It’s no secret that America’s healthcare system is in crisis. From a shortage of doctors and nurses, provider burnout, and of course, the rising costs and accessibility of care, there are many challenges to overcome. And, while these challenges impact all Americans, they are most keenly felt in rural America.
The rural healthcare crisis has been well documented in the media in recent months. However, while the coverage has been extensive, there has been relatively little discussion about how to actually solve this problem and not only deliver a better standard of care, but also extend the range of services available to rural communities.
To explore possible solutions, we caught up with Dr. Stephanie Lahr, Chief Information Officer and Chief Medical Information Officer at Regional Health in Rapid City, South Dakota. Both Dr. Lahr and Regional Health are leading the way when it comes to addressing the unique healthcare needs of rural communities.
The Urban-Rural Divide in Healthcare
While there is a national shortage of doctors, nurses and other medical staff, the impact of these shortages hits hardest in rural areas, shared Dr. Lahr.
“Physicians who work in rural settings may be working as an emergency room physician, an inpatient physician and as a clinic physician, and the dependence on them is much greater than in other settings,” Dr. Lahr explained. “If that one person leaves, you just lost your ER doctor, your clinic doctor and your hospital doctor all at the same time. The impact of the loss of even one person who is providing healthcare in rural America can mean a community goes from having healthcare to not having healthcare.”
With fewer clinicians, burnout comes more quickly. Because rural healthcare systems already lack a deep pool of applicants who can step in to replace a departing clinician, the burnout cycle intensifies as the search for a replacement continues.
Further compounding the human factors of the rural healthcare crisis is the technology divide. In addition to enabling better patient outcomes, the latest healthcare IT tools can help alleviate burdens on clinicians, but rural healthcare organizations often lack the ability to purchase the newest tools.
“Every provider wants more technology and doesn’t have enough money for all the technology they want. In rural environments, the expectation, especially with the consumerization of healthcare, is that the same care, tools, and technology will be available in small town America that are available in New York or San Francisco,” said Dr. Lahr
“What people don’t necessarily understand is that large organizations in urban settings are able to leverage their size in technology investments by distributing their costs over multiple business lines. Small-town America expects to have access to the same clinical systems and technical systems, but their local provider has a much smaller organization to support the cost of running that system,” she concluded.
Telemedicine: An Idea Whose Time Has Come
In spite of these challenges, Dr. Lahr is beginning to see improvements in rural healthcare thanks to telehealth and telemedicine. “Telemedicine presents an opportunity to solve the rural healthcare crisis,” shared Lahr. “It can bring extra physicians, expert physicians and other specialty resources to a rural community without the need to hire new staff, build new support systems or add to the workload of clinical staff.”
The regulatory and technological challenges that once stood in the way of telemedicine deployments are beginning to fall away. These include licensing challenges that, in the past, required a physician to have a license in every state to be able to provide care. Today reciprocities and other agreements are allowing providers to have some of their licensing expedited, or carried over, into other states or into a consortium of states.
However, what is still standing in the way of successful deployment of telemedicine programs is infrastructure, shared Lisa Hines, former director of telehealth at Greenville Hospital System in South Carolina and now a strategic advisor for Healthcare at NetApp. “Infrastructure is vital to the enablement of telemedicine initiatives. Data from Electronic Health Records, diagnostic images and bedside monitors has inundated healthcare systems,” she noted. “Having the necessary technology to ingest that data for analysis and then provide valuable insights that enable patient care actions and treatment is an underlying necessity to support programs such as TeleICU, TeleStroke, and TeleSepsis.”
In Dr. Lahr’s estimation, many of the remaining obstacles to telemedicine can be overcome by collaboration with partners – requirements and systems for secure teleconferencing with patients, and an easy path for physicians to access EMR and EHR systems to add notes, check on care and review status of patients.
“Security and integration are absolutely necessary for a successful telehealth offering,” Dr. Lahr said. “If you are running this as part of a business in which you need to get through 25 clinic patients from 50-60-80 miles away, you must have integration and the technology to facilitate the orchestration and coordination of patient data,” she noted.
The Bottom Line
While healthcare organizations will never transform from brick and mortar operations to a fully digital environments, telemedicine is bringing tremendous opportunities for rural communities across the country to access more healthcare support. “Immense change is happening,” shared Dr. Lahr. “Some of the trailblazing folks at big healthcare systems are proving that telemedicine works and showcasing their results, whether that’s in terms of better patient outcomes, great patient satisfaction or reduced costs.”
From Hines perspective, the benefits that rural communities are accruing from access to telemedicine will only increase over the next few years. “Next-gen telehealth services will include technologies such as chatbots and sensors that will help moms-to-be receive prenatal care remotely and seniors receive care more quickly in the event of a fall,” she shared.
While there are still some challenges to overcome, there is sufficient momentum to ensure that equitable access to quality patient care is now a fundamental part of rural healthcare. “The expansion of partnerships between healthcare systems coupled with the entry of major players outside the industry will help launch even more virtual health innovation and accelerate adoption,” Hines concluded.