<figure>
 <img src="https://media.eaglewebservices.com/public/2020/2/1581113122703.jpeg" alt=" Brian Skow, an emergency room specialist, and nurse Amanda Sandager respond to a video call at Avera eCARE telemedicine center in Sioux Falls, South Dakota. Avera eCARE" />
 <figcaption> Brian Skow, an emergency room specialist, and nurse Amanda Sandager respond to a video call at Avera eCARE telemedicine center in Sioux Falls, South Dakota. Avera eCARE</figcaption>
 </figure>By CORINNE BOYER, <a href="https://www.hppr.org/post/video-chatting-doctor-could-boost-rural-kansans-health-care-adoption-slow">Kansas News Service</a>GARDEN CITY, Kansas — When Christi Graber checked 
into the St. Catherine Hospital emergency room late last year, she 
thought she was having a heart attack.Her left arm ached, she felt dizzy, and she experienced shortness of breath.The
 hospital’s cardiologist wasn’t available that night or for the next 
three days, so Graber had two options: Travel by ambulance to see a 
cardiologist more than two hours away in Hays during a snowstorm; or 
simply go home. Ultimately, she and her husband drove home.They worried both about the weather and the cost.“That’s a huge expense to be taken by ambulance a few hours away,” Graber said.&nbsp;Even
 the largest hospitals in the rural counties of western Kansas struggle 
to hire cardiologists and other specialists. Instead, they often 
transfer patients to Wichita, Denver or Kansas City.&nbsp;<figure>
 <img src="https://media.eaglewebservices.com/public/2020/2/1581113179865.jpeg" alt=" St. Catherine Hospital Emergency Room Director Dora Leon uses a computer to call a neurologist to consult on a patient who might be having a stroke. Credit Corinne Boyer / Kansas News Service" />
 <figcaption> St. Catherine Hospital Emergency Room Director Dora Leon uses a computer to call a neurologist to consult on a patient who might be having a stroke. Credit Corinne Boyer / Kansas News Service</figcaption>
 </figure>Now those same hospitals increasingly bring in specialists with 
virtual hook-ups, beaming in doctors from South Dakota who direct 
treatment over ever-more-elaborate video calls to emergency rooms in 
Garden City or Goodland.Yet for all the solutions telemedicine 
might offer, its obstacles range from iffy internet connections to 
uncertainties about insurance coverage to simple technophobia.<h2>Emergency Room Telemedicine</h2>If someone suspects they are having a stroke or heart attack, getting to an emergency room in time is critical.But
 a visit to a rural emergency room that doesn’t have a cardiologist or 
neurologist can lead to a transfer by ambulance or air to a 
metropolitan-area hospital with specialists on hand.Several <a href="http://www.ipsr.ku.edu/ksdata/ksah/population/popden2.pdf" target="_blank">frontier counties</a> — areas that have less than six people per square mile — comprise the northwest corner of Kansas. Two <a href="https://www.ruralhealthinfo.org/topics/critical-access-hospitals" target="_blank">critical access hospitals</a>
 serving the area, Rawlins County Health Center and Goodland Regional 
Medical Center, have tailored their emergency rooms for telemedicine.Goodland Regional Medical Center and Rawlins County Health Center both contract with <a href="http://www.averaecare.org/ecare/" target="_blank">Avera eCARE</a>,
 a virtual hospital that works with 22 critical access hospitals in 
Kansas. When doctors in those hospitals need more expertise, they 
connect by video to Avera’s specialists.Ronald Robinson, a 
physician and CEO of the Goodland and Rawlins County hospitals, said 
pulling in the right specialists can make all the difference in a 
complicated case. Telemedicine, he said, makes that more practical.“The
 physician … can see the (electrocardiogram, see the monitor, see the 
patient and assist us in making sure that we’ve got that correct 
diagnosis,” Robinson said.Doctors working remotely with ER patients can also assist bedside nurses and doctors with procedures, such
 as guiding them on putting in a breathing tube. Robinson said cameras 
mounted in emergency rooms allow doctors to see hospital equipment and 
walk staff through the process.&nbsp;To begin a telemedicine call, someone simply presses a button.“Directly
 above that,” said Brian Skow, an emergency medicine specialist and the 
chief medical officer of Avera&nbsp; eCARE , “there’ll be a 55-inch 
high-definition monitor and then a camera that's attached to that to 
access our system.”The Avera physician appears on the screen in 
