Medical Director, Telehealth, St. John’s Health, Jackson, Wyoming
“My motto used to be: ‘Telemedicine is medicine.’ Today I say, ‘It takes a pandemic!’
Even in Teton County, Wyoming, with 10,000 full time residents, we’ve had 95 COVID-19
cases since late April, with one death. Now we’re concerned about the arrival of tourists
in May for the annual hunt in the mountains for antlers shed by elk each spring. Jackson
Hole, the parks and restaurants are closed for social distancing, but the governor
decided not to cancel the state’s signature event. We’re worried hundreds will come
to find a rack, and bring the disease with them. … When I came out here to this very
rural state 17 years ago to practice urology, I traveled long distances to see patients.
One clinic was 75 miles away—through Hoback Canyon—via a road closed at times by avalanches.
Another clinic was either a four-hour drive or a flight on a twin-engine King Air
turboprop. … We launched our first telemedicine initiative in 2010, but the technology
was not ready for prime time. It was frustration after frustration. … Two years ago,
when the technology had improved, I became president of the Wyoming Medical Society.
Telemedicine was my initiative. I led by example, with a HIPAA-complaint Zoom license,
and virtual visits with patients hundreds of miles away. I spoke to the Legislature.
I spoke to the governor. I traveled the state to get physicians on board. It was like
pushing a rock up the Grand Teton. … I had grueling conversations with doctors so
resistant to change. But my hospital network backed it. A Wyoming state grant that
sponsored 500 Zoom licenses for telemedicine technology meant a good network was in
place when the pandemic struck. Then we tripled the number of licenses in six weeks.
The house is burning down. What was just dribs and drabs is now a firehose.…From the
start, Medicaid and Blue Cross gave us parity on telemedicine visits. Remote patient
monitoring is the next step. It is reliable. Patients will be set up with a pulse
ox, thermometer, blood pressure cuff, scale. There are telestethoscopes that read
heart beats over a smartphone and digital devices that look into eyes and ears. …
Patients love the convenience. They don’t have to take the day off to be seen. They
can even do tele-visits from work. It takes stress off being sick. I can do 80 percent
of my exams with eyes on my patient over Zoom. … I really believe that the coronavirus
crisis marks a before and after in telemedicine. Once the dust settles, physicians
who incorporate telemedicine into their practices will have a leg up. … My next initiative
focuses on telemedicine education for medical students and residents. It goes back
to my motto: “Telemedicine is medicine.” The paradigm has shifted."
As told to David McKay Wilson
April 28, 2020
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