Telemedicine Expanding in Rural Areas

With more than 200 networks throughout the country, telemedicine is gaining a foothold in rural areas of the United States, according to Max E. Stachura, M.D., director, Center for Telehealth, at the Medical College of Georgia. He reports that states in every region of the country have major programs in rural telehealth that provide both general and subspecialty care.

Telehealth programs provide access to specialties that rural communities cannot sustain economically. Speaking of his own state, Stachura points out, "You can't possibly put a pediatric geneticist in every town in Georgia." But with the use of telemedicine, patients in rural areas can still have access to such specialty care.

Linking up rural areas to telemedicine providers does not have to be a challenge, says Stachura. If you have a patient at one end, a provider with a skill at the other end, and telecommunication technology that can link the two, you can establish this service. "If you can capture data and digitize it and send and receive it, you can [set up a telemedicine program]," he says.

Providing medicine to rural areas with the use of computers, digital imaging, and home monitoring devices is a lot like outsourcing of healthcare to doctors in other countries. This outsourcing has particularly benefited rural communities. "A lot of the development in telemedicine has been linking urban with rural areas," says Thelma McCloskey Armstrong, president of the American Telemedicine Association.

Not only does telemedicine improve access to care in rural areas, it can also reduce costs.  "Telehealth is unquestionably reducing cost, if you look at it broadly enough," Stachura says. As an example, prisoners are entitled to healthcare, and yet transporting a prisoner with a guard can be quite expensive. Telemedicine linking up a provider with a prisoner via a computer eliminates that additional cost.

Despite the advances in technology allowing telemedicine to become more widespread, certain hurdles may inhibit the growth of rural telehealth programs. Physicians and other health providers must be licensed in the state in which the patient resides. Licensure can become an issue for regional referral centers across state lines. Some physicians hold licenses in several neighboring states to practice. Another hurdle has been a lack of adequate reimbursement for telemedicine. Reimbursement policies differ among different providers, including Medicare, Medicaid, and private insurers. But according to Armstrong, reimbursement is improving. "For the most part," she says, "interactive services are fairly well covered in rural areas.

Technology advances have benefited rural telemedicine networks. For example, one network can now provide both health-IT services and transmit images to a radiologist for diagnostic purposes. "The more services and demands in rural areas that can run on the same telecommunication backbone, the more cost effective the system is," says Armstrong.

Armstrong also points out that strong federal support for rural telehealth has helped the field to continue growing. "Several grants fund rural telemedicine," she says, including grants from HRSA, the Rural Utility Services, and the National Library of Medicine. With improved funding and better reimbursement, patients in rural areas are experiencing improved access to care with the help of IT.

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