With the trend of remote working on the rise and telehealth becoming increasingly significant, high-speed internet has become a fundamental necessity for every community. Despite these advancements, rural Americans are being left behind. According to the Federal Communications Commission, around 17% of rural Americans lack broadband access as of 2019, the most recent data available. Urban Americans without broadband access is in the low single digits. As such, the absence of high-speed internet directly affects the implementation of telehealth in rural areas.
Even more concerning is the fact that rural communities in the U.S. are facing a shortage of healthcare professionals. It is estimated that 4,000 additional primary care practitioners are needed to meet the needs of rural communities. Rural Americans often need to travel long distances to access specialty care in person, but travel is not an option for everyone, leading to delayed care and poor health outcomes. Rural Americans also have higher rates of death, disability, and chronic disease than urban Americans, and are twice as likely to die from COVID-19 infections.
Fortunately, increased broadband access in outlying areas can help patients get the care they need and close the accessibility gap thanks to telehealth for rural communities. As these solutions gain traction, it is now more important than ever to ensure that telehealth options and increased broadband capabilities are implemented as we work to improve rural healthcare.
How Telehealth Solutions Are Closing the Accessibility Gap
Telehealth solutions are already closing the gap in healthcare access for rural citizens in several ways. For example, the technology used in telehealth has improved in recent years, with increased integrations between platforms, medical devices, and EMRs. The platforms themselves have never been more user-friendly. These advancements make it easier and more accessible for patients and providers to use telehealth services.
Furthermore, scalable solutions have provided a greater variety of services. The range of telehealth services available has expanded in recent years, with technology that addresses multiple specialties under a single platform. This also includes more widespread coverage. As telehealth solutions and services have expanded, so have insurance coverage options. These improvements make telehealth a more cost-effective solution for many patients for the right use cases.
There have been several regulatory changes in recent years that have made it easier for healthcare providers to offer telehealth services, such as temporary waivers on certain requirements. All these improvements in technology, insurance, and increased telehealth service offerings have worked together to create more accessible health solutions than ever before.
By Bill Thomson, vice president of marketing and product manager, DC BLOX.
In South Carolina, many residents are plagued by the unavailability of high-speed broadband connections. Despite 91.5% of the state’s residents having the ability to access wired connection speeds of up to 25 Mbps, 344,000 do not have a broadband connection that supports these speeds, while another 171,000 lack access completely.
To further this issue, many South Carolina residents have no choice when it comes to their broadband provider. In the state, 116 broadband providers operate yet more than half a million South Carolinians have only one option available, limiting competitive choices. The problem is much worse when you consider that even 25 Mbps, the speed that the FCC considers to be broadband, is too slow to support many of today’s applications.
Without reliable high-speed connectivity, healthcare facilities are unable to transport large diagnostic images, students are unable to access their education online, and businesses are unable to leverage cloud services for best-in-class solutions. These gaps place rural communities at a distinct disadvantage compared to metropolitan and suburban communities. As the public health crisis continues to evolve, these obstacles are amplified as remote work remains the norm for many companies and virtual learning is required for many students.
While access to the internet for educational and business purposes is essential, perhaps even more important is meeting the healthcare needs of rural communities. Across the country, there have been 138 closures of rural hospitals since 2010, including four in South Carolina. These hospitals play an essential role in the community, especially during the COVID-19 pandemic, to deliver necessary medical services. As it becomes more difficult for rural Americans to access healthcare locally, many will turn to telehealth for routine care. Without access to high-speed broadband services, it makes it nearly impossible to access much-needed healthcare services.
Additionally, as the public health crisis continues to bring uncertainty to communities across the United States, a portion of South Carolina schools continue to operate under either fully remote or hybrid classroom environments. If students at these schools are unable to access course materials because they don’t have the same broadband access as their urban and suburban counterparts, they are at a severe disadvantage.
