Taking health care on the road

Delivering Care Differently: Taking health care on the road

In rural Iowa, futuristic wind turbines dot the landscape of rich, fertile farmland. And the rolling hills capture a sense of nostalgia, a nod to simpler times. Dig deeper, though, and it’s evident rural Iowa is meeting its unique needs with innovative solutions, particularly in its quest for affordable, quality health care. While doctors here haven't made house calls in decades, they are doing the next best thing; and technology is a key component.

Case in point: Red Oak, a town of about 5,000 residents in southwest Iowa, and home to Montgomery County Memorial Hospital External Site. The hospital has a reputation as a regional leader, with a laser-like focus on improving health care access and quality, while reducing cost. Located about an hour east of Omaha, Nebraska, it is the center of care for about 12,000 residents in Montgomery County and surrounding areas. In recent years, the hospital has added a new outpatient clinic, and expanded its emergency department, surgery and rehabilitation services.

Over the years, however, a persistent problem remained.

“Patients in the surrounding, rural areas just couldn’t get the prompt care they needed. There was a lack of availability, particularly for office visits in our outpatient clinic,” says Ronald Kloewer, chief information officer and director of campus development at the hospital. “Working families, in particular, were in a bind. They had to miss school or work to travel to Red Oak for an appointment. Plus, there were transportation issues for our elderly patients who had a difficult time traveling to a central location.”

These surrounding communities included the towns of Essex, Stanton, Elliot and Emerson, all with populations between 300 and 800 residents. “Communities of this size struggle with access,” says Kloewer. “They aren’t large enough to support their own, stand-alone clinic. It’s simply cost prohibitive. Often, they are left with no other choice but to wait to receive care, often in an emergency setting, when their problems become severe.”

An idea evolves into a solution

While brainstorming solutions, a hospital clinical information technology (IT) nurse came forward with an idea. Instead of setting up clinics in each town, why not deliver care via a mobile unit that travels between locations?

“The idea took root, and the more we examined it, the more hopeful we became,” says Kloewer. A team began digging into the reality of having a mobile unit of their own.

In the process, they learned that mobile units aren’t typically found in rural settings. In fact, they are primarily located on the outskirts of populated, urban areas, such as San Francisco, Boston and Houston.

“Turns out, these neighborhoods are a lot like Iowa small towns,” says Kloewer. “You’ll find working families who simply don’t have time to travel into the city for routine or urgent care. You’ll find elderly and disabled residents who have mobility or transportation issues.”

On the road

Fast forward to today, the Heartland Mobile Health Unit sets up on a weekly rotation in each of the four small communities, as well as Red Oak. The mobile unit provides primary care from a specially equipped medical vehicle with full clinic services and electronic medical records on board. In addition to providing primary care, patients can have exams, immunizations, lab services, screenings, specialty referrals, sports physicals, and care for acute and chronic health problems. It’s staffed primarily by a doctor and two nurse practitioners.

The real challenge, though, was equipping the mobile unit with the technology required to provide the best care. In order to do so, the hospital partnered with a local cellular provider to power the program.

“The use of 4G LTE to achieve 100 percent access to electronic medical records (EMRs) was unique,” says Kloewer. “No other mobile clinics that we had found used this technology to deliver care. The EMRs are all there, in real time.”

The hospital has also partnered with local pharmacies to deliver medications to the residents, so they don’t have to wait to get the treatment they need, or drive a long way to fill a prescription.

The response? “It’s been incredibly, overwhelmingly positive. We have a 95 percent top-box patient satisfaction score,” says Kloewer. "This means 95 percent of the patients rated the mobile clinic at a 9 or 10 on a 10-point scale."

“We have been monitoring the program since its inception in November of 2014. It has resulted in an 83 percent reduction of emergency visits for the flu.” According to Kloewer, this is because they are delivering care in the right places and at the right times so people can easily access care.

The use of 4G LTE to achieve 100 percent access to EMRs was unique. No other mobile clinics that we had found used this technology to deliver care. The EMRs are all there, in real time.

Ron Kloewer, Montgomery County Memorial Hospital

“If you’re working in a factory or on a farm, you can’t just leave everything behind and head to the doctor for a few hours,” says Kloewer. “The mobile unit makes access more convenient. If you can get the health care you need, now, when you’re sick, you don’t have to visit the emergency room later. Now, you can get care after hours, after work, or on the weekend.”

What's it like to get care in a mobile unit?

Wondering how you can possibly get the type of care you get in a traditional doctor's office on wheels? See first-hand stories from Wellmark members who say they've come to rely on the Heartland Mobile Health Unit for quality, convenient care.

Plus, taking care on the road isn't the only innovative thing the Montgomery County Memorial Hospital does to deliver care to people in southwest Iowa. They're also bridging the gap through the use of smartphones, tablets and Bluetooth technology.