LARAMIE - When Rex Gantenbein talks about the long-distance health care experiment he is in charge of, the first thing he likes to show people is a roadside sign on U.S. 85, the highway that leads north from Interstate 25 to Lusk.

The sign reads, "Lost Springs, Wyo. Population 1."

"Down from 4 in the 1990 census," Gantenbein says. "Because Wyoming is full of places like this is why we need telehealth."

"Telehealth" and "telemedicine" are umbrella terms covering a wide range of pilot projects being carried out under a $1.5 million federal grant, using electronic tools to put patients at Wyoming's remote locations in touch with doctors and nurses in larger communities.

Until recently, Department of Veterans Affairs patients in Albany County had to drive over an 8,540-foot summit on Interstate 80 for checkups or follow-up treatment at the VA hospital in Cheyenne. The weather is chancy in winter, and they often missed their appointments.

Now the patient from Centennial or Rock River can make a short drive into Laramie and sit at a computer screen at the county's public health office. The patient has a nurse with him and they can talk to his doctor, who is in Cheyenne. Patient and doctor can see each other, and a stethoscope is hooked up so the doctor can hear the patient's heart.

"This is the way to go for VA, since you don't have hospitals in every town," said Diana Esteve, Albany County public health director.

"The more we can avoid having patients, or our doctors and nurses, get on the interstate, the safer it is and the more efficient it is," said Andy Ruben, public affairs director for the VA Medical Center in Cheyenne. "Telemedicine will be a very important aspect of how we deliver health care in Wyoming."

Isolated professionals

Karen Outzs, an assistant professor in the University of Wyoming School of Nursing, supervises a computer-based program giving small-town doctors improved access to medical information.

"Professionals in this state are as isolated as the communities they practice in," Gantenbein said.

Ordinarily, these doctors can find references to journal articles that might help them, but in order to find out they have to order copies of the articles.

"Providers are not going to pay $11 for an article" that might or might not be helpful, Outzs said. "It just isn't going to happen."

The telehealth project, still in the planning stage, is designed to provide a database where doctors can search for the specific information they need.

There are other projects - disability evaluations for Medicaid, a psychiatric program with the Wyoming Behavioral Institute, work with the Wyoming Comprehensive Cancer Control Consortium, and more.

However, Gantenbein cautioned, "One thing we are not planning is a state network for telehealth. A million and a half bucks just won't go that far."

This brought up another issue: "One of the biggest problems for telehealth is that you get grants, and when the grants run out the projects go away. We don't want that to happen," Gantenbein said.

The Wyoming program received its funding a year and a half ago. Most similar programs are centered on medical schools. Wyoming doesn't have one. So Gantenbein and his group modeled their proposal to some extent on that of Idaho, which doesn't have a college of medicine either, although Idaho State University is asking its state board of education to authorize one.

Susie Pouliot, interim director of the Wyoming Medical Society, said the society has been promoting telemedicine for several years, and "it's a wonderful thing that the state has been able to get this grant to implement specific projects."

"Right now in our rural state I think our physicians are very supportive of anything that can expand patient's access to care," Pouliot said. "We are just starting down this road, but I see the potential as really quite huge."

Gantenbein, asked if he had encountered any resistance among health professionals, replied, "I would not say that we encountered resistance as much as we found reluctance. People seem to think this is interesting, but it is difficult to try to change the way people do things."

Electronic links

Fran Cadez, a lawyer with experience in medical legal issues who heads the Office of Telemedicine in the Wyoming Department of Health, said that when she first came to Wyoming, "all I heard was the dearth of psychiatrists and the lack of mental health services."

Her office, working with the VA, is developing a system to electronically link community mental health centers along I-80 from Cheyenne to Evanston.

In partnership with the state Medicaid office, a commercial machine called Health Buddy, made by McKesson, is being employed that asks chronically ill patients, "How do you feel today?" and goes on from there to "What have you done? What is your weight?" and so on.

"The answers are transmitted to a nurse, a case adviser who can intervene over a telephone line, rather than the patient going to the emergency room, when immediate assistance is needed," Cadez said.

Gantenbein said he has been contacted by the Social Security Administration about evaluating disability claims from a distance instead of sending counselors to meet with the claimants.

"The problem is they not only have to travel to Laramie or Rock Springs, but if the client doesn't show up, they don't get paid," he said. "We're trying to use technology to make it easier and less expensive."

As oncologists in Wyoming are widely scattered, there is little opportunity for them to get together and exchange information as they would do at a large hospital. The cancer specialists approached the telemedicine office, and details are being worked out for a radio conference network over which they could get together once a month.

"We believe telehealth is the future of health care," Gantenbein said. "It is certainly the way that health care in rural states is going to have to go. What we will do is find ways so that eventually Wyoming can keep it in some form or other."

Star-Tribune correspondent W. Dale Nelson can be reached at wdnelson@bresnan.net.