“How do we help?”
That simple question launched a company, as four young physicians decided to take on the challenges of connecting rural populations with medical specialists.
Vigilias Telehealth, run out of a small office in downtown Wichita, is the medical community’s equivalent of a high-tech startup, and now serves patients across three states: Kansas, Nebraska and New Mexico.
“Four doctors got together and said, ‘There is a major healthcare gap in the rural areas. How do we help fill it?’ We’ve all either worked or spent time in small towns and have seen that there are hardly any specialists,” says Charles “Chuck” Coffey, MD, Vigilias’ Marketing Director.
Dr. Coffey, along with Elisha Yaghmai, MD, Patrick “Zana” Desgranges, MD, and Aaron Chen, DO, has utilized a combination of existing and newly developed technology to create an affordable portal through which specialists of almost any variety can evaluate patients who otherwise might have to travel hours each direction for the same appointment.
“I think we’re doing something that could make a real and positive difference,” Dr. Coffey says.
While working in a large healthcare system in Seattle, Dr. Yaghmai began to ask himself whether his work was making a real difference.
Having previously trained and worked in Kansas, he started thinking about rural medicine, and the early concept for Vigilias was born.
Charles “Chuck” Coffey, MD, Elisha Yaghmai, MD, and Patrick “Zana” Desgranges, MD, three of Vigilias Telehealth’s four founders, are pictured with a previous model of the MITEE telehealth system at the 2015 National Rural Health Association Critical Access Hospital Conference. Not pictured is Aaron Chen, DO.
Dr. Yaghmai soon approached one of his colleagues, Dr. Desgranges, about launching a program that would use cost-effective telemedicine technology to support rural primary care providers by regularly covering their communities on nights and weekends for a vastly reduced price compared with the locum tenens services most rural communities use.
What neither knew at that time was that specific Medicare policies make that solution to rural health needs nearly impossible to execute without running into regulatory problems. Dr. Yaghmai says attempts to discuss things with federal regulators went nowhere, and around the same time, small hospitals began to ask if the new company could instead supply subspecialty services or emergency department backup.
The expanded mission drove the creation of a technological, service and business model to support it. That evolution continues today.
While the physicians’ network of specialists provided a prime solution for physician services, creating a conduit for the delivery of care posed challenges, driving the physicians to develop affordable and user-friendly solutions.
“We looked at what was on the market, and there was a lot of expensive equipment that didn’t really do what we wanted it to and was often unreliable and complicated to use,” Dr. Coffey says.
The MITEE (“mighty”) portal is a streamlined, patient- and practitioner-friendly unit created by Vigilias Telehealth as an affordable way for rural areas to offer specialty care. The portal can be placed in a patient room, allowing a patient and physician to communicate via the larger screen. The smartphone and attachments then allow physicians to conduct the exam remotely.
Instead, the physicians innovated, starting with a bare-bones iPad, then developing the MITEE (“Mighty”), the world’s first smartphone-based telemedicine cart. Additional innovations followed, including custom telemedicine software that runs in low-bandwidth situations, such as cellular or satellite, and peripheral devices that enable a remote physician to do a full physical exam.
“We tried to start with components that were less expensive, knowing that critical access hospitals don’t have a lot of cash to burn,” Dr. Coffey says. “Our telemedicine equipment is probably a tenth of the price of what most are on the market right now, but it doesn’t sacrifice quality.”
In addition to keeping the setup affordable, the use of everyday technology as a foundation provides user-friendly setup and maintenance, making adoption easy.
Practicality in Practice
Feedback from participating healthcare organizations has been very positive, with Dr. Coffey touting the opportunity for local physicians and remote Vigilias Telehealth physicians to treat patients in tandem.
For example, a patient in St. Francis, Kansas — located in extreme northwestern Kansas and the first of the company’s 22 sites — might visit a local physician but follow up with an endocrinologist via telemedicine.
Another patient in Medicine Lodge, in south-central Kansas, might need to see a dermatologist or psychiatrist. Those appointments could be scheduled quickly with an available Vigilias specialist, who utilizes locally collected labs and imaging, plus Vigilias’ telemedicine setup, to assess the patient further and coordinate with local primary care providers.
“A lot of medicine can be done by looking at patients’ objective data, then combining that with their story and a physical exam,” Dr. Coffey says.
The MITEE’s many attachments enable a comprehensive physical exam and also provide the option of conducting EKG or ultrasounds remotely. On-site staff assist with functions requiring physical touch.
Vigilias also employs a cost-sharing model that includes payments to both the specialist and the local site for each visit.
“We’re not here to steal the patients,” Dr. Coffey says, adding that the technology actually prevents the revenue from leaving town. “Patients don’t have to leave their town, and they don’t have to drive six hours.”
For more information about Vigilias Telehealth, please visit vigilias.com.