Renay Baldes wasn’t in the same room as her doctor, urologist Lisa Finkelstein, during her appointment Tuesday morning. Instead, they used technology to conduct her follow-up appointment remotely.
The appointment with Baldes, 57, marks the first time that a St. John’s Medical Center physician held an office visit remotely. Using the secure platform Zoom Video Communications, Baldes sat in the Mountain Sage Family Clinic in her hometown of Dubois and received a specialist’s care.
“It’s so much easier if it’s just going to be talking, and I don’t have to physically be there,” Baldes said. “It’s easier for everybody, especially in the winter. I’m pretty open to experimentation.”
Telemedicine, a word often used interchangeably with telehealth, is the remote diagnosis and treatment of patients by means of telecommunications technology. It’s taking off in rural areas around the country where doctors’ offices could be many miles and hours away from patients.
Mountain Sage Family Clinic has used telemedicine for virtual visits with an infectious disease specialist in Cheyenne, a counselor in Riverton and, now, Finkelstein at St. John’s.
St. John’s has used telehealth technology in the past for different reasons, like local patients receiving diabetes and oncology consults with specialists elsewhere and a telestroke robot that connects doctors with a stroke center in Salt Lake City to identify a stroke, but this is a new iteration.
Baldes is a textbook case of a patient who benefits from telemedicine services. She has multiple sclerosis and doesn’t have a car, making access to care tricky when distance and mobility are factored in. Getting to her local clinic, even someday staying in her home, is ideal.
“Wyoming is a rural state; access is hard,” Finkelstein said. “Patients have to go over a pass, through a canyon in a storm, on and on and on, to get to a provider for much of the year. We should be an example of making this work.”
What it looks like here
St. John’s isn’t the only medical provider experimenting with telehealth. Registered dietitian Mary Howley Ryan, the owner of Beyond Broccoli, is the only dietitian in the state who is certified in eating disorders, and she receives referrals from near and far.
She’s done phone consultations with clients in the past, but now she is looking into FaceTime as an option since the U.S. Department of Veterans Affairs approved it with restraints.
“The VA has a very high standard, and a lot of people will follow their lead,” she said. “If it’s good enough for the VA it’s good enough for me.”
Ryan is finishing up a graduate program in social work and said that while eating disorders sometimes necessitate face-to-face interactions to look for ways that nutrition impacts one’s physical appearance, she’s excited to incorporate more telemedicine.
“I’m really selective with who I use it with,” she said. “And the client has to be on board, too. But it’s a great option, and it’s easy. It could open up possibilities for clients who don’t want to go to a physical office for fear of a stigma, and I’m open to it because I think I need to be. That’s the future.”
So far St. John’s has 34 providers — 32 physicians, one neuropsychologist and one genetic counselor — with telemedicine privileges. And while not every patient’s situation is a great fit for telemedicine, there are plenty of scenarios in which it could work.
“When I see a urological patient and I need to examine somebody’s prostate, I can’t do a rectal exam on a phone or on a screen,” Finkelstein said. “But 80 percent of what we do is just consultative. There are follow-up visits and many types of visits that are perfect for telemedicine.”
A slow start
The president of the Wyoming Medical Society as of July, Finkelstein became interested in telemedicine in 2011.
“I’m open to everything and anything,” she said. “So I said, ‘Sure, I’d like to do it.’”
At the time she secured a grant to attach a camera to her computer to allow communication from clinic to clinic. She tried that for a year, on and off, between Jackson and Pinedale. At first it was “just a mess.”
“The technology, the WiFi, we could not fix that appropriately enough so that these virtual visits or video visits would work,” she said.
So she stopped. Like many other doctors who already have a lot on their plates, she thought, “I just don’t have time for this.”
But now Finkelstein is working to start the program statewide by building relationships around the state, “beating down the bushes and tooting the horns.”
“We are ready,” Finkelstein said. “Wyoming is ready. There are a lot of people behind the scenes that have done this boring, hard work to make this happen. We need patients to embrace the concept, and we really need physicians to come on board.”
The technology has made leaps and bounds, said Tracy Baum, Mountain Sage Family Clinic’s family nurse practitioner. Baum has been interested in telemedicine for all 25 years of her career and remembers how it used to be “cumbersome.”
“I’m thrilled to be able to use this technology now that’s much more user-friendly,” Baum said.
In order to set up Baldes’ appointment, a nurse generated a meeting electronically, and all Baum had to do in Dubois was click on the link. A fiber-optic internet connection there helps visits run smoothly.
“It’s incredibly easy,” she said.
In Dubois Baldes communicated with Finkelstein through a TV monitor — a larger screen for a better patient experience — connected to a laptop with a Logitech conference camera and a microphone. The platform used, Zoom, complies with the Health Insurance Portability and Accountability Act and is free to sign up for.
One hurdle that still exists, Finkelstein said, is licensing. Physicians must be licensed in the states where they practice, but what about patients who live in Idaho? Can they be treated by a physician who is licensed in Wyoming and who they’d normally see in this state? No.
Licensing in another state typically takes months, but Finkelstein hopes that a licensing compact could expedite the process. On the flip side, one positive is that insurance pays for telemedicine visits, and they’re documented just like a regular visit.
Health care providers like Baum and Finkelstein want to spread the word that telemedicine is here and it’s easy. Just convincing patients, and providers, to try the new service can be just as much of a hurdle as getting streamlined technology was.
“No one likes change,” Finkelstein said. “That’s the biggest thing.”