title: Telerheumatology: A technology appropriate for virtually all.
abstract: Telerheumatology services were developed at Dartmouth-Hitchcock Medical Center (DHMC) to bring specialty care to New Hampshire (NH) and Vermont (VT) where a large proportion of the population lives in rural areas (60%) with limited resources and access to care. We sought to learn what challenges and accomplishments our early telemedicine program has encountered since inception.
  
  
  
  As part of a quality improvement initiative we performed an IRB-exempt retrospective review of patients seen in the telerheumatology clinic at DHMC from October 2011 to December 2014. We also interviewed the participants; including providers, presenters, and patients regarding their experience of care. We assessed both patient and provider satisfaction with the experience.
  
  
  
  Between October 2011 and December 2014, 176 patients were seen via telerheumatology between two clinical sites over the course of 244 telerheumatology patient visits. The top diagnosis for patients during the telerheumatology visits was inflammatory arthritis (n = 156, 63.9%). We found 19% of patients to be inappropriate for the visit type for the following two main reasons: the underlying diagnosis was unclear or the disease was too complex.
  
  
  
  The use of telerheumatology has successfully increased access to specialty care in rural regions of NH and VT with good patient and provider satisfaction. While telerheumatology improved the access to specialty care, consideration should be given to selecting the appropriate patient for this visit type given that 19% of patients were deemed inappropriate. We propose a triage mechanism to ensure that patients are appropriately paired to the proper visit type in the future.
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH; Rheumatology Department, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: zsoltk22@gmail.com.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Kulcsar
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH; Rheumatology Department, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Daniel
authors.initials: D
authors.lastname: Albert
authors.affiliation: White River Junction Veterans Affairs Medical Center, White River Junction, VT.
authors.forename: Ellyn
authors.initials: E
authors.lastname: Ercolano
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH; Rheumatology Department, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: John N
authors.initials: JN
authors.lastname: Mecchella
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000628:therapy; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D005356:Fibromyalgia / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000628:therapy; D017060:Patient Satisfaction; D058996:Quality Improvement; D012189:Retrospective Studies; D012219:Rheumatology; D025242:Spondylarthropathies / Q000628:therapy; D017216:Telemedicine
keywords: Patient satisfaction; Quality improvement;; Rural health; Telehealth; Telemedicine; Telerheumatology; Video consultation