Virtual Health: A Story from Region 3

Show Notes

Transcript

00;00;02;28 - 00;00;26;08
Yamila El-Khayat 
This is season one of NNLM Discovery, a podcast from the Network of the National Library of Medicine. I’m librarian Yamila El-Khayat, and I'll be your guide as we explore how NNLM is engaging with communities to provide access to trusted information for the purpose of improving the public's health. Today's episode is Virtual Health, a story from Region three.

00;00;26;24 - 00;00;32;05
Yamila El-Khayat 
Executive Director of Region three, Brian Leaf will be joining us today. Hi, Brian.

00;00;32;05 - 00;00;33;18
Brian Leaf
Hi, Yamila.

00;00;33;18 - 00;00;36;14
Yamila El-Khayat 
Brian, what story will you be sharing today?

00;00;36;24 - 00;00;48;09
Brian Leaf
So I wanted to share a project that my team funded and helped to oversee right at the beginning of the pandemic. In fact, this was one of the first NIH/NLM projects funded specifically for COVID-19 outreach.

00;00;48;23 - 00;00;56;01
Yamila El-Khayat 
One of the first. Wow, that's incredible. Before we jump in, where is Region three and what makes it unique?

00;00;56;12 - 00;01;06;27
Brian Leaf
Region three is comprised of Arkansas, Kansas, Louisiana, Missouri, Nebraska, Oklahoma, and Texas. Yamila, when I mention these states, what's the first thing that pops into your head?

00;01;07;16 - 00;01;12;24
Yamila El-Khayat 
Well, I guess wide open spaces, like the middle of America.

00;01;13;11 - 00;01;27;23
Brian Leaf
Exactly. We do have a few large metropolitan cities in our region, but for the most part, our region is very rural. The reason why I'm so passionate about this story today is that this outreach grant we're featuring really addresses the rural needs of our region.

00;01;28;10 - 00;01;36;01
Yamila El-Khayat 
This is huge. There is a big need in our rural communities for health care and health information. I can't wait to hear more about this.

00;01;36;04 - 00;01;59;00
Brian Leaf
Yeah. So one of the things NNLM assists with within our region is establishing partnerships. We go well beyond just writing a check for our grants. Our story starts at Region three headquarters on the campus of the University of North Texas Health Science Center in Fort Worth, otherwise known as HSC. I interviewed Jessica Rangel, Executive VP of Health Systems, about the challenges of rural health care.

00;02;00;06 - 00;02;03;29
Brian Leaf
Jessica, how many counties in Texas have no hospital?

00;02;03;29 - 00;02;33;03
Jessica Rangel
So as it stands right now, there are 77 counties that don't have a hospital. So when we reflect back on what's been going on, we look at these rural community hospitals and, and truly, they've just financially gone under. They're having trouble staffing those community hospitals. It is a desperate situation. It's an ongoing challenge. I don't see it turning around any time soon. And it's really tragic for our community members.

00;02;33;27 - 00;02;38;26
Brian Leaf
And why is this so tragic for rural America? What's a possible solution to this problem?

00;02;39;10 - 00;03;09;19
Jessica Rangel
When we think of social determinants of health and those are those elements that are very basic that can often determine how well we journey through health. One of those is simple transportation. Telemedicine solves that problem. Virtual health, telemedicine, telehealth, all that is, is encompasses care that is provided through a different medium, like perhaps your computer or your smartphone, even the telephone at times can be used.

00;03;10;03 - 00;03;12;28
Brian Leaf
Yamila, have you ever had a telemedicine appointment?

00;03;13;06 - 00;03;17;24
Yamila El-Khayat 
I have not. I actually live in a larger city, but I'm really curious to know what that's like.

00;03;18;07 - 00;03;31;13
Brian Leaf
For those that have never heard of this. We were given permission to record the beginning of an HSC telemedicine appointment between a doctor and patient that happened via video call. Let's take a quick listen to get an understanding of what it's like.

00;03;32;26 - 00;03;34;15
Dr. Buoy
Hello, Mr. Christian. How are you?

00;03;35;12 - 00;03;36;27
Christian
I’m doing okay, Doctor Buoy. How are you?

