Technology is the best prescription for advancing rural care

As urbanization has dramatically altered the demographics of our national landscape, the health and well-being of many rural Americans have suffered significantly from poor access to much-needed care.

More than half of the pregnant women living in rural areas reside farther than 30 minutes from a hospital offering obstetrical and gynecologic services. In fact, a Scientific American study found the mortality rate among rural pregnancy cases was nearly double that of metropolitan areas. At the same time, rural hospitals are closing their doors at an alarming rate. Of the roughly 1,300 critical access hospitals open today, 700 are either vulnerable or at risk of closure, according to a recent study by the National Rural Health Association.

These are two of the stark realities facing rural families who farm, ranch and provide the many natural resources and food staples we rely on. Thankfully for the nearly 20 percent of Americans who live in rural communities, advances in telemedicine are finally helping providers bridge this divide.

Still, more must be done. Englewood, Colo.-based Catholic Health Initiatives, one of the nation's largest nonprofit health systems, operates 29 critical access hospitals — more than any other system in the U.S. At CHI our mission is simple: Create and sustain healthier communities. For rural communities in particular, this means identifying new solutions and investing in new pathways to better, more affordable care.

Today, CHI manages more than 80 telemedicine programs that are helping provide those solutions. While we know that more needs to be done, CHI's rural hospitals have significantly improved care and increased access by integrating more real-time, two-way video and audio communications into the care continuum. Simply put, this is saving lives. For example:

  • Virtual health services: This telepharmacy program provides critical services to 48 small and rural hospitals, many not part of CHI, that don't have 24/7 pharmacist coverage. This is a critical program because many new regulations require a pharmacist to approve lifesaving medications before they can be administered. The program provides audio/visual connections so providers can verify that the correct medications were retrieved from the hospital's medication dispensary, check IV admixtures prepared by nurses, and can help identify patient medications. Today, the service reviews 3,900 medication orders daily and averages about 70 interventions a day — each representing a potential health risk from an adverse reaction. We are using the same technology to help curve the potential of overprescribing antimicrobial medications as well. Since the full program launch in August, we have identified 2,736 interventions, of which, 2,385 were accepted by the attending physician. This program alone has saved CHI $1 million in medication costs while extending expert care into rural America.
  • Teleradiology: This initiative enables rural providers to have their patient's X-rays and images read remotely by a fellowship-trained radiologist. For example, a woman getting a mammogram in rural North Dakota may have her images read by one of our radiologists in Des Moines, Iowa. Enhancing maternity care for women outside a metro area is just one of the many benefits of this effort.
  • Telepsychiatry: This program provides physician-mandated psychiatric evaluations for continued care and mental health sessions to those who typically can't — or won't — seek mental healthcare, sometimes with devastating consequences. In the first six months of the program's existence, there were 284 patients in the emergency department given mental health diagnoses, result­ing in 36 virtual ED visits. We have seen first-hand how this program can help prevent suicides and treat substance abuse.
  • In recent years, CHI has introduced e-hospitalist services to our communities. This newer platform for hospitalist services provides consults, hospital admissions and hospital follow-up care by using technology to remotely connect physicians, physician assistants, nurse practitioners and nurses. This type of program helps keep patients close to home in their community hospital, yet provides them with the appropriate level of care their condition requires.
  • At our tele-asthma clinic, patients receive the same set of services available in a normal clinic setting but without what can be a two- or three-hour commute each way. Patients are interviewed and examined via live radio by a resident physician and/or asthma educator located at St. Alexius Health in Bismarck, D., and the exams are conducted via a Jedmed digital scope that is shared virtually. Since the initial asthma clinic opened in Dickinson, N.D., in November 2017, patient satisfaction surveys have been extremely positive, with patients responding that they were either "very" or "completely" satisfied with the first telemedicine asthma clinic in the state.

Each one of these programs taught us valuable lessons. First, providers need to focus on leverage and local empowerment. For example, while we initially deployed a video-cart solution to address our pharmacist shortage, our rural teams were empowered to explore other ways these assets could be used to fill the care gaps they face. That led to the tele-psychiatrist program. We will also use the video carts to link eight of our rural hospitals with board-certified emergency room physicians 24/7.

The second lesson to bolster rural health access is that we have to be open to these and other innovative technologies and encourage our providers to embrace the disruptive changes that come with their use.

We are introducing e-hospitalists to help perform inpatient consults remotely. This new platform will help those in the field — whether they are a physician assistant or nurse practitioner — better serve and diagnose issues remotely. This type of program helps keep patients at home while receiving the level of care their condition requires.

This care innovation represents a massive change in our protocols. It requires our specialists to be open to changing how they treat their rural patients. They have to become comfortable with the electronic interface and the unique challenges these tools bring.

Healthcare choices for rural American can be more difficult than for their urban neighbors who have ready access to doctors, pharmacists and hospitals. This disparity will be remedied only if the healthcare community at large combines its creative talents, strategic thinking and dedication to bring quality of care to all parts of our country.


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