What is needed to address the challenges of rural communities is digital infrastructure. High-speed fiber-optic networks need to be laid within the rural communities, and then those local networks need to be connected to the Internet through local peering points and to other service providers to gain access to a variety of digital services.
Companies like DC BLOX are currently building digital infrastructure in regions that have been traditionally underserved. Cities like Greenville South Carolina and Birmingham Alabama are benefitting from state-of-the-art data centers and network exchanges that facilitate data connectivity for entities in their areas. For rural communities nearby, electric cooperatives are often taking on the responsibility to deploy broadband services. With robust digital infrastructure in the vicinity, cooperatives can partner with these providers to accelerate their broadband projects and improve the reliability of their services.
Through these initiatives, as well as the potential infrastructure investments from the federal government, bringing broadband access to underserved communities is accelerating. People will be able to access needed medical care and educational resources, and businesses will be able to grow. In the end, everyone benefits when these communities become connected and the digital divide is closed.
By Rahul Varshneya, founder and president, Arkenea.
Rural communities, often located amid isolated yet beautiful landscapes, are a defining feature of much of the United States of America. But those same landscapes can, at times, make it arduous for people to gain access to something as basic as a healthcare facility.
In these regions, patients are often tens of hundreds of miles from the location of their nearest caregiver. Community hospitals, with limited budgets and low volumes, generally don’t have specialists. And even if they do, there are too few to ensure constant coverage.
Telehealth is transforming these situations to everyone’s advantage.
A recent study of Intermountain’s neonatal telehealth program evaluated the effect of video-assisted resuscitation on the transfer of newborns from eight community hospitals to newborn ICUs in Level 3 trauma centers. The service produced a 29.4% reduction in a newborn’s odds of being transferred, which corresponds annually to 67 fewer transfers — and estimated savings of $1.2 million for affected families.
By leveraging telehealth, patients can receive expert treatment locally without the added cost and risk of transfer to a bigger hospital. Local hospitals retain vital revenue and ameliorate their services. Community members get better care that’s based on evidence-based best practices. Health care is far better overall.
1) Bringing Patients and Care Providers Closer for Better Outcomes
Most patients in the rural or suburban settings of the southwest, like the ones living in the remote terrains of Nevada, lack the necessary resources to travel to a healthcare facility.
Even for patients living in the urban areas, public transportation can be grueling and tedious. Less mobile or older patients might also not always have family or acquaintances who can be their caretaker and take them for frequent clinical visits.
Telemedicine can help such patients feel more independent. One study found that the use of a specific home-telemedicine strategy for care coordination improved functional independence in non-institutionalized veterans with chronic conditions.
Not only does telemedicine adoption help patients manage their conditions, it is equally beneficial for healthcare providers too.
Hospitals, clinics, public health offices and private practice healthcare providers in the southwest have been receiving free technical assistance for implementing or expanding their current telemedicine programs from various government authorities for quite some time now.
Since laws governing telehealth and reimbursement greatly differ by state, various Telehealth Research Centers (TRCs) spread across the country help providers discover the latest telemedicine and telehealth laws and regulations that apply in the state where the provider’s practice is based.
TRCs are also helping providers – generally free of charge – in developing a business model for telehealth in their healthcare setting, selecting the appropriate telemedicine platform as well as equipment, and providing education to patients alike on how to leverage telemedicine technologies to improve health outcomes and access to healthcare services.
What do you envision when you think of rural living? Chances are, images of pastoral fields, idyllic red barns, and even herds of dairy cows come to mind.
While such a vision is a reality for at least some of the 60 million Americans who live in rural areas — sparsely populated regions confusingly described by the U.S. Census Bureau as “not urban” — living in a rural area has its downsides when it comes to healthcare.
Lack of access to high-quality, affordable healthcare providers plagues rural America. One main reason is that hospitals located in low-population regions face significant financial struggles. According to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill, 132 rural hospitals shuttered their doors since 2010, leaving many Americans with fewer care options.
