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Montana Health Network Primary Care Telemedicine

Summary 
  • Need: Backup coverage for primary care providers in rural Montana.
  • Intervention: A network of healthcare facilities developed a primary care telemedicine program.
  • Results: While the technology worked for primary care telemedicine and patients were open to the process, primary care telemedicine did not become a long-term solution in this Montana region due to low patient volume and a lack of telemedicine provider availability.

Description

Montana Health Network (MHN) is a network of rural nonprofit healthcare organizations working together to improve effectiveness and efficiencies.

In 2011, MHN received a Rural Health Network Development Planning Grant from the Federal Office of Rural Health Policy to begin the process of offering primary care telemedicine.

Telemedicine for primary care services can benefit both patients and providers. For patients, timely care is received even in the absence of their primary care provider. For providers, telemedicine helps lessen backlog after an absence.

Though patients were open to utilizing primary care telemedicine, few providers were willing to take telemedicine shifts. Mid-level providers also had concerns due to the schedule accommodations required to match the availability of telemedicine providers. Due to these issues, the primary care telemedicine program was never fully established as routine. Patient satisfaction was high, but long term sustainability was not achieved.

Services offered

  • Primary care physicians via telemedicine would be available for backup or short-term coverage.
  • Nurses would be trained on-site to work in a telemedicine environment.
  • A toolkit of protocols to assist with implementation was available to MHN member hospitals. Some of the protocols were more clinical in nature, such as scheduling protocols. Other protocols involved billing and coding, and yet others provided guidance on electronic health record documentation and sign off from remote locations.

Results

  • Dispelled the myth that patients would wait to see a local provider rather than use telemedicine. Surveyed focus groups indicated patients clearly confirmed they would rather see a telemedicine provider immediately than wait for their local provider to return. During the focus group, an equipment demonstration was provided.
  • Confirmation that recommended technology and methods protocols worked for intended use.
  • MHN primary care telemedicine program is non-operational as of April 2015 due to a lack of providers to staff the telemedicine program.

Barriers

  • Healthcare facilities need to purchase peripheral equipment (tele-otoscopes, tele-stethoscopes) in order for nurses to gather the necessary information for primary care telemedicine. This can be a costly undertaking for a program that may not generate a great deal of patient volume.
  • Concerns by mid-level providers regarding schedule impact or need to change established practice days in order to accommodate a telemedicine provider.
  • Willing provider availability due to altered schedules required for telemedicine shifts.

Replication

Steps in the process of setting up Primary Care Telemedicine:

  • Purchase Equipment: While most facilities are technologically connected, peripheral equipment must be purchased, such as tele-otoscopes, tele-stethoscopes, high resolution cameras for dermatology use, and appropriate light sources.
  • Public Demonstration: In order to raise awareness of telemedicine services, public forums to demonstrate equipment and technology should be held at facilities.
  • Testing with Real Patients: Equipment utilization for actual patient care is important in order to anticipate difficulties, and to provide nurses with telemedicine environment experiences.
  • Documentation for Reimbursement: Medicare, Medicaid, and other third party payers need to be consulted ahead of time to determine covered benefits.
  • Connectivity Testing: Advance wireless connectivity needs to be established at MHN members' facilities in order to assure that electronic health record documentation can be performed in the local system.

Lessons learned by MHN:

  • Advance logistics need to be outlined for patient volume and flow
  • Address local provider concerns

Contact Information

Chris Hopkins, CEO
Montana Health Network
406.234.1420
chopkins@montanahealthnetwork.com

Topics
Healthcare networks
Primary care
Telehealth

States served
Montana

Date added
October 5, 2012

Date updated or reviewed
September 23, 2019


Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.