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The University of Mississippi and other medical groups have been pioneering the use of telemedicine to connect people living in the state's rural areas to health care. But while telemedicine has been slow to take off nationwide, the spread of COVID-19 is forcing the medical community to adapt to the pandemic. NewsHour Weekend's Mori Rothman reports as part of our series, "Chasing the Dream."
For those Americans living in rural communities and even small towns, a visit to the doctor can turn into a full day's trip. To lessen that burden in recent years, some physicians began to see their patients online. The practice is known as "telehealth," and in the age of the coronavirus pandemic, it has suddenly become more important than ever. NewsHour Weekend's Mori Rothman has our story; it's part of our ongoing series chasing the dream: poverty and opportunity in America.
Mississippi has a lot of small towns and Lena might be one the smallest with a population of less than 200. But that's the perfect size for 73 year old Ester Denson.
It's a big difference I guess. But I love the country. I just love being out here.
Like many rural areas, Lena has no hospital.
That's the only drawback of living in the country you're not near a facility and if you have a heart attack or something you might die.
Denson has type two diabetes. When she needs to visit the doctor, it's an hour's trip each way. She used to have to make that trip every three months, but not any more.
These are the strips I use right here.
Now she checks her own blood sugar three times a day.
She's part of a trial run by the University of Mississippi Medical Center.
Testing. Ooh I'm up. I'm usually 114 one something but I'm up to 137
Denson's nurse, Cindy Broome, keeps track of Denson's blood glucose from her office 40 miles away and checks in with her if she spots a problem.
Her numbers come to us, we're able to review it on our dashboard. We're really looking for a pattern, is she coming down, is she going up, is it up and down, up and down? Yesterday's blood sugar, 104.
Because of the trial, Denson sees the doctor half as often as she did before. It's part of a larger effort to increase care for rural patients in Mississippi where access to healthcare is a major problem.
Mississippi is a state that has a lot of healthcare issues. We're ranked at the, at top of all the bad list, at the bottom of most of the good lists.
Michael Adcock led what's known as Telehealth at University of Mississippi Medical center in Jackson for the past four years.
We have a very high incidence of chronic disease burden, and we have the lowest or the next to lowest number of providers per capita in the United States. So we don't have enough providers, and we have a very sick population in most cases. So it's- it's a bleak picture in a lot of ways, but that's also what helped push us into Telehealth.
So this is our electronic ICU. So we're monitoring patients in the intensive care setting.
The medical center began offering telehealth services to faraway patients in 2003 because in Mississippi, a good number of patients are far away.
When I think of, if I'm sick or if I have an emergency, I live in New York, I can go to the nearest hospital. How is that different here in Mississippi for folks if they're not right in Jackson?
Mississippi has one Level I trauma center. It's in Jackson. We have one children's hospital. It's in Jackson. We have one school of medicine. It's in Jackson. So all of these things are located in Jackson. There are some great medical centers, but they're all in the populated areas. And, you know, a very large percentage of the population lives outside of those populated areas. So it– it creates a barrier to care when you, you know, when your–when you have poverty and you have virality, it makes it sometimes difficult to be able to get to the provider's office, much less go to the hospital if it may be 1-1/2 or 2-1/2 hours away. It might as well be in another state or another country.
Many of our patients don't even have their own transportation so they may have to rely on a neighbor or a cousin or friend to bring them to their appointments.
Shannon Fryery is the Director of Telehealth at North Mississippi Medical Center in Tupelo, Mississippi. it's the largest rural hospital in the US. Fryery who also works as a nurse-practitioner says telemedicine has made it easier for her to care for her patients.
Well hey Miss Betty how are you doing today?
Hey Miss Shannon!
Her patient Betty Holloway uses telehealth to receive care for a bone infection.
Fryery can remotely discuss medication, view lab work, and using a stethoscope and camera connected to the internet, not only listen to Holloway's heartbeat but also inspect any wounds her patient may have.
You still got a little scab there don't ya?
You don't think about it, but when you're in pain, it's not easy for you to sit or stand, getting in and out of your house to a car, to get in and out, come into a clinic.
Specialists like mental health practitioners are a rarity in remote areas.
We are one of the lowest ranked states in services available. There is about, depending on what year you look at, it's about four to six psychiatrists per 100,000 people. That's in contrast which- with, for example, Washington D.C., which has about 24. So we're at the– at the very bottom.
Over the time that we have been talking and knowing each other, how do you think you compare to when you started out?
Doctor Demetrio Prota is based in Tupelo, but can reach his patients wherever they are through telepsychiatry. Prota says patients show up to more appointments when given the option of telepsychiatry. In a conversation this week, Shannon Fryery said because of the COVID-19 pandemic, telehealth has been thrust into the medical spotlight.
We do need to be cautious at times but I think this virus is really throwing telehealth in the forefront and has really helped some providers who had some concerns about this is really a good way to patient care,
Mississippi doctors aren't alone in adjusting to the Covid-19 pandemic. Before the pandemic there were few states that allowed patients to see a doctor from their home via telehealth, but now, most have now waived those restrictions. that makes sense to Fryery.
And now that we're trying to limit patients, especially those vulnerable patients, so nonessential visits, we don't want those patients to come into our clinic and risk exposure unnecessarily in our offices. But just getting out and about, getting in town, stopping to get gas, doing other things that they might be tempted to do. We really, really, really need people to stay at home. And so we're now able to do a virtual visit into their homes using some of those platforms that are available.
But telehealth is not a panacea. In Mississippi as in many states with large rural populations, a major obstacle to its expansion is lack of high-speed internet access. Shannon Fryery says that the connectivity gap is especially glaring now that the pandemic has increased the number of telehealth visits.
Not all of our patients have fancy-dancy iPhones or Androids and have that connectivity so there's certainly some restrictions. And that's where broadband and the push to move that forward is just so critical, especially in this rural state like Mississippi.
But she's says she's hopeful that the connectivity challenges can be overcome, and that the surge in telehealth will remain long after the coronavirus crisis is over.
I feel like having this unfortunate, unfortunate outbreak has really opened up the guidelines to be able to help us to deliver better care, more timely, more effective. My hope and my prayer really is that once this crisis is over, that the guidelines will stay, relax, or that we can at least go back and reevaluate kind of where we are, where worked well and leave things open so that we can continue to use and refine this very, very valuable and critical tool to patient care.
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