Digital Doctors

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New telemedicine platforms are emerging, which have the potential to deliver much-needed health care to rural Oregon.

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To be a part of the health care profession means constantly adapting to new advances in technology. These advances include the latest drugs, predictive algorithms to gauge a patient’s wellness, and the emerging presence of telemedicine, where patients communicate with providers over their computer screen rather than in person.

While having a digital doctor’s appointment might seem like a substitute for traditional service, the prospect of telemedicine has the potential to bring higher quality, easily accessible health care to underserved communities, particularly rural ones.

According to the Oregon Medical Board, Jackson, Josephine and Klamath counties are federally designated ‘Health Professional Shortage Areas,’ meaning the doctor-to-patient ratio is not enough to meet these local populations’ medical needs.

And a lack of reliable transportation means that unless a medical professional lives in the area, a patient might not receive the medical attention they need. 

Dr. Steven Goins, a neurohospitalist at St. Charles Health System, who works on providing stroke care to patients in rural communities, says a long ambulance ride could cost more than $30,000, and that is not including whatever cost might be incurred by the hospital visit itself.

Larger health care providers such as OHSU and Providence already have telemedicine offerings. The hospital systems’ telemedicine program treats a much wider range of ailments, including nausea, asthma, cough, and other urgent-care options.

But newer start-ups are starting to make inroads into the telemedicine space, providing options to rural communities that are underserved by the large health systems.  

Hims & Hers, a self-described telemedicine platform, launched nationwide last month, giving Oregonians digital access to treatment for a limited number of health conditions, as well as prescription drugs, including oral contraceptives for women.

While the doctors for Hims and Hers cannot treat patients for many common ailments, such as the flu, access to contraceptives has been a persistent issue for women in rural areas.

Women living in rural areas report lower salaries, more child-care responsibilities, and higher amounts of stigmatization and barriers surrounding reproductive health.

The company uses its own direct-delivery pharmacy provider, which means women can get the contraceptives they need without having to drive to a clinic. Affordable access to reproductive health care demonstrates the kind of impact telemedicine could have on rural communities.

Although rural areas must frequently pay uncompetitive rates for broadband connection, they are also poised to make the most use out of the accessibility offered by digital health care.

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“What telemedicine offers is access and price transparency,” says Dr. Patrick Carroll, chief medical officer for the telemedicine startup.

“I came to Hims & Hers because I saw it as the next iteration of consumer-facing care,” says Carroll. “Rural areas face significant challenges attracting primary care physicians. We have an advantage because we don’t need a brick-and-mortar office.”

Carroll has worked in underserved rural communities. A practicing family doctor for 25 years, he spent six years as part of the Indian Health Service, where he gained experience working with the Navajo communities in Shiprock, New Mexico.

The scope of what Hims and Hers is able to offer consumers is still small. The San Francisco startup only has the ability to treat 12 conditions, including hair loss, acne, erectile dysfunction, anxiety, trouble sleeping and cold sores. But it is seeking to expand.

“We’re looking at conditions where there’s a major access issue. We want to have a world-class behavioral health service. Seventy-five percent of rural communities don’t have a psychiatrist,” says Carroll. “We’re also looking at how we can do screenings for heart disease and diabetes.”

Hims & Hers is a cash-pay business, and follows a subscription model, much like streaming service provider Netflix. Subscriptions to Hims & Hers start at $20 a month.

Subscription-based health care option are growing. AIM Health, a Portland primary care medical clinic, provides a longer, more personalized doctor’s visit, as well as 24-hour availability, for patients who pay a subscription fee.

Nearly 50% of Oregonians are on high-deductible health insurance plans, according to a study by the University of Minnesota’s State Health Access Data Assistance Center. According to a 2017 study by the Oregon Health Authority, 10% of rural Oregonians are uninsured, nearly double the state average.

While telemedicine is still very much in its infancy, these new health care platforms have the potential to solve some of the most persistent problems faced by rural inhabitants.

There are certainly limitations as to what telemedicine can accomplish, but for populations with limited access to health care, a little has the potential to go a long way.  

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