KANSAS CITY, Kan.—Twenty years ago, a patient diagnosed with cancer in Goodland, a town of about 5,000 in western Kansas, faced a 10-hour roundtrip commute to Wichita for care. Or, if he was fortunate to have out-of-state health insurance coverage, he could make a 150-mile journey to Denver, Colo.
Meanwhile, in Kansas City, a parent with a sick child might spend an hour or more boarding one bus after another, sometimes making three connections before reaching the University of Kansas Medical Center just a few miles from the child’s school.
The landscapes surrounding their homes were dramatically different, but these Kansans living more than 400 miles apart shared the same struggle for access to health care.
Today, technological advances have minimized the extensive travel and long waits to schedule appointments. These advances often rely on telemedicine, where video conferencing equipment and other instruments can submit data electronically to providers hundreds of miles away. KUMC began working with these tools in 1991, making Kansas one of the first states with telemedicine. Over the last twenty years, KUMC has delivered telemedicine to tens of thousands of patients through its Center for Telemedicine and Telehealth. Today, KUMC provides clinical telemedicine services in 42 Kansas counties, with sites in the state’s largest cities and smallest communities.
Among the projects is the South Central Kansas Special Education Collaborative. SCKSEC is a school-based telemedicine project in seven counties (Stafford, Comanche, Pratt, Kingman, Barber, Kiowa, and Harper), covering 15 school districts. KUMC set up the infrastructure, but it’s sustained and run entirely by the collaborative.
“It really opens up doors to education and ideas,” said Shelly Brensing, a Pratt-based registered nurse with the collaborative. “This is one of the most rewarding and exciting things I’ve seen as a nurse.”
“We’ve come a long way in the last 20 years,” says Ryan Spaulding, PhD, the Center’s director. “We use telemedicine to treat patients with cancer, diagnose autism, educate elderly adults about healthy lifestyle options.”
Used for mental and physical health consultations with KUMC doctors, Brensing said the students, teachers, parents and nurses can all get the same information at the same time, Brensing said. “Everyone is working together, it’s a real team approach.”
Covering 15 school districts, the far-flung cooperative benefits from the real-time teleconferencing visits, the nurse said. “It works really well. The drive for some of these people would be really difficult.”
The goal is to focus on the student and support the family, Brensing said.
Relief for Hays
For decades, Hays pediatrician Robert Cox examined newborns shortly after delivery to ensure they were in good health. Sometimes, the newborn would have a heart murmur. The child might need immediate heart surgery, but only a pediatric cardiologist could know for sure. “In general pediatrics, we’re trained to read tests like a pediatric echocardiogram but not in the same way a pediatric cardiologist is,” says Cox, who is now retired. “We can’t always identify the nuances that can indicate a big problem.”
That’s why Cox sent all newborns with heart murmurs on a four-hour ambulance ride to the nearest pediatric cardiologists, located at the University of Kansas Medical Center in Kansas City — until Cox and KUMC forged a partnership to provide pediatric cardiology via telemedicine. With the new technology, a pediatric cardiologist could examine newborns with heart murmurs remotely.
“There’s a set of things that are necessary for any professional to make an assessment of any particular problem, and that doesn’t change, whether it’s face-to-face or electronic,” explains Cox. When Cox diagnosed a newborn’s heart murmur, the medical team in Hays would gather a variety of data, such as a chest X-ray and blood tests, for a consultation with the on-call pediatric cardiologist at KUMC. Both physicians would then link up via sophisticated video conferencing equipment, allowing the cardiologist to see the physical examination of the baby and watch the echocardiogram in real time.
“Telemedicine was a relief to the parents, a huge relief to me, and of course, a huge money saver,” says Cox.
When Cox first began investigating the new technology and thinking about building a relationship with KUMC in 1988, he was just seeking relief. Hays is a thriving town of 20,000 that serves as a medical hub for dozens of surrounding communities in central and western Kansas — and it had recently lost a pediatrician. Its remaining two pediatricians were overloaded with cases and extra on-call duty at the hospital. Cox thought KUMC pediatric residents might use the technology for initial screenings of children who arrived at the hospital outside of business hours, thereby reserving the in-town pediatricians for the most emergent cases. That never happened.
“We found that the telemedicine application was exceptional for specialty and sub-specialty visits, administrative meetings and continuing education,” says Cox.
Although the technology is best for specialty care, it wasn’t always easy to convince specialists to use telemedicine.
“It’s not like I went to medical school and thought I was going to do telemedicine - it didn’t even exist,” says KUMC oncologist Gary Doolittle, who has been using telemedicine since 1994 to provide follow-up care and second opinions for Kansans diagnosed with cancer. “But it had an awful lot of appeal. Telemedicine has enabled me to serve people in the rural parts of the state,” explains Doolittle. “With a diagnosis like cancer, it’s particularly important that patients be able to stay close to home and get chemotherapy close to home.”
