Telehealth expands local medical and psychiatric services

Monday, February 12, 2018
Clar Graesing, Spencer Hospital director of ICU and telemedicine, demonstrates the telehealth system. The hospital has used the system to expand coverage to specialists. Instead of traveling to see the doctor in-person, services are offered via a secure HIPA complaint, internet connection.
Photo by Colin Van Westen

Recruiting mental health professionals to rural Iowa has been a challenge for Seasons Center's President and CEO Kim Scorza. But through telehealth services, Season Center now has three psychiatrists on staff.

Telehealth is a service offered by Seasons Center and Spencer Hospitals which allows physicians to be seen remotely through a secure HIPA complaint, internet connection.

"It is very challenging," Scorza said. "It is challenging to recruit candidates to a rural area. Often we have candidates who want to live in Omaha, Des Moines and Sioux Falls. It takes a specific type of person that wants to live in a rural area. Living in a rural area and practicing, you run into your clients at the gym, getting groceries and going to the movies. Living in an urban area your contact with your clients is really reduced."

Both Seasons Center and Spencer Hospital have seen increases in telehealth services over the last five to ten years. Spencer Hospital director of ICU and telemedicine Clara Graesing said the hospital had 379 exams via telehealth in calendar year 2017. The numbers have been increasing steadily each year since 2011.

"To provide telemedicine to people you match the services available over telehealth to what your patients need locally," Graesing said. "Right now, Avera is the hub we go through for our telehealth and they have lots of specialties to choose from. ... Outpatient services is different from inpatient services. So our outpatients come in, the nurse does the screenings with them and the types of services a nurse would typically provide during an exam. Then the doctor comes on screen and does his exam. For inpatients, the law and the billing is a little different. The services are a little more limited for what you can provide for inpatients."

One of the problems faced by telehealth providers is the law does not require patients who see their doctor via computer to receive the same insurance coverage as if they see their doctor in-person. A bill before the Iowa legislature, House Study Bill 572, would change that.

Susan Zulk, Spencer Hospital vice president of marketing and fund development, said visiting the doctor remotely via computer is not that much different from meeting with the doctor in-person.

"There is not a huge difference between in-person and remote care because as a patient you are in an exam room, and you're with the nurse," Zulk said. "The specialist, the physician, is right there via telemedicine technology, to see you and to visit with you. For example, in infectious disease if there is something on the skin, they can zoom the camera in and see it. They can get all the vitals and the lab work is typically done ahead of time and they can do a follow up, too."

Scorza and Zulk agreed telehealth services provide a great resource for rural communities by allowing patients to be seen locally instead of having to travel hours to see a specialist.

"We are pretty fortunate in the Spencer area, we have a very diverse medical staff," Zulk said. "Some rural areas don't have the mix of specialists we have. We do use telemedicine and we are using it increasingly; however, in some of the more rural areas telemedicine becomes even more important."

"Telehealth services most definitely expand access in rural Iowa," Scorza said. "We would have to be on a wait list months and months out if we did not have telehealth. People would not be getting care if we did not have telehealth."

The hospital now uses telemedicine to offer services in infectious disease, pulmonology, neurology and cardiology. It also offers services in nephrology, a medical speciality focusing on the care of the kidneys and treating kidney disease, and a liver specialist.

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