Rural Health Care Hurdles: Telehealth and Telemedicine

 IN A NUTSHELL:

• Telehealth can decrease lengths of hospital stay
• Increases access to those who may not be able to travel
• Expands what types of health care services can be offered
• Vital for use during a health care crisis

A variety of issues contribute to health care complications in rural America, including a shortage of health care workers, continuing closures of hospitals, a high rate of elderly, poor, and underinsured residents, as well as a high frequency of chronic illness. In the second edition of our series on the dilemmas facing rural health care, we examine the importance of telehealth in rural areas and the hurdles impeding its use.

The Health Resources Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies that make telehealth feasible include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

Telehealth vs. Telemedicine: What’s The Difference?

Telehealth is different from telemedicine because it refers to a broader scope of remote health care services than telemedicine. In order to be defined as telemedicine,  interactive health communication must occur with a patient and clinician on both “ends” of the exchange.

While telemedicine refers specifically to remote clinical services, telehealth can refer to remote, non-clinical services, such as provider training, administrative meetings, and continuing medical education. Telehealth can also include medical devices that collect and transmit health information to manage chronic conditions, such as Smartphone apps, wearable technologies like activity trackers or blood glucose monitors, and automated reminders for prescription medications.

How Telehealth is Beneficial for Patient Care:

One of the primary obstacles involving patient access to health care in rural America is distance to hospitals and travel times in the event of a medical emergency. A study conducted by the University of Iowa and published in the journal Telemedicine and e-Health focused on 14 rural hospitals in the Midwest with emergency department telehealth programs. Researchers found that the use of telehealth technology has helped reduce emergency room wait times for patients in rural hospitals by an average of six minutes. Another benefit of telehealth which emerged from the study found that the length of stay for patients that were seen by telehealth providers prior to hospital admission was an average of 22 minutes shorter. This is due to the fact that the patient was seen by the physician providing their care within the hospital setting, prior to physically being in the hospital.

Telehealth also has the potential to expand access to more health care services which may not be accessible at a local, rural health care facility. Provider recruitment and retention, a low volume of patients, and inadequate resources are all factors that prevent a greater variety of health care services in rural America. An American Hospital Association report found that telehealth also holds great potential to address some of the patient access disparities discussed in Part One of this series that have continuously existed in rural communities, such as geographic isolation. As technology continues to improve and the notion of health care delivery via virtual connections becomes more accepted in the general population, the utilization of telehealth services will increase.

Telehealth is especially important for providing care in specialties that are not well represented in rural areas. In a recent analysis of rural Medicare beneficiaries, researchers found that nearly 80 percent of telehealth visits were related to mental health conditions. Actions are being taken at the federal level to help provide these services, as Medicare has increased its coverage of telehealth services for patients living in rural areas. In 2018, Congress further expanded coverage to include telestroke care.

How Telehealth is Beneficial for Facilities:

While patient care, access, and overall well-being should be of primary concern for rural health care systems to implement the use of telehealth technologies, it can be economically advantageous for facilities and communities alike. The NTCA Rural Broadband Association describes themselves as the “premier association representing nearly 850 independent, community-based telecommunications companies that are leading innovation in rural and small-town America.” In their Anticipating Economic Returns on Rural Telehealth report, researchers stated that hospitals could save more than $80,000 annually in states such as Texas, Oklahoma, Kansas, and Arkansas. The rural communities in these states could save an average of $40,000 a year by using telehealth technologies instead of traveling. The report stated that if residents in rural communities utilized physician services with telehealth, an average of $24,000 would be saved in travel costs and an average of $16,00 would be saved in lost wages associated with taking time off from work to travel a long distance to receive services from qualified physicians.

How Telehealth is Beneficial During a Health Crisis:

Due to the coronavirus pandemic, health care facilities across the United States and around the globe are overwhelmed. Many are facing supply shortages, staffing shortages, and health care administration is overwhelmed. Consequently, the advantages of telehealth and telemedicine are moving to the forefront. For example, Congress included $500 million for the use of telehealth services in its emergency COVID-19 aid package passed toward the beginning of March. The legislation gives $200 million to the Federal Communications Commission to help it expand telehealth services during the pandemic. The FCC Chairperson proposed part of the funding to allow eligible health care providers to purchase devices to assist with broadband connectivity.

