Trinity Hospital, a 40-bed rural hospital in Erin, Tenn., was facing anumber of challenges in providing specialized medical care to the community.Like many rural hospitals, Trinity Hospital is very small and is located in acommunity with a moderate population. Trinity did not have the best reputationfor service, and was losing too many patients to Clarksville, forty miles away.

Jack Buck, chief executive officer at Trinity Hospital, became intriguedwith the possibilities that telemedicine could provide. Although he had oftenheard that rural hospitals could not afford telemedicine, Buck decided toattend a presentation made by a medical systems integration organization,InTelemed, on the role telemedicine could play in rural healthcare.
A system integrator's expertise is in "linking" large hospitals viatelecommunication lines to regional and rural hospitals. They typically offer acomprehensive range of telemedicine systems integration, strategic planning,needs assessment, applications, and services designed specifically for theunique diagnostic and information needs of healthcare organizations.

Convinced that telemedicine would benefit Trinity, Buck developed severalgoals that he wanted to accomplish with such a system; he needed to attractmore physicians to the hospital, convince patients to stay locally rather thandrive 40 miles to Clarksville or 120 miles to Nashville, and improve his censuscount and technical fees while keeping costs low.
The implementation of telemedicine was made possible through private fundingfrom the rural hospital budget, and a radiology group, RCI. The 18-memberradiology group in Nashville had never dealt with teleradiology, but hadprovided outstanding service to physicians at their large, flagship hospital,Columbia/Centennial, and possessed a wealth of subspecialty expertise.

The system integrator was able to connect Trinity Hospital and RCI to a highspeed, secure ATM network backbone. RCI had already chosen a vendor for theirteleradiology equipment, but needed someone to help with integrating it intotheir workflow. More importantly, they needed someone to come up with solutionsto providing remote dictation and remote fluoroscopy. The integrator alsoassisted with the implementation of RCI's diagnostic quality imaging, so theradiologists could provide a primary diagnosis within minutes over thetelecommunications link.

"Before we adopted our teleradiology program, we had to transportradiology patient records 70 miles by courier before a radiologist could reviewthem and provide a diagnosis," Buck explained. "With teleradiology,we have the diagnosis almost instantaneously and can proceed with treatmentmore rapidly."

Trinity had been receiving radiology services 2 hours a day, 2 days a week.As part of the network, interactive video technology allows the radiology groupto perform remote fluoroscopy and CT scans 7 days a week, rather than only whenthe radiologist is on site. "The change in service levels for the ruralphysicians was immediate and noticeable. They were amazed by the support theywere now getting. It was service-oriented and really worked to build theradiologists' relationships with the rural physicians," Buck said. With atelemedicine network in place, physicians no longer had to feel that they wouldbe isolated from the rest of the world once they moved to tiny Erin, Tenn. Buckwas able to attract six add-itional staff physicians, including anortho-pedist, podiatrist, pediatrician, ob/gyn, and a general surgeon, andthree family practitioners. Physicians who were being squeezed out of thelarger markets by competition and managed care were able to move to a ruralsetting, have a better family life, and endure less competition.

As predicted, Trinity Hospital has grown at a staggering rate. Trinity'smarket share has risen from 24% to 74% in two years. The hospital's outpatientcensus has grown 25 percent, with additional growth in its patient base.Outpatient visits at Trinity have grown from 600 per month to more than 1,100per month in one year, and its bottom-line revenues have increased by $250,000,far exceeding the cost of the system.

Trinity is now considered a top-notch facility in the area, and was recentlyrecognized as among the top 10 percent of Columbia facilities in qualitypatient care. They have been so successful that they are now opening clinics inClarksville to draw patients to trinity, and plan to expand the telemedicinesystem to include cardiology in the near future.

Maneuvering around the obstacles often encountered by rural hospitals, theteam of a systems integrator and Trinity Hospital have proven that providingcost-effective excellent patient care can become a reality. When presented withsimilar challenges, rural hospitals that implement the proper technologicalsolution can make a positive change which the entire community can appreciate.AR