Bristol Family Practice is first to offer video appointments with physicians

BRISTOL — Dr. Natasha Withers of Bristol Family Practice makes house calls that don’t add a single mile to her vehicle odometer.
No, she doesn’t take a bus, nor does she have a helicopter.
Withers is the first family practice physician within the entire University of Vermont Health Network to pilot a new technology called “telemedicine.” It allows the doctor to see and converse with patients from her office, thus saving them, in some cases, a ton of travel time and lost wages that would have been required for a conventional, face-to-face meeting.
“One of the biggest benefits of this is the patient doesn’t have to travel,” Porter Medical Center spokesman Ron Hallman said of the new service, which during the next few months will be extended at all Porter primary care practices in Middlebury, Vergennes, Bristol and Brandon. “It’s the convenience and efficiency that comes with being able to have the patient be seen in the privacy and comfort of their own home, especially if they have transportation issues.”
Withers arrived at Bristol Family Practice around a year ago with some past experience serving patients remotely. But those “e-visits” were largely through email, without a video component. Still, she saw the potential for new technology to cut through the many miles that some frail patients have to travel to get to their physician, sometimes just for a follow-up appointment to discuss symptoms.
“When I came here, I really wanted to hit the ground running and use technology in a way that’s beneficial for patients and providers,” Withers said.
When she learned UVM Health Network was looking to pilot a telemedicine program at one of Porter Medical Center’s family practices, she enthusiastically volunteered. Todd Young is director of the network’s telemedicine services.
“I emailed (Young) and said, ‘We’ve got to get this started,’” Withers recalled with a smile.
Young assigned a team to outfit Bristol Family Practice with telemedicine technology using a “Zoom”-brand platform, and the training to use it.
It was more complicated than just flicking a switch.
Organizers had to identify patients who had the appropriate electronics, technological aptitude and medical needs to benefit from telemedicine. In other words, patients who didn’t possess the right electronic device and who required an actual physical exam were taken out of the mix for a virtual visit.
Officials also had to make sure insurance companies would pay for primary care services delivered through cyberspace. While Medicare won’t reimburse for the service, Blue Cross-Blue Shield of Vermont and Medicaid are among those that will.
Patients are still responsible for the same co-pay and deductible as if it were a face-to-face appointment with their doc.
Since the program’s inception last April, Withers has used telemedicine technology daily, including for conversations about chronic conditions such as diabetes, and other health care issues not requiring physical contact between the physician and client.
Withers’ colleague, Dr. Emily Glick, is also using telemedicine technology to communicate with some of her patients. Glick is one of the county’s foremost practitioners of medically assisted treatment for folks seeking to wean themselves off of prescription painkillers.
Fortunately, the technology hasn’t proven a big barrier for most patients. All they need is a discreet location and a computer, Kindle, computer tablet or smart phone.
“Anything with a camera and the ability to connect with the Internet,” Withers said of the rudimentary requirements.
While interfacing electronically doesn’t allow the physician to check a client’s pulse, lungs and other functions, that could change in the near future.
“There’s lots of technology where we can look in people’s ears and eyes — things that are pretty simple,” Withers said.
The Zoom platform is so good that Withers can clearly see the patient, including the parameters of a suspicious mole that could result in a patient being referred to a dermatologist.
Withers noted telemedicine is well suited for collaboration between physicians and home health professionals. A home health worker could check a patient’s vitals and symptoms while the physician looks on from his or her office.
“They could be our eyes and ears in the patient’s home and report back,” Withers said.
In the earliest stages of telemedicine, Withers was confining her virtual doctor-patient visits to what she said were “simple, straightforward things,” like birth-control options counseling and updates on how a patient’s new medication is working. She’s also used it to go over lab results with patients, whom she can see in their home environment without making an old-fashioned house call.
“Now that we’ve worked out the kinks, I’d use it for any kind of follow-up visit,” she said.
Early “kinks” have included background noise and interruptions in the video feed. Fortunately, Zoom allows the physician to remotely adjust the patient’s camera and volume, if need be.
“If it’s someone who’s not tech-savvy and they accidentally hit the ‘mute’ button, I can un-mute it for them,” Withers said.
Trinity Bryant is a 17-year-old student at Middlebury Union High School. She provided a glowing testimonial for telemedicine, which allowed her to converse with Dr. Withers prior a recent minor medical procedure.
It saved her a 30-minute drive to Bristol and allowed her to get to work on time.
“My mom would have had to go to work early — or I would have had to leave school early — so it was a lot more convenient for us to go to the house and set it up on her laptop, and it was very clear to see the doctor,” Bryant said of her virtual visit.
“It was easy for us to do it at home, together,” Trinity’s mom, Danielle, said of the experience. “Dr. Withers is great; she answered all of Trinity’s questions. I think it took longer to set the computer up and get it running than to connect and have the visit.”
Zoom is also compliant with the patient confidentiality requirements of the Health Insurance Portability and Accountability Act. Physicians discuss up-front with their patients the potential glitches that can occur with telemedicine technology.
The technology allows the patient to interact with multiple health care providers at the same time, if a specialist and/or family member is needed during a telemedicine session.
“This is yet another way we’re striving to provide more convenient access to specialists far away,” Hallman said. “We have some specialists in Addison County, but there are some specialists we don’t have. The opportunity to use this technology down the road to be able to get consults with people in Chittenden County would be a real benefit for our patients.”
Young is pleased with how the telemedicine system has been working for Withers, Glick and their patients. Bristol Primary Care will train its nutritionist to provide telemedicine consults with patients on dietary issues.
“Having (Withers’) leadership has been a very good thing for both Porter and the network as a whole, to see how it could work successfully,” Young said. “What tells me this is successful … is all (Withers’) colleagues want to do this. They’re getting positive feedback from the patients and from Dr. Glick and Dr. Withers.”
Once telemedicine is running in all Porter Medical Center family practices, officials will seek to implement it within other network practices in the Burlington area, according to Young. UVM Health Network officials wanted to have Porter physicians take telemedicine for a test spin during a time when other member-providers are contending with major changes — including being outfitted with a new Epic health records system. Porter will also go through an Epic transition, but not for another year or so, according to Young.
Porter Medical joined the UVM Health Network almost two years ago, and telemedicine is one of the perks of that alliance.
“This is the type of benefit we’re able to provide a small community like Middlebury,” Young said. “The ability to be more nimble and progressive in these small communities with great leadership like Dr. Withers provided.”
Young believes telemedicine is the wave of the future. He said the network is working with Maine Health and Dartmouth-Hitchcock medical centers on a joint plan for implementing telemedicine on a regional basis with shared resources.
Hallman is pleased to see a Porter practice taking a lead role in a new service.
“I think it’s a feather in Natasha’s and Bristol Family Practice’s cap to be out there doing things that are … going to be more and more important in the future state of health care.”
Reporter John Flowers is at [email protected].

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