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The Arizona Telemedicine Program Blog

Students at Universidad Mayor in Chile learn benefits and risks of using simulation for dentistry.

Phase One: Using Simulation Labs to Teach Future Telehealth Providers

For 15 years, I was a home hospice nurse who went out on emergency nighttime visits to patients who were experiencing symptoms that terrified their family. The travel distance added to the anxiety and suffering of family and patients. I always thought that just because a family chooses to live in a rural area, they should not have to accept suffering as “the price they have to pay.”

Since then, I have focused on enabling the provision of healthcare services to patients who choose to live in the beauty of a rural environment.  Using telehealth technology to rapidly view, assess and improve a patient’s situation has been foremost in my program of research.

 I know I do not have to describe the explosion of telehealth during the last 15 years to readers of this blog. In my telehealth experience, I have gone from home hospice organizations, thinking that I was suggesting a cold and unfeeling method of providing end-of-life care, to a Global University interest in me sharing my telehealth expertise as an international Fulbright Specialist.  

For medical students with the University of Arizona College of Medicine – Tucson, weeks of suspense will end on March 15. Otherwise known as Match Day, it’s the day the students will learn where they will go for their residency training, in their chosen medical field, after they graduate from medical school in May.

Sarah Joy Ring, who has completed the College of Medicine – Tucson’s Rural Health Professions Program and a 16-week Rural Health Distinction Track, is hoping for a residency focused on both pediatrics and emergency medicine, potentially in a rural location.  Her “capstone” paper, an in-depth research project that all Distinction Track students are expected to complete, carries the impressive title of “A Survey of Rural Emergency Medicine and the Discrepancy of Care for Pediatric Patients that Present to Rural Emergency Departments.”

Carlos Gonzales, MD, Director the Rural Health Professions Program, briefs the Arizona Telemedicine Council on the success of those programs

After four challenging years as a medical student – while maintaining her roles as a wife and mother of five daughters – Mary Alyson Smith will graduate from the University of Arizona College of Medicine-Tucson, in May. She has decided to pursue a career in pathology, and is especially interested in telepathology, “I feel it’s an area that still has great potential for growth,” she says.

But there’s more to Mary’s medical training. In addition to the usual four years of study, Mary applied and was one of 26 students accepted to the UA College of Medicine’s Rural Health Professions Program (RHPP), designed to broaden students’ knowledge of healthcare delivery by matching them with physician preceptors working in small towns, including Indian Health Service sites, throughout Arizona.

When implementing a telemedicine program, you should create a new workflow. It’s easier to adapt a current workflow into the technology than to create a new productivity model. Your daily processes will need some changes but not entirely, and this can be to your advantage.

After your workflow model is altered – and it’s an easy process if done properly -- you can integrate it slowly into your daily practice. This will make this easier for you and your patients.

Is telemedicine “as good” as a face-to-face patient visit?  Take a few cues from television and movie professionals to make sure!

In today's digital world, we've all become visual image connoisseurs.  Part of what we respond to is technical and part is artistic. It's largely the “artistic” portion in which meaning and emotion are created. 

As such, telemedicine professionals would be wise to pay attention to certain artistic aspects, when creating the telemedicine patient/provider encounter.

Beyond the 'good enough' technical aspects of the telemedicine encounter – available bandwidth, relatively clear and fluid video, and audio of an acceptable level – there is a higher-quality bar that we, as telemedicine professionals, must strive to reach, in order to be trusted and to overcome  objections that our viewers might have.  Often, these objections may even be subconscious on the viewer's part, but still come into play, and nothing is harder to resolve than an unconscious objection!

(L to R) Matthew Gembala, MD, of AKDHC demonstrates how a telenephrology consultation works with Troy Layden, RN, Summit dialysis manager, and Fredda Kermes, Summit telemedicine director.

When Summit Healthcare in Show Low, AZ, lost its inpatient dialysis service and its two local nephrologists in 2016, it was no longer able to provide dialysis for patients who were hospitalized. Instead, Summit had to transport these patients to a hospital in Phoenix, Tucson or Flagstaff, where they could receive not only acute inpatient services but also inpatient dialysis. These transports, nearly always via air medical services, cost on average $42,000 per flight.

Word quickly got around the local dialysis community that if you were admitted at Summit for an inpatient stay (say for appendicitis or pneumonia), you would have to be transported to a metropolitan hospital so you could receive your needed dialysis as an inpatient. These patients started avoiding the Summit Emergency Department—and necessary healthcare—because they knew they would be flown out to a larger city.

Ruby and I have got it down pat. A bark at the back door tells me one of two things: "I want to go outside" or "I'm ready to come back in."

But a few months ago, when Ruby – my 65-pound standard poodle -- signaled her wish to come in, the next thing I noticed was how she was holding up her left front foot, while giving me her "Do something!" look.

Standing or walking on that foot was obviously painful, but I found no wound or bite to tell me what was wrong.

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