Wednesday, May 25, 2011

Helping Rural Surgeons

A study supported by Saint Alphonsus Regional Medical Center and Boise State University in Idaho addresses the need for remote presence general surgery to help build surgery capacity in rural communities. For example, in Idaho, there are at least six critical access hospitals (CAH) with one or totally without a general surgeon in their operating room.

This is a serious problem for the U.S. in general since 20 to 25 percent of the U.S. population resides in rural areas, while only 10 percent of general surgeons practice in these areas. Today, rural populations have only 4.67 surgeons per 100,000 residents plus the fact that rural surgical residency training programs account for only 5 percent of all offered residency programs. In future years, the number of general surgeons in rural areas is expected to decline.

The research team took part in the study “Remote Presence General Surgery Program: Building Surgery Capacity in Rural Communities” supported in part by TATRC, to study the feasibility of using telemedicine systems to help further educate surgeons.

In taking the first step, the team met with partnering hospitals to identify opportunities for possible collaborations. Next, the team worked on an operating room assessment to understand the necessary information on the cases performed at each CAH. The operating room assessment was then used as a tool to study how telemedicine could play an effective role. It was found that approximately $500,000 in annual surgical revenue could remain in the local hospitals, if telemedicine was used as a tool in some of the cases.

The team determined that rural surgeons could perform 70 percent of all inpatient operations at their own facilities if they had additional training available which could be done using telemedicine systems. It has been shown that rural hospitals with one well trained general surgeon can bill an average of $1.5 million in annual surgery revenues.

Through the use of “InTouch Health Remote Presence”, the partnering hospitals involved in the study were able to increase their education opportunities. With InTouch providing surgical telementoring and training, information can be provided on preoperative planning along with new procedure training using by two-way audio/video communications.

Telemedicine has been successfully used to educate and train surgeons and the staff but the technology can also be used to observe procedures in the operating room. Future development of surgical assessment tools based upon preliminary results will further help improve telemedicine education.

By studying how to use telemedicine technologies to help rural surgeons, the team learned some valuable lessons:

• Education is a non-threatening way to form relationships between providers and to promote consultations
• Initial telemedicine encounters need to be positive for continued utilization of the program
• Prior exposure to technology for educational purposes before clinical use is imperative for staff comfort
• Technology must be used on a consistent basis for users to be comfortable with its use in emergent situations
• The technology can’t interfere with surgical workflow
• Construction of assessment forms to identify site specific needs is vital
• Development of a flexible collaborative network is needed to create a balance