burden, specialists she has contacted for a consultation often are not reimbursed, an issue she believes needs resolution as telemedicine progresses.
“It is a challenge. It is a different way of life,” Deibert said, “but this is the future direction of medicine.”
