Marshfield Telehealth Program Reaches Rural Kidney Patients in Northern Wisconsin

by Candi Helseth

Examination via Computer Monitor

A physician with Marshfield Clinic examines a patient in a rural Wisconsin location via computer monitor.

For rural people diagnosed with end-stage renal disease, access to treatment often depends on whether they have the financial means and transportation access to travel long distances. Since most patients with end-stage renal disease are elderly, and many reside in skilled nursing facilities, long transports are often impossible. As a result, many go without any care for their chronic, advancing disease. For such patients, telehealth services can be a godsend.

Marshfield Clinic in Marshfield, Wis., is providing that kind of care, in addition to other telehealth services in advanced specialties that are practically non-existent in rural areas. Its renal disease telehealth program serves low-income, mostly disabled, nursing home residents living in five rural north central Wisconsin counties where travel to specialists can involve a distance of up to 600 miles.

Marshfield Clinic TeleHealth (MCT) also provides services for patients in earlier stages of renal disease who travel to their local clinic for care. Marshfield nephrologists use telehealth to work with freestanding or hospital-based dialysis units in the rural regions, greatly reducing transport time for patients who are on regular dialysis.

“Ninety percent of this service area is rural, covering somewhere around 250,000 miles,” said Nina M. Antoniotti, director of telehealth. “We have five nephrologists that work with patients out in those rural areas. Until we began the service, for the most part, patients were simply going without care. They had to drive long distances to get care and weather can often prevent them from making it to an appointment. If they missed, there was a long wait to get in again. Telehealth has definitely improved access and made it possible for these patients to get the care they need.”

Since its inception in 1997, MCT has grown to include 54 locations including rural clinics, rural nursing homes, Head Start centers and an Indian Health Center, in addition to two hospitals. MCT also offers other highly specialized services including Burn Management, Cardiology, Clinical Psychology, Diabetes Management, Gerontology, Psychiatry and Wound Therapy. Geriatrics, pediatrics and special needs patients are primary populations for outreach. MCT serves about 15,000 patients annually.

“We have patients who see a clinician in Denver because he’s the only one in that specialty,” Antoniotti said. “Our local communities really want telehealth services. For many of their residents, the difference in care is simple: drive 200 miles in the middle of winter for a 15-minute cardiology visit or drive two minutes across town to the local primary clinic. Talk to your neighbor at the reception desk, feel comfortable with a nurse you already know, and be back home in less than an hour.”

In addition to improving patient health care, MCT stabilizes rural community economies and proves that telehealth can be a sustainable program, Antoniotti added. Initiated in December 1997 with a Rural Telemedicine Grant from the Office of Rural Health Policy, the grant proposal proposed seven telehealth services. Within two years, MCT had 15 telehealth services. In 2000, the Office for the Advancement of Telehealth,  provided a grant to expand the program and service area. Since then, MCT operations have not relied on grant funding.

“Many programs begun with grants aren’t able to sustain themselves after the three-year grant is up,” Antoniotti said. “We believe we have a moral obligation that if we start telehealth services in a remote community, we can’t pull those services out. We have a business approach to be sure that necessary service is going to continue. We do continue to apply for and get grants on a regular basis that we use as venture capital money, but we no longer use any grant funding for operations.”

The MCT consortium of health care partners funds operation costs. For more information about the program, contact Antoniotti at

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