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The Arizona Telemedicine Program Blog

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.

Veterans Administration Building in Washington, DC

In May of 2018, the United States Department of Veterans Affairs (VA) introduced new legislation that would allow network healthcare providers to treat veterans using telehealth technology. The VA has extended this privilege across state lines.

During the announcement of the new legislation, the Veterans Administration also introduced VA Video Connect, a video conferencing app created especially for veterans and VA care providers. The innovations allow care providers to deliver services no matter where physicians or patients are located.

The Veterans Administration collaborated closely with the White House Office of American Innovation and the Department of Justice to draft the new law. They partnered from the original incarnation of the law as the "Authority of Healthcare Providers to Practice Telehealth" to its new name called "Anywhere to Anywhere." The ruling is essential for supporting initiatives designed to improve the accessibility and quality of healthcare services for veterans.

There’s no question that telemedicine is incredibly innovative, and changing healthcare as we know it. Beyond that, of great importance is telemedicine’s wonderful potential for disaster planning and recovery efforts.

Telemedicine has proved its potential to transform the healthcare industry in many ways. Doctors can prescribe medication and treatments without ever seeing their patients face to face. Industry experts and experienced professionals can communicate with more people outside their usual network, offering services and guidance.

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