Telemedicine connects Tri-City patients to specialists

Virtual doctor’s visits becoming more widely available – not just for routine illnesses

Tri-City patients are connecting with medical specialists for more types of care, thanks to the growing use of telemedicine, or telehealth, which can allow a provider to make some diagnoses of a critical patient without even being in the same room.

“Telehealth started as an access strategy to improve access to care in communities where patients wouldn’t otherwise have that and really it was around specialists to start,” said Dr. Todd Czartoski, a neurologist and chief executive of telehealth for Providence St. Joseph’s Health, the parent company of Kadlec Regional Medical Center in Richland.

In the 12 years since the hospital network first incorporated telemedicine into its practices, the fields have grown to include stroke detection, Lou Gehrig’s disease treatment, speech therapy, psychiatry, dietetics, maternal fetal medicine, wound care and genetic counseling. These specialties are in addition to the Express Care service offered for diagnosis of routine illnesses like strep throat, ear infections or pink eye. These are options available to patients using their own device to connect with a provider.

“You could be anywhere. You could be sitting in your home or car. It’s incredibly convenient,” said Cassandra Bilodeau, a registered nurse and director of outreach and development for telemedicine at Providence.

For conditions that require a specialist, patients would be seen by a provider at a clinic or hospital using a high-tech cart, which puts the clinician virtually in the room with a patient, similar to Skype or FaceTime, while remaining compliant with federal privacy laws to protect patients’ medical information. The telemedicine effort through Providence started with stroke diagnosis by keeping a stroke neurologist on call at all times to assess patients during the crucial initial minutes when it’s suspected someone may have suffered a cerebrovascular accident.

“When Dr. Czartoski logs in to the software, we see his face pop up and there’s a nurse in with the patient because this is a critical patient and you need medical personnel there to attend to them,” said Abigail Richardson, a registered nurse and telemedicine coordinator at Providence. With the help of a trained telepresenter, “You’re helping the physician finish the exam, so you’re testing for arm and leg weakness and those types of things, visual deficits. And then Dr. Czartoski, on his end, can make the assessment, how we’re going to treat this.”

By using telemedicine, the hospital can leverage its expertise to get patients the necessary care or diagnosis as quickly as possible.

“We like to call it moving knowledge, not people,” Czartoski said. This allows two stroke-trained neurologists to serve 55 hospitals across the Providence St. Joseph system.

“When you think about 50 hospitals it sounds like an awful lot, and it is, so we’ve had redundancy and backup built in for what we call the ‘jump ball’ model, and that’s been super helpful for the backup so we have quick responsiveness,” Czartoski said. “Our responsiveness 24 hours a day is two minutes, two seconds. That’s our average time it takes to get an answer from a stroke neurologist when they’re paged.”

For some patients, the speed of seeing a provider isn’t critical, but rather a matter of convenience. Some patients appreciate the ability to see a specialist without traveling outside the region.

This is the case for patients with amyotrophic lateral sclerosis, known as ALS, or Lou Gehrig’s disease. Prior to the use of telemedicine, patients often had to travel to Spokane or Seattle to see a specialist in the field.

“These caregivers that are helping out have a huge burden for them to be able to travel the patient over the mountains,” Bilodeau said. “We have wrap-around service where it’s very comprehensive with all of our ancillary services with a neurologist able to come in and see these patients and keep them local. So it decreases the burden for the family.”

A visit with a patient diagnosed with ALS tends to last about three hours using a multi-disciplinary approach. The virtual visits are done only after the patient has had an in-person visit with an expert in Seattle who offers the initial establishment of care and diagnosis.

“When they’re coming here, they have those direct caregivers in the clinic who go in teams,” said Lisa Braudrick, supervisor of therapy services. “One of the teams is comprised of the neurologist who’s on the cart, and then there’s the nurse in the room, as well as the respiratory therapist. So the nurse and the respiratory therapist might be doing hands-on with the patient, but the neurologist is also asking and getting an idea of what’s going on and what are the concerns.” The Kadlec team said telehealth can really mirror what could be done entirely in person.