00;03;36;27 - 00;03;42;27
Dr. Buoy
I'm doing well. Well, we're going to have a telemedicine visit today. Have you had a telemedicine visit before?

00;03;43;11 - 00;03;44;16
Christian
No, ma'am. This is my first.

00;03;44;22 - 00;04;01;22
Dr. Buoy
Okay. Well, essentially, we can talk about how you're doing. We can talk through your biggest concerns, how you're feeling. We'll do a little bit of what we can on the screen. If there's anything that I need to see you in person, we can do that. And if we need to prescribe something or order anything, we can do that, too.

00;04;02;10 - 00;04;02;21
Christian
Okay. Great, thank you.

00;04;02;21 - 00;04;05;05
Dr. Buoy
Okay. Tell me how you're doing.

00;04;05;05 - 00;04;09;27
Christian
I've been having these headaches for the better part of two weeks now.

00;04;09;27 - 00;04;17;10
Brian Leaf
So, seems like an easy solution for rural America, right? Just set up a bunch of telehealth appointments for those areas that don't have hospitals.

00;04;18;07 - 00;04;27;01
Yamila El-Khayat 
Nothing is ever that easy, Brian. Are hospitals and doctor offices even prepared for telemedicine? I wouldn't even know where to start to set up this kind of appointment with my doctor.

00;04;27;08 - 00;04;49;29
Brian Leaf
And you wouldn't be the only one. There are so many hurdles with rolling this out. The biggest being connectivity in rural America. Most of our region and rural America have little access to high speed Internet, the type of Internet that would allow you to livestream video. Our story focuses on one rural library in Texas, the Pottsboro Library. Pottsboro is about 90 minutes north of Dallas.

00;04;50;04 - 00;05;14;26
Brian Leaf
The biggest attraction is Lake Texoma, where a lot of Dallas locals have second homes. The middle of Pottsboro though, is more modest and lacks the infrastructure and public services you find in larger cities. It has little internet connectivity. The nearest hospitals 30 minutes away and there is no public transportation or ride sharing options. I asked Dianne Connery, who runs the public library in Pottsboro, what it was like moving to this community.

00;05;15;15 - 00;05;59;26
Dianne Connery
I had always lived in large cities my whole life. My kids were raised in large cities. And then when we moved here in 2010, realized that Internet was a real hardship for some people. Some places the infrastructure doesn't exist. Some people can't afford it or know how to use it. And when I started working here at the library, I would see kids come in who didn't know how to use computers and thinking back to my kids and their experience, I just I was concerned about how kids here would ever be on a level playing field with their peers from suburban and urban areas if they didn’t know how to use computers.

00;06;00;20 - 00;06;20;21
Dianne Connery
When they talk about social determinants of health. Digital inclusion is a super social determinants of health. No matter what problem you've got, if it's employment related, health care related job, whatever. It's made worse if you can't access the Internet and know how to use it.

00;06;21;14 - 00;06;26;00
Brian Leaf
Were things made worse during the pandemic? How did the Pottsboro Library respond?

00;06;26;23 - 00;06;53;29
Dianne Connery
We started getting a couple of calls from people who wanted to have doctors appointments. One of the the people I remember right before the shutdown had had an MRI. She was having some neurological symptoms. And so the neurologist wanted to talk to her. When the MRI results were back, but because she had chronic obstructive pulmonary disease, he didn't want her to come into the office.

00;06;53;29 - 00;07;13;06
Dianne Connery
And so he asked her to get to a place with with a computer. She came here and we set her up so that she could talk to the doctor. And then after that, a veteran came in who could no longer phone call to request refills for prescriptions. So he needed our help.

00;07;13;17 - 00;07;21;07
Brian Leaf
That's wonderful to hear that the community came to you for solutions. I don't think a lot of people think of doctors appointments when they think of their local library.

00;07;21;17 - 00;07;48;18
Dianne Connery
Libraries are perfectly positioned to work with with telehealth because we're oftentimes the fastest Internet connection in town. People trust librarians. It's a neutral space. We're accustomed to helping people with digital literacy skills. So it all came together to request funding to to start a virtual health room here.

