The Topeka Capital-Journal | Sunday, January 7, 2018 | 11H
For speciality care, telemedicine a breakthrough Patients in underserved areas see benefits By Allison Kite
allison.kite@cjonline.com
Before Julie Laverack’s son, Lincoln, could have his autism medications managed through telemedicine, treating him at home in Pittsburg meant “trial and error.” Laverack said Lincoln has aggression associated with his autism and attention deficit hyperactivity disorder, or ADHD. She took him to the Community Health Centers of Southeast Kansas — where she works as a pediatric care coordinator — but he wasn’t getting the specialized medication management he needed. Once, a change in his medications sparked an onset of serotonin syndrome, which can cause agitation or restlessness, confusion, headache and loss of muscle coordination among other symptoms. It can be lifethreatening. “He ended up having to be hospitalized for five days for it in a psychiatric hospital,” Laverack said. Managing Lincoln’s treatment was difficult until the last few years, Laverack said, but the community health center now offers medication management through telemedicine. Lincoln gets services from providers at Marillac, a psychiatric hospital in Overland Park that was recently acquired by the University of Kansas Health System. Lincoln is one of many Kansans in underserved areas who has benefited from increased access to treatment through telemedicine. Behavioral health care, specialty medicine and psychiatric treatment services have all come online to serve Kansans in shortage areas, but health care providers are split on whether
Kansas has fully embraced telemedicine. Laverack said there were no other providers who could manage Lincoln’s medication in the Pittsburg area, so he didn’t get specialty care. “Unless you have people that are working with kiddos every day doing this and specializing in it they don’t know the right combinations,” Laverack said. When he developed serotonin syndrome, he became dangerous to himself and tried to climb out the school bus window. Laverack said she had to stay home with him while they waited for a psychiatric bed to open up. “This was not my child,” Laverack said. “I mean, he’s never done anything risky like that before.” Laverack said having Lincoln’s treatment available through telemedicine has been amazing. “It’s been a blessing to us because we have that expertise of the specialists,” Laverack said. The community health center in southeast Kansas, which provides care for several counties, has expanded its telemedicine services in recent years. Health center president and CEO Krista Postai said the clinic brings in specialty care from providers around the country through a contract with Wichita-based FreeState Healthcare. It also provides behavioral health care through telemedicine, and is Pittsburg-based provider can see patients in other clinics across southeast Kansas. Postai said telemedicine was working “smarter, not harder,” but she didn’t think Kansas had fully embraced telemedicine. She said the state was on the edge of
recognizing the need, especially in rural areas. “There is no public transportation, and we have an aging population and there are no specialists,” Postai said. “We’ve got to do something.” Julie Stewart, an internal medicine and pediatric physician at the health center’s Pittsburg location, said the clinic decided to expand its reach through telemedicine after the Independence hospital closed and office-based internal medicine physicians left Coffeyville. “As a federally-qualified health center, in the state’s poorest and least healthy sector, yes — that is one of the driving forces for us doing telemedicine is to reach people who otherwise don’t have access to care,” Stewart said. “And you’re talking about insured patients that used to have access to care, and now they don’t even have access to care.” Michael Kennedy, associate dean for rural health at the University of Kansas Medical Center, said telemedicine was an effecive resource for behavioral health and psychiatry as well as coaching patients managing long-term conditions. He said he thought the state had been an early adopter of telemedicine but lagged in recent years. Providers with the Community Health Center of Southeast Kansas shared that view. Stewart said the organization provided services regardless of patients’ ability to pay, but getting reimbursement for telemedicine services can be difficult for providers who don’t work in safety-net clinics. Uyen Dinh, of Wichita, is a psychiatric advanced practice registered nurse for the clinic. She commutes to
Photo illustration by Stephanie Potter /THE morning sun
On screen, Advanced Practice Psychiatric Mental Health Nurse Practitioner Uyen Dinh, PMHNP-BC prepares for a patient to arrive at the Community Health Center of Southeast Kansas. Pittsburg once a week and provides care from Wichita for the remainder. She said she thought the community health center was one of the most advanced in its use of telemedicine. Richard Barohn, a professor of neurology for the University of Kansas Medical Center, said he thought KU and Kansas were “ahead of the curve” on telemedicine. He helped establish a multi-disciplinary clinic in Wichita where patients with ALS, or Lou Gehrig’s disease, can get treatment from various therapeutic provider. Barohn can provide neurological care from Kansas City through telemedicine. “They just feel like they’ve gotten a whole other level of health care through that approach,” Barohn said. One barrier, however, is that KU can’t bill on behalf of the respiratory therapists, nutritionists, speech therapists and other health care professionals work-
STEPHANIE POTTER/The Morning Sun
Julie Stewart, M.D., communicates with a nurse at another facility at the Community Health Center of Southeast Kansas. Stewart is able to access documents while communicating with patients, nurses and doctors. ing in Wichita. Barohn said providers needed to be able to bill for telemedicine the same way they bill for inperson care. The Wichita ALS clinic is one of several telemedicine programs KU has begun. Eve-Lynn Nelson, director of the KU Center for Telemedicine & Telehealth, said KU has been able to extend its reach through tele-
medicine. KU has brought a range of services to families in southeast Kansas through a partnership with the community health center, called Telehealth ROCKS. Specialists at KU can also advise primary care doctors in rural areas though Project ECHO, which started at the University of New Mexico.