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
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