When COVID-19 struck, one rural library in Texas made a bold move to help their community. They reached out to NNLM about funding opportunities for a virtual health room in Pottsboro, Texas. This had NEVER been done before, having an established room in a library dedicated to tele-health appointments. On this episode of the NNLM Discovery podcast, Region Three Executive Director Brian Leaf shares his story with host Yamila El-Khayat about how he and Jessica Rangel, Executive VP of Health Systems University of North Texas Health Science Center in Fort Worth, helped Pottsboro County Librarian Dianne Connery use an NNLM grant to establish a nationwide model to harness the power of telemedicine to overcome the lack of access to healthcare in much of rural America.
Building on the pilot’s success, the Texas State Library and Archives Commission has expanded this funding model for more libraries to implement similar telehealth spaces, including Austin Public Library.
You can view a short video about this story here on the NLM YouTube channel.
The NNLM is the outreach arm of the National Library of Medicine with the mission to advance the progress of medicine and improve the public health by providing all U.S. health professionals with equal access to biomedical information and improving the public's access to information to enable them to make informed decisions about their health. The seven Health Sciences Libraries function as the Regional Medical Library (RML) for their respective region, with Region Three consisting of: Arkansas, Kansas, Louisiana, Missouri, Nebraska, Oklahoma, and Texas. To learn more about Region 3 visit: www.nnlm.gov/about/regions/region3
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This is season one of NNLM Discovery, a podcast from the Network of the National Library of Medicine. I’m librarian Yamila El-Khayat, and I'll be your guide as we explore how NNLM is engaging with communities to provide access to trusted information for the purpose of improving the public's health. Today's episode is Virtual Health, a story from Region three.
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Executive Director of Region three, Brian Leaf will be joining us today. Hi, Brian.
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Brian, what story will you be sharing today?
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So I wanted to share a project that my team funded and helped to oversee right at the beginning of the pandemic. In fact, this was one of the first NIH/NLM projects funded specifically for COVID-19 outreach.
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One of the first. Wow, that's incredible. Before we jump in, where is Region three and what makes it unique?
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Region three is comprised of Arkansas, Kansas, Louisiana, Missouri, Nebraska, Oklahoma, and Texas. Yamila, when I mention these states, what's the first thing that pops into your head?
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Well, I guess wide open spaces, like the middle of America.
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Exactly. We do have a few large metropolitan cities in our region, but for the most part, our region is very rural. The reason why I'm so passionate about this story today is that this outreach grant we're featuring really addresses the rural needs of our region.
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This is huge. There is a big need in our rural communities for health care and health information. I can't wait to hear more about this.
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Yeah. So one of the things NNLM assists with within our region is establishing partnerships. We go well beyond just writing a check for our grants. Our story starts at Region three headquarters on the campus of the University of North Texas Health Science Center in Fort Worth, otherwise known as HSC. I interviewed Jessica Rangel, Executive VP of Health Systems, about the challenges of rural health care.
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Jessica, how many counties in Texas have no hospital?
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So as it stands right now, there are 77 counties that don't have a hospital. So when we reflect back on what's been going on, we look at these rural community hospitals and, and truly, they've just financially gone under. They're having trouble staffing those community hospitals. It is a desperate situation. It's an ongoing challenge. I don't see it turning around any time soon. And it's really tragic for our community members.
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And why is this so tragic for rural America? What's a possible solution to this problem?
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When we think of social determinants of health and those are those elements that are very basic that can often determine how well we journey through health. One of those is simple transportation. Telemedicine solves that problem. Virtual health, telemedicine, telehealth, all that is, is encompasses care that is provided through a different medium, like perhaps your computer or your smartphone, even the telephone at times can be used.
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Yamila, have you ever had a telemedicine appointment?
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I have not. I actually live in a larger city, but I'm really curious to know what that's like.
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For those that have never heard of this. We were given permission to record the beginning of an HSC telemedicine appointment between a doctor and patient that happened via video call. Let's take a quick listen to get an understanding of what it's like.
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Hello, Mr. Christian. How are you?
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I’m doing okay, Doctor Buoy. How are you?
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I'm doing well. Well, we're going to have a telemedicine visit today. Have you had a telemedicine visit before?
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No, ma'am. This is my first.
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Okay. Well, essentially, we can talk about how you're doing. We can talk through your biggest concerns, how you're feeling. We'll do a little bit of what we can on the screen. If there's anything that I need to see you in person, we can do that. And if we need to prescribe something or order anything, we can do that, too.
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Okay. Great, thank you.
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Okay. Tell me how you're doing.