Since the early ‘90s, as telemedicine technology has improved, so have physicians’ participation rates. Today, Kansans across the state have telemedicine access to specialty providers such as oncologists, neurologists, rheumatologists and others.
Mental Health specialists Statewide
One of the specialty services best suited to telemedicine is behavioral and mental health care, available in dozens of locations across Kansas, including Goodland.
Goodland is home to Sherman County’s only hospital: Goodland Regional Medical Center, a 25-bed hospital staffed by four physicians and two nurse practitioners. The medical center offers specialty care in many areas, including psychology and oncology — services that are unusual at most critical access hospitals due to the shortage of specialty health care providers in rural areas.
Telemedicine enabled the medical center to begin offering these services in 2007, when the Northwest Kansas Area Medical Foundation bought the equipment and built a partnership with KUMC’s Center for Telemedicine and Telehealth.
“It definitely has added to our local clinics and hospital,” says Crystal Schultz, speech therapist and telemedicine coordinator at GRMC.
Telemedicine makes it easier to coordinate care for patients such as Ruby Arvanetes, 74. Arvanetes’ primary care provider recommended she see a psychologist two years ago when Arvanetes’ typically pleasant mood soured.
“You get pushed against the wall and you can only take so much,” says Arvanetes of how she felt before beginning treatment. “I didn’t know what to do.”
Sherman County doesn’t have a licensed psychologist or psychiatrist; nor do its neighboring counties. But Arvanetes didn’t need to travel far to get help. Each month, Arvanetes “visits” with KUMC psychologist Elizabeth Penick, PhD, and now says her depression is “in remission.”
Penick also fixed another disruption in Arvanetes’ daily life. During their telemedicine sessions, Penick observed that Arvanetes had a lot of involuntary leg movements while sitting.
“The movements happened while I was standing, too, which was embarrassing because it looks like I have to go to the restroom,” said Arvanetes. “But when I was sitting in the chair, she spotted them right away.”
Penick thought it might be tardive dyskinesia, a movement disorder and side effect of one of her daily medications. Arvanetes’ physician took her off the medication and her symptoms have subsided. She believes the telemedicine setting made it easier for Penick to notice odd movements.
“Telemedicine was something new for me, but it has worked out great,” she says.
According to Crystal Schultz, Arvanetes’ reaction is par for the course among patients of all generations. “The younger kids think it’s pretty awesome, having grown up in the technological age. Some of the older adults have been a little leery but once they get into it, they really see the benefit.”
Younger kids attending school in the Kansas City, Kan., school district have access to health care providers during the day thanks to telemedicine.
Windy Garrett, RN, MSN, has worked as a school nurse at Bertram Caruthers Elementary School in the Quindaro neighborhood for 12 years. When she first started, Garrett saw plenty of sick students — kids with earaches, swollen tonsils, uncontrolled asthma. Even though Wyandotte County had more than more than 300 practicing physicians, the Quindaro neighborhood didn’t have any family practitioners. The few available safety-net clinics required long bus trips, lots of walking and lots of waiting.
“For the parents of children in our school, it was essentially an all-day event to take them to the doctor,” Garrett recalls.
When Garrett heard about Telekidcare-the nation’s first school-based telemedicine project, devised by KUMC to connect sick students with doctors remotely during the school day-she campaigned to be part of the project. Today, with several safety net clinics in the neighborhood, telemedicine helps Caruthers’ students and their families get access to care such as child development screenings and behavioral health services.
Garrett remembers one little boy who was experiencing performance anxiety. “He cried constantly. He honestly could not function in the classroom,” she says.
The boy’s teacher and Garrett asked the parents’ permission to provide behavioral health services with a licensed specialist through telemedicine. The family also agreed to participate in some of the sessions.
“Together, they all problem-solved and it was really nice to see him come out of his shell,” says Garrett. “This little boy was just basically paralyzed, and now he’s excited about his adventures.”
The team approach for school-based telemedicine is one of the biggest benefits, according to Garrett, who invites teachers, parents, students and others regularly involved with the child to be part of the process. “It’s nice for the doctor to be able to hear of different areas of a child’s life and how the child presents in those various aspects,” says Garrett. Now school-based telemedicine services are available in several districts across the state.
Ryan Spaulding is proud of telemedicine’s robust and long-standing presence in Kansas. The Center is one of the longest-running telemedicine programs in the nation and Spaulding is looking ahead to technological changes that will continue to revolutionize health care.
“We want to keep expanding access and using the video model, but also expanding access through mobile technologies that people use throughout the day or in their homes,” Spaulding says, citing examples of smartphones and tablets, bandages that monitor vital signs or hydration levels, and carpeting that can detect abnormal gait patterns more.
“Our center will research these developments to determine which ones will most effectively improve health care for Kansans,” he says.
The Center for Telemedicine and Telehealth will also have new technological opportunities to harness as the Kansas City area pilots the Google Fiber network in the coming years.
“Google Fiber will be the model for what will soon be available everywhere,” says Spaulding. “Now it’s our opportunity to develop the telemedicine technology that will help everyone someday.”