House call

Nevada ranks as the seventh-largest state in terms of land size. With many rural communities around Reno seeking access to specialty physicians, it can be challenging for doctors to regularly visit small towns like Elko, Tonopah, Winnemucca and Fallon to provide patients with the medical care they need.

As technology continues to change, many health care companies like Renown Health have incorporated telemedicine offered to better meet the needs of those in rural areas who otherwise would have challenges seeing a doctor for certain conditions due to their geographic location.

According to Mitchell Fong, Director of TeleHealth at Renown, telemedicine comes in multiple forms, depending on the patient’s location and medical needs. When Renown launched its TeleHealth program in 2012, it was designed as a small pilot project to provide rural populations with access to remote specialty care using advanced technology such as Bluetooth stethoscopes, high-definition peripheral cameras and enhanced broadband connectivity.

In the past, specialty physicians would have to make trips out to small towns throughout the state maybe once or twice a month to provide care, or patients would struggle to find transportation or the means to travel hours into a city to see a doctor at a large hospital, according to Fong.

“Patients tell us that they wouldn’t even get care for some of these specialties if they had to drive all the way in [to Reno],” Fong said. “Ultimately, I hope that we’re improving the lives of these patients by allowing them to live their best life and not waiting until they have a severe episode.”

Many general practitioners working in rural areas also experience isolation and burnout being the only doctor in town, which leads to high physician turnover and doctor shortages across remote areas. Now that rural doctors have the opportunity to interact and engage with specialty physicians and other health care providers via telemedicine, it has provided a greater sense of community and lower levels of isolation and burnout in rural doctors, according to Fong.

In 2019, Renown’s TeleHealth program logged over 5,500 telemedicine visits. Fong said the focus is now on how telemedicine can create an impact for those still underserved in urban communities, too.

Urban expansion

One of the biggest challenges companies like Renown face when it comes to expanding telemedicine into the urban setting are the rules and regulations of reimbursing the cost of services. According to Fong, specific services were only approved to be reimbursed if they were done in rural locations. Programs like Medicare are eliminating these limitations, which will allow patients in urban settings to use telemedicine services as well.

Fong said when it comes to services Renown will offer to urban patients, it will be a direct-to-consumer method of care such as video chatting with a doctor on a smartphone. Of course, there are limitations. Patients don’t have the proper equipment such as high-definition cameras or stethoscopes at home, but there are many specific uses the direct-to-consumer method is good for.

“It’s really thought of as a lower acuity urgent care setting,” said Fong. “Some of the most common conditions that we treat in that virtual setting are sinusitis, respiratory infection, urinary tract infection and flu symptoms.”

Minor skin lesions can also be examined over video chat, but Fong said those are the top four most common virtual visits the direct-to-consumer method should be used for.

Still, patients might be unsure if their maladies are fit for a virtual visit or a trip to the hospital. Fong said TeleHealth’s online platform prompts patients to answer a series of triage questions about the length and severity of their condition before directing them to make a decision on where to go.

“Some triage questions have a built-in algorithm, so as you’re answering these questions based on your condition, your severity your exposure, it can actually stop the questions and say, ’Your condition sounds like you should be going to the urgent care,’ or ’Your condition sounds like you should be going to emergency care,’” Fong said. “That way, instead of going through the entire questionnaire, getting your virtual visit and then being redirected, it’s redirecting you upstream.”

Medical misconceptions

According to Fong, a common misconception about telemedicine is that it’s difficult for patients to develop a relationship with their health care provider. Fong said many patients have stated in recent surveys that they prefer communication with their doctor through telemedicine over a traditional face-to-face visit. Patients expressed their in-person experiences wherein their doctor spent much of their time sitting behind a computer documenting information. Those who’ve used telemedicine experienced more interaction from their doctor despite the conversation taking place over video.

Another common misconception is that the level of care in telemedicine isn’t as high as it would be in a regular doctor’s office. Although the direct-to-consumer method of video chat has its limitations, in-clinic visits come equipped with HIPAA compliant technology such as advanced cameras and stethoscopes that allow doctors to examine the eyes, nose, ears and throat as well as listen to the patient’s heart and lungs as if they were in the exam room with them.

“At the end of the day we ask our providers to ensure that the service we’re delivering is at least the same level of quality as they would be delivering face-to-face, and that is the expectation that we hold across our TeleHealth program,” said Fong.

When Fong joined Renown’s TeleHealth department in 2012, Nevada was ranked as the 47th worst state for access to health care providers. According to Fong, the future of telemedicine in the state is leveraging these innovative technologies in a more efficient fashion in order to better serve both rural and urban populations.