It is my hope that patients will be able to
get some of their regular diabetes checkups
and screenings done via telemedicine, so
that patients can reduce their trips to the
hospital and still meet the standards of care.
Initially, patients will still need to visit with
their physicians regularly, but the burdens
of frequent screenings, eye and foot checks,
and nutrition visits will be eased by providing
these services at Chapter Houses.
Challenges for Rural Telehealth
Major challenges for rural telehealth
programs include the lack of infrastructure
such as paved roads, Wi-Fi signals, cell
towers, and sparse populations. It can also
take time for populations to get comfortable
with a novel program and utilize services to
their maximum benefit.
With our mobile telenutrition program,
the biggest challenge thus far has been
the difficulty in assuring a reliable signal to
accommodate video conferencing even in
remote communities. We have run tests and
simulations, but the ultimate test of signal
strength will be when we drive the van out
to the communities we intend to serve and
attempt a stable video connection. A reliable
and fast internet connection is a luxury that
many on the Navajo Nation do not have yet.
This lack of infrastructure has delayed the
implementation of many worthy telehealth
programs.
Another challenge has been accessibility of
distant sites. Many of the communities we
hope to serve are reached via dirt roads, and
we needed to ensure that our new van would
be able to handle a bumpy ride—despite its
sensitive equipment. Again, the big test of
our success will be when the van arrives, and
can be road-tested.
These uncertainties with a major project
always serve as a reminder of the difficulties
of providing patients with the care they need
despite the limitations in resources that
are an unfortunate part of daily life in rural
communities.
Future Opportunities
TCRHCC hopes to expand its telemedicine
options in the coming years thanks to the
improvement in facilities allowed by the
grant. We have been offering telenutrition
and telepsychiatry services to high schools in
Tuba City, follow-up surgery and dermatology
visits via telemedicine, and various
educational opportunities for our medical
staff. We are also establishing a telestroke
program with the Mayo Clinic in Arizona.
Rural health providers and their patients
would greatly benefit from telemedicinebased collaboration with larger health
centers. A great model for this type of
collaboration is the University of New
Mexico’s Project ECHO. A similar project,
which included pulmonology, rheumatology
and other specialist care, would be of
great benefit to Northern Arizona’s rural
communities.
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