Winding Waters Clinic

Winding Waters Clinic, a community health center in Enterprise, Ore., was an early adopter of telehealth and has seen a huge increase in its virtual telemedicine appointments during the pandemic.

COVID-19 has forced health care into cyberspace, and some rural providers say the shift could be a post-pandemic "silver lining."

When Gov. Kate Brown ordered health care providers to stop non-emergency services March 30, it created what some medical providers call a "telemedicine revolution," in which providers have "seen" their patients through calls or videos using computers, tablets or smartphones. Providers say they expect telemedicine will become a permanent feature of rural health care.

"I do believe telemedicine is here to stay," said Gail Nelson, CEO of Rinehart Clinic, a community health center in Wheeler, Ore.

In far-flung Enterprise, Ore., seat of Wallowa County, family doctor Elisabeth Powers at Winding Waters Clinic has been examining patients the past few months via computer screen.

Powers is a long-time advocate of telemedicine that can result in faster diagnoses and treatments, reduce patient stress and reach rural people who otherwise may not have health care access — for example, those limited by mountain passes and transportation options. Even as a telehealth pioneer, her use of virtual medicine catapulted during COVID-19.

In early March, according to Winding Waters' CEO Nic Powers — Dr. Powers' husband — about 2% of the clinic's patients had telehealth appointments. Now, he said, it's 45%.

Medical professionals say many patients are still afraid of virus exposure and will likely utilize telehealth for months to come.

"I think patients are very leery of the hospital right now. Even as we open up, I don't see patients walking in enthusiastically," said Eric Wiser, medical doctor and deputy director of the Oregon Area Health Education Center.

Providers predict virtual visits will be part of the new normal.

"I think the role of telehealth will increase where people have limited access to providers," said Kevin Mealy, spokesman for the Oregon Nurses Association.

National studies show one in four people in rural areas say they're unable to access health care. According to Joyce Hollander-Rodriguez, a doctor and associate professor of family medicine at Oregon Health and Science University, the disparity worsens as rural clinics and hospitals close, older doctors retire and young medical students gravitate toward larger cities.

While many providers are enthusiastic about telehealth, the move to cyberspace wasn't easy for everyone.

"Learning the new technology has been stressful for all of us," said Wiser, a doctor. "But now I'm used to it. I see injuries over the phone, tell patients how to check their own pulse. I can't see or hear certain things, but it's amazing what can be done virtually."

Some providers say technology use during COVID-19 has brought separate providers into closer collaboration.

Brenda Johnson, CEO of La Clinica community health clinic in Medford, Ore., recalled a recent case in which a 28-year-old heroin addict was hospitalized mid-March. Had he been discharged from the hospital in normal times, she said, he would have likely been "dumped" back into the world with a high chance at relapse. But because of virtual connections established during the pandemic, a primary care provider at Johnson's clinic had a video visit with the patient while he was still in the hospital. That coordination, she said, built a bridge for long-term primary care.

Johnson said she hopes telehealth collaboration will also build relationships between rural and urban providers.

But barriers to telehealth remain, including limited access to high-speed broadband internet in rural communities. Betsy Boyd-Flynn, executive director of the Oregon Academy of Physicians, said rural telemedicine holds "a lot of promise" if internet access is addressed.

In Enterprise, Ore., schools and businesses have made their Wi-Fi free to the public so patients without internet access at home can do telehealth in parking lots.

Another challenge is that aging populations are often unfamiliar with technology. Some providers, such as One Community Health, a clinic  in Hood River, Ore., train patients' kids or grandkids to set up telehealth technology.

Perhaps the biggest blockade to telemedicine expansion, providers say, is how appointments are reimbursed. Most insurers do not consider telehealth visits billable and Medicare provides minimal reimbursement.

"The payment rate doesn't really keep the lights on," said Katie Harris, director of rural health and federal policy at the Oregon Association of Hospitals and Health Systems.

Federal rules have temporarily changed during COVID-19 to allow reimbursement, and Harris said medical organizations are advocating for long-term reforms.

"COVID-19 has presented some amazing challenges," said Nic Powers of Winding Waters. "But telehealth is taking on a life of its own, and I'm all about the silver linings."

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