Telemedicine sees a dramatic rise in Minnesota, with urban-rural contrast

The popularity of telemedicine has soared among Minnesotans in the past decade, with urban dwellers seeking the convenience of routine care online and rural residents videochatting with distant doctors for everything from prescription refills to psychiatric sessions to cancer consults.

A first-of-its-kind report used a Minnesota database of health insurance claims and found that the number of telemedicine visits increased sevenfold from 2010 to 2015. The study is part of a special edition of the influential journal Health Affairs that assesses the national impact of telemedicine — a broad term to describe billable patient care that isn't provided face to face, including online queries and videoconferencing.

"[The study] really illustrates the multiple ways that telemedicine is being utilized in the health care system and really starts to get at the question of what's working and what's not," said Jean Abraham, a co-author of the local study and a professor in the University of Minnesota School of Public Health.

Most of the increase was in virtual visits by privately insured patients in metro areas, who used online portals such as VirtuWell to receive routine care for sore throats and skin rashes.

Such visits accounted for only 20 percent of the 11,113 telemedicine visits in Minnesota in 2010, but 60 percent of the 86,238 visits in 2015.

Patients in rural areas used telemedicine more to connect with doctors in other communities — either to avoid long drives for routine checkups or to get second opinions from specialists, the data showed.

Duluth-based Essentia Health has videoconferencing in every one of its clinics in northern Minnesota. Patients in International Falls, for example, can connect remotely with doctors in seven different specialties, including psychiatry and cardiology.

"We use it to bring the specialists to the rural environments," said Maureen Ideker, a senior telehealth adviser at Essentia, who helped set up one of the state's first programs at Tri-County Hospital in Wadena in 1994. "You can share the scarce resources."

Essentia also links doctors and pharmacists with patients to taper dosages of opioid painkillers, or help them manage or avoid opioid addictions.

Mayo Clinic provides similar specialist support to smaller hospitals, including advice on managing premature births. Dr. Christopher Colby recalled how a hastily arranged video link helped him guide Mankato doctors in 2013 on whether to resuscitate a baby born at the threshold of viability at 22 weeks.

"The baby survived," he said, adding that the case inspired Mayo's formal telemedicine neonatology program.

Claims data showed less growth in telemedicine among patients covered by state and federal programs such as Medicare and Medicaid. That could change now, because Medicare has relaxed rules that it would pay for telemedicine only for patients outside metro areas, said Pam Mink, a co-author of the study with the state Health Department.

Researchers said they were pleased to find a high number of videoconferencing appointments for psychiatric care. Rural access to mental health specialists has been a problem in Minnesota amid rising depression and suicide rates.

Half the telemedicine visits, whether online or via video, were completed by nurse practitioners or physician assistants. However, almost 1 in 5 involved psychiatrists who assessed patients or updated their medication or treatment regimens.

"Telemedicine may be emerging as an option to overcome some of the geographical barriers [to] specialty care in Greater Minnesota, particularly in the area of mental health," said Jan Malcolm, state health commissioner.

Telemedicine accounts for less than 1 percent of all patient care visits, but the local study suggests continued growth. Abraham noted that her research did not assess the effectiveness of virtual vs. in-person visits, just the numbers of them.

Technology hasn't improved to the point that a doctor could do a colonoscopy remotely, but better screen resolution and broadband networks have made telemedicine more useful, said Matt Anderson, a senior vice president for the Minnesota Hospital Association.

Patients have gained comfort with the distance, he said, recalling one young person saying it would be creepier to see a therapist in person.

"Individuals are much more accepting and sometimes even eager to get services through virtual mechanisms," Anderson said, "than they are face to face."