Joyce Dalley approached the shiny, imposing kiosk cautiously. Some uninformed passerby might have mistaken it for a supersized photo booth, but the 78-year-old resident of the small rural town of Rockdale, an hour northeast of Austin, had attended several community meetings ahead of its installation in neighboring Cameron last month. She worried that her relative lack of technological savvy would prove an impediment to making much use of this newfangled device that promised to change the way folks in Milam County accessed health care. But once she stepped inside and the glass door of the kiosk—11 feet long, 9 feet tall, 7.5 feet wide—closed behind her, she was surprised at how easy the rest came.

Before her, embedded in one wall of the telehealth station was a large touch screen. Near the top of the screen was an image from a thermal camera that showed the heat emanating from her body, useful in determining whether she was running a fever. Next to that was a square ready to display her weight once she stepped onto the scale built into the center of the floor. From the ceiling above her hung a stethoscope and a handheld camera that could be lowered for closer visual examinations. And in two places near the center of the screen was a sketch of a hand next to the words “Start. Touch to Begin.”

Seconds after clicking the button, Dalley was connected on a video call with a nursing assistant, and then shortly after with a nurse practitioner more than a thousand miles away, at the Tampa headquarters of OnMed, the telehealth company that had invented and patented the technology. The clinician used the booth’s instrumentation to measure Dalley’s weight, height, and blood pressure, and they discussed her history of hypertension. Dalley learned that should she ever urgently need a supply of the medication that her primary care physician prescribes, the booth’s attached dispensary could provide it.

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“I was laughing so hard, just because it’s such a new thing,” she says of her first encounter with this new technology that promises to fill a health care gap in many rural areas of the state. “I go to Florida for the beach and fun, and it’s funny to think of somebody in Florida taking care of my health issues.”

The kiosk in Cameron is only the second deployment of OnMed’s telehealth station in the United States, and it’s the first in a rural setting. Texas A&M researchers paid for the kiosk to be installed in Milam County to test whether it can be a solution to the dearth of medical clinics and physicians in the county and other rural parts of the state. The kiosk’s medical equipment is capable of taking respiratory, blood oxygen saturation, and other vital readings, and its dispensary is stocked with the most common antibiotics, as well as blood pressure and diabetes medications and over-the-counter drugs. After each patient’s visit is finished, an ultraviolet light sanitizes all of the surfaces, which are all reflective, ensuring that every nook and cranny gets exposed.

Ever since Milam County’s two hospitals abruptly closed in late 2018, the area hasn’t had accessible medical care outside the regular business hours of its few primary-care clinics. There are no urgent care centers or emergency rooms remaining, so residents often must drive up to an hour, to Temple, Round Rock, or College Station, when they are ill and their needs are greatest.

Rural communities throughout Texas face similar challenges. According to the Texas Organization of Rural & Community Hospitals, 26 Texas rural hospitals have closed in the last decade. Thirty-five counties have no physicians at all, and many more lack specialists. This crisis led Blue Cross Blue Shield of Texas to grant $10 million to A&M in 2018 for the pursuit of “moonshot” solutions to address the unmet health care needs of the state’s rural population. The introduction of the $200,000 OnMed station is among the first projects it funded. “These innovations are supposed to be disruptors to rural health care. It’s supposed to be something nobody has seen before,” says Joy Alonzo, an A&M professor and the lead researcher on the Cameron project.

Milam County will get to keep its telehealth station for at least two years, during which A&M will monitor its use. Until early September, the kiosk’s open by appointment only, but soon it will be available for unscheduled public use between 6 a.m. and 6 p.m., and eventually around the clock. Patients with or without insurance will be charged between $45 and $65 per consultation, a relatively low cost made possible by the reduced overhead of the station as compared with a typical doctor’s office. (A visit to a typical urgent-care or ER for even a minor ailment might run hundreds or thousands of dollars.)

telemedicine-kiosk-milam-county-1

OnMed CEO Austin White explaining the station to a group of local officials.

Courtesy of Catalyst Communications Group

OnMed had planned to have five other stations deployed by now, at major airports, university campuses (including Texas A&M), and a convention center, but those contracts were delayed by the pandemic. Still, CEO Austin White expects as many as fifteen to be in operation by the end of this year. The company is working with two other universities, Auburn and Tuskegee, in placing stations in rural settings in Alabama as well.

Alonzo is already looking to place telehealth stations elsewhere in rural Texas, like Brewster County in the Big Bend region, which has no doctors for its fewer than 10,000 residents. “So there we’re trying to figure out, can we place one of these stations and have maybe an itinerant clinician drive through once a month?” she says. “In addition to what we’re using it for in Milam County—the urgent care and overnight care.”

Before expansion, what remains to be seen is how Milam County residents will embrace the technology. As in many rural places, the area’s population skews much older than the state of Texas as a whole, and Dalley worries that the oldest residents will be reluctant to give the telehealth kiosk a try. Whether the elderly, in particular, adopt the technology will likely prove key in the county government’s decision whether to take over funding of the OnMed station once A&M’s research is complete or to let the project go.

Michelle Morgan, the county’s economic development coordinator, is optimistic that many will use the kiosk, judging from the early demonstrations she’s helped set up. So far, more than 120 patients have used the kiosk since it opened July 7. “Every single person that’s gone through it has just raved about it,” Morgan says. “They can’t wait to be able to bring their elderly father there to use it. They can’t wait to bring their children there so they don’t have to drive 45 minutes to an urgent care center to sit in waiting rooms with other sick people for two to six hours and then pay those atrocious ER or urgent-care billings.”

Dalley, too, is working hard to promote it to her neighbors. She doesn’t want to risk losing this new avenue of health care access for the community. I would like everybody just to see it, to experience it, to learn firsthand what it is,” she says. “Because I think rather than have that closed mind, let’s see what we have. Let’s see what our opportunities are.”