- Excellent.

I had the opportunity to sit down with Dr. Deirdre Mooney, a doctor with the Center for Advanced Heart Disease, and Transplantation Cardiologist at the Providence Heart Institute here in Spokane, to really dive into how lack of access impacts patients when they need a specialist, like a cardiologist, and the different ways they're trying to get creative, and meet the need.

(upbeat music) - [Aaron] By the time patients see Dr. Mooney, their conditions are pretty advanced.

- I'm a general cardiologist who also has additional training in advanced heart failure, meaning that I get to take care of people who have reached a very aggressive, or advanced stage of their heart disease.

- [Aaron] People in the United States are living longer.

An unintended effect of that, an increase in heart disease.

According to the CDC, it's one of the leading causes of death in rural areas.

And access to care for heart disease is not keeping up.

- This is people who have to drive a great distance to see a cardiologist.

So the red area is where people have to drive over 60 miles to see a cardiologist.

All the little areas where they're driving 20 miles or less are usually urban centers.

Heart failure is one of the hardest doctors to see.

Interventional cardiologists are the people who open up the heart arteries in the middle of the night, they are more spread out, but heart failure tends to be at research centers or major centers like Sacred Heart Medical Center, because we want to collaborate, offer research trials.

- [Aaron] In urban areas, 50% of people live within 12 miles of cardiac care.

For people living in rural areas, that number drops to just 5%.

The distance isn't the only barrier for people who need to travel to urban areas for care.

As people age, driving into bigger cities can be intimidating.

Then there's parking, and navigating a medical campus, before even sitting down with their doctor.

- And now they're short of breath, tired.

And now we're supposed to have a meaningful conversation about what are their goals, what are we gonna do, what is the right diagnostic testing for them?

That's hard.

And they may or may not have their significant others or caregivers with them.

- Add in things like blood work, testing, imaging, reviewing the results, and an appointment that might take a few hours locally, can end up being a three day trip for patients.

There is technology that is helping eliminate unessential travel; video appointments.

- Most of our virtual health usually is some sort of audio visual, so we're hearing them and we're seeing them.

With like our Stevens County virtual clinic, we were able to bring an electronic stethoscope into the room, and so we would have a medical assistant put it on the patient's chest, and I could hear them breathe, I can hear their heart sounds.

We have that technician who can do EKGs from a check oxygens and vital signs.

- [Aaron] Allowing patients to visit the closest clinic and get connected with a specialist who is hours away.

- And so that's been excellent to keep care local, we can get their labs local and have their labs sent.

We can get the echoes pushed electronically, and be reviewed ahead of time.

I think that has been amazing.

I had another patient I just saw recently who, we can call him Jim.

Jim was having profound shortness of breath.

- [Aaron] And Jim lived hours away.

Weather and travel over mountain passes a huge barrier to the care he needed.

But with technology bridging that gap, he was able to keep his appointments, and find targeted solutions for his heart condition.

- We are simplifying meds.

And we have a protocol where, he was seeing a cardiologist every one to two months.

We are now doing virtual visits, we're getting echoes closer to home, and having the images uploaded.

So he's barely gonna have to come down here, and getting one of the newest FDA approved medicines specifically designed for this disease.

- [Aaron] This solution doesn't work all the time.

There are some things that just don't translate over a computer screen.

Labs and studies might get uploaded in a different way.

- If you had your lab drawn at a local lab, it might get scanned as a PDF, it might get entered on a separate line, maybe the echo tech in a rural community doesn't have the same level of cutting edge echo machines that we've got the latest and the greatest.

- [Aaron] And in some cases, experience with those tests can be a hurdle, which means there's still a need to meet people where they live.

- So we in our advanced heart failure group, recognizing that barrier, have historically gone to major centers, so that patients don't have to travel as far, even though they still have to travel, we have gone to Swedish to help some of our patients on the western side of the state to Tri-Cities, and to Missoula.

We've also gone to our more rural patients in Stephens County.

And so those are often need-based clinics.