Virtual Mobility: Telemedicine Plugs Rural Gaps

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Elderly woman consulting nurse via telemedicine

Nurses looking for a change often are thinking in terms of seeking a job that provides greater pay and prestige. But mobility may not have to be the upward kind to improve a nurse’s lot.

There’s one huge transformation underway in health care that will reward specialists in more subtle ways, and that’s the goal of making better health feasible for more than 50 million rural Americans. Telemedicine is playing a growing role in that quest.

Nurses are increasingly specializing in remote patient monitoring, which has been called “Skype for the medical community,” although it largely entails smartphones and email.

Rural health care issues

It is fast becoming prevalent as the health care system addresses the dire straits of rural health care, in accordance with a major plank of the Patient Protection and Affordable Care Act.

There are two major problem areas in rural health care:

  • One is the plight of rural hospitals, which are numerous — about one-third of the national total as of 2012 — but underfunded — with barely 10 percent of the health care system’s financial resources. Dozens go under every year.
  • The other problem area is the isolation of many rural residents, who may live far from any hospital or may need regular care from a well-equipped hospital a formidable distance from home.

Rural demographics are at the heart of both problems. Some of the definitions are nebulous. Even in agriculture-dominated states such as Indiana, Nebraska, Kansas and Oklahoma, most people live within 90 miles of a major hospital. A full 60 percent of rural residents live in rural areas that are adjacent to urban areas, while only 10 percent of rural residents live in remote areas with small populations.

There’s also a shortage of health care workers in the hinterlands and a lack of economic viability to change that.

Then there’s the relatively ripe age of the rural population; the nation’s obesity epidemic and the general population’s health decline, which are more marked in rural areas and have been exacerbated by the denial of benefits to those with pre-existing conditions. Other factors include lack of preventative care; lack of mental health care, primitive technology in primitive facilities; and the rampant dependence on emergency care, which can’t keep up with demand.

Because of the rural tendency to rely on emergency care on an outpatient basis, the immediate emphasis on facilities is centering upon critical access hospitals. According to the Department of Health and Human Services, critical access hospitals must:

  • have an acute care average length of stay of 96 hours or less,
  • have 25 acute care beds or less,
  • be 35 miles or more from another hospital (or 15 miles from another hospital in mountainous terrains or on secondary roads).

As of June 2015, there was movement in Congress toward altering the 96-hour rule, but it appears a shift from outpatient care to a more versatile system will not occur soon.

Telehealth in rural areas

That’s among the reasons help from afar is increasingly the most effective ongoing treatment available to rural residents, especially the 2 percent who live in remote areas with small populations.

In addition to reducing reliance on emergency rooms, telemedicine has been credited with increasing access to specialists, better clinical outcomes, reduced costs, and better patient satisfaction.

It isn’t new. The University of Texas Medical Branch claims it has been pushing technology to bridge rural medicine gaps since the 1990s in a 268,000-square-mile state whose advanced facilities are largely relegated to four large cities. In 2009, 10 percent of Texas’ counties had no physicians.

More than half of all U.S. hospitals now use some form of telehealth, Jonathan Linkous, CEO of the American Telemedicine Association, told modernhealthcare.com. That 2015 article reported that there were about 200 telemedicine networks connecting large health centers to about 3,000 largely rural sites for specialty consultations, continuing medical education and other services.

Much of the treatment is low key, often enabling isolated patients with chronic but not critical illnesses to be seen without having to make arduous journeys to hospitals or clinics.

Smartphones are becoming crucial to these ongoing treatments. With the use of wireless sensors, smartphones can monitor a person’s blood glucose, blood pressure, temperature, body movement and heart rate, according to doctors at the University of Texas. The sensors can be worn on the patient’s body or embedded in a garment.

“The use of this wearable/portable embedded physiological and cognitive monitoring system will enable a medical team to closely monitor patients without bringing them into a hospital or a specialty care center. This real/near-time monitoring could enable a health care team to address patient problems before they require major intervention in a specialty care center,” said the University of Texas doctors.

Even major intervention is possible remotely.

Telehealth nursing

For instance, the Carolinas HealthCare System includes 10 small hospitals whose intensive care units are monitored in North Carolina’s largest city, Charlotte.

Dr. Scott Lindblom, an administrator in the Charlotte command center, says patient volume is increasing and mortality rates and length of stay are decreasing by about 5 percent.

Similarly, a program in the prairie states, Avera Health, has a hub in South Dakota that monitors patients in that state and in neighboring states ranging from Minnesota to Wyoming. Avera estimates its virtual ICU has resulted in savings of $70 million in the past 10 years.

Despite the nebulous definitions of what’s rural and where telehealth is most needed, it’s clear that health is a major component of an urban-rural divide that is a major component of America’s political dichotomy. And, as usual, nurses will be crucial to the delivery.

For several years, the American Telemedicine Association has provided online information on how nurses can prepare to take advantage of the virtual medicine movement.

It will, as nursingcenter.com wrote in 2008, “provide nurses — be they novices, experts, or somewhere in-between — the opportunity to play an important role in the development, deployment, and utilization of telemedicine and telehealth applications in patient care.”

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