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Nurseweek/Healthweek|Rural Technology
Rural Technology
Illustration
by Malcolm Garris/PhotoDisc
by
Anne Federwisch, OTR
June 7, 1998
Rural
settings include more than just cows and picturesque scenes these
days. Increasingly, high-tech telecommunications equipment is dotting
the countryside as well, making rural health care a less isolated
endeavor while expanding opportunities for continuing education.
"I feel so
strongly about the changes that technology is going to precipitate
in healthcare delivery in rural and isolated areas," said Mary
Wainwright, MS, RN, assistant director for projects and operations
with the East Texas Area Health Education Center (AHEC). As part of
her work with the program, she addresses workforce issues such as
the maldistribution of health professionals in nonmetropolitan areas.
"I believe
that there are going to be such profound changes," she said,
"that we could very well see changes in demographics [of healthcare
professionals]. Some of the distribution issues may very well be overcome
by the technology itself." That’s because nurses and therapists
may be more willing to work in the country if technology can bridge
the gap to the city, Wainwright said.
TV for health care
Technological
changes are already happening. For example, television is being used
for more than just diversion in some hospitals. The pediatric telemedicine
clinic at the University of Texas Medical Branch at Galveston (UTMB)
has been serving patients in rural areas since September 1996. The
interactive video clinic also offers rural health professionals a
chance to consult with distant colleagues who may be more specialized.
Rather than traveling all the way to Galveston, patients, families,
and clinicians need only travel to Lamar University-Beaumont or Stephen
F. Austin State University in Nacogdoches for certain interdisciplinary
evaluations and consultations with UTMB staff.
"This is
really a time and money saver for the family," said Kimberly
Bachmeier-Conner, OTR, a pediatric occupational therapist involved
with the project. Shorter travel time often translates to happier,
more cooperative kids as well.
Mastering the medium
Yet, evaluating
patients via interactive television has taken some adjustment. "One
of the first visits, I found myself sitting at the edge of my chair,
yelling into the TV," Bachmeier-Conner said, "as if since
they were so far away, they wouldn’t hear me."
Through experience,
she developed strategies for guiding remote colleagues through evaluations.
"I never imagined practicing without my hands," she said.
But that constraint of telemedicine has helped her hone her observation
skills. She has also learned to use easily understandable functional
descriptions of what she wants patients to do. She might guide the
onsite nurse practitioner or another therapist through a fine motor
evaluation of a child or talk the patient through an ADL assessment.
Pluses and minuses
Typically, the
entire treatment team attends the telemedicine evaluations, and that
can be both positive and negative, according to speech therapist Marte
Hersey, MA, CCC-SLP, supervisor of speech pathology for the Center
for Audiology and Speech Pathology at UTMB. While communication among
clinicians improves, waiting for others to complete their assessments
is not a productive use of practitioners’ time, she said.
Technical glitches
can also decrease efficiency. Delay in transmission or distortion
of sound can make it difficult for children with auditory or language
problems to understand Hersey. She compensates by providing the remote
clinics with evaluation materials, such as word and picture cards,
and relaying instructions to the onsite clinicians. They in turn repeat
the instructions to the children, who can see the materials in person
instead of on the TV. Both Hersey and Bachmeier-Conner see a lot of
potential for telemedicine, particularly in rural settings. "I
think it’s an ideal situation for us to use as a learning tool,"
Hersey said. By guiding students through the interactive video, practitioners
can help expand the students’ learning without requiring their presence
in the city. The urban therapists can also help rural clinicians who
may not be as experienced with a particular diagnosis develop effective
treatment plans.
The scope of telemedicine
is likely to expand as reimbursement improves, according to Myrna
Armstrong, EdD, RN, FAAN, a professor at Texas Tech University Health
Sciences Center School of Nursing in Lubbock and author of Telecommunications
for the Health Professional: Successful Strategies for Distance Education
and Telemedicine.
"Telemedicine
is not being financed yet. That is preventing it from getting into
the forefront of activities," she said. As the medium is more
widely used, health professionals will likely devise new uses for
it, Hersey said.
Often the interactive
equipment used for telemedicine is also used for professional education
or distance learning. Bringing education to health professionals rather
than making them travel long distances is crucial in rural settings,
Armstrong said. Because rural practitioners are usually generalists,
they need information about a variety of topics. Yet, because they
often practice solo, they usually have no replacement if they leave
for a seminar, she said. To fill the need for accessible education,
Texas Tech’s Healthnet provides about 800 hours a year of video CE
for rural health professionals,according to Armstrong.
The East Texas
AHEC has an outreach program to provide advanced nursing programs
to rural areas through interactive TV, Wainwright said. "We were
able to facilitate their learning experience while they still live
in their own area," she said. "We don’t want them to leave
either, because they are critical to those [rural]communities."
Healthcare
superhighway
A major factors
to improve information access is the Internet, said Gail Bellamy,
PhD, the incoming president of the National Rural Health Association.
It doesn’t matter if your computer is in the country or the city,
you can still tap the Net’s vast medical resources. The only obstacle,
she said, is that some rural settings lack local Internet service
providers, making each connection a toll call.
However, she
said that the Universal Service Fund, a program through the Federal
Communications Corp., is subsidizing rural facilities so they can
hook up to the Internet at costs comparable to urban areas.
Shrinking
the distance
The desire for
more education opportunities via cyberspace is apparent to Sandra
Dirks, MSN, RN, the RN education coordinator for the School of Nursing
at the University of Wisconsin-Eau Claire, which is piloting some
online courses this semester. Dirks said a mention of the experimental
program in Working Mothers magazine resulted in inquiries from across
the country.
Not all were from
rural residents, she said, but "wherever they are, they are miles
from a nursing program. They’re what we call ‘geographically immobile.’
They’re already immersed in a job, family. They cannot pick up and
move to a campus."
Many urban practitioners
can benefit from Internet applications and distance learning, Armstrong
said. It can sometimes take just as long to drive through downtown
Dallas as it does to drive in from the remote countryside.
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