Expanding the Horizon—Telemedicine’s Implications for Rural Health Care 

“It’s pretty simple math,” my dad said when I asked him what he thinks about telemedicine (which most agree can be used interchangeably with the word “telehealth”). As a pediatrician who started his career in rural India and now practices in Southern California, he’s seen a huge spectrum of problems and solutions. He explains this set-up:

A specialist goes off site once a month to a rural clinic about 3 hours away. She drives out, sees patients back-to-back for 2 or 3 hours before turning around for the drive back. Instead, what if four trained healthcare professionals drove out to four different sites? Our physician, at one of those sites, or from the comfort of home base, spends two hours at each site—virtually– checking in on patients and advising the trained health care professional on how to proceed. Four times the patients benefit from her expertise, in the same amount of time. Pretty simple math. A survey conducted by the Bureau of Labor Statistics and the US Census Bureau and the Rural Broadband Association estimates that as of 2017, a hospital in North Carolina might expect to save over $20,000 annually through telehealth use. That’s a nice number too.

Current North Carolina State Law defines telemedicine or telehealth as “the use of two-way real-time interactive audio and video between places of lesser and greater medical capability or expertise to provide and support health care, when distance separates participants who are in different geographical locations” (NC General Statute 130A-125).

Telemedicine is game-changing for patients and providers alike, particularly in rural communities where the nearest services are not always so near. A variety of forms of practice can facilitate quality remote consulting. Using store and forward practices can allow a patient to snap a picture of a rash to the dermatologist who can assess severity and call next steps without having a face-to-face meeting. Remote patient monitoring allows data to be collected regularly from the convenience of home, and can facilitate more thorough tracking and early recognition of complications. The transmission of high quality x-rays and EEGs can allow for easier transfer of care. And in the age of smartphones, mHealth (mobile health)  is enabling patients of all ages to take an active role in their health through applications right at their fingertips. In this sense, telemedicine has the ability to, quite literally, can broaden the horizons of patient care.

It’s certainly not a new concept—my dad remembers helping start push the idea in Kansas twenty-five years ago—but it has come leaps and bounds in the past couple of decades in terms of technology and ubiquity. The Kaiser Family Foundation notes that results from interviews with 2,000+ human resource and benefits managers show that over half of firms with 50 or more workers and who offer health benefits do include telemedicine in their largest health plans. About a quarter of these actually provide a financial incentive for the use of telemedicine. A 2017 Statista survey revealed that almost  90% of U.S. adults would be willing to use email, online web, text messages, mobile health applications, or online chat to communicate with their healthcare provider. 

 

Regulation of telehealth practices are, at this point, negotiated at the state level of jurisdiction. Upon the direction of the North Carolina General Assembly, the NC Department of Health and Human Services provided recommendations and rationale on key parameters surrounding the practice of telemedicine in our state. Notably, they highlighted two key opportunities of substantial growth: 1) to require Medicaid Managed Care Organizations to incorporate telemedicine into their payment methods and allow interstate licensure compacts to help better reach underserved areas, and 2) to expand the broadband network.  We are eager to follow progress on these two fronts in the upcoming months. The work of the Foundation’s programs intersects with telemedicine in several evolving fields—tele dentistry and tele psychiatry, an understanding of the intricacies of delivery and payment models that need to be in place, and recognizing that advocating for healthcare means knowing both the barriers and solutions that telemedicine presents.

Telehealth holds the hope of solving some one of the greatest barriers to health faced by rural, remote communities: access. However, increased access shouldn’t mean decreased quality of care or replacement of the traditional patient-provider interaction. As the DHHS outlines in their vision of the scope of telemedicine, it “is not a service in itself; it is a modality for providing the service”, effectively granting it the flexibility to evolve with a changing field, and subject to the same credibility and rigor as all medical practice. Telemedicine has a place within our medical system, one that is slowly becoming clearer. Nevertheless, there’s a learning curve for any new modality. As an organization that supports innovation and the removal of barriers to care, we’re proud that our programs are at the heart of understanding and defining telemedicine in North Carolina.

Sources: NC Department of Health and Human Services, NC Health News, Center for Connected Health Policy, Statista (links to surveys above), Kaiser Family Foundation  , Dr. Gurbani 🙂