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Making Healthy Connections

Marshfield Medical Center project an example of using telehealth to reach rural residents

By Julian Emerson, WFU Rural Voices Correspondent

NEILLSVILLE – Dr. Swetha Gudibanda moved toward a room at Marshfield Medical Center-Neillsville, headed to address a patient about a healthcare concern.

A moment later Gudibanda smiled and said pleasantly “Hello. It is good to see you. What can I help you with today?”

This interaction was seemingly just like any other between a patient and a doctor. Only it wasn’t.

Tracy Moe, left, an advanced practice nurse practitioner, and Linda Worden, chief nursing officer, work with Wendell, a telehealth robot used to help provide specialty care to patients at Marshfield Medical Center-Neillsville, as Dr. Swetha Gudibanda converses via a screen atop the robot. Medical care providers across Wisconsin and the rest of the country increasingly are using telehealth to better connect with patients. (Photo by Julian Emerson)

Gudibanda, a hospitalist and home recovery care medical director for Marshfield Clinic Health System, wasn’t at the hospital in the Clark County city of Neillsville at all during the interaction. Instead, she was a half hour’s drive to the east, at Marshfield Medical Center’s home site in Marshfield. Rather than appearing in person, Gudibanda’s face was visible in the hospital room on a screen atop a human-sized telehealth robot named Wendell.

Since May 8, 2021, patients at the Neillsville hospital who require specialized care have been visited by Wendell rather than seeing a doctor in person. The effort allows patients to receive medical care for more serious health situations for which doctors aren’t available on site without having to travel to more distant locations for specialized care. Like many small-town hospitals or clinics, the Neillsville facility is a critical access hospital and is not staffed with specialists to treat various illnesses.

Rather than travel to Marshfield to receive that care, patients living near the Clark County community of Neillsville converse with Gudibanda via a screen and a nurse in person, who also interacts with patients and conducts vital checks on patients. So far Wendell appears to have been a hit.

“We have had tremendous patient satisfaction responses,” said Dr. William Melms, Marshfield Clinic Health System chief medical officer. “They love it. We look forward to expanding that program.”

Such efforts to ensure high-quality care through virtual means are becoming a growing necessity as staffing hospitals and clinics in rural areas is becoming more difficult, Wisconsin health care experts say. An existing shortage of medical care staffing was exacerbated by the coronavirus pandemic, leaving many providers in the state’s rural regions without enough employees – especially in certain specialties – to keep up with demand.

Wisconsin Hospital Association (WHA) figures show a shortage of healthcare workers at virtually every care level, and shortages are often particularly acute in the state’s rural regions. Nationally, the gap between healthcare jobs and people to fill those positions doubled from 578,000 in 2019 to more than 1 million by the end of last year, and that difference likely has widened during this year, according to the U.S. Bureau of Labor Statistics. In addition, many rural communities once had hospitals that are now closed because of outdated buildings and financial challenges.

With fewer staff available to provide care to patients, healthcare providers in rural parts of Wisconsin and elsewhere across the country are increasingly relying on technology to do so. Telehealth, in which providers connect via video on screen with patients in their homes or other locations to provide non-critical care, is growing in popularity.

Gudibanda said she was uncertain whether patients would be willing to listen to her on a screen mounted atop a robotic body instead of seeing her in person.

“What if the patient says ‘I want a real doctor in front of me?’ ” Gudibanda said. “I didn’t know how they were going to take this.”

However, instead of rejecting her bedside visits via a screen, Gudibanda’s patients appear excited to visit with her virtually, she said. Gudibanda is able to see her patients and to examine them closely by adjusting her screen. Nurse practitioners accompany Wendell to patient visits and assist Gudibanda with needed care.

Dr. Swetha Gudibanda, a hospitalist and home recovery care medical director for Marshfield Clinic Health System, provides specialty care to Marshfield patients via telehealth. Doing so allows patients to receive that care in their home communities rather than have to travel elsewhere. (Staff photo by Julian Emerson)

“You wouldn’t believe it, how much these patients like interacting this way,” Gundibanda said. “I am able to be a doctor to my patients, just as if I was there with them in the room. That is the beauty of this, that we are able to provide care to our patients without them having to go through the struggle of travel to come to see us.”

