How remote medicine is transforming care of rural sexual-assault survivors

Arielle Zionts reports for Kaiser Health News and The Atlantic. The excerpt that follows features nurse Amanda Shelley in Eagle County, Colorado (population 55,731), and it picks up after she's received a call from the local police that a teenager has reported a sexual assault. 

Shelley... called a telehealth company to arrange an appointment with a sexual-assault nurse examiner, or SANE. The nurse examiners have extensive training in how to care for assault survivors and collect evidence for possible criminal prosecution.

About an hour later, Shelley met the patient at the Colorado Mountain Medical urgent-care clinic in the small town of Avon. She used a tablet to connect by video with a SANE about 2,000 miles away, in New Hampshire.

The remote nurse used the video technology to speak with the patient and guide Shelley through each step of a two-hour exam. One of those steps was a colposcopy, in which Shelley used a magnifying device to closely examine the vagina and cervix. The remote nurse saw, in real time, what Shelley could see, with the help of a video camera attached to the machine.

* * *

TeleSANE services are expanding across the country in rural, sparsely populated areas. Research shows that SANE programs encourage psychological healing, provide comprehensive health care, allow for professional evidence collection, and improve the chance of a successful prosecution.

... [T]here are no comprehensive national data on the number and location of health-care professionals with SANE training. But she says studies show that there’s a nationwide shortage, especially in rural areas.

Some rural hospitals struggle to create or maintain in-person SANE programs because of staffing and funding shortfalls, Pierce-Weeks says.

Training costs money and takes time. If rural hospitals train nurses, they still might not have enough to provide round-the-clock coverage. And nurses in rural areas can’t practice their skills as often as those who work in busy urban hospitals.

* * *

Avel eCare, based in Sioux Falls, South Dakota, has been providing telehealth services since 1993. It recently added teleSANE to its offerings.

Avel provides this service to 43 mostly rural and small-town hospitals across five states and is expanding to Indian Health Service hospitals in the Great Plains. Native Americans face high rates of sexual assault and might have to travel hours for care if they live in one of the region’s large, rural reservations.