The REACH Montana Telehealth Network is able to link providers to each other through live interactive video technology from the hub site in Great Falls, Montana where the network currently serves rural counties in the north central region of the state.
Today, the REACH Network includes one community hospital, nine critical access hospitals mainly staffed with mid-level providers, two clinics where one clinic is on an Indian reservation, and two Indian Health Service hospitals.
The system uses a combination of T1 and fiber optic connections to all sites, operates with both standard and high definition equipment, uses portable clinical carts, and is presently working on getting wall-mounted units in the emergency rooms located in remote sites.
Specialists using telehealth include pediatricians treating mental health issues and other specialties such as gastroenterology, endocrinology, and NICU ophthalmology. So far, the use of telehealth has enabled the NICU to reduce the number patients needing transports to other facilities. For example, cost savings were achieved in the NICU when telehealth was used for 14 patients that needed to be transported to other facilities for a total of $157,500 versus previously when 176 patients needed to be transported for a total of $1.5 million.
The telehealth radiology program implemented in the 1990s now connects to ten REACH sites and is able to do 60,000 consultations per year. The PACS system used by obstetricians and cardiologists are available for two afternoons a week to do consultations plus consultations are also provided by specialists in neurology and neurosurgery. Oncology patients receive support as there are five support groups offered over REACH with tumor board meetings also provided via telehealth.
Genetic counseling is provided to a patient base located in northwestern Montana where referrals come from a variety of providers with consultations usually taking 30 to 60 minutes. The program is looking to expand to Lewistown Montana.
The hope is that in the future, telehealth will include speech therapy especially for rehabilitation after a stroke, children that have speech issues, consultations on wound care management, and for pain management.
Burn patients in the state are able to benefit from telehealth. When they need to be seen at a burn center, they have to drive 500 miles which is an eight hour drive or a two hour plan ride. Using telehealth means that physicians in Montana can do the initial consult and then send patients out of state to the University of Utah Burn Center. After the patient returns home, physicians can follow-up via telehealth consultations.
REACH regularly connects to other telemedicine service providers in Billings, Missoula, and Helena as part of the Montana Healthcare Telecommunication Alliance. The Alliance was formed to promote interoperability between current teleconferencing systems, to decrease the cost for the operation of networks, and pursue legislative activities affecting telemedicine.
A serious problem has been the issue of reimbursement. However, to remedy the problem, State Senate bill 270 was passed and requires private insurers to pay at par for telemedicine. The bill was passed in February 2012 and will take effect January 2014.