For every challenge in healthcare delivery, there is some potential approach for improvement; that was a broad theme underlying the message delivered by Suleima Salgado, of the Office of the Chief of Staff of the Georgia Department of Health, on Thursday morning at the Health IT Summit in Nashville, sponsored by Healthcare Informatics. Speaking to an audience at the Sheraton Nashville Downtown, Salgado delivered a presentation entitled “Telemedicine: Improving Population Health through Collaboration and Partnerships.”
The Atlanta-based Salgado sketched a portrait of the state of Georgia that many in Tennessee and throughout the Southeast and Appalachia would find relatable, of a state with vast rural areas that remain underserved for their residents, and in dire need of the benefits of telehealth/telemedicine solutions and strategies. “We have 159 counties in Georgia, and 110 of those are rural,” Salgado noted. “Meanwhile, here in Tennessee, you have 89 rural counties and only six urban counties, according to your state office of rural health. We need to find ways to provide access to quality care for a huge percentage of the residents of our states,” she said. And that involves facing up to daunting challenges of all kinds, from funding to staffing to data and information infrastructure challenges. “The reality at the end of the day is that most of our rural health partners are facing severe data issues,” she said, noting that, just to take one smallish example, “Clinics tell us that they have to schedule their participation in webinars around potential data crashes.” Many rural clinics have fragile Internet connections; what’s more, some have only one active nurse on staff, so if that nurse drives to a live educational session, that particular clinic has to shut its doors for a day.
Of course, every state has its own peculiarities in terms of addressing rural health issues, as well. Salgado pointed out that, while the Georgia Department of Public Health is overseen by one commissioner and one board of public health, and that one commissioner appoints the 18 district health directors who oversee the state’s 18 public health districts, its 159 county governments each have their own county health departments and county boards of health, which are managed independently and which independently implement broad statewide policies. “Our state health commissioner employs the health directors, but has no control over policies implemented at a local level,” she noted. Still, that fact in itself is not necessarily negative, she pointed out. “I’ve worked in a state office and in a county office. And to me, the work happens at the county level. At the end of the day, most of the work and effort come from those county organizations,” she said. So the independence of county health organizations is not in itself a problem; it just adds to the complexity of addressing broad rural healthcare policies, she emphasized.
One positive in the landscape around rural health in Georgia has been around funding, Salgado said. “In Georgia, we’re always looking towards the federal, state, and local organizations that can help us. And Georgia [health] has undergone a dramatic change in the last ten years as a result of increased federal funding, state legislative support and intra-state collaboration.”
The Georgia Telehealth Network
That increased funding has been absolutely necessary to address some disparities around access to quality healthcare in Georgia. “About 60 of our 159 counties don’t even have specialists in certain specialties; people are having to drive four to five hours to see a specialist,” Salgado noted. “So we established a telemedicine network through the state,” she reported, with an initial funding grant of $2.3 million to establish the Department of Health-led network. But, she quickly added that, though that figure sounded large in the abstract, in practice, “when you start figuring in technology, data, and other costs, it wasn’t a lot. Still, it provided a strong start. “The goal of the Department of Health,” she continued, “is to connect patients to providers in their local communities and not extract business/medical services from the local economy. We’re trying to help those counties without specialists in specific specialties. We want to help those counties so that people don’t have to drive to Atlanta or Jacksonville or across the state line to Alabama. It’s not a replacement, and we’re not using it as a medical home.” Indeed, she said, she and her colleagues have emphasized to the local communities they’ve reached out to, that providing adequate telemedicine medical specialty services actually helps local communities, and does not take resources out of communities. In that regard, she said, “Significant inroads have been made with private physicians, local hospitals and other telehealth entities within Georgia to advance towards a cross-collaborative network,” with the goal of the telehealth network “as a means to better communicate between each other and most importantly as a way to provide access to specialty care for our patients.”
Among the key points made in her presentation, which included a slide presentation, were the following:
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