00;07;49;20 - 00;08;16;29
Brian Leaf
So that's when Dianne reached out to me at Region three, about funding opportunities for a virtual health room in Pottsboro, Texas. This has never been done before. Having an established room in the library just for telehealth appointments. Dianne's proposal was quickly funded because the need for telehealth was so important at the beginning phases of the pandemic. Region three awarded Pottsboro library $20,000 to renovate a storage closet in the library to a virtual health room for telehealth appointments.

00;08;17;13 - 00;08;20;18
Brian Leaf
Here's Dianne walking us through the room and describing the space.

00;08;22;02 - 00;09;11;22
Dianne Connery
So we are now in the telehealth room. It used to be we called it a weeding room, donated books put in here that had been in here for who knows how long. When we cleaned it out, we found a smashed dead frog under the books. So we've come a long way from then. So let me tell you what, what exists here. We do have an adjustable desk. So if someone comes in and they are wheelchair, it adjusts to where they need to be. Lighting, we learned, is really important for the health care providers to be able to see proper skin tone on people. And then we also have the webcam. If once in a while a doctor will need to see a patient walk to assess their gait.

00;09;11;22 - 00;09;41;25
Dianne Connery
And they had told us that they were having an issue with people doing telehealth visits in their car, on their phone, which didn't lend itself to that. So people can walk through here. And then we have some accessories. Blood pressure cuff, pulse oximeter, thermometer, and scale. A lot of times before appointments, the doctors want to have that baseline of what people's vitals are so they can come in here and connect.

00;09;41;25 - 00;10;02;05
Dianne Connery
And we provide as much technology assistance as they need. We have a HEPA filter running in here, 15 minute space between appointments to make sure we have time to disinfect everything and soundproof panels to absorb the sound from reaching the rest of the library.

00;10;03;21 - 00;10;21;13
Brian Leaf
Now, $20,000 doesn't seem like a lot in comparison to some of the larger NIH grants out there. But for someone like Dianne, who doesn't have a dedicated accounting department, it's the perfect amount to immediately take action and get things going. Here's Dianne talking about how she rolled this out and where she needed help.

00;10;22;02 - 00;10;50;19
Dianne Connery
Often in a small library, we do things very quickly and experimentally. It's like, Hey, we've got an idea. Let's see if this works. Let's get started. And so I could conceptualize on our end what a virtual health room would look like. But I didn't. I couldn't figure out the other end of the equation. So like, how would we not double book our room if people were making their own appointments?

00;10;51;01 - 00;11;13;13
Dianne Connery
And so working with the people at Health Science Center, they were able to really collaborate well with me. Sometimes in a small organization, people collaborate on you rather than with you. But it's been a really good partnership to see what works with both parties.

00;11;15;00 - 00;11;32;15
Brian Leaf
Region three helped manage this relationship between HSC and Pottsboro library. Now that the room was converted, HSC was instrumental in the coordination and activation of this virtual health room. Here's Jessica Rangel from HSC again, talking about how she worked with Pottsboro to actualize this space.

00;11;33;00 - 00;12;00;05
Jessica Rangel
The room was converted. We helped with the electronic equipment, help her determine what would be best. And then we helped set up protocols for how we would interact with anybody who wanted to have care in a very private and confidential manner, but also talked about how do we disinfect in between people? Because, again, in the beginning stages of COVID, we were not clear on a whole lot.

00;12;00;05 - 00;12;26;16
Jessica Rangel
So what was going to be required. We followed CDC guidelines, but we wanted to make sure was absolutely thorough and that people felt safe following one another into that room where they would have the telehealth experience. So there's plenty of opportunities when you have a creative group of people out there like they do in Pottsboro, to continue to have the library be the heartbeat of that community.

00;12;27;06 - 00;12;43;06
Brian Leaf
The Pottsboro library is truly the heartbeat of this community. The best way to understand the effectiveness of the space is to listen to testimonials. We talked with a local from Pottsboro, Jamie Kimberlin, about her experience with going to the telehealth room.

