From rural to urban: Remote patient-doctor interactions in the heart of South LA

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Decades ago, doctors needed a way to bring medical care to folks who lived in isolated rural communities, miles away from the nearest doctor.

Thus telemedicine was born: A way for patient information to be relayed electronically to doctors, so that they don't have to meet face to face.

Neither the technology nor the idea are nothing new – but where it's being used is. Telemedicine is seeing a rapid growth within urban communities like South Los Angeles, and Nina Vaccaro, the executive director of the Southside Coalition of Community Health Centers, says that's because residents there are in dire need of access, particularly when it comes to specialty care.

"There aren't enough specialists that are willing to come to South Los Angeles as a whole, to provide for the needs of this community," she said. "So the clinics really have to look outside of their four walls to find access to those specialists."

That's why Veronica Morales, a medical assistant at St. John's Well Child and Family Center, was taking high-resolution photos of diabetic patient Ivory Corothers' retinas. She'll send them to a specialist based in Northern California, who will let doctors at St. John's know if Corothers' vision is worsening and if he'll require further care.

"I'm hoping to hear my eyesight is OK," laughed Corothers. "That's what I'm hoping to hear."

That form of telemedicine – taking a photo, saving it and forwarding it to a remote medical professional – is called "store-and-forward." Most southside clinics use store-and-forward, but telemedicine is traditionally thought of as a videoconference: Doctor on one end, patient on the other.

Vaccaro said store-and-forward is cheaper than videoconferences of that sort, because it's only a consultation, as opposed to tele-treatment where the patient is directly involved (e.g. a real-time Skype session with a doctor). Not only that, but it beats the cost of an in-person by a lot: Retinal screenings cost around $15.

Telemedicine has skyrocketed in popularity. Jonathan Linkous is the CEO of the American Telemedicine Association, and he said that in 2005, around 1 million patients nationwide had used telemedicine. Today, that number's up to 10 million – and within the next two years, he estimates that number will double. Its expansion into urban areas makes a lot of sense to Linkous.

"People talk about if you're in a rural area, you have to travel a long way to get to the doctor," he said. "Well, I'm sorry, if you're in an urban core, you may have to travel a long, long way to get to the doctor."

Telemedicine isn't without its wrinkles: Skeptics worry about the security of patient data and quality of care. There are also reimbursement issues. South L.A. community clinics use grants to cover the uninsured and, failing that, patients without coverage are charged. Medicare won't cover a lot of telemedicine in metropolitan areas, says Linkous, and Vaccaro explained that Medi-Cal will only reimburse patients if a special billing code is used – one that explains why an urban resident is using this tool originally conceived for rural patients.

Jim Mangia, the president and CEO of St. John's, also said it should only be a supplement to – and not a replacement for – flesh-and-blood consultations.

"I think it's not the totality of what the health care system will be," he said. "I don't think everything's going to be done remotely, obviously."

But for its flaws, advocates say telemedicine makes the process more efficient. For example, workers in several Southside Coalition clinics say before they started it, they'd send all their diabetic patients to L.A. County clinics for eye exams, overloading that safety net system. Now, thanks to these consultations with off-site specialists, they only send the patients who actually need additional treatment, freeing up the system considerably.

Those are only some of the reasons why Linkous says telemedicine is the future.

"Oh, it's happening today," he said. It's absolutely where we're going, and one of the reasons we're going there is because consumers are demanding it."

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