The following article is from Arkansas Hospitals magazine, a custom publication of Vowell, Inc., which also produces Arkansas Money & Politics.
by Ben Boulden, UAMS Communications Specialist
Jackie Gosselin first became aware of ANGELS telemedicine in 2014, when the program serving mothers with high-risk pregnancies was introduced to her. It must have seemed like something out of a Gene Roddenberry screenplay – Star Trek™ medicine brought to life.
Telemedicine collapses space by shrinking the distance between a medical specialist and her/his patient. It often saves critical time, eliminating the need for patient travel and allowing rural or isolated hospitals to provide their patients access to the expertise of otherwise unreachable specialists.
“My third pregnancy brought my first experience with telemedicine,” Gosselin says. “I was at the UAMS Northwest campus in Fayetteville, and the doctor interpreting my ultrasound was at UAMS in Little Rock. Using a camera, she was able to read and discuss my ultrasound results with us right away.”
It was important for the Gosselins to know immediately what the doctor saw. Jackie, a resident of northwest Arkansas, discovered the baby had a kidney ailment that required careful monitoring. Through the ANGELS telemedicine program, she and her unborn child gained access to UAMS specialists nearly 200 miles away, and she and her husband could learn the doctors’ findings without the anxiety of waiting
The ANGELS (Antenatal and Neonatal Guidelines, Education and Learning System) program is an innovative consultative service connecting patients to a wide range of physicians including family practitioners, obstetricians, neonatologists and pediatricians in Arkansas.
Sometimes called distance health, telemedicine – including the ANGELS program – includes an expanding array of telecommunications applications and services featuring two-way video, smart phones, email, wireless tools and other forms of telecommunication. Through its use, patient and doctor converse “face-to-face” across vast distances, with accompanying medical data made available to the physician immediately.
What seemed a generation ago to be futuristic and other-worldly, today’s telemedicine routinely involves the remote diagnosis and treatment of patients through live high-speed, high-resolution video connections. It can mean access to specialized care in rural Arkansas communities, sometimes available to these patients “locally” for the first time.
Gosselin’s fourth pregnancy in 2016 also resulted in the need for ANGELS consultations with UAMS specialists on the main campus in Little Rock.
“I needed several ultrasounds, which would have required several trips to Little Rock,” Gosselin says. “Through the ANGELS telemedicine connections, I was able to have my level 2 ultrasounds done at the northwest campus, but interpreted in Little Rock. I could stay in Northwest Arkansas and take care of my children, and my husband didn’t need to take off work to travel with me. He could even come over on his lunch break to attend my telemedicine appointments. Thanks to the ANGELS telemedicine program, we were able to get immediate results and talk to the doctor about our concerns.”
Despite decades of growth in Arkansas’s urban areas, the state remains largely rural with hundreds of small towns and a widely-dispersed population.
Many communities and counties simply don’t have the population density necessary to support a variety of medical specialists.
In the early 2000s, Curtis Lowery, MD, chair of the UAMS College of Medicine’s Department of Obstetrics and Gynecology, began the quest to connect medical expertise in the state’s urban areas to patients in rural Arkansas. Specifically, he wanted mothers-to-be with high-risk pregnancies living in rural communities throughout Arkansas to have access to the obstetrical expertise they and their unborn babies required for the delivery of healthy infants. His mantra became, “Where you live shouldn’t determine whether you live or die.”
In the early 1990s, UAMS had begun a small distance education program using live video classes for nursing education and another early telemedicine outreach programs aimed at a handful of rural hospitals. The emphasis was on education.
Lowery looked at this education program and realized the potential it held for patient care.
The UAMS distance learning program expanded into the distance health program. Over time, the use of new mobile devices like tablets and smart phones would enable on-call physicians the freedom to travel, so long as they could connect to the Internet. One specialist could take call for the entire state, allowing others to get their much-needed rest. And then, the possibilities expanded beyond imagination.
“It’s a game-changing technology for health care,” Lowery says.
BIRTH OF ANGELS
Lowery, along with Tina Benton, BSN, RN, and a small team of clinicians and staff, in 2003 founded ANGELS and the UAMS Center for Distance Health to bring maternal-fetal medicine to pregnant women across the state needing medical help with their pregnancies, but living too far from required specialists.
Over the years, the program has expanded exponentially. Today, experienced registered nurses staff the Center for Distance Health’s Call Center every day, around-the-clock. They provide counseling, telephone triage of immediate health concerns and education concerning health problems during pregnancy. In 2016, the Call Center managed 175,728 calls, including 417 obstetrical consultations and 12,957 nurse triage calls.
Through telemedicine and distance health tools, UAMS, for more than a decade, has delivered subspecialty care services to high-risk Arkansas mothers and their fragile infants.
Jackie Gosselin, her husband and their four healthy children, are thankful for it.
Since the ANGELS program was first introduced in 2003, the Center for Distance Health has expanded telemedicine into an increasing diversity of clinical areas to extend medical expertise and learning to medically underserved areas of the state. Here are some of those programs:
CDH Language Interpreter Video Exchange (CDH LIVE) uses standalone devices like tablets or video teleconferencing systems as a low-cost option to meet the medical interpreting needs of patients.
The Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES) program offers neurology consultations for patients in rural emergency rooms who show symptoms of stroke. It has provided more than 1,000 consultations since its inception.
Tele-Rehabilitation Interventions through University Based Medicine for Prevention and Health (TRIUMPH) provides patients presenting with spinal cord injury or traumatic brain injury access to specialty care for follow-up consultations and medication management.
Psych TLC allows primary care providers across Arkansas to connect with board-certified child and adolescent psychiatrists at UAMS and Arkansas Children’s Hospital.
The Trauma Hand Program (via high-speed, high-resolution live video) enables hand surgeons to visually evaluate hand trauma patients for direct care, streamlining transfers to the most appropriate facility. It has facilitated more than 1,500 hand consultations since its founding in January 2014.
The Hand and Burn Program is a new offshoot of the Trauma Hand Program. From May to December 2016, it facilitated nearly 350 consultations between burn surgeons and burn patients across the state.
These programs offer patients in rural Arkansas the access to specialty care they need. In addition, many of these programs help patients receive their medical care in place, avoiding the strain and cost of travel or medical transfer.
Education Through Telehealth
The earliest use of telemedicine at UAMS focused on providing continuing medical education. Though distance medicine has taken a major role in medical care, the original provision of continuing medical education has continued to grow as well.
Learn On Demand has been making available continuing education credit to health care professionals through online modules they can complete without traveling for conventional classwork since January 2014.
UAMSPatientsLearn.org educates patients regarding health and wellness by offering online modules with the most up-to-date information.
The Neonatal Resuscitation Program is an online self-study course providing instruction on the resuscitation of the newborn for physicians, nurses, respiratory therapists and other health care professionals.
STABLE is an instructional program for nurses working in neonatal critical care. Stable is a mnemonic that stands for the six assessment and care modules in the program: Sugar, Temperature, Airway, Blood pressure, Lab work and Emotional support. A seventh module, Quality Improvement, stresses the professional responsibility of improving and evaluating are provided to sick infants. STABLE’s goal is to reduce infant mortality in Arkansas medical facilities.
Telemedicine is a tool for sharpening the skills of the state’s health care professionals. UAMS telemedicine programs offer care through almost every stage of life, from pre-birth (ANGELS) to adolescence (Psych TLC) to adults of all ages affected by stroke and other maladies.
UAMS telemedicine is positively affecting health outcomes and enhancing care for patients across Arkansas. It’s a medical force propelling health care toward stronger connections with Arkansans. Gene Roddenberry would be proud.