Polycom video network helps raise standard of healthcarefor rural Northern Californians Typically, when people think of California, visions of sun drenched beaches and fast-paced city life in placeslike Los Angeles or San Francisco come to mind. But in reality, 75% of California is categorized as rural, withsome towns so remote they're home to less than 100 residents. Among the host of challenges associatedwith rural living is the very serious concern of access to adequate healthcare. In many remote Californiacommunities, specialty care is non-existent and the nearest large medical center can be hours away.

One area especially affected by the lack of quality specialty care is the Northeastern portion of California, anarea encompassing nine counties spread out over 30,000 square miles with 435,000 rural residents. This is a region with a lot of two-lane roads and mountain passes that are often closed during winter storms.

Susan Ferrier, regional telemedicine program coordinator, with the non profit Northern Sierra Rural HealthNetwork explains the convergence of factors that make healthcare delivery such a challenge in this particular region.

“The geography of the area alone, with five mountain ranges, six national forests and a desert, provides anidea of how vast and remote it is,” says Ferrier, “And its population is generally older and less affluent, with a much higher proportion of unemployed, and under-insured or uninsured residents than the rest of the state.Add to that the fact that it's difficult for the types of clinics and small hospitals that service rural communitiesto find the time and resources for effective grant writing which can bring in significant aid and money, andyou end up with a pretty desperate healthcare situation.”

The Power of the CollectiveSperanza Avram, founder and executive director of the Northern Sierra Rural Health Network, became acutelyaware of the disparity in the availability of healthcare between urban and rural settings in the mid 1990s. Atthat time, she was living in a very rural part of Sierra County, Calif. with only 3000 residents, and working in alocal clinic.

“When I would communicate with other remote, rural healthcare facilities in the area, we all agreed theremust be a way to more effectively bring resources and healthcare money into the region. So, a small group ofrural health clinics, rural hospitals and public hospitals, in Northeastern California got together to discussorganizing and applying collectively for healthcare dollars,” says Avram. “The majority of healthcare providersin this region are safety net providers - those who care for the under and uninsured, so funding is particularlycrucial to maintaining their operations.”

Out of the coordination of this small group of rural health care providers came the non-profit Northern SierraRural Health Network. Incorporated in 1996 with just 12 rural health sites participating, today the networkencompasses more than 40 providers with one of the most valuable services it offers being a video telemedi-cine network.

“One of the most pressing problems in rural healthcare is access to specialists,” explains Ferrier. “For example, there is only one child psychiatrist from Redding, in Northern California, to the Oregon border 140miles to the north and to the Nevada state border 175 miles to the east. Our best bet for delivering access to needed clinical specialties to our residents is through telemedicine.”

Video telemedicine is ideal for connecting remote residents with specialists because it eliminates the need forpatients to travel, which can be a hardship for the elderly or those for whom travel is simply cost prohibitive.In addition, by keeping patients in their home communities, the revenue from things like diagnostic work andprescriptions also stays in that community, giving what is often a needed boost to the local economy.

Virtual Visits Ease Healthcare Disparity

ChallengeRemedy the severe and at times life threatening lack of quality specialty healthcare in rural Northeastern California

SolutionPolycom VSX™ video conferencing solutions,Polycom MGC™-100 multipoint control unit,Polycom VisualConcert™ data collaborationsolution

ResultA telemedicine network that offers access to31 distinct medical specialties and has facili-tated nearly 3300 clinical consults and morethan 1600 non-clinical conferences in the fiveyears it has been up and running

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Northern Sierra RuralHealth Network

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Telemedicine in PracticeThe Northern Sierra Rural Health NetworkTelemedicine Network is based on Polycom videoconferencing systems, which are deployed through-out the region at 30 small clinics, hospitals and pub-lic health departments. The interactive video confer-encing technology allows clinic and hospital staff inthese small communities to easily connect directlywith larger medical centers and specialists all overthe state for real-time, face-to-face discussionsabout patient care, diagnosis and prognosis.

In the five years the telemedicine network has beenup and running, it has logged nearly 3300 clinicalconsults, including more than 2000 psychiatry ses-sions and over 400 neurology consults. In all, thenetwork facilitates access to 31 distinct medical specialties as varied as pediatrics, cardiology andHIV/AIDS programs and even the occasional den-tistry and optometry consult.

“We're able to use our video conferencing capabili-ties for a multitude of clinical applications,” saysFerrier. “For example, a man recently visited a clinicin Downieville, California complaining of chest pains,but was reluctant to leave his home community.Using an electronic stethoscope connected directlyto the Polycom video system, the clinic staff wasable to conference with doctors at UC Davis whodiagnosed him as having a massive heart attack. He was quickly transferred to a major medical centerfor treatment.”

