It was a medical experience Jared and Kristina Burns wouldn’t wish on other parents.
Without a specialist in town to serve the needs of their young children, the Walla Walla couple had them airlifted for care they believe could have been provided through the telemedicine movement that’s become a growing trend here and across the country in the last decade.
Several years later, it’s a situation others in their shoes won’t have to endure.
Inspired by a thoughtfully written letter and suggestion from the family, Providence St. Mary Medical Center spent more than a year and a half creating a telemedicine program designed to give ill infants and children access to neonatologists and pediatric critical-care physicians available in larger communities.
The Burns family — choosing to keep specifics of their own experience private — was so appreciative when they learned of the program, they provided a donation to fund it. The amount was not disclosed. The program just went live last week.
“Our family’s desire to do something stems from our feeling of helplessness with our own children needing specialty care,” Jared Burns said in a prepared statement. “St. Mary provides good care, but we didn’t have the specialty care. Had (telemedicine) been available, I think our children might have been able to stay in Walla Walla.”
Telecommunications and information technology have been critical tools in clinical health care from a distance in the community for a gamut of specialty services. That includes beaming in specialists for emergency treatment of stroke, critically ill adults and psychiatric consultations.
More than 20 different services are offered through the Jonathan M. Wainwright Memorial VA Medical Center. The operation’s telehealth services include clinical treatment as well as a range of nonclinical services, such as tobacco cessation and a Tai Chi training.
At Walla Walla Clinic, patients in La Grande, Ore., beam into the local facility through a partnership with Grand Ronde Hospital for care in diabetes/endocrinology, CEO Kevin Michelson said. The clinic, he said, has also provided dermatology services in the past and would offer them again with recruitment of another dermatologist.
Providers collectively say the services are as good as an in-person consultation but without the travel that can sometimes be traumatizing and bank-breaking.
The VA service has been life-changing for veterans who may not have much mobility and those who prefer to live in rural America but where services have been so sharply reduced, said Dr. Melanie Thompson, chief of staff for the Walla Walla’s Wainwright facility.
In Boardman and Enterprise, she said, the VA has no providers on the ground, and veterans are exclusively served through a telehealth system. Through home telehealth nurses, added VA Associate Director for Patient Care Services Donna Wickre, patients are managing their own congenital heart conditions, diabetes, weight and more. They’re sent the equipment for their homes and can lean on help for care regularly.
“They’re actually managing themselves and keeping themselves out of the hospital,” Wickre said.
The technology has made incredible strides. A patient with audiological needs, for instance, can have their hearing aids adjusted wirelessly by a provider hundreds of miles away.
Under the new system for children at St. Mary, a robot that looks like a computer on wheels is equipped with a high-end camera for real-time screen interaction with neonatologists and pediatric intensivists, said Dr. Christopher Hall, chief medical officer for Providence St. Mary and a pediatrician. The machine can see down to the bumps on a tongue when steered with a joystick by a provider 200 miles away at Providence Sacred Heart Children’s Hospital and MedNax in Spokane, Hall said.
Telemedicine — the broad term for the use of technology to bridge the geographic gap between patients and physicians — is expected to become a more vital solution to medical treatment with a critical shortage of physicians across the country.
The population is both growing and aging at the same time as a swell of baby boomer physicians prepares for retirement.
By 2030, a shortage of between 42,600 and 121,300 physicians is predicted, according to a study conducted for the Association of American Colleges. Those shortages will affect primary care, but they will be particularly noticeable in specialty care, the report said. Smaller and particularly rural communities face a void without the competitive advantages of metropolitan areas that generally pay more, have a larger population and station practitioners in the company of peers that provide a support network.
Furthermore, rural communities are losing hospitals. The Cecil G. Sheps Center for Health Services Research reports 102 rural hospitals have closed since January 2010.
The changes have seriously affected how service is delivered, Hall said.
Walla Walla is not large enough to support a neonatologist, for example. But in an average month, two to three infants and children need such a specialist and are transported during medical emergencies to larger facilities, St. Mary reports.
The cost of airlifting a critically ill child can run up to $25,000. Hall emphasized the purpose is not to avoid transporting patients if the best care would come elsewhere. But avoiding an unnecessary trip can’t be overlooked either.
“There are times where I’ve had to put a baby in transport to Spokane when the family doesn’t even know where they’ll get the gas money for the trip up,” Hall said.
Conversely, there are times when transport may be needed but is simply not possible. A classic Walla Walla January, when fog crushes visibility three blocks up the road, is a time when air travel simply isn’t safe or possible.
“If you don’t feel like you can drive to Safeway, we’re definitely not flying out of here,” Hall said.
In such times, telemedicine is crucial to helping patients.
In less critical moments, the connection to specialists helps build strength and credibility for the health care professionals on the ground here, too, by backing up physicians, Hall said.
The Providence system — much like the VA’s — paves the way for added telemedicine services because the specialists needed are already part of the network.
Right now the new program serves as a pilot and demonstration for other hospitals. It’s designed to eventually be scaled up.
The program was developed with Cass Bilodeau, region director of Outreach and Telemedicine for Kadlec Regional Medical Center and St. Mary.
Bilodeau is an expert with the telemedicine strides made regionally, versed in the effects from the support for patients with neurological, wound care, stroke and psychiatry needs. Patients, including those with the new pediatric service, who may ultimately need in-person care from the remote medical teams experience a seamless transition with the doctors who, at that point, already know the patient and conditions.
“It’s changing the way we’re delivering medicine,” Bilodeau said. “It’s helping with access and with the work/life balance.”