The Neillsville hospital’s elderly patients seem to especially enjoy interacting with Wendell, said Linda Worden, the hospital’s chief nursing officer. Many of those patients require medical care that would not be available without the telehealth options that Wendell provides, she said.

“With Wendell, these patients don’t have to go anywhere to get the care they need. They can get it right here, in the community where they live. That means a lot to them.”

Care Close to Home

WHA and healthcare providers throughout the state say maintaining rural medical services with fewer staff as they leave the healthcare field in the wake of the coronavirus pandemic has grown increasingly challenging. In addition, U.S. Census data shows that rural parts of Wisconsin and other states are losing people to urban sites at an increasing rate, making staffing hospitals even more of a struggle.

However, linking patients needing care through telehealth is one way providers can reach patients in rural areas without those patients having to travel to hospitals in urban sites. During the coronavirus pandemic, medical care providers were forced to use technology to reach many patients, Melms said, improving their access to care. COVID relief dollars and emergency rules changes allowing providers to be reimbursed more fully for telehealth services helped make that possible, Melms said, calling that development “a game changer.”

“There has been a major improvement for access for patients who otherwise had access challenges,” he said. “We want to deliver as much care as we can to people as close to their homes as possible. We know that is what they want.”

Like Marshfield, Mayo Clinic Health System has been using telehealth for years to provide healthcare to rural residents in rural Wisconsin and ramped up those efforts significantly during the pandemic, said Dr. David Blair, chair of primary care for Mayo Clinic Health System in Northwest Wisconsin.

To better provide care, during the pandemic Mayo expanded telehealth to connect with patients directly in their homes. That service has been expanded to all primary care and specialty care areas, Blair said. In addition, he said, Mayo has boosted its use of remote patient monitoring, through the use of devices such as a tablet and specialized medical equipment that allows for checks of patients vital signs and other health-related information and makes possible low-risk pregnancy checkups from home.

Mayo also is utilizing technology to connect its larger hospitals such as Eau Claire and Rochester, Minnesota to rural hospitals to assist with patient care. In northwest Wisconsin, Mayo also is working with paramedics in rural communities to conduct health assessments when patients can’t make it to hospitals or clinics, Blair said. Their emergency response vehicles can communicate with medical staff even in areas that lack high-speed internet.

“The biggest expansion that we made was in the connections to patients in their homes,” Blair said, noting that hopefully many telehealth changes necessitated by the pandemic will become more regular going forward to better treat rural patients.

Future Telehealth Hopes

Boosting access to high-speed internet, commonly referred to as broadband, will be key to continuing to expand telehealth, medical experts say. Federal and state funding during the past couple of years has added significantly to broadband connections across Wisconsin, but many areas, especially those in rural areas, remain to gain access, necessary for patients to access telehealth.

“Some patients do not have a device or internet access,” Blair said. “In our portion of the state there are some areas that lack cellular coverage and/or broadband access, though with satellite access now becoming a potential option for some people, this will help.”

In addition, he said, some patients aren’t yet comfortable using the technology required for telehealth visits. However, as telehealth’s use is becoming more commonplace, so too is the number of people who are gaining technology skills, Blair said, noting that support staff help patients with video visits.

A lack of broadband presents obvious challenges to providing telehealth, Melms said. However, as health care providers face growing financial pressures and employee shortages, especially in rural locations, telehealth could play a huge role in continuing to provide and improve health care, he said. As a sign of its increasing usage, telehealth at Marshfield and other providers has become integrated across departments and specialties.

Telehealth also provides cost savings opportunities as healthcare providers face financial challenges. Positive patient responses to Wendell is one example of how telehealth can be beneficial for patients while helping caregivers expand their quality and reach, Melms said.

“We can bring speciality care to individuals in our outlying clinic facilities,” he said. “We can reach people in their homes. We can provide care in places like Minocqua or Park Falls … Right now we’re really on the cutting edge of all of this.”

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