Unsurprisingly, COVID-19 has only accelerated rural hospital financial hardship, potentially making in-person office visits even more of a herculean challenge.
Technological innovations, including in-app communication and HIPAA compliance, enable telemedicine to become a must-needed lifeline for rural communities requiring medical care and guidance. In short, tech is shifting the healthcare landscape for the better.
Distance Connecting
Rural Americans have the longest commute to visit a hospital compared with people who live in suburban or urban regions. According to Pew Research Center’s analysis, those who live in rural areas must travel an average of 10.5 miles to reach a hospital — 139% greater than those who live in urban areas and have ready access to healthcare facilities.
Telemedicine, defined as the practice of using technology to deliver care at a distance, is mitigating and sometimes wholly eliminating long travel times required to visit a rural healthcare facility. Via the use of HIPAA-compatible live chats, video meetings, and phone calls, people living in sparsely populated areas receive quality care and guidance from the comfort of their homes.
By Troy Corley, executive vice president of service delivery, Proactive MD.
Troy Corley
In an ideal world, individuals would be able to access health care services in a quick and convenient manner — regardless of where they live. However, entirely too many residents in rural areas face a variety of barriers to access, limiting their ability to obtain the health care they need.
For many patients living in rural areas, having to drive for more than an hour just to see the nearest primary care practitioner is entirely too common. Because of this and other barriers, patients are generally not equipped to be proactive and preventive with their health due to the significant investment required to receive basic care.
Making matters worse, rural patients often face traditionally higher rates of poverty and are less likely to have health insurance than their urban counterparts. These economic challenges, in combination with higher rates of underlying chronic disease, make rural patients more likely than city dwellers to face poor health outcomes and suffer complications from heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke.
Today, about 60 million Americans, or nearly 20% of the U.S. population, live in Census-defined rural areas. And with the U.S. Department of Health and Human Services reporting only 39.8 primary care physicians are available per 100,000 people in rural populations, the gap in care between rural and urban Americans is only growing wider. The provider shortage — coupled with increased transportation challenges, social inequities, and the additional access barriers brought about by COVID-19 — makes physical access to care extremely difficult for many rural communities.
The Rise of Telehealth
While the current pandemic has forced the U.S. health care system to face numerous challenges, it has catalyzed the rapid adoption of telehealth services to safely deliver care at a distance.
As patients embrace this digital transformation, health care providers are beginning to look outside of their traditional base to reach new patients in unexpected locales. Employing telehealth services reduces access barriers for patients in rural areas, allowing them to receive basic care regardless of how far they live from a physician’s office.
By Dr. Donald Voltz and Eric Tran, master of science in microbiology and immunology, School of Medicine, Tulane University, New Orleans, LA.
The COVID-19 virus is ravaging the planet at a scale not seen since the infamous Spanish Flu of the early 1900s, inflicting immense devastation as the U.S. loses more than 200,000 lives and counting.
According to CDC statistics, 94% of patient mortalities associated with COVID-19 were simultaneously suffering from preexisting conditions, leaving a mere 6% of victims with COVID-19 as their sole cause of death. However, while immediate prospects for a mass vaccine might not be until 2021, there is some hope.
The fact that four in ten U.S. adults have two or more chronic conditions indicates that our most vulnerable members of the population are also the ones at the greatest risk of succumbing to the pandemic.
Healthcare providers must pay close attention to patients harboring one of 13 chronic conditions believed to play major roles in COVID-19 mortality, particularly chronic kidney disease, hypertension, diabetes, and COPD.
Rural populations are some of the most vulnerable and must be supervised due to their unique challenges. The CDC indicates 80% of older adults in remote regions have at least one chronic disease with 77% having at least two chronic diseases, significantly increasing COVID-19 mortality rates compared to their urban counterparts.
