Doctors routinely made house calls in the ’40s. The practice may be enjoying a revival, especially in rural areas such as Wallowa County.
In the latest iteration, the doctor won’t be present in flesh and blood but on a television screen over the Internet. It’s called telehealth.
The county’s medical providers, led by Wallowa Memorial Hospital, have begun exploring the opportunities.
“Telehealth has enabled us to … ensure access to high-quality care in our frontier county,” Jenni Word recently told members of the House committee on Energy and Commerce Subcommittee on Communications and Technology in Washington, D.C.
The associate administrator and chief nursing officer at Wallowa Memorial was among a handful chosen to testify. U.S. Rep. Greg Walden is a member of the committee.
Most of the examples Word shared with the subcommittee included televised hookups utilized by patients from the hospital. In-home hooks-ups between patients and providers will require expanded broadband Internet service.
“Moving forward, reliable, affordable broadband in homes and remote rural hospitals and clinics will be critical as we transform the current healthcare delivery system,” Word told the committee. “We are fortunate in Wallowa County to have good broadband infrastructure; but, even so, our county has many remote areas that do not yet have broadband connectivity.”
By one estimate, the county is among the 10 Oregon counties with the highest digital divide index –– least likely to have broadband connectivity in the home.
Lack of high-speed availability isn’t the only issue. The use of telemedicine has outpaced governmental regulations on health care.
“Medicare reimbursement has been the really problematic piece,” said Katherine Britain, executive director of Telehealth Alliance of Oregon in Mill City, east of Salem. Word is a member of the group’s board.
Only recently have reimbursements been approved, and Britain said Medicare has signaled a willingness to expand coverage to include telehealth sessions.
“Medicare does not reimburse for remote patient monitoring, a potentially vital tool in monitoring patients with chronic conditions ...” Word told the subcommittee. “Providers would like these geographic and setting location requirements eliminated and expansion of the types of technology that can be used, and coverage for all services that are safe to provide.”
Another issue has been requirements imposed on doctors.
“Many states did not allow the use of telemedicine to deliver services and even more problematic were the restrictions around cross-state licensure,” Britain said. “These restrictions would have made it nearly impossible for hospitals like Wallowa Memorial to receive services telemedically from a hospital like St. Alphonsus in Boise –– across the Oregon border.
Other challenges to full implementation include cost of equipment, training, security and privacy issues and cultural acceptance.
“It often requires starting small with a single application, a lot of education, engaging telehealth ‘evangelists’ and developing a successful strategy that all can support,” Britain added. “Wallowa Memorial has done much of that work, and its telehealth success reflects that.”
Wallowa County’s Winding Waters Clinic has also been dipping its toe in the telemedicine stream.
The clinic purchased a telehealth “robot” through a Greater Oregon Behavioral Health Inc. grant in 2016. Wallowa Valley Center for Wellness and Wallowa Memorial have similar units.
It is most often used to connect patients to specialists, according to Meg Bowen, Quality Director for Winding Waters a nonprofit community health center in Enterprise,
Bowen said the clinic would also like to see in-home uses where sufficient Internet speed permits.
“Being able to log into medical services from the comfort of their home would greatly enhance the experience of our patients,” Bowen added.
HOW TELEMEDICINE WORKS AT WALLOWA MEMORIAL
A baby is delivered at the hospital by a family practice physician during a snowstorm on a January night. The closest Neonatal Intensive Care Unit is more than 150 miles away.
Roads out of the county were closed early in the day due to ice, and snow has been falling off and on for most of the day. An hour after delivery, the newborn is struggling to breathe, and oxygen levels are lower than normal.
The physician has been on the phone with a neonatologist who recommends transferring the baby to a NICU, but due to weather, neither a fixed-wing plane nor a helicopter is able to land, and road conditions are not safe enough to make the four-hour highway trip.
The solution: The hospital was able to use a telemedicine robot to allow the neonatologist to assess the newborn throughout the next week. He was able to listen to the baby’s heart, lungs and belly. He could see the baby’s color, hear its breathing and talk with the parents.
The hospital was able to provide all the care necessary. The family avoided Life Flight surgery and NICU costs. The baby was discharged a week later.