How telemedicine augments Indian health service resources to reach new patients, improve outcomes

Telemedicine could be the future of health care for American Indians and Alaska Natives who live in tribal communities and remote areas.

The Indian Health Service (IHS) cares for more than 2.2 million American Indians and Alaska Natives on the nation’s numerous tribal reservations, which are often located in very rural and isolated areas.

While IHS does its best to provide comprehensive, high-quality care to tribal communities, the government agency faces the same problems as many other health care providers serving remote regions: long distances, scarce resources, and limited staff make it difficult to connect patients with the right care at the right time.

These systemic challenges are amplified when it comes to complex emergency care, comprehensive specialty care, and behavioral health services.

Emergency departments in these rural areas are typically small and can only provide basic life-saving care – and the nearest facility may be hours away for some patients. Meanwhile, the ongoing shortage of clinical and mental health providers means that specialists are few and far between.

Unfortunately, this combination of factors leaves many American Indian/Alaska Native communities without the ability to access care in a timely, convenient, and affordable manner. As a result, when patients present to their providers, their illnesses are often much more advanced and require significantly more high-level resources.

Over the past 5 years, IHS has worked to reverse this troubling trend by using telemedicine to enhance the exceptional work of IHS providers. Virtual care has made it faster and easier for American Indians and Alaska Natives in the Great Plains region to access and benefit from high-quality health care—especially in emergency situations.

Expanding access to critical resources in emergency situations

Rural emergency clinicians must be prepared for everything from common injuries to rare diseases. But with few on-site resources and the nearest high-level trauma centers often hours away, IHS emergency departments benefit from providing assistance.

This is where telemedicine comes into play. With just the push of a button on the wall, on-site providers can bring in a virtual team of board-certified emergency physicians and critical care nurses to assist with unusual or complex procedures. The virtual team can monitor the room via two-way video to offer advice and guidance when needed.

Mental health services in the emergency department can be provided using telemedicine in a similar way. For example, psychiatrists can remotely assess people in crisis and make medication recommendations or recommend a higher level of care if needed so that each individual receives the most appropriate course of treatment.

Support doctors on site with experts in their field

Specialized services are also scarce in the Great Plains, despite the fact that many American Indian populations are more prone to certain problems, including autoimmune and endocrinological diseases, as well as dermatological conditions such as acne scarring.

With telemedicine, clinic staff can connect with qualified specialists to provide consultations. Carts equipped with video cameras and intelligent examination tools allow specialists to see and hear everything they need to make an accurate diagnosis from hundreds of kilometers away.

Telemedicine also helps start conversations about mental and behavioral issues. Through home visits or clinic interactions, patients can receive help for depression, anxiety, substance abuse, attention deficit disorder, and other conditions.

Consultation is also available from social workers to address the social determinants of health and to help communities overcome socio-economic challenges.

Creating an expectation of reliable and affordable care for patients and providers

Telemedicine is truly transformative for remote tribal populations as well as the providers who work so hard to provide optimal care to their patients. Using technology to expand the capacity of IHS facilities and expand the skills of field providers is critical to overcoming provider shortages and preventing burnout in a high-stress environment.

By integrating behavioral health care and social work with acute and specialty care, we can help IHS providers get ahead of the mental and physical health conditions that can disrupt communities, better preserve valuable traditions, and build a more robust infrastructure for the future.

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