top of page is an outreach Telemedicine initiative developed by the Midwest Center for Rural Health. Development of was a direct result of difficulties encountered by our rural patients and providers to access specialty services in their rural communities. These difficulties were (and are) exacerbated by a high proportion of elderly and low-income patients who often face transportation barriers in traveling to distant sites to receive care. In a study performed at the University of Missouri, Columbia, 256 participants were questioned about their experience with Teledermatology. Participants were asked, “How would you have handled your health problem without Telemedicine?” 26% of the survey respondents answered that they would not have received healthcare at that time if Telemedicine were not available. Telemedicine programs such as give patients and providers the convenience to access specialist recommendations and keep treatment at the site of the general provider. is a store-and-forward Telemedicine technology that addresses medical provider shortages and lack of access to specialty information and services in rural America. This platform provides for non-emergency consultations in nine specialty areas. These currently include: dermatology (2 specialists), neurology, endocrinology, gastroenterology, pediatrics, geriatrics, clinical toxicology, obstetrics and gynecology, and HIV. is a patented technology which has been in use since June 1999. It is a low cost alternative for providing non-emergent care, especially in remote rural areas where access to specialty care can be problematic at best.

Objectives of the project are to: (1) improve access to specialty services among populations in rural Indiana; (2) improve support by specialists for isolated generalist providers in rural areas; and (3) provide continuing education that can be accessed by providers at their own pace and without leaving their rural location. Activities associated with these objectives include creating educational materials and conducting presentations about this initiative; researching which specialties are most needed and best suited for specific rural geographic areas. Approximately 120 generalists and 10 specialist providers are currently registered users of, and there is no cost associated with using the system.

System Operation

The inquiring generalist provider (e.g., family practice physician, nurse practitioner, etc.) logs onto the website, selects the specialist that is best suited for the case and complete the online consult form. The provider denotes the severity of the condition and provides the specialist with the case information (e.g., medications, history of the problem, provider findings, previous diagnostic tests and therapies, working diagnosis, reason for consult, etc.) If relevant to the case, the provider can attach several digital photos or moving images. The digital photo portion of the program is particularly invaluable for dermatology consults.

As the provider clicks to submit the consult, the specialist is notified via e-mail that a consult is awaiting review. The specialist then logs into to draft an assessment/diagnosis, differential diagnosis and recommendations. The response is submitted to and the inquiring provider is notified by e-mail that a response is waiting. Some specialists also e-mail relevant journal articles or cite helpful references; this supports and enhances provider education. was retired in 2014 as the growth of the Wabash Valley Rural Telehealth Network has resulted in live Telemedicine modalities offering alternate methods for accessing these services.

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