00;12;43;06 - 00;13;02;01
Jamie Kimberlin
During COVID, there was, you know, the mask mandate, all the germs, everything spreading around. I did not want to go sit in a doctor's office and expose myself to bigger things when I just had a minor health issue. So this made it where my safety came first and it was private, easy, convenient. That's why I chose it.

00;13;02;15 - 00;13;07;01
Brian Leaf
And if you don't mind me asking, did the appointment help your health?

00;13;07;24 - 00;13;31;20
Jamie Kimberlin
Well, it did. It was for a minor thing. I ended up with pink. I got to love kids and what they bring home. But I didn't want to go to my doctor. I didn't want to go sit in line at the, you know, doctor's office and wait in the waiting room for hours. And this was I mean, start to finish probably 20 minutes, tops. And that was leaving work, coming here and the appointment itself.

00;13;31;20 - 00;13;44;26
Yamila El-Khayat 
I love hearing testimonials like this. Another advantage I see as a parent with small kids at home is the ease of doing a telemedicine appointment. Instead of dragging my kids to the doctor's appointments or even trying to find a daycare during that time.

00;13;45;15 - 00;14;08;10
Brian Leaf
That's exactly right, Yamila. This virtual health room really has the power to change and improve the health and well-being of the Pottsboro community and hopefully all of rural America. This grant wasn't just about converting one room. This project was funded as a pilot to be used as an educational tool to establish best practices that can be shared with other libraries and institutions who are looking to implement their own virtual health room.

00;14;08;24 - 00;14;13;23
Brian Leaf
Here's Dianne and Jessica talking about what this project means to them personally and professionally.

00;14;14;12 - 00;14;47;27
Dianne Connery
It means a lot in terms of it has been a national interest, not just from libraries, but insurance organizations, Health care systems from all over the country, from practically day one have been contacting me. I mean, Pottsboro, we have 2500 people in our city limits, basically one big room for our library building. So we can do it on one scale. And then there are large libraries who are adopting this on a larger scale.

00;14;48;13 - 00;15;31;26
Jessica Rangel
We've created a playbook because this is not about secret sauce. This is about let's make our communities healthier. Here's what we learned from this experience and here's what we wish we had done a little bit differently, because how fabulous would it be if all rural communities had this kind of access? We really feel like broadband access in rural communities where you can set up virtual health care is truly a solution to many of our rural community problems, and at least at a minimum, being able to determine what needs to go perhaps into the big city to be looked at in a more diligent manner versus small things that can be taken care of before they turn into big problems.

00;15;32;12 - 00;16;05;04
Dianne Connery
Whenever Pottsboro, Texas is on national news. I know we've done something worthwhile, so we have gotten a lot of buzz around the country and I am proud of being the first pioneer to do this, to be able to help other libraries across the country make this happen. It's just a really energizing experience to create something new that impacts the community the way it does.

00;16;05;04 - 00;16;30;27
Brian Leaf
Today, Pottsboro’s Virtual Health Room is still active. You can call and reserve the space throughout the week. They're connected with two clinics, HSC Health being one of them. But you also have the ability to reserve the room for any health care appointments if it's available. TSLAC, otherwise known as the Texas State Library and Archives Commission, have actually expanded on this model funding for more libraries to implement similar telehealth spaces, including Austin Public Library.

00;16;31;08 - 00;16;47;17
Yamila El-Khayat 
Thanks, Brian. This was an amazing story and I think it really shows the power of the network within our regions. We're not just handing out grants, we're building relationships, providing education, and we're focused on the process of getting out good, reliable health information.

00;16;48;00 - 00;16;51;08
Brian Leaf
I absolutely agree. It was a pleasure being here. Thank you.

00;16;52;07 - 00;17;20;19
Yamila El-Khayat 
We’ll be featuring other profiles, grants, and interesting information from all our Regions during this season of NNLM Discovery. Subscribe, rate and comment on our podcast. Be sure to share these episodes to help us grow our audience. For more information, including a video featuring content from this story, check out the links within this episode's description. The NNLM offers free training, partnerships and many resources that help to improve health and wellness.

00;17;21;00 - 00;17;27;05
Yamila El-Khayat 
Membership is free. Learn more at NNLM.gov