Remote doctors, one answer to physician shortage in rural Minnesota

When a man with a dislocated knee came to the emergency room in the small city of Appleton, in western Minnesota, he was treated by a doctor who had never worked on this particular condition. But the doctor was able to hit a button and consult on camera with a specialist in another location. “The eDoctor was able to help him and go step by step,” said Stacey Weinkauf, director of nursing at Appleton Area Health Services.

“It’s helpful to have the backup,” she said.

Many rural hospitals in Minnesota are small, remote and understaffed. The lack of rural doctors, nurses and other providers has been a theme running through the Minnesota Rural Health Conference this week in Duluth. And so has the use of technology to fill the gaps, both by bringing services where they are lacking and creating the kind of partnerships encouraged by federal healthcare reform.

The Helmsley Cheritable Trust, based in New York and South Dakota, has invested millions in remote medicine in the rural upper Midwest. Areas of focus include cancer screening and care for the elderly—for example, a model for senior living that includes sensors to measure health and detect when a person has fallen. It also has put money into remote pharmacy services. “We know the challenge with an aging pharmacist population,” said the trust’s program officer Wayne Booze. “As they are retiring, they are not being replaced.”

“This is kind of big stuff,” Booze said.

The hospital in Appleton has just 15 beds and a small staff. The nearest hospital is 50 miles away. There are a lot of conditions the staff might only see once or twice a year, if ever. So the use of electronic medicine holds a lot of promise. “It’s very easy to use,” said Weinkauf, who said the hospital started using remote doctors about two years ago, with a Helmsley Trust grant. “There is a box in the (emergency room). You can use the doctor if you want or a nurse if you want. Once we got used to it, we used it more.” She said the system allows access to specialties like cardiology and neurology.

There can be a time delay in treatment when the doctor or nurse practitioner is on call and off site. “But with eEmergency, you can push the button right away,” she said. “The assessment starts and you can get the orders started. The care plan starts sooner.”

“Especially when you have a lot of nurses without a lot of experience, it’s essential.”