Chasing the horizon of rural telemedicine

By: Rural Horizons | 4/28/20

Pat Schou, Illinois Critical Access Hospital Network executive director

Decades ago, the thought of getting a suspicious mole checked via videoconferencing may have seemed farfetched. Today, telehealth and telemedicine are playing a more visible role in the delivery of health care in rural communities. Telemedicine has been used to link local practitioners and distant specialists for everything from assisting in high-risk deliveries to diagnosing skin conditions to remotely supervising chemotherapy for cancer patients.

Pat Schou, NRHA president and longtime Illinois Critical Access Hospital Network director, has advocated for telehealth as a critical tool for rural communities for decades.

“People in rural communities often must travel long distances to receive health care services,” Schou says. “This can be made worse by lack of reliable transportation or public options, difficulty leaving the home particularly for the elderly and disabled, the cost of travel, and increased downtime from work.”

Telemedicine can help alleviate these issues. A study of the University of California Davis’ telemedicine program from July 1996 to December 2013 found patients saved an average of 278 miles in driving, four hours in time, and $156 in travel costs by using interactive video-based consultations.*

“In addition, rural areas tend to have fewer health care practitioners and may lack specialty care providers,” Schou says. “Telemedicine provides the ability to connect rural practitioners and patients with outside specialists and helps expand the scope of nearby care.”

Supporting the rural health care landscape

“Telemedicine provides the opportunity to share resources, lower costs, increase access, and provide specialty services that might otherwise be unavailable,” Schou explains. Despite its efficacy, telemedicine has a way to go to gain greater acceptance. Challenges include:

• Access to technology: “There are still areas around the country where broadband coverage is inadequate,” says Schou. “We want and need equal access to broadband in rural areas. Rural providers and policymakers can apply for help to cover some of the costs.”
• Resistance: “Patients and practitioners may prefer meeting face to face,” Schou says. “But in general, people of all ages have smartphones and are more open to using technology. As time goes on, people may become more comfortable using mobile apps to communicate about health care issues.”
• Payment, liability issues, and state laws: “Not all states require insurance companies to reimburse for telemedicine,” Schou says. “In addition, we don’t have a full picture of potential legal liabilities when practitioners are texting health advice. We also need a better handle on cybersecurity and how to protect patient privacy and confidential medical records. These are all areas that need further study.”

Progress in telemedicine

Telemedicine in has been around in some form since the telephone was invented (and even earlier, if you count messengers and telegraphs carrying medical information from one place to another). Doctors could, for example, listen to a patient’s cough over the phone or explain to a caregiver how to dress a wound. As technology advanced, diagnosis and treatment became more sophisticated.

“In the 1990s, the Carle Foundation Hospital in Illinois was one of the pioneers in using videoconferencing to connect hospitals converted to critical access and has expanded to multiple service lines through the years,” Schou says. “Videoconferencing allows a visual connection, which is a great improvement over a simple phone call. However, early on it was cumbersome to set up video equipment to conduct a meeting or discuss treatment options.

“Now, programs like Zoom and Webex make it easy for providers to connect with each other online and share medical information and education,” Schou says. “They don’t have to travel as much, saving time and money. Practitioners in the ER are using technology to communicate with outside specialists for diagnosis and treatment of a wide range of conditions, such as stroke. We’ve also seen good outcomes using technology to help monitor and manage chronic diseases, such as high blood pressure, congestive heart failure, and diabetes. It’s even being used to make rounds on a routine basis through a robot in some hospitals.

“Today, with nearly everyone owning a smartphone, we’re potentially opening up new frontiers of patient engagement as well,” she adds.

Meeting a growing need for mental health services

“One of the biggest challenges for hospitals occurs when a patient comes into the emergency room in mental health distress and needs counseling and support services,” Schou says. “Many rural hospitals don’t have mental health professionals on staff.”

Non-metropolitan counties in the U.S. are more than twice as likely to lack a psychiatrist than metropolitan counties (65 percent versus 27 percent). Almost half (47 percent) of non-metropolitan counties do not have a psychologist, versus just 19 percent of metropolitan counties.**

In addition, in small, tight-knit rural communities, patients with mental health issues may be reluctant to seek help. “Consulting with a provider using a smartphone or laptop at home rather than visiting the psychologist’s office can add a level of confidentiality and comfort for the patient,” Schou says. “Patients may feel that home is a ‘safe space’ where it’s easier to discuss their issues.”

Mental heath care is one area where it is particularly important to maintain patient privacy. Providers need to ensure communications are HIPAA compliant, and in an era in which health care data security is an urgent issue, telemedicine needs to keep up. Cybersecurity is essential to prevent hackers from gaining access to personal data. According to Schou, this is one of telemedicine’s most vital frontiers.

The future of telemedicine

Greater acceptance and implementation of telemedicine will depend on increasing access and setting standards for performance and payment.

“We haven’t done a lot of quality measurements or set consistent benchmarks for performance, particularly for more complex medical issues,” Schou says. “We need to increase public awareness of the potential benefits of implementing telemedicine in rural communities. We need consistent rules for managing medical records that involve telemedicine. Finally, we need to ensure public policy is fair, with equal access for rural and urban areas, and work toward consistent payment policies and insurance coverage.

“Telemedicine has proven useful in its current applications and has the potential to be an even more powerful tool,” Schou adds. “As we create more consistent ways of applying telemedicine and address its challenges, it is sure to become a game changer for delivering quality health care to rural communities.”

* Source: “Telemedicine Saves Patients Time, Money,” UC Davis, March 21, 2017, https://www.universityofcalifornia.edu/news/ telemedicine-saves-patients-time-money.
** Source: “Geographic Variation in the Supply of Selected Behavioral Health Providers,” American Journal of Preventive Medicine, June 2018, www.ajpmonline.org.