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I've been having these headaches for the better part of two weeks now.
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So, seems like an easy solution for rural America, right? Just set up a bunch of telehealth appointments for those areas that don't have hospitals.
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Nothing is ever that easy, Brian. Are hospitals and doctor offices even prepared for telemedicine? I wouldn't even know where to start to set up this kind of appointment with my doctor.
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And you wouldn't be the only one. There are so many hurdles with rolling this out. The biggest being connectivity in rural America. Most of our region and rural America have little access to high speed Internet, the type of Internet that would allow you to livestream video. Our story focuses on one rural library in Texas, the Pottsboro Library. Pottsboro is about 90 minutes north of Dallas.
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The biggest attraction is Lake Texoma, where a lot of Dallas locals have second homes. The middle of Pottsboro though, is more modest and lacks the infrastructure and public services you find in larger cities. It has little internet connectivity. The nearest hospitals 30 minutes away and there is no public transportation or ride sharing options. I asked Dianne Connery, who runs the public library in Pottsboro, what it was like moving to this community.
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I had always lived in large cities my whole life. My kids were raised in large cities. And then when we moved here in 2010, realized that Internet was a real hardship for some people. Some places the infrastructure doesn't exist. Some people can't afford it or know how to use it. And when I started working here at the library, I would see kids come in who didn't know how to use computers and thinking back to my kids and their experience, I just I was concerned about how kids here would ever be on a level playing field with their peers from suburban and urban areas if they didn’t know how to use computers.
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When they talk about social determinants of health. Digital inclusion is a super social determinants of health. No matter what problem you've got, if it's employment related, health care related job, whatever. It's made worse if you can't access the Internet and know how to use it.
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Were things made worse during the pandemic? How did the Pottsboro Library respond?
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We started getting a couple of calls from people who wanted to have doctors appointments. One of the the people I remember right before the shutdown had had an MRI. She was having some neurological symptoms. And so the neurologist wanted to talk to her. When the MRI results were back, but because she had chronic obstructive pulmonary disease, he didn't want her to come into the office.
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And so he asked her to get to a place with with a computer. She came here and we set her up so that she could talk to the doctor. And then after that, a veteran came in who could no longer phone call to request refills for prescriptions. So he needed our help.
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That's wonderful to hear that the community came to you for solutions. I don't think a lot of people think of doctors appointments when they think of their local library.
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Libraries are perfectly positioned to work with with telehealth because we're oftentimes the fastest Internet connection in town. People trust librarians. It's a neutral space. We're accustomed to helping people with digital literacy skills. So it all came together to request funding to to start a virtual health room here.
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So that's when Dianne reached out to me at Region three, about funding opportunities for a virtual health room in Pottsboro, Texas. This has never been done before. Having an established room in the library just for telehealth appointments. Dianne's proposal was quickly funded because the need for telehealth was so important at the beginning phases of the pandemic. Region three awarded Pottsboro library $20,000 to renovate a storage closet in the library to a virtual health room for telehealth appointments.
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Here's Dianne walking us through the room and describing the space.
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So we are now in the telehealth room. It used to be we called it a weeding room, donated books put in here that had been in here for who knows how long. When we cleaned it out, we found a smashed dead frog under the books. So we've come a long way from then. So let me tell you what, what exists here. We do have an adjustable desk. So if someone comes in and they are wheelchair, it adjusts to where they need to be. Lighting, we learned, is really important for the health care providers to be able to see proper skin tone on people. And then we also have the webcam. If once in a while a doctor will need to see a patient walk to assess their gait.
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And they had told us that they were having an issue with people doing telehealth visits in their car, on their phone, which didn't lend itself to that. So people can walk through here. And then we have some accessories. Blood pressure cuff, pulse oximeter, thermometer, and scale. A lot of times before appointments, the doctors want to have that baseline of what people's vitals are so they can come in here and connect.
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And we provide as much technology assistance as they need. We have a HEPA filter running in here, 15 minute space between appointments to make sure we have time to disinfect everything and soundproof panels to absorb the sound from reaching the rest of the library.
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Now, $20,000 doesn't seem like a lot in comparison to some of the larger NIH grants out there. But for someone like Dianne, who doesn't have a dedicated accounting department, it's the perfect amount to immediately take action and get things going. Here's Dianne talking about how she rolled this out and where she needed help.
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Often in a small library, we do things very quickly and experimentally. It's like, Hey, we've got an idea. Let's see if this works. Let's get started. And so I could conceptualize on our end what a virtual health room would look like. But I didn't. I couldn't figure out the other end of the equation. So like, how would we not double book our room if people were making their own appointments?