Additionally, the federal government lifted restrictions on Medicare reimbursement for telehealth services. This immediately allowed telephone and videoconferencing between doctors and patients.

Practical applications of the new, more lenient regulations regarding telehealth and telemedicine have already been put into place for health care services treating coronavirus and COVID-19 patients. One such example is at Robert Wood Johnson University Hospital in New Jersey. According to the online publication NJ Spotlight, the facility has installed “video robots” in its pop-up tents. The devices are able to transmit a video of the patient in the tent to a physician inside the emergency room. The device is also equipped with an electronic stethoscope to monitor the patient’s breathing. After the consultation, the physician recommends if the patient should be admitted to the emergency room or if the patient should simply self-quarantine at home. This shows how telehealth is not only vital for rural America but has applications for the health care industry as a whole, especially during a time of crisis.

Hurdles for Telehealth in Rural America:

Despite the proven benefits of telehealth throughout the past decade, industry experts say that the tool has not reached the prime point of widespread acceptance in the health care industry. However, telehealth access continues to increase, and it is shown to be safe and effective. At the same time, the integration of digital health tools has grown significantly among physicians in recent years. However, more needs to occur before telehealth is simply viewed as a form of health care–first and foremost would be an increase in patient awareness.

The J.D. Power Telehealth Satisfaction Study conducted in 2019 found that a lack of access and awareness for telehealth options is the primary hurdle for widespread adaptation of the technology. The survey traced telehealth user experience and real-world patient concerns. The report found that while nearly 10% of Americans have used telehealth services, nearly 75% said they either don’t have access or are unaware of telehealth options available to them. The study found that approximately 9% of rural residents have adopted the service, compared with approximately 12% of suburban residents and 11% of urban residents.

Other hurdles that telehealth faces in rural America include:

• Restrictions on how Medicare covers and pays for telehealth
• Lack of internet connectivity and adequate connection speeds
• Licensure hurdles for health care providers across state-lines
• Equipment costs

Summary:

The tremendous benefit and potential of telehealth for rural America goes without saying. While there are undeniable goals that must be met and hurdles to overcome, applications of telehealth and telemedicine services in response to the coronavirus pandemic via in recent weeks shows that it is an achievable reality. Our final installment of the Rural Health Care Hurdles series will examine staffing shortages in rural health care facilities—a dilemma that telehealth has the potential to alleviate.   

References:

Armour, S. (2020, March 22). What You Need to Know About Telehealth During the Coronavirus Crisis. Retrieved from https://www.wsj.com/articles/what-you-need-to-know-about-telehealth-during-the-coronavirus-crisis-11584874801

Eggerton, J. (2020, March 30). Pai Circulates Plan for Spending $200 Million on COVID-19 Telehealth. Retrieved from https://www.multichannel.com/news/pai-circulates-plan-for-spending-200-million-on-covid-19-telehealth

Health IT Playbook. (n.d.). Retrieved from https://www.healthit.gov/playbook/patient-engagement/#section-5-3

Nicholas M. Mohr, Tracy Young, Karisa K. Harland, Brian Skow, Amy Wittrock, Amanda Bell, and Marcia M. Ward.Telemedicine and e-Health.Feb 2019.93-100. http://doi.org/10.1089/tmj.2018.0013

Emergency Department Telemedicine Shortens Rural Time-To-Provider and Emergency Department Transfer Times. Retrieved from https://www.liebertpub.com/doi/10.1089/tmj.2017.0262

Power, J. D. (2019, July 31). One in 10 Americans Use Telehealth, But Nearly 75% Lack Awareness or Access, J.D. Power Finds. Retrieved from https://www.prnewswire.com/news-releases/one-in-10-americans-use-telehealth-but-
nearly-75-lack-awareness-or-access-jd-power-finds-300892939.html

Rural Report: Challenges Facing Rural Communities and the Roadmap to Ensure Local Access   to High-Quality, Affordable Care. (2019).  Retrieved from https://www.aha.org/system/files/2019-02/rural-report-2019.pdf

Wagenen, J. V., BizTech, & HealthTech. (2019, May 1). Rural Connectivity Stands as One of  Telehealth’s Last Hurdles. Retrieved from https://healthtechmagazine.net/article/2018/01/rural-connectivity-stands-one-telehealths-last-hurdles

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