Wild-Harvesting Primer
Finding Solutions with Technology
Technology is changing the face of many industries, and medicine is no exception. A health care revolution may be in the works, resulting in access for anyone, anytime, anywhere. The main barrier for rural practices? Money. Many technologies require enormous infrastructure improvements, and are expensive to maintain. Technology is either prohibitively expensive to invest in, or medical insurers refuse to pay for "experimental" techniques.
Internet
Communication between isolated rural doctors and their colleagues is being improved by even the most rudimentary email access. The downside: "I have a hundred emails every day," complains a Portland doctor. Practitioners can access studies, articles and databases that are posted on the Internet, discuss issues and treatment strategies via "list-servs" (group email communications), and access specialists via the Oregon State Health Services consulting service.
Winged Ambulance
To assist rural communities in providing emergency or time-sensitive treatments, Oregon has medical air transport service. Companies like Air Life, based in Bend, and Cal-Ore Life Flight, based in Brookings, provide emergency personnel and transportation using private fleets of helicopters and airplanes. A flight can cost anywhere from $5,000 to $12,000, depending on transport distance and medical acuteness. Annual and lifetime "memberships" are available for those who want to guarantee a speedy escort to the nearest trauma center, should the need arise.
High-tech Equipment
Most doctors list "outdated equipment" within a medical facility as one reason to not take up a rural practice. Rural hospitals try to keep up with the latest technology but have a hard time paying for it. A closed MRI can cost $1.5 million to 2.6 million, and $150,000 per year to maintain. A CT scanner will run between $1 million and $1.8 million. If these machines are used only a few times per year, the investment is not compensated by insurance claims, and hospitals have to try to raise funds within the community or leverage the cost from other revenues.
Hand-held Computer
Dr. David Graham of John Day uses his hand-held computer to reference prescriptions, dosages and other information that allows him to work more efficiently in the field. This is a fairly low-cost solution, with the average hand-held computer retailing one or two hundred dollars. In the future, a wireless Internet connection might extend his technological reach, enabling him to access telemedicine resources as well.
Telemedicine
New technologies are being developed to eliminate the distance between a patient and his practitioner by linking them digitally. Video conferencing with rural health providers, the transmission of high-resolution digital imaging, and access to specialists' opinions without travel or delay are just a few of the possibilities. A patient may be able to have his blood pressure checked electronically by a nurse in another town, or talk to his therapist via teleconference. A paramedic could bring a digital camera to an accident scene and send real-time images to the hospital.
The challenges are providing the infrastructure for these technologies, and convincing insurance companies to reimburse for them. Oregon Health & Science University's Internet Technology Groups is working with rural communities to provide high-bandwidth connections through the Health Education Research Oregon Network. Reimbursement for commercial insurers is expanding slowly; nearly all cover radiology, most cover remote cardiology and some cover diabetic monitoring. However, even when rural hospitals have invested in the technology, providing the opportunity for long-distance, expert consultations and evaluations, most insurance companies still refuse to reimburse many of theses services, making it difficult for doctors to make full use of this new resource.