March 26, 2017
In 2011, with the support of the AIDS United Access to Care Initiative, Medical Advocacy and Outreach of Alabama (MAO) established the Alabama eHealth program to deliver high-quality care in underserved communities in rural portions of the state through telemedicine. Specifically targeting areas that serve as epicenters of HIV/AIDS incidence, MAO has leveraged telemedicine technology against rurality and poverty-driven barriers to accessing HIV care, ultimately empowering Alabama's rural residents to access the quality care that they deserve in the communities where they live.
I spoke with Dr. Laurie Dill, MAO's medical director and chief medical officer, to learn more about MAO's experience with telemedicine.
Can you share with us what motivated you to explore using telemedicine?
We cover a lot of geographic territory in Alabama, most of which is very rural. Before using telemedicine, our patients frequently traveled between one and two hours for an appointment, or we would put all of our staff and equipment in a van and hold clinic for a day in a rural location. There is no public transportation in the rural areas, and a lot of people didn't have friends or family support to help them with transportation. To serve our patients, we needed a better answer. So we were very motivated to see if telemedicine would work!
How did you feel when MAO started to explore telemedicine?
When we first started thinking about using telemedicine, I did not have any experience with it. I had concerns around how well we could do patient exams, how comfortable our patients would be, and the learning curve with the technology. But, since we've started using telemedicine, we have been very, very pleased with it. It's worked really well for us.
Was learning to use the telemedicine technology a large hurdle for you, your colleagues, or your patients?
The technology is remarkably easy to learn, but it does require good IT support. Our initial AIDS United grant allowed us to hire an IT director, who is critical to our telemedicine work. Additionally, it is important to research what broadband is available, as this can be an issue in rural areas.
How do your patients respond to the switch to telemedicine?
It is very easy to convey personal warmth and interest in the patient when using telemedicine equipment, and when possible, we do the first appointment in person to start building that rapport. Our patients appreciate that telemedicine makes their HIV-specialty care more accessible and we've had very good response and comfort level from our patients.
The other thing that has worked very well for us is that we send our nurses to the patient sites and they build trust with patients over time and help them get comfortable with the equipment. Even our older, less technologically-savvy patients have felt very comfortable using telemedicine. We've had very little negative feedback from patients and a lot of very positive feedback.
Our telemedicine retention rates are very good, and generally have been higher than our in-person rates. We even have some patients who come dressed up for their appointments because they want to look good on television, so that's been fun.
Did you have to make any changes in your patient appointments to use telemedicine?
The main thing that's different is the nurse workflow on the patient end of the appointment. The nurse stays with the patient during the exam to operate the telemedicine equipment. This is an important role, as they make sure the patient can see and hear the doctor. This means the nurse isn't able to prepare the next patient until the appointment is complete. Other than making that workflow accommodation, it has worked really well.
Did you discover any unexpected benefits that came with implementing telemedicine?
We've been able to expand the array of services available to our rural patients. Before, when we were driving staff out to the rural clinics, it was difficult to have staff like pharmacy adherence counselors or case managers readily available. We are able to offer all of those services through telemedicine now.
Also, we have switched to a web-based electronic medical record system. In the past, if someone walked in to a rural clinic and we hadn't been planning on seeing them, we may not have had their records with us. Now we can access all our patients charts online.
One other benefit is as an organization with two main locations, telemedicine has been incredibly helpful for intra-agency communication. For example, when I have a weekly clinic meeting, staff from two other sites use telemedicine to join the meeting in real time. We can to pull people into meetings quickly and easily from other sites and it's been a major communication benefit for the agency.
What advice do you have to other providers looking to implement telemedicine programs?
Scheduling can get more complicated than people initially realize. For every provider appointment, you have to schedule two telemedicine machines, one at each end. If you're starting to use telemedicine in multiple places, think through how you will schedule those resources.
Anything else you'd like to share?
We've certainly found telemedicine to be fun, exciting, and rewarding to expand services to our patients in rural areas in a much more comprehensive way.
We are very happy to try to help other agencies think through how to use telemedicine and provide logistical support. Thanks to AIDS United, we were able to host a Telemedicine University, and we're putting a toolkit online. We figured out how to implement telemedicine on our own and we are happy to make that learning curve easier for others.
Sarah Hashmall is communications manager at AIDS United.
|Rural HIV Toolkit Available|
|Benefits and Barriers to Decentralized HIV Care for Patients in Underserved Communities|
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