While telemedicine can allow patients in the Tri-Cities to be seen by specialists outside the area, it also offers the same opportunities in reverse, bringing local experts to more remote locations around the region and as far away as Montana, using the Providence network.

A well-equipped cart allows health care providers at Kadlec Regional Medical Center in Richland to remotely connect with patients, diagnosing acute conditions or even emergency cases, like strokes, without needing to be in the same room, or even the same state, as the patient. (Photo courtesy Kadlec Regional Medical Center)
A well-equipped cart allows health care providers at Kadlec Regional Medical Center in Richland to remotely connect with patients, diagnosing acute conditions or even emergency cases, like strokes, without needing to be in the same room, or even the same state, as the patient. (Photo courtesy Kadlec Regional Medical Center)

“There are communities where we simply don’t have that ability to have a provider there each and every day,” Czartoski said. “The way I’ve described it more recently is, we’re essentially following in the footsteps of what some of the tech companies have done, like Microsoft and Amazon and Google, we’re building on a cloud. They built this cloud infrastructure that would allow you to only purchase the amount of server space that you needed instead of investing in an entire server farm with computer hardware. We’re building a clinical cloud that allows you to use and access world experts in different areas without investing in an entire team of stroke neurologists or psychologists or intensivists.”

After more than a decade of building on this model, there remains a question of how else telemedicine can be leveraged to assist patients.

“There’s a few services that make sense to scale because we’re never going to have enough stroke specialists and psychiatrists,” said Czartoski, who described what he calls the “secret sauce for success.”

“When we vet new opportunities, the lens that our team uses, we really ask four questions: one, first and foremost, can we provide care safely doing it remotely using telehealth? And if you can’t answer that without certainty, we stop there.”

When the team is confident the care can be provided safely, the next assurance is whether it can be offered with high quality. Czartoski said. “Is the quality of service and care that we’re delivering better or as good as we would be able to do with an in-person service? In some cases that means stroke care to an outlying facility where we don’t have any stroke neurologists available, having a stoke neurologist available by video is actually better than the status quo.”

The team also assesses whether the financial model for a new telemedicine setup will be sustainable.

“We can get grants for telehealth, but if it’s not built in a way that allows us to at least cover the cost of the program, our experience has been that you won’t get it to take off and spread in scale and be used as much as we would want,” said Czartoski, who says the final piece of the “secret sauce” recipe includes a “provider champion” who believes in the system. Someone who will, “wake up every day and think, ‘I’m going to make this a successful telehealth program,’ ” said Czartoski.

The telemedicine option also is beneficial to fill gaps in service, either due to a lack of demand or the time between recruiting a new provider. This includes speech therapy, which can be a game-changer for rural communities where there aren’t enough patients to warrant a provider on staff full time.

“It’s like the cloud model where they’re paying when they need it because they don’t need it full-time,” Bilodeau said. “It’s also hard for them to recruit specialists when someone leaves. Rather than go months and months, and having that gap, we’re looking at telemedicine to help meet the need.”

The team said starting up a new telemedicine offering is not as simple as just supplying a cart. “It’s like setting up a new clinic, if you will. It takes a lot to vet it and ensure that we’re doing it correctly,” Bilodeau said.

Kadlec sees telehealth services as an increase to the care that’s available and not a means of replacing true face-to-face contact between a provider and patient.

“It’s enhancing it and allowing us to meet the patient where they need to be met,” Bilodeau said. “I think the options really are endless and that’s scary for a lot of people, but I think we really need to think outside the box because telemedicine can really help our communities, our patients, and when you look at the social determinates of health and why people can’t get access to care, telemedicine can really help mitigate all those challenges. It can help reduce barriers.”

Bilodeau said a patient or provider always has the option of requesting an in-person visit if either party feels they cannot capture what needs to be captured using a virtual appointment. But, she added, it has never happened.

Trios Health in Kennewick uses telemedicine through its Urgent eCare service for diagnosis of minor illnesses.

Media contacts for Trios and Lourdes Health did not immediately return requests for more information on their telemedicine offerings. Both hospitals are owned by Tennessee-based LifePoint Health.

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