| | Rural settings include more than just cows and picturesque scenes these days. Increasingly, high-tech telecommunications equipment is dotting the countryside as well, making rural health care a less isolated endeavor while expanding opportunities for continuing education.”I feel so strongly about the changes that technology is going to precipitate in healthcare delivery in rural and isolated areas,” said Mary Wainwright, MS, RN, assistant director for projects and operations with the East Texas Area Health Education Center (AHEC). As part of her work with the program, she addresses workforce issues such as the maldistribution of health professionals in nonmetropolitan areas.”I believe that there are going to be such profound changes,” she said, “that we could very well see changes in demographics [of healthcare professionals]. Some of the distribution issues may very well be overcome by the technology itself.” That’s because nurses and therapists may be more willing to work in the country if technology can bridge the gap to the city, Wainwright said.TV for health careTechnological changes are already happening. For example, television is being used for more than just diversion in some hospitals. The pediatric telemedicine clinic at the University of Texas Medical Branch at Galveston (UTMB) has been serving patients in rural areas since September 1996. The interactive video clinic also offers rural health professionals a chance to consult with distant colleagues who may be more specialized. Rather than traveling all the way to Galveston, patients, families, and clinicians need only travel to Lamar University-Beaumont or Stephen F. Austin State University in Nacogdoches for certain interdisciplinary evaluations and consultations with UTMB staff.”This is really a time and money saver for the family,” said Kimberly Bachmeier-Conner, OTR, a pediatric occupational therapist involved with the project. Shorter travel time often translates to happier, more cooperative kids as well.Mastering the mediumYet, evaluating patients via interactive television has taken some adjustment. “One of the first visits, I found myself sitting at the edge of my chair, yelling into the TV,” Bachmeier-Conner said, “as if since they were so far away, they wouldn’t hear me.”Through experience, she developed strategies for guiding remote colleagues through evaluations. “I never imagined practicing without my hands,” she said. But that constraint of telemedicine has helped her hone her observation skills. She has also learned to use easily understandable functional descriptions of what she wants patients to do. She might guide the onsite nurse practitioner or another therapist through a fine motor evaluation of a child or talk the patient through an ADL assessment.Pluses and minusesTypically, the entire treatment team attends the telemedicine evaluations, and that can be both positive and negative, according to speech therapist Marte Hersey, MA, CCC-SLP, supervisor of speech pathology for the Center for Audiology and Speech Pathology at UTMB. While communication among clinicians improves, waiting for others to complete their assessments is not a productive use of practitioners’ time, she said.Technical glitches can also decrease efficiency. Delay in transmission or distortion of sound can make it difficult for children with auditory or language problems to understand Hersey. She compensates by providing the remote clinics with evaluation materials, such as word and picture cards, and relaying instructions to the onsite clinicians. They in turn repeat the instructions to the children, who can see the materials in person instead of on the TV. Both Hersey and Bachmeier-Conner see a lot of potential for telemedicine, particularly in rural settings. “I think it’s an ideal situation for us to use as a learning tool,” Hersey said. By guiding students through the interactive video, practitioners can help expand the students’ learning without requiring their presence in the city. The urban therapists can also help rural clinicians who may not be as experienced with a particular diagnosis develop effective treatment plans.The scope of telemedicine is likely to expand as reimbursement improves, according to Myrna Armstrong, EdD, RN, FAAN, a professor at Texas Tech University Health Sciences Center School of Nursing in Lubbock and author of Telecommunications for the Health Professional: Successful Strategies for Distance Education and Telemedicine.”Telemedicine is not being financed yet. That is preventing it from getting into the forefront of activities,” she said. As the medium is more widely used, health professionals will likely devise new uses for it, Hersey said.Often the interactive equipment used for telemedicine is also used for professional education or distance learning. Bringing education to health professionals rather than making them travel long distances is crucial in rural settings, Armstrong said. Because rural practitioners are usually generalists, they need information about a variety of topics. Yet, because they often practice solo, they usually have no replacement if they leave for a seminar, she said. To fill the need for accessible education, Texas Tech’s Healthnet provides about 800 hours a year of video CE for rural health professionals,according to Armstrong.The East Texas AHEC has an outreach program to provide advanced nursing programs to rural areas through interactive TV, Wainwright said. “We were able to facilitate their learning experience while they still live in their own area,” she said. “We don’t want them to leave either, because they are critical to those [rural]communities.”Healthcare superhighwayA major factors to improve information access is the Internet, said Gail Bellamy, PhD, the incoming president of the National Rural Health Association. It doesn’t matter if your computer is in the country or the city, you can still tap the Net’s vast medical resources. The only obstacle, she said, is that some rural settings lack local Internet service providers, making each connection a toll call.However, she said that the Universal Service Fund, a program through the Federal Communications Corp., is subsidizing rural facilities so they can hook up to the Internet at costs comparable to urban areas.Shrinking the distanceThe desire for more education opportunities via cyberspace is apparent to Sandra Dirks, MSN, RN, the RN education coordinator for the School of Nursing at the University of Wisconsin-Eau Claire, which is piloting some online courses this semester. Dirks said a mention of the experimental program in Working Mothers magazine resulted in inquiries from across the country.Not all were from rural residents, she said, but “wherever they are, they are miles from a nursing program. They’re what we call ‘geographically immobile.’ They’re already immersed in a job, family. They cannot pick up and move to a campus.”Many urban practitioners can benefit from Internet applications and distance learning, Armstrong said. It can sometimes take just as long to drive through downtown Dallas as it does to drive in from the remote countryside. |
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