Telemedicine technology an asset to rural healthcare

• Dan Rustvang

Family nurse practitioner Dan Rustvang, a wound care specialist at Altru, monitors progress on a healing foot wound through telemedicine technology recently. photo by Eric Hylden/Grand Forks Herald
• Altru telemedicine locations

Altru telemedicine locations

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A serious leg injury could have cost Mark Romfo valuable time in the middle of planting season last spring on his farm near Langdon, N.D.

But his doctor, 120 miles away in Grand Forks, was able to monitor his progress through technology that allows health professionals to see and talk with patients and manage their treatment from a distance.

The telemedicine technology freed Romfo from having to make the two-hour trek to Grand Forks several times to see the doctor in person.

“It saved us hours and hours of traveling,” said his wife, Sherri. “Basically, it’s a whole day when we go to Grand Forks.”

After an initial evaluation at Altru Clinic in Grand Forks to determine if surgery was needed (it wasn’t), Romfo had five appointments using a telemedicine site in Langdon.

“He was comfortable with the doctors and how the whole process worked,” Sherri said. “The whole experience was very positive.”

Telemedicine “is a great thing in rural communities,” she said. “It’s more convenient this way.”

A growing option

Telemedicine has been around several years, but advances in equipment quality and availability as well as patient satisfaction have bolstered its appeal among providers at Altru Health System, according to Marsha Waind, manager of regional services.

“Providers at Altru have been very receptive,” she said.

Early on, doctors had to leave their offices and go to a separate basement location where telemedicine equipment was housed.

“Now, it’s integrated logistically into their daily practice,” she said. Health professionals can use newer, smaller desktop equipment in their offices.

Waind has been working with Altru’s telemedicine program since it was introduced for renal dialysis patients in 2007 in Devils Lake.

Renal dialysis accounts for an average of 150 visits per year, she said in an email. Since 2008, 1,238 outpatient visits have been conducted by Altru via telemedicine.

Wound care specialists, Dr. Rolf Paulson and family nurse practitioner Daniel Rustvang, were the first to offer services in 2008, followed by the dermatology department.

“The Wound Care Clinic is a great resource in this region,” Waind said. Wound patients need to see their physician weekly.

A leg wound, for example, may impede the patient’s ability to walk, making travel more difficult. Treatment plans for these patients can change almost weekly, she said.

Telemedicine fills that need for frequent check-ups.

“The doctor can talk to the nurse, who is with the patient at the site, and problem-solve,” she said. They can discuss various options concerning what’s best for the patient.

With telemedicine, “all kinds of communication problems are solved,” Waind said. “The care-planning that happens is just beautiful. That’s what should happen.”

The nurse who presents the case at the distant telemedicine site increases the patient’s comfort level, Waind said. “And our doctors can deliver care at the right time.”

Building relationships

Telemedicine enhances relationships between patients, their doctors and others who care for them, she said. “We can be part of that relationship-building.”

Since inception, telemedicine has expanded to include other specialties such as neurology, diabetes, infectious disease, bariatrics, pulmonology and prosthetics.

Psychiatry is another growth area, Waind said.

The network of 16 area communities is expected to grow, she said, as new sites are opened at Grafton, N.D.’s Unity Hospital and the Spirit Lake Health Center, south of Devils Lake.

Controlling costs

Through telemedicine, costs can be better controlled, too, both for the health care facility and the patient. For example, use of an expensive wound dressing can be replaced sooner with a less-expensive but more appropriate one based on results of more-frequent assessments via telemedicine.

Outlying health care facilities save the expense of personnel — and temporary loss of an ambulance — when they transport patients to Grand Forks.

Telemedicine improves revenue-generation in the site community by keeping certain services, such as lab work, local.

“It also helps the local hospital or clinic maintain its identity as the local medical provider,” Waind said.

But mostly, telemedicine is about convenience.

When the sole reason to see the doctor is to get lab results, “patients don’t have to come to Grand Forks for a 10-minute visit,” Waind said.

Some patients simply can’t afford the travel expense.

“Patients like that, in the past, would have just stopped coming to Grand Forks,” said Seth Dorman, family nurse practitioner with the Wound Care Clinic.

Now, wound patients come to Grand Forks for an initial visit to determine blood supply to the affected area — which predicts likelihood of the wound healing — and to develop a treatment plan. Subsequent visits can be done via telemedicine with professionals on the patient’s end giving hands-on care.

An integrated digital medical record that is tied into the telemedicine system and stores high-resolution images allows health professionals in Grand Forks to track progress of wound-healing.

“The quality of the camera is so much better than even three years ago,” said Rustvang, who sees four to eight patients a week via telemedicine. Most of his and Dorman’s patients live in nursing homes.

Telemedicine “is another mechanism to deliver care,” Rustvang said. “It keeps growing.”

Patient response

When telemedicine was emerging as a potential alternative for delivering care, some questioned whether it would work in this region, especially with elderly patients, Waind said. Those doubts have subsided.

“I have seen 85-year-old patients who’ve never been on a video connection of any kind, open up” and speak candidly and directly with their doctors, Waind said. “They’re open to making it work, so they don’t have to go to Grand Forks” where traffic can be intimidating.

Instead, with telemedicine, “they can walk to their local hospital, where there are people they know and who can advocate for them.”

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