The doctor will screen you

For many patients in the North State who need specialized health care, long wait times have become all too familiar. Often they’re faced with long drives to metro medical centers or with local appointments scheduled weeks or months out.

Meanwhile, unbeknownst to most, Feather River Hospital has specialists available—ready and able to see patients insured by Blue Shield, even under Covered California plans. Feather River’s Canyon View Clinic in Paradise has a room dedicated to people who need to see, well, you name it—a cardiologist, dermatologist, gastroenterologist, neurologist, hematologist/oncologist, pulmonologist, rheumatologist, infectious disease doctor, orthopedic surgeon or neuro-spine surgeon.

And soon, the list of specialties will expand to endocrinology, radiation oncology, urology, pain management, psychiatry and stroke care, as will the number of eligible patients once Feather River completes its process with Medi-Cal.

Thing is, you won’t find these physicians physically at the clinic; they’re part of a telemedicine network through Adventist Health, the hospital’s parent organization. With a technological interface and the assistance of an in-person professional, though, the doctors are able to treat patients as if they’re with them in person.

“It’s very exciting to offer this level of care to our community,” said Eden Davis, Feather River’s community and media relations coordinator. “We struggle with access to specialty care, being a rural community. This brings it all home.”

Adventist Health and Blue Shield announced the program’s launch last March. Yet, as of this issue’s deadline, Feather River had not seen a single telemedicine patient since establishing the service in December 2013.

Unlike at other locations in the AH Telehealth Network—11 total, including Paradise—telemedicine locally remains an untapped resource.

“It just makes me so upset when people aren’t getting care, the care they need,” said Ceara Adlam, telemedicine coordinator at Feather River. “Now they can, and I cannot wait until we get credentialed with Medi-Cal. We’re a Rural Health Clinic, and 90 percent if not more of our population has Medi-Cal for insurance….

“I feel like this is where the future is going, with telemedicine, and there’s a lot of opportunity to see the specialist you need to see. I just find it so interesting and amazing for patients and what we can do for them around here now.”

Technological advances make telemedicine possible by allowing for instantaneous videoconferencing via broadband Internet, with high-resolution imaging and high-definition audio.

The doctor just needs a computer with the right webcam, monitor and speakers hooked up to a secure, restricted network for privacy. On its end, the clinic uses a more complex machine with two flat screens, a stethoscope, an otoscope, a vital signs monitor and an exam camera.

That camera, which can be operated remotely by the physician, can zoom in at up to 50-times magnification to capture, for example, skin lesions or zoom out enough to show walking gait or range of motion. From that, the machine can record 60 seconds of footage, portions of which may be selected for inclusion in the patient’s electronic health record.

There’s a strong interpersonal connection as well.

“It’s like Skypeing,” Adlam explained, albeit not Skype per se. “You see the doctor’s face; he talks directly to us; you look eye-to-eye at each other.”

“Us” includes the other person in the room—the healthcare professional known as a “patient presenter.” A nurse or medical assistant with specific telehealth training, the patient presenter handles standard nursing tasks—detailing symptoms, reviewing medical histories, measuring vital signs—and operates the machine and performs tactile maneuvers that the physician cannot do remotely.

“I look at it as [becoming] the robot to the doctor,” Adlam said. “They tell us exactly what they want us to do. We call it being the doctor’s hands.”

Dr. Arbi Ohanian is one such doctor. A neurologist who works in a 10-physician practice in Pasadena, he’s participated in telemedicine since 2006.

“Once you really start using the equipment, you do start feeling like you’re there in the room with the patient,” he said. “We can’t physically touch the patient, but the facilitator there can, so it really has been an amazing experience where we can log into a remote facility and actually provide care as if we we’re there… Speaking from a neurologist’s standpoint, I think most of the things you can do in your office you can do through telemedicine.

“The more you do it, the more you realize there aren’t many [limitations] … Telemedicine is even being used in surgery now, where they’re having specialists log in to different surgeries and give their opinions while the other surgeon is operating. It’s really taken the entire field in an amazing direction.”

Ohanian, a vascular and stroke specialist, said he appreciates the opportunity to expand his reach without the burden of travel for either him or far-flung patients.

“It allows people to stay in their community, be treated in their community, and receive the same level of care that they would if they lived in a major metropolitan city with a large hospital,” he said. “It’s a great tool that’s going to benefit a lot of individuals, so it’s very exciting, and it’s only going to grow from here.”

Indeed, just in the AH Telehealth Network, 14 more facilities are coming online, and Feather River may have some specialists contribute as their schedules permit.

Adlam said a telemedicine appointment for the patient is “not any different at all” from a traditional appointment as far as the care received from the doctor.

“If they feel something needs to be addressed,” he said, “they can contact a primary provider in our general area.

“Anything you would experience in a normal office visit, that’s exactly what this is.”