Primary Care Puzzle Piece

A cloud-based technology to provide health care through virtual appointments could be the future of rural medicine, and South Dakota State University’s College of Nursing is the first educational institution to train its students to use it

BY LISA GIBSON

In a fast-paced and ever-changing health care industry, students at South Dakota State University’s College of Nursing will be trained in some of the most advanced up-and-coming technology in their line of work. SDSU will be the first educational institution to add CareSpan USA Inc.’s newest technology to its curriculum.

CareSpan’s Virtual Clinic is a system that allows physicians to deliver primary care services over the internet that are equal to an in-person visit, according to Mark Winter, CEO of CareSpan USA. It’s a step above current telemedicine services that allow patients to see their doctors remotely, he says, as it allows the monitoring of vital signs through digital health instruments and, perhaps most important, allows remote access to all enrolled patients’ medical records, as well as other physicians for second opinions. Physicians can then adequately prescribe treatment and medications. “It’s really the most comprehensive platform of its kind for delivering what we call digital health care,” Winter says.

“The beauty of the CareSpan platform is that it is a primary care clinic in a cloud,” says SDSU College of Nursing Dean Nancy Fahrenwald. “It’s patient-centered and I believe it’s part of the solution of helping to make primary care available to our rural populations.” Fahrenwald says CareSpan is the puzzle piece that pulls technology-based care together. “Our vision and our mission is that we prepare our graduates, both registered nurses and the nurse practitioners as well as the nurse educators and nurse scientists who address rural health care ... to help meet the gap of primary care needs, and we know that part of that solution is integrating technology into the curriculum.”

Robin Arends, College of Nursing clinical

assistant professor and nurse practitioner for Avera, says, “We know that this is a very mobile world, so it would be very helpful if you’re traveling to a different part of the country, or even to a different country, to have your records available for you at all times in case there is some medical emergency.”

SDSU was chosen as the first university to train students in CareSpan for a few reasons, says Terry Knapp, CareSpan founder, chairman and chief medical officer. First, Native American reservations are often the most underserved in primary care, which made North Dakota, South Dakota and Nebraska prime candidates, Knapp says. SDSU is the alma mater of CareSpan Senior Vice President for Clinical Quality Jo Ellen Koerner, which boosted its candidacy for the partnership, but Fahrenwald’s enthusiasm for the program helped seal the deal, Knapp says. “We found in Dean Fahrenwald a very forward-thinking individual,” he says.

Fahrenwald says she is impressed with the quality of the CareSpan platform and says the school and company are “kindred spirits” in their desire and motivation to remedy the global primary health care shortage.

Knapp says CareSpan is excited about the partnership and will ensure SDSU’s graduates enter their careers already familiar with such a program. “It is instrumental that in the higher education of medical providers that there is a foundation in that education that addresses the new era of digital health. … I would love to have CareSpan in every medical and nursing school on the globe.”

Across the Globe

SDSU’s nursing school will implement the program on its campuses in Brookings, Rapid City, Aberdeen and Sioux Falls, Fahrenwald says. The college received a $1.3 million federal grant in July that facilitated the purchase of telehealth equipment. The addition of CareSpan is an added bonus, according to Arends, who is the project director for the grant. “As we are developing the competencies and the curriculum and simulation for that telehealth grant, the introduction of CareSpan is an exciting opportunity for us.”

“We were able to integrate technologies for video-interactive care and purchase various pieces of equipment that were plug-and-play,” Fahrenwald says of the telehealth grant. “Our goal is that we will develop the virtual-based training so that other primary care education programs can integrate those education modules into their curriculum.” SDSU is building its curriculum and expects its students to begin using the CareSpan program this spring semester.

“We’re working on an education platform, a demo platform, but [CareSpan] is providing actual care in off-shore oil sites, south of Texas,” Fahrenwald says.

CareSpan also is rolling out service in Sweden, Finland, Norway and soon Denmark, Winter says, and is serving people on ships traveling through the Panama Canal in Latin America. The company is in negotiations to bring the virtual clinic to Nigeria, as large cities there with enormous populations struggle with transportation and citizens can’t always get across town to a clinic, Winter says.

CareSpan’s network functions with the help of providers who enter agreements to administer care through the program. Those physicians are then entered into the system and patients can look through their schedules, make appointments or request an immediate exam. Insurance programs often initiate the contact with physicians and patients enrolled with CareSpan, Winter says. It’s designed for consistency of care, not “episodic” care like current telehealth systems, where patients sometimes never see the same doctor twice. Winter calls those “talk-to-a-doc” systems.

The Future of Medicine

Darlene Hanson, director of simulation for the University of North Dakota’s nursing program in Grand Forks, agrees that virtual care is key to solving rural health care needs. The school employs a variety of virtual training programs, including IV administration, simulated charting and a virtual Alzheimer’s Disease care program called Second Wind. The system demonstrates how disorienting Alzheimer’s and dementia can be for patients by clouding auditory interpretation and increasing