The Northern Sierra Rural Health Network is in theearly stages of a new telemedicine program focusedon assistive technology. The primary use of assis-tive technology in the Network is to aid developmen-tally disabled clients who need speech enhance-ments or have no speech and may be helped byusing a computer to communicate. When the regionlost its assistive technology vendor, it decided torevamp the program and use video to deliver thisservice to its clients. Now a patient comes into theNorthern Sierra Rural Health Network TechnologyServices Center in Redding and connects over videoto assistive technology specialists from around thestate. These experts are able to interact in real timeand evaluate the patient to determine which devicewould be best suited to that specific person.

In a very touching example, the human side of technology came through. An elderly woman inGreeneville, Calif. was living in a long-term carefacility and reaching the end stage of a terminal ill-ness. Her husband of more than 50 years visited herdaily until he suffered a heart attack that requiredhim to be air lifted to a hospital in Redding, Calif.,more than 125 miles away. Through the telemedi-cine network, the Northern Sierra Rural HealthNetwork staff was able to connect them over videoso they were still able to visit one another, despitethe distance.

Keeping Doctors Up to Speed and in the CommunityThe telemedicine network has also facilitated more than 1600 non-clinical conferences, includingcontinuing medical education (CME) and administra-tive meetings.

“Delivering continuing medical education to our prac-titioners is a vital function of the telemedicine net-work,” says Ferrier. “Often times, there is only onedoctor or nurse in a rural community, making it nearlyimpossible for that person to travel to attend classesthat are required for recertification and licensing.”

More than 800 CME classes have been offered overthe telemedicine network in the past five years andan average of two classes weekly are available,connecting care providers with such highly regardedinstitutions as the University of California at Davis.

The telemedicine network has also helped alleviatethe pressure of a severe nursing shortage in thestate. Several of the nursing staff at Fall River MillsMayers Memorial Hospital were pursuing RNdegrees which required them to travel an hour and ahalf and traverse several mountain passes to attendclasses at Shasta College in Redding. Often, foulweather made the drive impossible. So, ShastaCollege began offering the courses over video andthe nurses currently attend 16 hours of class perweek right from the hospital where they work.Community residents in Fall River Mills also haveaccess to the classes.

The telemedicine network has saved the organizationtime and money on administrative meetings as well.

“It's several hours travel time between most of thesites in the network, so things like board meetingsand regional health planning can take place overvideo,” adds Ferrier.

Making the ConnectionsThe Northern Sierra Rural Health Network hasdeployed numerous Polycom video conferencing systems, including its award-winning VSX™ line,which delivers the industry's highest audio and video quality.

“The Polycom video systems have been extremelyreliable, and it's so nice to have the same user-friendly interface among our 30 geographically dis-persed sites,” says Ferrier. “And when it comes toease of use, we always say – if you can use aremote control, you can use a Polycom!”

The network also uses a Polycom MGC™-100 confer-encing bridge to seamlessly connect video systemsrunning over T1 lines with ISDN-based systems andfor multipoint conferences. For data sharing, whichis a frequent component of CME sessions and usedoften in assistive technology consults, the organiza-tion has deployed Polycom's Visual Concert™.

Advancing Rural HealthcareBoth Ferrier and Avram agree that in healthcare,needs are constantly changing and evolving, andtheir goal is to continue leveraging the latest in communications technology to effectively and effi-ciently meet those needs, now and in the future.

“We're proud of the difference we've been able tomake in the lives of the rural residents we servethrough our telemedicine network,” adds Ferrier.“Video conferencing truly is an ideal medium forhelping level the playing field and providing equalaccess to the best specialty care.”

Current plans include an effort to identify additionalhospitals that can provide specialty consults in orderto continue best serving the Northeastern Sierra pop-ulations through telemedicine. Ferrier is also opti-mistic that the nursing programs offered remotely by Shasta College can be expanded to include otherproviders in the network.

©2005 Polycom, Inc. All rights reserved.

Polycom and the Polycom logo are registered trademarks and VSX, MGC, Siren and StereoSurround are trademarks of Polycom, Inc. All other trademarks are the property of their respective owners. Information in this document is subject to change without notice.

The IT PerspectiveThe Northern Sierra Rural Health Network Telemedicine Network relies on Polycom video communica-tions systems, including the award-winning VSX™ line, which includes Siren™ 14 audio and PolycomStereoSurround™ to deliver the best audio and video performance in the industry. Systems aredeployed at 30 sites throughout the counties the Network serves with most calls running at 384 kbps.

ISDN is not available in most of the remote sites on the network so the organization installed T1 linesat the locations and uses a Polycom MGC™-100 bridge to connect with outside ISDN lines. The net-work is primarily ISDN, but Ferrier and her colleagues are in the process of adding IP capability to theexisting MGC bridge.

For the frequent data sharing that takes place on the network, the organization uses Polycom's Visual Concert.

Virtual Visits Ease Healthcare Disparity