Rural Medicine and UVa's Telemedicine Program

Jan 2, 2017

Rural Virginia still struggles with not having enough doctors – particularly specialists. But one University of Virginia program is working on trying to bridge that gap by providing a variety of telemedicine services. WMRA's Kara Lofton reports.



Jenny: Hi Lindsey, how are you?

KENNEDY: I'm good, how are you?

Lindsey Kennedy manages the telemedicine program at Bland County Medical Center in southwestern Virginia. She’s standing in front of a monitor speaking with a colleague in Charlottesville. 

Jenny: I’m calling regarding your psych referral you had submitted. I have an availability block available next Friday at two o'clock.

KENNEDY: OK, do you have anything sooner than that? I really feel like this patient needs to be seen as soon as possible.

The Bland County clinic is one of 150 rural clinics that the University of Virginia works with to provide specialty care services to underserved areas.  Most telemedicine systems are like video conference calls: They connect patients with remote doctors via the Iinternet. Here, in Bland County, remote means three hours away.

DAVID GORDON-CATTELL: I think there’s been a clear communication in the country that rural people need access to resources.

That’s David Gordon Cattell – director of telemedicine for UVa. Since the program’s inception more than 20 years ago, UVa's telemedicine has had more than 60,000 patient encounters in more than 60 different specialties.

GORDON CATTELL: And we have saved Virginians more than 16.4 million miles of travel.

Lindsey Kennedy says although travel is a big deal in rural Virginia - a several hour drive is not feasible for a 90-year-old cardiac patient - wait times are even more of the issue.

KENNEDY: For endocrinology, the endocrinologist in our area accepts new patients every other Wednesday and they’re booked up pretty far out. So when you have a severe diabetic that has ulcers and is uncontrolled and their A1C is through the roof and you can’t get an appointment for six months that’s not very beneficial to them.

Right now most of UVa’s telemedicine services are provided at clinical sites such as Kennedy’s clinic, rural hospitals, health departments and even correctional facilities. But Gordon-Cattell’s hope is that eventually the program will be able to put telemedicine services into people’s homes.

GORDON-CATTELL: We have to pay attention to the fact that if our goal really is to keep people home and well -- and I would love to see us be a nation where home and well is more important than a coronary bypass surgery -- that we’re going to have to be able to go to the home.

He says that the tools exist so that a person with a chronic condition, or even an elderly patient who wants to age in place can be monitored at home. But Gordon-Cattell says critics of in-home telemedicine are concerned about Big Brother, meaning the possibility of the U.S. government using the cameras to spy on and record information about users.  There are also  reimbursement issues to be worked out. If a patient is seen in home, how exactly is the provider paid?

GORDON-CATTELL: The tools are all there.  What’s not there is the policy that enables us to reach into people’s home. But I feel if we do this well and we get the support of healthcare providers and legislators we’ll move to the home.

Gordon-Cattell makes the distinction that there are providers who will “see” you over the phone, but he says that is NOT the same thing as the videoconferencing work that UVa does.

GORDON-CATTELL: The reason being is because you don’t see the patient. You don’t have the patient’s medical information in front of you, you're not able to do anything that remotely resembles an exam.

Gordon-Cattelll is optimistic about the future of telemedicine in rural healthcare. He says it not only provides care to underserved areas, but gives us a glimpse into ways to expand jobs, support regional hospitals, improve the health of the workforce and support the rural economy.