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May 17, 2016: Livewell Nebraska

Telemedicine Service Expanding in Nebraska to Spare Rural Patients Long Trips

A large group of independent physicians plans to enter the expanding world of telehealth.

The Midwest Independent Physicians Practice Association, a group of about 450 primary care physicians and specialists who are not tied to a specific hospital system in Nebraska, will begin using video-audio consultations for patients who need to be seen by a specialist but live too far away to conveniently see the specialist in person.

The arrangement between Omaha-based MIPPA and Norfolk, Nebraska-based AET will give participating physicians a web-based platform for those appointments and for the secure exchange of patient records and data. AET is a technology company founded in 1999 by Dr. Keith Vrbicky, a Norfolk obstetrician and gynecologist.

The service will enable rural patients to avoid having to drive to Omaha, Lincoln or another city to see a specialist. Instead, they can see the specialist by telemedicine from the office of their hometown physician. MIPPA also has hundreds of nurse practitioners, physician assistants and other medical providers in Nebraska and western Iowa.

The initiative exemplifies the boom in the use of medical services that don't require a patient to sit knee to knee with a doctor but rather can be "seen" from hundreds of miles away. The main hospital systems based in Omaha and Lincoln — CHI Health, Methodist Health System, Nebraska Medicine and Bryan Health — offer growing numbers of services through telehealth technology.

"This is going to be the health care of the future," said Dr. Gamini Soori, a cancer specialist and the CEO of MIPPA. "It is not going to be a flash in the pan."

Soori said patients push for telehealth because they don't want to travel long distances, sit in waiting rooms and miss considerable time at work because of an appointment with a doctor. Patients have begun sending smartphone pictures of moles, rashes and sore throats to doctors, Soori said.

Though smartphone photos aren't part of the arrangement between MIPPA and AET, Vrbicky said, "The smartphone has replaced the black bag. The technology is exploding."

MIPPA began enrolling physicians in the initiative last week. MIPPA specialists will pay a monthly fee to use the AET technology platform, but primary care providers will not. Patients typically will pay the same fee as if they had visited the specialist in person. Insurers will reimburse specialists for the appointments, Vrbicky said. About 75 percent of MIPPA's doctors are specialists, Soori said.

Dr. Rebecca McCrery, an Omaha urogynecologist, participated in the pilot project for MIPPA, conducting about eight appointments by telemedicine with patients in Norfolk.

"It just makes the specialist more accessible," McCrery said. Having grown up in a town two hours from Minneapolis, she said she understands the burden of trying to get to a specialist many miles from home.

Many of her patients are elderly women, she said, who are daunted by driving into a big city or need a family member to drive them. Telemedicine provides an important service for them, McCrery said.

McCrery said she needs to actually touch some patients and examine them in person. Other patients, including many of those suffering urinary incontinence, can be seen by computer video and audio, particularly if another doctor has seen the patient and documented his or her findings.

MIPPA joins many organizations that perform some medical services by telemedicine. Bryan Health, through an entity called Bryan Telemedicine, does consultations with patients in Hastings. CHI Health has a service in west Omaha in which nurses and doctors help monitor patients in intensive care in numerous hospitals in the area.

Methodist Women's Hospital's maternal-fetal medicine specialists do consultations by telehealth with patients in Norfolk. And Nebraska Medicine provides geriatric psychiatry by telemedicine technology with patients across the state.

Organizations such as CHI Health, Bryan Health and Blue Cross Blue Shield of Nebraska also offer 24-hour-a-day virtual care services.

Through these virtual visits, patients use phone or video chats to get medical assistance for minor conditions, such as a sinus infection. The fees are generally lower than an office visit.

Mary DeVany, director of telehealth with Nebraska Medicine, said institutions and individuals increasingly recognize the value that telemedicine can bring. "Telehealth has been around in many shapes or forms for 20 years," DeVany said. "It's really become something that is expected and used on a daily basis."

Soori said that in order to thrive, MIPPA's telehealth program will need sufficient numbers of primary care doctors and specialists to sign up. Soori predicted the technology will be rapidly adopted by MIPPA doctors. Consumers, he said, will insist on it.

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