Imagine experiencing painful daily headaches, knowing something isn’t quite right, but the primary care physician in your rural town isn’t sure how best to treat your pain, and the nearest headache specialist is six hours away. For residents of rural areas, this scenario is, unfortunately, a common one.
“We have patients who come from as far away as the Upper Peninsula which is 4 to 6 hours away—that’s a problem,” says Edmund Messina, MD, director of the Michigan Headache Clinic in East Lansing, Mich.
Timothy Smith, MD, a headache specialist at the Mercy Clinic Headache Center, is vice president of research at Mercy Health, a system that includes both large metropolitan hospitals and small rural clinics. He says that many small towns in the health system don’t have a neurologist, let alone a headache specialist. “These patients suffer a lot and don’t have much access to specialty care,” Smith says.
To ensure that his rural residents get the best possible headache treatment and maximize their time in the office, Dr. Messina uses a video nurse to take patients’ medical history remotely, prior to an office visit. The technology called Arbor Medicus®, which Dr. Messina developed, utilizes an artificial intelligence language which simulates an expert’s reasoning, to better ask detailed and personalized questions.
For patients with a long medical history, the program could take up to two hours to complete—but it gives the patient time to sit and think about their condition, unlike an office visit in which the patient has little time to remember all relevant information. Data is stored in a secure server, and the patient receives a form with their answers at the end, which he or she can then e-mail to his or her doctor. When the patient visits the office for a neurological exam, Dr. Messina goes through his or her answers in person.
“Right now we still have them come in to see us face-to-face for that initial visit, but in the future we hope to use the same technology to automate return visits so they don’t have to come in to have that follow-up conversation,” Dr. Messina says.
In St. Louis, Dr. Smith uses remote video technology (which he calls “teleheadache” technology) to do consultations with patients at a rural clinic in Rolla, Mo., using two-way streaming video.
“I’ll be the first to say that in an ideal world, the best medical care involves a face-to-face meeting,” Dr. Smith says. “But in some of these remote places where face-to-face isn’t possible, this turns out to be the best way to do consultations. Otherwise, these patients would have to drive 120 miles to St. Louis to find treatment.”
The process goes something like this: A physician in Rolla orders the consultation with a headache specialist at Mercy Health in St. Louis. The patient then goes to the community clinic in Rolla where a nurse checks her in, checks her vital signs, takes her medical history and assigns her to an exam room. Instead of the specialist walking into the room, a screen is turned on and the patient can see the specialist. The headache physician has access to the patient’s medical record electronically and, with the assistance of a nurse at the Rolla clinic, can listen to the patient’s heart and lungs using a stethoscope and other equipment hooked up to the telemedicine unit. At the end of the visit, the specialist can electronically submit a prescription to the patient’s community pharmacy and can send educational information to the patient that will print out in the patient’s exam room.
“I just consulted on a case using remote technology this week,” Dr. Smith says. “The woman was desperate and didn’t have headache resources in her community. When we hung up the connection she was very encouraged, and I think we have a good chance at helping her recover.”
Dr. Smith says many patients question why he doesn’t just use Skype or other available video chat services for consultations. Although the use of Skype for health care interactions is an evolving issue, Dr. Smith points out that for medical consultations, a more secure service must be employed. Mercy’s teleheadache system uses encrypted pathways to ensure patient privacy. And all of this is at virtually no extra cost to the patient. In most cases, a facility charge of $20 to $25 is billed to insurance so there is no extra cost to the patient to use the technology.
The National Headache Foundation funded Mercy’s research analysis and seeks to learn from Mercy’s use of the equipment to see if it’s an effective way to treat rural patients. Such projects could be expanded to other communities in the future, though Dr. Smith says it would likely require staff in a rural clinic reaching out to larger hospitals for alliances.
Dr. Messina says patients are hungry for these types of systems, particularly headache patients who are desperate for information and willing to go online if it means they can connect with a physician. But, he warns, “the technology is less important than getting the right content out of the conversation.” If an online visit or virtual history taker can help a patient share the right information and help a physician to make a proper diagnosis, it could be worthwhile.
“This is going to be the functionality of the future,” Dr. Smith says, “and it’s just starting to take hold.”
