Telehealth in Rural Care Settings

by | Aug 16, 2022 | Blog, Telehealth

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In 2020 there were 46 million U.S. residents – 14% of the U.S. population –  living in rural areas. While healthcare across the country could be improved, rural healthcare faces some unique and exacerbated challenges. Even before the COVID-19 pandemic began, it was difficult to recruit and retain all types of clinicians in rural health, with many organizations relying on locum tenens physicians and nurses. However, these shortages have gotten worse. Over 60% of areas designated as primary care shortage areas are in rural parts of the country.  Rural areas also see shortages in specialists. For example, only 6% of all OB/GYNs serve rural communities, even though 14% of the population resides there. 

Residents in rural areas face other obstacles beyond clinician shortages. People in rural areas are older, poorer, and less likely to have health insurance than their urban counterparts. As of March 2022, COVID-19 case and mortality rates were higher in rural areas compared to metropolitan areas. Rural residents also have less access to care facilities. A 2018 Pew Research Center study found that on average, it takes 17 minutes for those in rural communities to drive to the closest hospital, which is nearly 65% longer than those in urban communities. For those in rural communities above the 75th percentile, it takes an average of 34 minutes to drive to the nearest hospital. Even when residents can get appointments, transportation becomes an issue. With limited transportation options, residents may struggle to get a ride to their appointment. 

Telehealth As A Solution

Telehealth has the potential to greatly improve care in rural areas. In the last few years, telehealth has been rapidly adopted across the country. In 2021, telehealth utilization levels stabilized at 38 times higher than before the pandemic. And consumers want telehealth to stay. A McKinsey study found that about 40% of respondents said they want to continue using telehealth services, while 40-60% said they are interested in more virtual care solutions beyond video conferences. Telehealth is convenient, and research supports that for specific uses and patient populations, clinical outcomes with telehealth are as good or better than care as usual. And new tech is constantly being developed to continue improving telehealth, such as remote patient monitoring devices and real-time collaborative patient charts

How can telehealth help in rural areas? Telehealth can allow residents to talk with a clinician from their own home, removing barriers with transportation. Telehealth can also give rural residents access to specialist physicians that may live hundreds of miles away. Even at hospitals or primary care clinics, telehealth can allow a clinician to consult with a specialist that lives hours away to get an expert opinion. 

Broadband Disparities

While telehealth may seem like the obvious solution to many of the problems in rural healthcare, there is one big barrier to implementing telehealth services across rural areas: lack of access to broadband internet. It’s estimated that around 42 million Americans lack access to broadband internet. Even if people have access to some type of internet, that does not mean that it is sufficient for telehealth services. In 2018, approximately 22.3% of rural residents and 27.7% of Americans in tribal areas did not have access to broadband internet that met the minimum speed benchmark set by the Federal Communication Commission. This can make telehealth video calls unfeasible, often requiring patients to instead go to a physical office. Expanding telehealth could be great, but giving access only to patients with internet access perpetuates inequities. 

Recently, steps have been taken to address internet access across the country. In spring of 2022, the Biden-Harris Administration announced a plan, with funding, to bring broadband internet to all Americans. This is a great step towards making telehealth available to everyone. What other SDOH barriers need to be addressed to make telehealth more accessible? 

Addressing Challenges Telehealth Providers Face

In addition to addressing broadband disparities that many patients face, it is important for organizations to address challenges that the clinicians providing telehealth services deal with. For telehealth providers, communication can be a challenge, especially if the provider is in a remote location away from the other members of the care team. Interoperability issues make it difficult to communicate with team members that use a different EHR. Providers may need to resort to insecure communication methods, like texting, to collaborate. Even when they use the same EHR, clinicians are not able to see the little notes that other clinicians write throughout the day, but instead only see the finalized note. This means that the entire care team is not seeing the most updated information, which can impact how they care for the patient. 

CareAlign allows telehealth providers to collaborate in real-time with other clinicians, even when they are thousands of miles apart. And because CareAlign is device-agnostic, it doesn’t matter if clinicians use different EHRs. These collaborative features are why telemedicine provider RemoteMDER recently chose CareAlign to improve collaboration of their providers with remote skilled nursing facilities. Learn more here