Telemedicine Helps Rural Patients Get Care Close To Home

Aug 8, 2018

For some people, it's easy to schedule a doctor's appointment and get immediate treatment. But for those who don't live close to a hospital or clinic, this can be more difficult. "Telemedicine" is making this process easier.  

Mark Pfeiffer is a Hampshire-based small business owner who teleconferences with his doctor about sleep apnea.
Credit Chase Cavanaugh/WNIJ

Mark Pfeiffer is a Hampshire resident and small business owner who was having difficulty sleeping. He contacted his local physician, who had Pfeiffer take part in a clinical study.

"After that sleep study, they confirmed, yeah, you have sleep apnea, and so they referred me to Dr. Jain at Delnor Hospital," he said.

Sleep apnea is a condition where pauses in breathing interrupt nighttime rest. To address it, Dr. Jain gave Pfeiffer a CPAP machine, which keeps the airways open by pumping air through a special facemask.  Pfeiffer says the machine was exactly what he needed, but going to the doctor took a lot of time.

"For me to leave here and drive to Geneva to have a meeting and then wait in the waiting room, have the meeting, then come back, it's about a three-hour investment of my time," he said.

So Dr. Jain suggested the next appointment be done by teleconference. Pfeiffer agreed, since it sounded similar to the video meetings he conducts with employees.

"We're face-to-face, talking with each other as it would be if I was in his office," he said. "The only difference is I didn’t have to go anywhere other than sit down at my chair in my desk and start the conversation. Ten minutes later, the meeting was over. I walked back out into my shop and continued with what I was working on ten minutes earlier."

For Pfeiffer, the process is made easier because the doctor can adjust the settings on his CPAP machine through the internet. But this isn't the only case where telemedicine is used to facilitate treatment. Dr. Richard Bernstein is a neurologist and clinical head of telehealth efforts at Northwestern Medicine. He says NM started offering consultations between stroke patients and specialists in hospital emergency rooms.

"Within a few minutes, the patient can see us. We can see the patient. We can talk to the patient and they can talk to us. We can review their brain imaging, their CAT scan, and make a recommendation within another few minutes about treatment and about disposition of the patient," he explained.

Dr. Richard Bernstein is a neurologist at Northwestern Medicine and head of their telehealth initiatives.
Credit Northwestern Medicine

Dr. Bernstein says this helps the patients get assessed quickly, and, if necessary, referred for in-person visits with urban-area specialists. The service has allowed for quicker stroke diagnosis in areas like Lake Forest, Central DuPage Hospital, and even as far west as Sterling. Bernstein says Northwestern also is expanding telemedicine to specializations like eye care.

"Patients with diabetes who were being seen at a diabetes clinic out west, not far from CDH, can have a picture of their eyes taken and that photograph can be reviewed remotely by one of the Northwestern Medicine ophthalmologists to look for diabetic retinopathy, which is a cause of blindness," he said.

Bernstein says in about a hundred of these tests, more than half of the patients got in-person appointments for further treatment. 

Despite telemedicine's advantages it can sometimes be difficult for patients who have these treatments get reimbursed by insurance companies. Dr. Bernstein says the trouble is drawing the line between a doctor's appointment and private correspondence.

"What if they take a picture of something on their skin, upload it, I look at it the next day, and send them some recommendations?" he asked. "All of these are variations on the theme of doctors interacting with patients or doctors interacting with other doctors remotely."

Even so, telemedicine also can be useful for mental health care. Dr. Jayne Braden is a clinical psychologist who operates counseling centers out of Sycamore, Rochelle, and several other locations.

"There isn’t that hands-on piece: Where does your shoulder hurt? Let me manipulate it. Can you move it that way? Those pieces make it easier," she said.

Braden's practice began offering telepsychiatry services because there's a lack of those doctors in DeKalb County, and in general.

"There are fewer going into psychiatry as a specialty because they can make more money doing other specialty services," she said.

She has two staff psychiatrists who communicate with patients through videoconference. They can speak with their patients directly about how they’re feeling, what they expect to get out of treatment, and if they need to make adjustments to medication. This is all done without having to visit a larger hospital in larger, more distant cities such as Rockford. 

Braden's practice requires patients to also get treated by a counselor. While contract restrictions mean psychiatrists are only available at clinic locations, she says counselors can teleconference with patients at home.

"Sometimes they don’t want other people to know that they attend services. This is one easy way to get those pieces to fit together without having to share what all you're doing," she said. 

Braden's psychiatric patients used to only get reimbursed if they had Medicare, but their treatments recently received approval from Bluecross as well. Braden says this expands the market for patients, and gives people more options if they're looking for a psychiatrist. 

While telemedicine may not replace conventional appointments, doctors like Bernstein say it's a natural progression in medicine, especially in rural areas.

"We want to minimize the impact of getting medical care on a patient's life," he said, "and coming to the doctor's office when all that's needed is a face-to-face conversation is too intrusive when we could do it in a way that's much less intrusive. So I have no doubt that this is going to keep expanding."