A telemedicine home healthcare project, "Rural Health Care Through Telemedicine: An Interdisciplinary Approach" has been funded by the United States Office for the Advancement of Telehealth through the University of Tennessee Medical Center Telemedicine Network in order to improve access to quality health services for the rural residents of Grainger County, Tennessee.

Grainger County has a population of about 19,000 and no hospital. Primary medical care is provided by four clinics with three full-time and two part-time physicians. The patient to physician ratio is 4667:1, which is ten times the ratio for Tennessee and the United States. One of the clinics has had 18 physicians in 22 years, which graphically illustrates the problem of retaining health care professionals in isolated rural areas.

The geography of the area makes it difficult for people to go from their homes to medical care or for medical care to come to them. The Clinch Mountain, in the foothillls of the Appalachian Mountains, along with the Tennessee Valley Authority lake system, creates geographical barriers to health care delivery. There is severely limited road access, no public transportation, no taxi service, and long travel times within much of the county to the clinics.

For emergency care, the county has only three ambulances and no 911 service. Clinch Mountain divides the county, and, from 7:00 PM to 7:00 AM, there is no ambulance service north of the mountain which has an elevation of 2,200 feet.

The focus of the telemedicine project is to improve access to quality health services and to reduce the isolation of rural health care professionals in Grainger County. During this three year project, each of the four clinics will be provided with interactive audio-video telemedicine equipment and training for its use in patient consultations. This will enable a primary care physician in one of the rural clinics to examine a patient in another. In addition, the clinic patients will have access to consultations with specialist physicians at UT Medical Center in Knoxville.

To improve emergency care, the county-owned EMS service is being equipped with digital EKG units which can transmit 12-lead EKG data from a patient to a clinic physician or the UT Medical Center Emergency Department via cellular telephone. The EMS staff have been trained on equipment use and procedures.

To support rural home healthcare patients, Home Touch ™ interactive audio/video equipment is being provided to selected home care patients. Patients are able to communicate with healthcare providers using a small video camera with tripod and monitor and videophone connected to a standard electric outlet and telephone line.