Editor’s Note: This is the first of three articles describing the oncology and diabetes telemedicine services at Eastern Plumas Health Care. The first article will focus on EPHC’s telemedicine oncology services.
Telemedicine offers an exciting new horizon in rural health care. Patients can be “seen” by specialists utilizing a high-quality secure telemedicine video connection. This allows patients who either can’t afford to or don’t feel well enough to travel the ability to stay close to home and still receive the best available care.
Eastern Plumas Health Care’s Telemedicine Program includes the following specialties: cardiology, dermatology, diabetes education, diabetic retinopathy screening, endocrinology (diabetes, thyroid conditions), internal medicine, nephrology, neurology, oncology (cancer), pediatric emergency/critical care, psychology counseling, psychiatry, pulmonology and rheumatology.
EPHC’s Dr. Michelle Kim reports that her patients are initially hesitant when she suggests a telemedicine visit. But all it takes is one visit, said Kim, for patients to become enthusiastic supporters. In fact, Telemedicine Program Director Mark Schweyer reports that patient satisfaction surveys are overwhelmingly positive.
“EPHC’s specialists for its oncology and diabetic retinopathy programs are among the best available anywhere,” said Linda Satchwell, public relations coordinator. “It’s quite astounding to find specialists at this level partnering with a small, isolated rural hospital in Plumas County.”
EPHC’s cancer program utilizes oncologists from Tahoe Forest Cancer Center and UC Davis Medical Center through their Cancer Care Network. Opthamologists from UC Berkeley read diabetic patients’ retinal screenings.
Specialists are able, utilizing telemedicine stethoscopes, otiscopes (ear instruments) and dermatology cameras, to hear and see everything they would if they were in the same room with their patient. With the help of Telemedicine Coordinator Sylvia Jawad, who has been trained on the equipment, and nationally certified oncology nurse practitioner Christina Potter, who facilitates oncology visits, specialists can view a greatly magnified skin lesion, for example, with the same precision as if they’re in the room.
EPHC’s oncology telemedicine program has been up and running since last November. The program connects local patients with Dr. Laurence Heifetz at Tahoe Forest Cancer Center in Truckee. Tahoe Forest has become a recognized leader in rural oncology, and the center’s connection with UC Davis, a National Cancer Institute-designated cancer center, brings it to a level that’s on par with the best in the nation.
According to the NCI, it awards the cancer center designation to facilities meeting rigorous criteria, including “developing research programs, faculty and facilities that will lead to better approaches to prevention, diagnosis and treatment of cancer.” Davis is only one of three such top cancer centers in all of Northern California, and it is dedicated to working with rural hospitals to provide top quality care.
Potter trained at the Tahoe Forest Cancer Center in Truckee with Heifetz and his staff before taking on the role at EPHC. Every Thursday in Portola, Potter sees one or two of EPHC’s cancer patients. All patients are referred to Tahoe Forest Cancer Center for their initial consultation and treatment.
And, while the hope is that EPHC will eventually be able to offer chemo treatment, currently patients do have to travel to Truckee for chemo and radiation therapy. But stable patients — even those who are receiving chemo — can take part in EPHC’s telemedicine oncology program, said Potter.
Patients have their labs, CT scans and MRIs done at EPHC. Potter has the results available by the time of their appointment so that she and Heifetz can discuss results with the patient. Potter said that one patient, who is still actively receiving chemo, comes every two weeks. During the appointment, she and Heifetz review his lab work and discuss how he’s feeling, including any side effects from treatment. Together, Potter and Heifetz do a physical exam. They also discuss any necessary changes in medications, such as blood pressure medicine, and chemo dosing.
Potter appreciates the ability to be able to follow her patients after she has referred them out for cancer treatment. In the past, they would simply go, and she would have no idea how they were doing, she said. Now, she welcomes the opportunity to help them as they’re going through the treatment process.
Potter said she appreciates the collaborative nature of this work, adding that, based on what they learn during the appointment, Heifetz might determine when to schedule the next chemo appointment, for example, and she might adjust the patient’s blood pressure medication. Also, said Potter, Heifetz is very good about sending his appointment notes to her after each visit.
A very exciting aspect of the program, said Potter, is the monthly “virtual cancer board,” offered through the UC Davis partnership. Potter travels to Tahoe Forest Cancer Center to participate in what she describes as a meeting of the top oncology specialists who discuss “interesting, complex cancer cases,” and come up with a consensus about care management.
The cancer boards, according to UC Davis, “offer improved opportunities for remission or cure.” Potter said that several of her patients have been the topic of discussion at the boards. Specialists are connected via the same high-quality video system used for telemedicine appointments. There might be a number of “live” participants in Truckee and other cancer centers, along with several UC Davis oncology specialists, all of whom appear on-screen from their remote locations, so it seems as though they are in the room together having a lively discussion. In addition, all attending members can view pathology slides or radiological scans, which are on a separate section of the video screen, as they discuss a particular patient’s cancer.
Potter can’t say enough positive about Tahoe Forest Cancer Center. Not only is the physical aspect of patient care state-of-the-art, the center also offers excellent emotional and psychological support for patients. According to Potter, cancer patients are unique in that most have a very positive attitude and are focused on getting well. “Patients are so good at knowing their meds — they know what they’re taking. For most, their goal is to beat this. They’re compliant. They follow through. It’s because the support, the foundation is so strong. Nobody lets them fall through the cracks,” said Potter.
She added that she really looks forward to seeing her Thursday oncology patients. “You’re seeing the best of these people at the worst time.” It makes her realize “the little things we tend to complain about aren’t big.”
Potter is excited about opening a second telemedicine oncology appointment day — this one in Loyalton — on Wednesdays. Heifetz met with Potter and Schweyer last week to firm up plans, which will give Loyalton cancer patients the option to receive follow-up cancer care from their home clinic in early September.
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