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And so working with the people at Health Science Center, they were able to really collaborate well with me. Sometimes in a small organization, people collaborate on you rather than with you. But it's been a really good partnership to see what works with both parties.
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Region three helped manage this relationship between HSC and Pottsboro library. Now that the room was converted, HSC was instrumental in the coordination and activation of this virtual health room. Here's Jessica Rangel from HSC again, talking about how she worked with Pottsboro to actualize this space.
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The room was converted. We helped with the electronic equipment, help her determine what would be best. And then we helped set up protocols for how we would interact with anybody who wanted to have care in a very private and confidential manner, but also talked about how do we disinfect in between people? Because, again, in the beginning stages of COVID, we were not clear on a whole lot.
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So what was going to be required. We followed CDC guidelines, but we wanted to make sure was absolutely thorough and that people felt safe following one another into that room where they would have the telehealth experience. So there's plenty of opportunities when you have a creative group of people out there like they do in Pottsboro, to continue to have the library be the heartbeat of that community.
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The Pottsboro library is truly the heartbeat of this community. The best way to understand the effectiveness of the space is to listen to testimonials. We talked with a local from Pottsboro, Jamie Kimberlin, about her experience with going to the telehealth room.
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During COVID, there was, you know, the mask mandate, all the germs, everything spreading around. I did not want to go sit in a doctor's office and expose myself to bigger things when I just had a minor health issue. So this made it where my safety came first and it was private, easy, convenient. That's why I chose it.
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And if you don't mind me asking, did the appointment help your health?
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Well, it did. It was for a minor thing. I ended up with pink. I got to love kids and what they bring home. But I didn't want to go to my doctor. I didn't want to go sit in line at the, you know, doctor's office and wait in the waiting room for hours. And this was I mean, start to finish probably 20 minutes, tops. And that was leaving work, coming here and the appointment itself.
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I love hearing testimonials like this. Another advantage I see as a parent with small kids at home is the ease of doing a telemedicine appointment. Instead of dragging my kids to the doctor's appointments or even trying to find a daycare during that time.
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That's exactly right, Yamila. This virtual health room really has the power to change and improve the health and well-being of the Pottsboro community and hopefully all of rural America. This grant wasn't just about converting one room. This project was funded as a pilot to be used as an educational tool to establish best practices that can be shared with other libraries and institutions who are looking to implement their own virtual health room.
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Here's Dianne and Jessica talking about what this project means to them personally and professionally.
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It means a lot in terms of it has been a national interest, not just from libraries, but insurance organizations, Health care systems from all over the country, from practically day one have been contacting me. I mean, Pottsboro, we have 2500 people in our city limits, basically one big room for our library building. So we can do it on one scale. And then there are large libraries who are adopting this on a larger scale.
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We've created a playbook because this is not about secret sauce. This is about let's make our communities healthier. Here's what we learned from this experience and here's what we wish we had done a little bit differently, because how fabulous would it be if all rural communities had this kind of access? We really feel like broadband access in rural communities where you can set up virtual health care is truly a solution to many of our rural community problems, and at least at a minimum, being able to determine what needs to go perhaps into the big city to be looked at in a more diligent manner versus small things that can be taken care of before they turn into big problems.
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Whenever Pottsboro, Texas is on national news. I know we've done something worthwhile, so we have gotten a lot of buzz around the country and I am proud of being the first pioneer to do this, to be able to help other libraries across the country make this happen. It's just a really energizing experience to create something new that impacts the community the way it does.
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Today, Pottsboro’s Virtual Health Room is still active. You can call and reserve the space throughout the week. They're connected with two clinics, HSC Health being one of them. But you also have the ability to reserve the room for any health care appointments if it's available. TSLAC, otherwise known as the Texas State Library and Archives Commission, have actually expanded on this model funding for more libraries to implement similar telehealth spaces, including Austin Public Library.
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Thanks, Brian. This was an amazing story and I think it really shows the power of the network within our regions. We're not just handing out grants, we're building relationships, providing education, and we're focused on the process of getting out good, reliable health information.
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I absolutely agree. It was a pleasure being here. Thank you.
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We’ll be featuring other profiles, grants, and interesting information from all our Regions during this season of NNLM Discovery. Subscribe, rate and comment on our podcast. Be sure to share these episodes to help us grow our audience. For more information, including a video featuring content from this story, check out the links within this episode's description. The NNLM offers free training, partnerships and many resources that help to improve health and wellness.
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Membership is free. Learn more at NNLM.gov