Health behaviors also play a role in rural patients who have decreased access to healthy food and physical activity while simultaneously suffering high incidences of smoking. These lifestyle choices compound with one another, leading to increased obesity, hypertension, and many other chronic illnesses. Overall, rural patients that fall ill to COVID-19 are more likely to suffer worsened prognosis compared to urban hubs, a problem only bolstered by their inability to properly access healthcare.
The recent global medical crisis forced people into isolation and even quarantine environments. It also revealed weaknesses in such areas as medical translation and interpretation services that were previously viewed more as a matter of convenience rather than as an absolute necessity.
There is talk today of an imminent second wave of the Coronavirus crisis and further lock-downs and more extensive isolation being put in place to stem the spread of the virus. Is the telehealth industry ready for a new wave? What weaknesses in remote health care remain to be addressed? What does the future of telehealth hold to help not only in times of crisis but in everyday life?
Remote Healthcare, Telehealth, and Medical Interpretation Services
There was a time in the not-so-distant past, and even to this day in many cases, where medical interpretation services are seen as more of a nuisance than they are a real benefit. In the United States, this is especially common with Spanish interpretation but remains a common occurrence that can be effectively resolved with remote medical interpreters and other telehealth solutions. The role of remote medical interpreters should increase in use and importance in the world of telehealth and telemedicine.
The role of the medical interpreter can be exceptionally challenging, especially given the lack of specific knowledge regarding medical terminology. In lieu of a more pleasant sampling, the example here will focus on the specificity of relevant medical terminology that is especially important given the nature of the coronavirus pandemic.
When individuals are gathered in a more informal conversation regarding colds, cases of flu and COVID-19, they may refer to a more generic word like “spit.” In reality, this is not so much a medical term as phlegm, saliva, and mucus, all three of which have a more specific medical meaning, and all three of which are very relevant to a proper diagnosis and treatment, most notably in terms of any potential respiratory disorders such as those produced by the Coronavirus family.
Any time when someone who is not a professional or certified medical interpreter is used, there is an increased risk that the precise medical meaning of the term may not be fully understood in either language, and the incorrect translation will result in a misdiagnosis.
Struggling rural hospitals face financial pain amidst the coronavirus outbreak. Revenue has been lost as elective procedures have been canceled since patients can’t safely visit in person for fear of being infected or spreading the disease. As a result, rural communities may lose access to critical care as the pandemic progresses.
Rural residents hurt
The financial and operational pressures on rural healthcare facilities can leave patients who are displaying COVID-19 symptoms or require ongoing care for chronic conditions with limited access to critical care, especially considering many rural residents live more than 30 miles away from the nearest hospital. Plus, rural populations are often more vulnerable to severe to serious outcomes with COVID-19. Compared to urban populations, rural Americans:
Are older: More than 20% of the population in completely rural counties are ages 65+, according to U.S. census data, compared to around 15% in mostly urban centers.
Have higher rates of: obesity, diabetes, high blood pressure, and cigarette smoking
Have increased mortality rates from: heart disease, cancer, lower respiratory disease, stroke, and unintentional injuries.
Technology must be used to solve the problem
Mobile, Alabama-based healthcare technology company CPSI understands the challenges facing rural hospitals and clinics, so the company is providing a free telehealth portal so doctors can continue to provide quality care.
While telehealth regulations were quickly changed amidst COVID-19, allowing providers to be reimbursed at $220 per remote appointment instead of at $13, telemedicine is not a reality for cash-strapped rural hospitals that:
Lack the technological infrastructure and resources required to implement telemedicine
Require a highly secure, HIPAA-compliant platform (Zoom, Skype, Microsoft Teams are not secure options)
Need a platform that operates smoothly on low-bandwidth connectivity, common in rural areas
Treat patients who don’t have computers or webcam capabilities
Rural hospitals need an affordable, secure, easy-to-use telehealth platform that can be set up in hours, not months, to give their patients quality care while allowing them to tap into a desperately needed revenue stream that could help them stay afloat. They need CPSI’s turnkey telehealth solution: Talk With Your Doc.
