The Health Wagon: A Telehealth Resource in a Rural Wilderness

A mobile health clinic started 30 years ago in the back of a VW Beetle is now using telehealth, mHealth and even drones to deliver healthcare to isolated communities in Appalachia.

By Eric Wicklund mHealthIntelligence

A mobile health service started more than 30 years ago out of the back of a Volkswagen is using telehealth, mHealth devices and even drones to improve healthcare access and outcomes in one of the most underserved regions of America.

The Health Wagon visits dozens of sites in southwest Virginia, targeting a region known for its rugged terrain, insular communities, high chronic disease, opioid abuse and suicide rates and limited access to healthcare and insurance.

“We’re just in a very poor resource area,” says Teresa Gardner Tyson, DNP, FNP-BC, FAANP, executive director of the Wise, Va.-based nonprofit.

But with a going digital health platform, the Health Wagon is giving Appalachia millions of dollars of healthcare each year and inspiring healthcare providers to add mobile outreach to their calendars.

Launched in 1980 by Sister Bernadette Kenny, a medical missionary from Massachusetts who’d travelled to Appalachia in her VW Beetle to administer care on behalf of a nearby hospital, the program now encompasses five Remote Area Medical vehicles (the first was given to the organization in 1983 by an anonymous benefactor for $1), staffed by nurses and nurse practitioners, and a network of rural health clinics in remote communities.

READ MORE: What Telemedicine, Telehealth Resource Centers Offer to Providers

“We’re basically just one very small clinic,” says Tyson, a 1998 graduate of the University of Kentucky in 1998 who followed Sister Bernie’s footsteps. “But we have a lot of help.”

Tyson, who’s been with the organization for some 25 years, says telehealth and mobile health form the backbone of the program, enabling nurses to connect with the University of Virginia Health System, about six hours distant.

She started that partnership by accident, coming across an unused telemedicine cart at a local clinic and deciding to put it to use on her patients. UVA Health officials then offered her a new telemedicine cart, and by 2004 the Health Wagon was collaborating with the health system.

That telemedicine connection with UVA Health, which also houses the Mid-Atlantic Telehealth Resource Center, now enables the Health wagon to offer a wide array of specialty clinics, including pulmonology, radiology, cardiology, endocrinology, ostomy, nephrology, ear nose and throat, women’s health (colposcopy), mental health and dermatology.

Those are vital services. Some 98 percent of the Health Wagon’s patients are uninsured, with 78 percent making less than $20,000 a year in a region where the poverty rate is 70 percent to 140 percent higher than the rest of the state.

READ MORE: Are mHealth Programs Targeting the Right Populations?

In this area, the lifespan for adults is about 30 percent shorter than those living elsewhere. They’re 21 percent more likely to die of heart disease, 14 percent more likely to succumb to diabetes, 35 percent more likely to die of COPD and 50 percent more likely to commit suicide.

“We have needs that you can’t even imagine,” says Tyson. “And if UVA has any [telemedicine] resource there for us, we’ve got the patients for them.”

“They literally save lives on a daily basis,” she adds.

In 2016 alone, the organization served more than 6,000 active patients in about 9,000 encounters, and also saw almost 25,000 patient encounters at its three Remote Area Medical Volunteer Corps ”health fairs,” the largest of which is held right in Wise. The total value of healthcare services delivered in that year was more than $6.1 million.

The RAM clinics offer an ideal example of how healthcare has become mobilized.

READ MORE: Mobile Health Units Put the Emphasis on Access for mHealth

Held every July since 2000, the RAM clinic at the Wise County Fairgrounds is billed as the largest medical outreach event in the country. Spearheaded by the Health Wagon, some 1,400 volunteers treat thousands of patients over a three-day weekend, handling conditions that include hypertension, diabetes, coronary artery disease, chronic obstructive pulmonary disease, chronic kidney disease, mental health issues such as depression and anxiety, and dental and vision services.

But the RAM clinic also had one significant barrier: Those being treated needed medications, and there was no way for the local pharmacy to handle all those prescriptions at once.

The solution presented itself in one of the country’s most popular toys.

In 2015, Tyson and the Health Wagon partnered with NASA and an Australian drone delivery service called Flirty to launch a drone-based delivery service. Flirty’s six-propeller drone was used to ship packages of medications from Lonesome Pine Airport, about a mile away, to the fairgrounds, where they were dropped to waiting pharmacists who had requested the drugs. The activity marked the first time a drone was used to deliver supplies in the US.

“The use of drones for medication delivery provides a great opportunity to address the medical needs of underserved communities,” Tyson wrote in a December 2016 blog. “Living in a rural, mountainous area with frequent heavy snowfalls in the winter presents certain hardships, and patients often run out of much-needed medications. Last winter, southwest Virginia had a record-breaking 42 inches of snow, and the National Guard had to travel into rural areas and deliver life-saving medications such as insulin. The use of a drone to deliver medications to patients in need or to take supplies from our stationary clinics out to our mobile unit would be highly beneficial and meet crucial needs. Embracing this technology would give rural communities such as ours distinct advantages in the delivery of health care.”

According to Tyson, the 2016 RAM event in Wise drew patients from more than 13 states and delivered more than $1.3 million in medical services. The Flirty drone, meanwhile, is now in the Smithsonian National Air and Space Museum.

Along the way, the Health Clinic has become a national symbol of mHealth outreach, appearing in profiles on Inside Edition in 2005, on 60 Minutes in 2008, 2014 and 2016, on ABC Nightlinein 2013 and on PBS Newshour and the UK newspaper The Guardian in 2016. It was also a key moment in presidential hopeful John Edwards’ 2007 campaign, when his visit was covered by the Wall Street Journal, New York Times, PBS, CNN, CNBC, Fox News, AP News Wire, Time Magazine, ABC, NBC, CBS, Boston Globe and the Washington Post.

The Health Wagon has travelled to the United Nations in New York for an event on the empowerment of women, and it has been involved in disaster relief, visiting Katrina-ravaged New Orleans in 2006 and Knoxville last year, following large wildfires in Gatlinburg and Pigeon, Forge, Tenn.

Those interactions have reaped benefits. In 2016, executives at Saint Barnabas Medical Center in Livingston, N.J., inspired by the latest 60 Minutes profile, launched two medical missions to Virginia. A team of doctors and nurses from the New Jersey hospital treated 79 patients and performed more than 200 eye screenings for local school children that August, and another team of gastrointestinal and anesthesiology specialists saw 42 patients and performed 67 procedures in October.

Through it all, there is Tyson, who speaks passionately about who the program has served rather than where it’s been. She’s quick to note the latest services, such as a first-of-its-kind-in-the-world bladder cancer screening clinic last year and a telecystoscopy clinic now in development.

“These people not only can’t find these services [in Appalachia}, they can’t afford them,” says Tyson. “For us, it’s all about removing those barriers. When you’ve done that, then you’re going to get some good results.”

When asked about the future, Tyson focuses on diagnostics. Now that she has a link to UVA and its specialists, she wants to open more channels for viewing and acting on tests and images, and for teaching patients how to live healthier lives.

“This is where medicine is going,” Tyson says, indicating the rolling Appalachian countryside outside her office. “We want to bring healthcare to them. It truly means the world to them.”

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