September-October  |  Volume 99, Number 5

1809 HP Cover

Telemedicine: Health Care Unconfined by Walls


Over the past two decades, the telemedicine industry has morphed from a grant-funded research project into a tangible tool for delivering care. In part, this has been the result of technological improvements from other industries. High-speed internet, increased computing power and video conferencing all have contributed to a provider and patient experience rivaling in-person encounters. Though adoption has been uneven, radiology, my specialty, made the transition quickly. Teleradiology now is an indispensable tool for competitive practices.

Other clinical areas have taken longer, but telemedicine in general is reaching a tipping point. Access issues — both rural and urban — and rising consumerism are pushing health care systems to be more available. Newer "at risk" reimbursement models make collaboration the priority. Paper schedules, pagers and phones have been replaced with text, voice and video. Better patient access, improved clinical outcomes and a highly efficient workforce of providers are critical components for a competitive health care delivery system. Telemedicine can help health care systems achieve these goals.

How Health Sectors Can Leverage Partnerships

How Health Sectors Can Leverage PartnershipsBY: JOHN MORRISSEY
Health care organizations and public health agencies have operated in parallel for many decades, brushing up against each other at times of crisis or, occasionally, building on mutual interests. Public health departments often address health problems that arise from chronic or infectious illnesses and are aggravated by negative neighborhood and home circumstances. Health care providers have had to adjust their focus away from reacting to illness and toward intervening in people's lives to lessen chronic conditions, though their influence wanes once patients go home to a host of nonmedical threats to health.

Is There an App for That?

My mother was an RN, a well-read, hard-working, environmentally conscious woman who sometimes worked in doctors' offices, as head nurse in nursing homes and (in her early career) as a private duty nurse. She put in a vegetable garden and flower beds every year, fed the birds, answered questions about health for our neighbors and friends and, without charge, gave them injections prescribed for allergies or other conditions and took blood pressures.

From Collaboration to Collective Impact:
Baton Rouge's Story


East Baton Rouge Parish, home of Louisiana's state capital, has more than 440,000 citizens, two universities and a robust community college system. There are five acute care hospitals located in the parish, but no local public health department.

Pilot Project Tests Direct Primary Care

When her daughter had an irritating rash, Wendy Reiss called her primary care doctor and was able to get the high schooler in to see him the same day. When her younger daughter had a stubborn virus, Wendy had immediate access to the doctor again. It was a best-case scenario for the mom. Even better, Wendy didn't have a copay. She didn't have to worry about meeting the family deductible for the year. The prescriptions her doctor wrote were free.

Access to Medical Devices in Low-Income Countries

In eastern Uganda, a regional hospital receives a much-needed donation: an X-ray machine that appears to be in good working condition upon arrival. The hospital staff quickly puts the machine to use, only to have it fail during a procedure. With no trained biomedical technicians at the hospital, the machine sits unused for months. Eventually, an available technician is located in Kampala. He travels to the hospital and examines the machine, identifying the replacement part that is likely needed, but he cannot verify the part without the machine's accompanying manual. The hospital finds the new part to be more costly than anticipated and must be special ordered because it is not available in the country. When balancing the costs against the other demands on its limited budget, the hospital administration regretfully decides it cannot afford to spend time and money on securing the new part. Despite the need for its services, the X-ray machine remains out of use.

Love and Logic: Catholic Health Care and Catholic Charities Bring Expertise and Robust Partnership Possibilities

Love and Logic - Catholic Health Care and Catholic Charities Bring Expertise and Robust Partnership PossibilitiesBY: ROD HOCHMAN, MD, AND SR. DONNA J. MARKHAM, OP, PhD
It is rare in our world today to see a scenario where doing what is best for the poor and vulnerable also achieves what is best for the balance sheet. The transformational work of serving those most in need commonly represents financial risk and liability for organizations like Catholic Charities, Catholic health care and the tax-paying citizenry. The opportunity to do what is best for those who are most fragile while increasing the bottom line and return on investment for everyone is exactly what is possible and what is beginning to happen. When it comes to the intentional, aggressive collaboration of Catholic health and Catholic Charities, it is the unconditional love of all people coupled with the undeniable logic of achieving the Triple Aim — providing better care for lower cost to more people — that is undergirding some very important innovation.

Adding Shelter and Food to Medical Care

Adding Shelter and Food to Medical Care_ci

The patient completed the screening form. Was she short of food? Yes. Were her utilities in danger of being shut off? Yes. Was she worried that she would lose her house? Yes. She had filled it out while waiting for the doctor, and Pamela Smith received it before the patient left the clinic in London, Kentucky, a town of 7,000 in one of the poorest, sickest states in the country.

Mental Health and Substance Abuse:
Partners Forge Links Beyond Hospital Walls

In Mercy's St. Louis region, which contains St. Louis City, St. Louis County, St. Charles County and the more rural Jefferson, Franklin and Lincoln counties, all five of the health system's Community Health Needs Assessments have ranked behavioral health high on the list, survey after survey, data source after data source. However, Mercy leaders knew that the prevalence and complexity of behavioral health issues meant they would need partners to make an impact, collaborating with local health departments, other area health systems, social service agencies and nonprofit organizations focused on mental health and substance abuse issues would be key.

Engaged Local Governance Can Transform Communities

At the end of 2011, Resurrection Health Care of Chicago and Provena Health of Mokena, Illinois, merged to ensure the continued flourishing of Catholic health care in the state and of the spirit of healing and hope in the communities served.

A Reflection on the Search for Healing: Outside the Walls and Through the Roof

The story of the paralyzed man lowered through the roof to receive Jesus' healing appears in the Gospels of Matthew, Mark and Luke, but the best details are in Luke's version. The miracle of note, of course, occurs at the moment when Jesus has the man rise, pick up his stretcher and go home.


Her Dark Thicket

Her Dark ThicketBY: BRIAN DOYLE
Many years ago I was a newspaper delivery boy in our small town — five afternoons and two early mornings a week, every day of the year but Christmas, on my bicycle, with a cavernous canvas bag hanging from the handlebars; a bag of such admirable strength and endurance, no matter how many thousands of papers were crammed into it, and rain and snow and mud and launderings inflicted upon it, and gimlet-eyed dogs fended off with it, that I wish I still owned it today, just to be able to pull it out of a drawer occasionally to contemplate its bruised and sinewy dignity and grace.

I collected more stories along my route than there were addresses to reach, for even then, as the son of gifted raconteurs, I was eager to hear tales and details, hints and intimations, chapter and verse, and then happily try to imagine the backstories, as I rode home through the dusk, skiffling the oak leaves, wary of cars and owls. And here and there I have written some of those stories, for it seemed to me that there were amazing tales on every street — the family with thirteen pale gaunt children who never spoke, but sat silently on their immense porch as I opened their mailbox; the old man who paid me in nuts and berries and vegetables, and never once did we discuss the unusual coin of transaction, though I had to cover his bill myself from my small profits; the seemingly rich man who never paid me at all in the years I delivered his paper, though he often promised to next week at the latest, and drove the brightest shining cars in town.