Tech Talks Connect Physicians across the Country

BWH rheumatologist Paul Dellaripa, MD, holds a video conference with Indian Health Service (IHS) physicians and patients in Shiprock and Gallup, New Mexico, as part of the Brigham and Women’s Outreach Program. BWH physicians from a number of specialties participate in video conferences with IHS physicians twice per month.

BWH rheumatologist Paul Dellaripa, MD, is examining the labs and medical documents of a 58-year-old woman with hypothyroidism. The patient has been experiencing muscle aches that are most painful when she is sitting and ease while she is walking. She has also been having trouble making a tight fist.

Dellaripa asks her to make specific hand and foot movements, which he demonstrates himself. After more consultation, Dellaripa concludes that she is likely experiencing early-stage inflammatory arthritis.

This may sound like a routine specialty visit, but Dellaripa and the patient are nearly 2,500 miles apart - the former, in Boston, and the latter, in Shiprock, New Mexico. Alongside the patient in Shiprock is Indian Health Service (IHS) physician Kimberly Mohs, MD, chief of Internal Medicine at the Northern Navajo Medical Center.

For the past two years, the Brigham and Women's Outreach Program has been harnessing video conferencing technology to bridge the distance between BWH physicians and physicians serving the Navajo reservation at IHS hospitals in Shiprock and Gallup, New Mexico. Physicians with the IHS, a federal agency within the Department of Health and Human Services, provide care to nearly two million American Indian/Alaskan Natives at 35 hospitals and more than 300 health centers across the country.

In addition to site visits to Shiprock and Gallup each year, BWH physicians from a variety of specialties volunteer to discuss patient cases with IHS physicians twice per month in the video conference program. The virtual partnership allows BWH physicians to directly support their IHS colleagues and enhance patient care, ultimately helping to improve the health status of American Indian/Alaskan Natives, a vastly underserved community.

"The IHS physicians are an exceptional group, but they face significant barriers in delivering high-quality care to this underserved population," said rheumatologist Ronald Anderson, MD. "These barriers include limited access to specialty services."

Paul Dellaripa, MD

For these reasons, remote teaching from Boston is extremely valuable to IHS physicians.

"There's a great deal of education in having someone review what you're doing," said Anderson. "With technology, it's possible to have an interactive conference. I don't think the video conferences take the place of site visits - during which you can do a lot of good in a short period of time - but they certainly add another dimension."

BWH physicians also find the partnership rewarding.

"All of our physician volunteers report tremendous personal and professional satisfaction from participating in the Outreach Program, but not everyone can commit to traveling to New Mexico," said Thomas Sequist, Outreach Program medical director. "The video component of our program has allowed even more Brigham and Women's Physicians Organization members to participate since it is locally-based."

Anderson, Dellaripa and fellow rheumatologist Daniel Solomon, MD, MPH, along with dermatologist Ruth Ann Vleugels, MD, hosted the first BWH/IHS video conference in Nov. 2010. The program expanded from one conference in 2010 to six in 2011, and has been growing steadily ever since.

This year, 16 physicians and four nurses from 12 clinical specialties, including emergency medicine, cardiology, endocrinology, psychiatry, neonatology and OR management, have participated in IHS video conferences. Eighteen conferences are already scheduled for next year.

"The presentations are a hybrid," said Ellen Bell, MBA, MPH, senior project manager for the Outreach Program, before the video conference. "They can be more formal and lecture-based or informal, but we encourage the sites to present challenging patient cases for our physicians to use as a focal point of the conference. BWH physicians use the cases to provide specific clinical advice as well as educate on current thinking in the field, including pharmaceutical treatments. The Rheumatology physicians had a particular interest in this from the beginning and are working closely with us as we continue to expand."

Dellaripa and Anderson use the video conferences as a way to stay connected with IHS physicians and patients between their yearly site visits to the IHS hospitals in New Mexico. Sometimes the patient on the other end of the video conference is someone they have seen and cared for in the past during a site visit. They are a way to continue and extend the relationship. 

"One of the great things about an academic medical center like the Brigham is the constant feedback and discussion," said Anderson. "There is steady reinforcement of the good things you're doing and a process of learning when things don't work well. Here, I can walk 20 yards and find someone who knows more about a topic than I do, and that's how you keep learning. But out in the desert, you're on your own, and there may not be a chance to review puzzling cases with someone who knows more than you do. By giving IHS physicians an opportunity to have others review their work with them, it helps them and reinforces what they're doing. I think that's a great experience for them to have." 

To learn more about the Outreach Program or IHS, visit www.brighamandwomens.org/ihs, or e-mail Tom Sequist at tsequist@partners.org.