BRATTLEBORO — At Brattleboro Memorial Hospital, emergency room patients are connecting via video with neurologists who are more than 60 miles away.
At the Brattleboro Retreat, administrators are planning to set up remote psychiatry consults. And soon, a group of patients suffering from diabetes and hypertension will be chatting with Grace Cottage Hospital staffers by webcam from the comfort of their own homes.
Windham County's hospitals are jumping on board a trend that seems to be, in the words of one local nurse, "gaining momentum quite rapidly" in Vermont: Health care providers are investing in new forms of telemedicine or "telehealth," terms used for the practice of linking doctors, nurses and patients who aren't in the same physical space.
The investments come as technology continues to improve and as state legislators consider a bill that expands insurance reimbursement for telemedicine. Health care administrators say those developments, along with new focus on preventive medicine, are leading to changes in how patients interact with their caregivers.
"The timing is probably right politically and at all levels in health care in general," said Crystal Mansfield, a member of Grace Cottage's Community Health Team. "We could have done this 10 years ago, but the whole system wasn't really ready."
As Mansfield indicates, the concept of telemedicine is not new. Nor is the basic technology that enables it — generally, a secure broadband connection and a webcam or other video setup.
Rutland Regional Medical Center has been using telemedicine to support gynecology, oncology and neurology treatment. And at the University of Vermont Health Network, "there has been a lot of work done on telemedicine" over the years, said Barbara Paganelli, a project manager for the network.
But Paganelli now is among those working to significantly expand the Burlington-based network's telehealth programs.
There are several pilot projects in the works, with administrators assessing new technology — including medical instruments tailored to telemedicine — and examining the interactions between physicians and patients.
"I think the possibilities right now are limitless," Paganelli said.
For hospitals in Windham County, those possibilities are manifesting in different ways. Brattleboro Memorial has a neurologist on staff. But the hospital recently announced a partnership with Dartmouth-Hitchcock Connected Care that will bring the New Hampshire hospital's neurology experts into Brattleboro's emergency room via video conference.
The program is aimed at patients who are suffering strokes and other neurologic emergencies. Dartmouth-Hitchcock doctors are available 24/7 to review records, examine a patient and talk with doctors, nurses and family members in Brattleboro, administrators said. There are no other such programs in Brattleboro at the moment, but a spokeswoman said the hospital is "actively exploring other telemedicine options for needed services."
At the Brattleboro Retreat, administrators are ready to test the possibilities of remote psychiatry.
The idea is that doctors who are off-site could consult at the Retreat, and the Retreat's psychiatrists also could treat patients who are located elsewhere.
"We've had requests from local emergency departments ... to do telepsychiatry for them, so we can evaluate a patient and start them on treatment," said Louis Josephson, the Retreat's president and chief executive officer.
"We want to pilot it here internally, and then take it externally," Josephson added. "We're very excited about doing that."
Windham County's third hospital, Grace Cottage, is embarking on a telemedicine experiment of its own. Having received a grant from the Vermont Community Foundation's Crosby-Gannett Fund, the hospital is starting a pilot project to see how care providers can connect with diabetes and hypertension patients in their homes.
The grant is small — under $1,000 — and the number of patients is limited to about 16. But hospital administrators say the roughly nine-month trial will give them an idea of how well patients can connect to and use the new resource.
"We're hoping that this pilot will lead to something bigger that will allow us to be able to affect more lives," Mansfield said.
Whether the telemedicine programs are large or small, the goals are similar.
It's about using technology "to provide the right care to patients at the right time and at a place that's most convenient to them," said Jeff Tieman, president and chief executive officer of the Vermont Association of Hospitals and Health Systems.
"I do know that all of the hospitals in Vermont are at the very least exploring if not actively using this technology," Tieman added.
Quality of care is often cited as a motivator. In Brattleboro, the Dartmouth-Hitchcock collaboration is expected to improve safety and shorten response times - a major factor when attempting to limit stroke damage.
Caregivers also talk about making health care easier to access, especially in rural areas where isolation and transportation are potential barriers for patients.
"Oftentimes, the patients who are most at risk are the most reluctant to tap into the medical system," Mansfield said. "We're hoping this will make it easier to keep people from falling through the cracks."
Another goal is to spread staff farther. Josephson cited a chronic shortage of psychiatrists as a big driver behind telepsychiatry.
"It's really a challenge — not just in Vermont, but any rural state where you have a limited number of specialists," he said. "How do you get patients in front of them?"
Of course, saving money also is a factor.
Telemedicine can cut down on transportation time and expense, and it offers the possibility of more efficient treatment. Josephson also is hoping for better outcomes due to quick telepsychiatry interventions.
"The research shows very consistently that, if you have somebody admitted to an emergency room with a psychiatric crisis and you are able to start some medications and treatment, 25 percent of them are able to be discharged without going to an inpatient bed," he said. "That will save everyone money and time."
There are still some barriers, however, to widespread implementation of telemedicine.
Technological literacy is one. Grace Cottage is working directly with pilot program patients to get them set up and make sure they're comfortable with the system.
"That's what I find most exciting, is the ability to educate - to break down that barrier to access," said Bill Monahan, outreach coordinator for the hospital's Community Health Team.
He's also advising patients about the best way to use the system so that their medical privacy is preserved. The video connection is secure, he said, but in order to prevent others from overhearing confidential information, "it is the patient's responsibility to make sure that where they're communicating from is secure."
Spotty broadband access is another potential problem: If a patient doesn't have reasonably fast internet service — a not-uncommon problem in the area of Grace Cottage — he or she can't videoconference with a doctor.
"That's the other half of this puzzle that has to get figured out," Mansfield said.
For hospitals, cost also is a major factor. Grace Cottage administrators said they had not been able to afford Dartmouth-Hitchcock's telemedicine service. And they previously looked into home monitoring programs, but limited insurer reimbursements were an obstacle.
A bill approved Friday by the state Senate, S.50, attempts to tackle the reimbursement problem. It says all insurance plans including Medicaid should cover telemedicine services "to the same extent that the services would be covered if they were provided through in-person consultation."
The bill also includes a broad definition of what constitutes a telemedicine provider. In addition to physicians, physician assistants and advanced practice registered nurses, the long list of covered caregivers includes psychologists and psychoanalysts; clinical mental health counselors; social workers; and alcohol and drug abuse counselors.
Also included are marriage and family therapists, physical therapists, occupational therapists, speech-language pathologists and dieticians.
Tieman said the hospital association supports the bill, and it's also welcome news to the hospitals that are looking to expand their telemedicine offerings.
"We're hoping that continues to move forward," Paganelli said.
Mike Faher writes for VTDigger, the Brattleboro Reformer and The Commons. He can be contacted at firstname.lastname@example.org.