New way to help rural cancer patients?

Charlie Denison

Montana State University Nurse Practitioner grad student Heidi Linhart of Central Montana Medical Center shared her project on implementing telehealth services in Central Montana at CMMC to providers and colleagues Tuesday, shedding light on a service she believes is highly beneficial for rural patients.
Photo by Charlie Denison



Looking for a way to fulfill the needs of the rural community, Hobson native Heidi Linhart is taking on an ambitious Doctorate of Nursing scholarly project on telehealth services, which allows patients an opportunity to have an appointment with their healthcare provider through video technology.

“Telemedicine/telehealth has been in place at Central Montana Medical Center for rural patients since 2014 as a way to augment care provided by the visiting doctor,” Linhart said. “I conducted a research study evaluating patients’ perspectives with telemedicine and how well they are satisfied with this form of care. I also surveyed local primary care providers to determine their level of satisfaction.”

On Tuesday, Linhart shared her presentation to a number of CMMC health providers and representatives. Many of them are her colleagues, as she works in the CMMC oncology department part-time while continuing her education.

“My first job out of school was actually in oncology,” Linhart said, “so this project reflects not only that love, but also my love for this rural environment.”

This being the case, her focus for this study was on teleoncology.

The presentation Tuesday started off with Dr. Bryan Martin of the Benefis Sletten Cancer Institute Oncology Department in Great Falls delivering an introduction. It’s Martin, Linhart said, who has really helped patients get comfortable with telemedicine, as he’s been instrumental in utilizing the program, regularly working with CMMC patients from Great Falls via videoconference.


Why telehealth, and what is it exactly?

During her presentation Tuesday, Linhart explained thoroughly what telehealth is and why it is important.

 “The goal of telehealth is to exchange medical information from one site to another in a variety in order to improve a patient’s clinical health status,” Linhart said. “It’s a tool first introduced in the 1970s but as technology has taken off and rapidly expanded, telehealth has followed suit in a variety of ways.”

Telehealth has come a long way on a global scale, Linhart said, as it is commonly used in Australia, New Zealand, Sweden, Germany, Canada, Japan and Norway.

“The list is extensive,” Linhart said. “It’s caught on.”

And, after doing such extensive research, Linhart said she can see why.

“Telehealth decreases the disparities of distance,” Linhart said. “By using this service, patients located at a distance are still able to receive specialty care.”

This is particularly important in rural areas like Central Montana. According to her research, Linhart said 65 percent of the population of Montana is rural. Furthermore, 52 percent of Montana residents travel more than 50 miles for their oncology care and 26 percent travel up to 100 miles for the care.

That’s why “teleoncology” is catching on at CMMC and why it has grown since its inception in 2014, when Dr. Martin saw his first patient in Suite 5 of CMMC while still in his office in Great Falls.

“[Martin] just pops into a room with the capabilities of telemedicine and conducts the visit that way,” Linhart said.

When using telemedicine, patients are assisted by a nurse during their visit to help with the stethoscope, the camera and more.

This works well for oncology patients, Linhart said, as a lot of oncology visits are about symptoms and “taking care of the whole self.”

“Oncology patients feel it’s a good tool,” she said.


Survey says…

Linhart did an extensive literary review on this subject, and results have been positive.

“Overall, we’ve had high satisfaction rates, especially with the decreased travel burden,” Linhart said. “Cost savings were also significant, as well as decreased wait times.”

Telehealth, Linhart said, “increases access to quality health care and specialty health care for Central Montana residents” and would fulfill a need for the area she holds dear.

“I love this area and I want to continue to improve peoples’ lives here,” she said. “This is a wonderful place to live. I think we all know this, but it comes at a cost, too.”

There is some work to do to increase the use of telehealth tools, as, according to a 2015 survey, only 52 percent of Montanans said they’d consider video conferencing. This being the case, Linhart is dedicated to telehealth awareness, gathering baseline information, what providers think about it and what patients think about it.

With the increased rates of aging, higher rates of chronic disease and higher financial costs, Linhart said it’s crucial to look into the benefits involved with this new medical opportunity.

Earlier this year, Linhart conducted a local survey adapted from the work of Medical Oncologist Dr. Malcolm Brigden of Ontario. Twenty-one telemedicine patients and 21 face-to-face patients completed the survey. Eighty-three percent of patients were in for a routine check. On average, most patients drove 13 miles to get to the clinic, but the furthest patient away from Lewistown drove in 40 miles.

“Telemedicine saved our patients a 214-mile round trip to Great Falls,” Linhart said, “which, according to the IRS medical reimbursement per mile, saved them $40.66.”

And even more striking, Linhart said, was the high satisfaction rate of patients, , as 81 percent of those who experienced telemed visits in her recent survey were very pleased with the results. Linhart said she believes that is no fluke.

“The study that I did hopefully shows that the satisfaction by our patients and general satisfaction by primary care providers gives us enough room to gadge how well our patients appreciate being able to be seen here in any capacity, whether face-to-face or telemedicine,” Linhart said. “The minimal difference we see shows the two are comparable.”

Furthermore, Linhart said after her presentation, the survey is encouraging, leading her to believe “there is a place for this in our little community.”


Spreading the word

Of those who participated in the survey, Linhart said 93 percent of the face-to-face patients did not know telemedicine visits existed, and 46 percent of the telemedicine patients were unaware prior to the check-up.

“Those are some pretty high numbers for the lack of awareness,” Linhart said. “The general lack of awareness by the providers, patients and everyone is really one of the major end factors. This lack of awareness contributes to the low utilization, and, considering the widespread acceptability we’ve seen across the literature and here at our own facility, this is an important area for us to address going down the road.”







What is your favorite part of the Fair?