30 seconds or less, Skow said. Heart attack and stroke calls rank among 
the most frequent.“We can determine if it truly is just stroke,”
 Skow said. “I can read the CAT scan of the brain so I can determine, 
yes, this would meet criteria for (a) clot-busting drug.”Finally,
 the telemedicine service can assist with patients needing further 
treatment at trauma centers by arranging helicopter, ambulance and plane
 transfers.At St. Catherine Hospital in Garden City, if an 
emergency room patient shows signs of a stroke, a mobile cart with a 
camera and computer screen wheels a remote a neurologist in to examine 
the patient.<figure>
 <img src="https://media.eaglewebservices.com/public/2020/2/1581113210274.jpeg" alt=" St. Catherine Hospital Emergency Room Director Dora Leon positions a telemedicine cart at the foot of a hospital bed. Credit Corinne Boyer / Kansas News Service" />
 <figcaption> St. Catherine Hospital Emergency Room Director Dora Leon positions a telemedicine cart at the foot of a hospital bed. Credit Corinne Boyer / Kansas News Service</figcaption>
 </figure>“So if we have that accessibility,” said Dora Leon, a nurse who 
manages the emergency room at St. Catherine, “that makes us feel more 
comfortable knowing that if our ER doctor wants a little bit of backup, 
it’s there. It’s available.”She said the mobile cart is placed 
at the foot of a patient’s bed so the neurologist sees the entire body 
when looking for signs of weakness.The neurologist can view a patient’s medical information on another screen.“We
 hold their arm up, and see how long they can hold it up. (Then, their 
leg. It's just to check which side of the brain is affected by the 
stroke,” Leon said.All the while, a neurologist, the sort of 
specialist that St. Catherine doesn’t have on staff, can examine the 
patient in those critical early moments when a possible stroke’s been 
detected. And when the right treatment matters most.<h2>Virtual Specialists</h2>Based in South Dakota, Avera eCARE works in 16 states in more than 200 hospitals — stretching from Vermont to Texas.Avera
 also employs specialists who work remotely with schools, jails and 
monitor intensive care patients. Doctors who work for the telemedicine 
company also rotate through Sioux Falls-area hospitals to keep their 
skills sharp.&nbsp;Physicians must be certified in the state where 
they work and the states where their telemedicine links take them. They 
also need credentials in the individual hospitals that hire telemedicine
 contractor.<h2>Telemedicine Expansion</h2>In 2018, the Kansas Legislature passed a bill <a href="https://www.kcur.org/post/telemedicine-ok-passes-kansas-legislature-anti-abortion-clause#stream/0" target="_blank">expanding telemedicine</a> by requiring insurance companies to cover treatment given over video hook-ups as if it were delivered in person.Robinson
 said that, in turn, has given small hospitals like Goodland and Rawlins
 County more incentive to pay for dedicated internet lines and tap into 
some federal subsidies for those connections.Yet obstacles remain. Some telemedicine rules remain uncertain.“An
 insurance plan must provide coverage for telemedicine services, but it 
does not require that insurance company to pay this same as it would for
 the in person visits,”&nbsp; said Jennifer Findley of the Kansas Hospital 
Association.That means hospitals can be unsure how much reimbursement they get from insurance companies for care involving telemedicine.Meanwhile, Findley said, reliable broadband isn’t wired into every rural hospital in the state.“We have (some) places where it’s still challenging to get a dedicated connection,” she said.Even
 when the billing might be clear and the internet steady, hospital 
administrator can find themselves worried about what it costs to start 
up telemedicine or whether a small outfit can muster a plan.Janine
 Gracy assesses hospitals’ technology and organization for the Heartland
 Telehealth Resource Center. She says some facilities are more 
intimidated than they should be.“If you have a smartphone, if 
you have an iPad, if you have a laptop, if you have a desktop with a 
camera and speakers, you can do telemedicine,” she said. “You don't have
 to go out and buy a robot in order to offer telemedicine.”Corinne Boyer covers western Kansas for High Plains Public Radio and the Kansas News Service. You can follow her on Twitter <a href="https://twitter.com/Corinne_Boyer" target="_blank">@Corinne_Boyer</a> or email cboyer@hppr.org.

Video chatting could boost rural health care, but adoption is slow