One of the first things Rachel Lescher does when she arrives at work is get online.

She's not starting her day by scrolling through social media posts or deleting junk mail. She's determining which rural Alaska clinics she needs to video call to meet with her patients.

Lescher is a pediatric endocrinologist for Alaska Native Medical Center — the only one in the whole Alaska Tribal Health System — and she sees about a third of her 900 patients each year from the computer screen in her office.

"We wanted to be able to do telemedicine because Alaska is so giant and it was hard for patients to come in from all over to see us," Lescher said.

Having all of her patients fly in for appointments that were often no more than an hour long was costly — both in money and in time, particularly for families who have to take several flights to get to Anchorage.

"For families from rural villages, those appointments mean getting plane tickets, a hotel room, meal vouchers, taxis, and missing work and school," Lescher said. "Whereas with the telemedicine appointments, we can see them on the video screen from their local clinic and be back at school the same day. It's a better service for families."

On the other end of the video call, with the patient, is a health aide or nurse who helps facilitate the appointment, keeping everyone on the same page when reviewing medications and prescriptions, performing any hands-on work (checking blood pressure, weight and temperature) and acting as a cultural interpreter for Lescher.

"The aide helps interpret if what I'm saying isn't going to work in their village for whatever reason," Lescher said.

It's also helpful for parents who simply don't have the time during certain seasons — whether that's due to gathering subsistence food or seasonal work — to come down to Anchorage for a visit or who aren't able to come to the regional hubs like Fairbanks, Nome, Sitka and Bethel when Lescher is there on her statewide rounds.

"Before telemedicine, it wasn't feasible for everybody to come to Anchorage every three months and if I wasn't going to their specific regional hub, then we were seeing them less frequently than the standard of care," Lescher said. "But most people can pop into their clinic for a video call, so now we're able to provide them that care."

Lescher isn't the only ANMC doctor practicing telemedicine, though. She said the hospital's speech pathology department often does weekly appointments with its patients from around the state. Other specialties use it for a variety of reasons.

Lescher's patients and families say the biggest benefit is that all of a child's caregivers can attend the local video call visits, whereas when the child needs to go to Anchorage for appointments, only one caregiver can act as escort.

Not all appointments are done via telemedicine, however. Lescher said every other or every few appointments are done at ANMC, depending on the patient's needs. The telemedicine appointments are more for providing education, reviewing prescriptions and checking symptoms — things Lescher can do from miles away.

Even diseases like congenital adrenal hyperplasia — a disease that affects a patient's adrenal glands and requires medication three times a day — can be managed over video.

"We can do medication management, get a good pictures of their growth and weight gain and provide specific instructions to keep those kids healthy," Lescher said. "I can provide that to the family and their health aide. And really, that saves lives."

The biggest challenges of telemedicine, Lescher said, are internet connectivity and educating parents that although the visits are done over video, it doesn't make them any less necessary.

"We had to do a lot of education about how these are still real and important visits," Lescher said.

Part of that, Lescher said, could be because telemedicine is so new, not just to Alaska, but the United States as a whole.

"This is really groundbreaking," Lescher said. "When I've gone to telemedicine conferences it's clear that what we're doing here is at the forefront of what's happening in the country."

Lescher referenced one Alaska family who lives in the northern part of the state as emblematic of the kind of people who benefit from telemedicine. Their daughter was diagnosed with Type 1 diabetes at 4 years old.

"She's almost 1,000 miles away, and having her come in every three months was next to impossible," Lescher said. "She's the only kid with diabetes in her village, so being able to provide education to her family and her health aide with those frequent appointments by video has been helpful for them and me."

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This article was produced by the special content department of Alaska Dispatch News in collaboration with ANTHC. Contact the editor, Jamie Gonzales, at jgonzales@alaskadispatch.com. The ADN newsroom was not involved in its production.