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NCPR: After rapid expansion, how telehealth services work in one North Country hospital

When people talk about the future of health care, and solutions in rural areas, telehealth comes up a lot. It can help connect people in low-population areas with specialists and niche services.

And in just the last few years, during the pandemic, the usage of telehealth skyrocketed. Today, it accounts for about 5% of health care claims. Here's what it looks like in one North Country hospital. 

Diabetes management from afar

Shannon VanHouse is a diabetes care and education specialist, and she teaches classes here, like diabetes management and chronic disease prevention.

She loves it when people have their aha-moment. "They learn about their disease, and you can see the light go off," said VanHouse. "Like, oh, ok! That’s what’s happening and this is why I should eat this way or start moving a little more."

During the coronavirus pandemic, VanHouse and other educators, like Michele Caitlin, started offering all their classes virtually, aided by a sleek technical set-up. 

"The [in-person] participants are here in the room, and then we have up here as our mastermind computer for the telehealth stuff," said VanHouse. "And it has a nice new camera that actually will follow wherever [you go]."

She joked that "it's probably more sophisticated than we understand," and Michele Caitlin laughed and said, "But it works!"

In the past, that meant people had to come here. Or it meant educators had to travel.

"We used to travel to, you know, Madrid, which is like 30 miles away," said VanHouse. "Or to Alexandria Bay," said Caitlin. They say all that travel cut down on time actually spent with patients. 

These days, VanHouse and Caitlin reach people all over St. Lawrence County, and beyond, virtually. Right before we met, Caitlin was talking to a new patient. "Today I got a call from a lady in Malone, who was looking for individual diabetes counseling and wellness classes," she said. And happily, they offer both.

"That happens about once a week, we get calls from other counties looking for services," said Caitlin. She said several doctors in Clinton and Franklin counties now refer patients to them regularly. 

A dramatic expansion of telehealth 

Ogdensburg's diabetes unit is just one example of a telehealth service that’s expanded since 2020, when the coronavirus pandemic accelerated the adoption and use of telehealth across the US.

The federal and state governments temporarily broadened the usage of telehealth, and many of those flexibilities became permanent. The range of telehealth services that are covered by Medicaid and Medicare was dramatically expanded during the COVID 19 pandemic.

FAIRHealth, a national database of insurance claims data, shows that telehealth claims in the United States increased from about 0.1% to 5% between 2019 and the end of 2021.

His organization is a partner on the North Country Telehealth Partnership, which works to help regional hospitals and clinics implement telehealth services. The organization has also been tracking telehealth visits in the region for the last decade.  

In 2019, Hunt says they recorded about 3000 telehealth visits. Then, the pandemic hit, and those numbers increased astronomically. "In 2020 that shot up to 128,000, and in 2021, it doubled to 211,000."

Hunt says its stabilized now, to around 120,000 visits per year.

Tele-stroke and infectious disease consults 

At Claxton-Hepburn, they now offer a selection of telehealth services in 2023.

Dave Ferries, the chief nursing officer at Claxton-Hepburn Medical Center and the Carthage Area Hospital, said the goal with all their telehealth services is to keep patients from having to travel.  

"You know, we're local, families are local. So it's rough on people, if they have to be transferred to another facility for some of these specialties," said Ferries.

At both Claxton-Hepburn and Carthage, the oldest telehealth program is called 'Tele-stroke'. Basically, they call a doctor at Upstate Medical Center, in Syracuse, when a stroke patient comes in to the Emergnecy Room, "and have a neurologist or neurosurgeon on camera to do an evaluation of the patient," said Ferries. "We can do all the testing here. But having that backup support for strokes is very important because you want to get the thrombolytics or the treatment started as soon as possible."

Ferries says getting a quick and correct evaluation makes all the difference, and said of Tele-stroke that, "it's worked very, very well. And we've had patients with great outcomes," he said. 

In the last few years, they’ve picked up more telehealth services, including select pysch evaluations and infectious disease consults. With that one, they have the doctor on an ipad, and a local nurse assisting.

"We have a stethoscope that the nurse can place and the doc on the iPad can actually hear the lung sounds," said Ferries. "You can take the iPad and actually point it at the patient if there's something in particular they want to see. It is truly remarkable."

Telehealth has limits... 

Ferries said they've been happy with their telehealth services, but that telehealth isn't the solution to all rural health care woes. "I don't think it'll be the savior. But I definitely think it's useful in certain circumstances," said Ferries.

There are limits to what can be done remotely. Not everyone wants to see a provider online, and many would like to have a more personal connection with their doctors and specialists. 

And Ferries says the sort of ‘dark side’ to a lot of telehealth adoption and innovation, is that it’s being pushed by staff shortages, and a lack of doctors and specialists. Telehealth can’t fill an empty hospital. 

Where Ferries said he really sees telehealth working is when it helps connect on-the-ground rural health care professionals with support and expertise. "Sometimes docs just need advice," said Ferries. "Sometimes it's just...we can do it here locally, you just kind of need that backup support."

...but it also has possibilities 

However, in some cases, telehealth offerings may even work better than in-person appointments.

Shannon VanHouse, from Claxtob-Hepburn's Diabetes Education Program, said for individual diabetes counseling, it actually helps to see people in their home environment. 

"If they're able to go grab, like their favorite snack off of a shelf and read the nutrition label. You know, that's real time education that they can see," saud VanHouse. "Seeing where they live and what it's like is valuable information."

She says some people who might have skipped an in-person session because they have a conflict (with child care, with work), now can video-chat in from their car, or from home. 

 And it’s not always a choice between in-person or virtual, said Michele Caitlin. For some of the folks they see, like elderly patients who don’t drive, virtual is theonlyoption that would work for them. And they figure the technology side of it out. "I mean, they're a lot smarter than people think when it comes to technology. And you know, the majority of our telehealth patients are actually elderly people," said Caitlin. 

This year alone, the diabetes education unit has received 250 referrals, a huge increase from years past. VanHouse and Caitlin say that’s because word is spreading, and post-pandemic, people are more comfortable using telehealth services.

They’re excited for every new person they can help, says Caitlin, because their work has big impacts on patients AND their families.  

"There's the education that they get as well the knowledge that they have to make better decisions throughout their life," said Caitlin. "And the beauty of it is [that] it trickles down. Like we've seen it trickle down into their families; like their grandchildren, their children. So it's you know, it's just like a rolling ball that keeps going."

We wrapped up our interview because they needed to set up for a farm-to-fork class in the room. It had both in-person and virtual participants.

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