Defining Telemedicine and Its Applications in Rural Healthcare

A variety of services can be provided through telehealthcare. Chronic illness monitoring and care, access to emergency care providers and consultation, home health monitoring, long-term care, online therapy and remote counseling, and telepharmacy are just a few examples.

Common conditions that can be treated by a primary care doctor via telehealth include:

• Allergies;
• Arthritic pain;
• Bronchitis;
• Cold and flu;
• Conjunctivitis;
• Diarrhea;
• Headaches;
• Rashes;
• Respiratory infections;
• Skin inflammations;
• Stomach ache;
• Sore throat;
• Urinary tract infections.

There are a variety of telemedicine specialties, such as teleradiology and teleobstetrics. These subfields of telemedicine generally are used to allow patients to audio or video conference with specialty doctors who may be too expensive or inconvenient to bring in.

Telemedicine specialties include, but are not limited to:

• Teleradiology - Teleradiology makes it possible for radiologists to interpret medical images without physically being on-location. Having a radiologist on-site can be expensive, making teleradiology a cost-efficient tool for rural areas.
• Telepsychiatry - Telepsychiatry provides a range of services such as psychiatric evaluations, therapy, patient education, and medication management. The use of telepsychiatry can be beneficial for patients seeking mental health support or primary care providers needing expert advice in the field of psychiatry.
• Teledermatology - Teledermatology encompasses the evaluation, diagnosis, and treatment of conditions and diseases related to the skin via telecommunication technologies.
• Teleophthalmology - Teleophthalmology is the practice of delivering eye care via telecommunication technologies. Essentially, a healthcare professional conducts an onsite eye exam that is then interpreted by a remote ophthalmologist.
• Telenephrology - A specialty of medicine focusing on the kidneys, telenephrology makes it possible to provide care to patients without having a specialist onsite by means of telecommunication technologies.
• Teleobstetrics - Teleobstetrics brings teleservices to the field of obstetrics and gynecology. This technology facilitates the management of medications, postoperative care, and the discussion of lab results, among other uses.
• Telerehabilitation - Telerehabilitation provides rehabilitation services, such as clinical assessment and clinical therapy, via telecommunication technology.

Insurance coverage for telehealth services is dependent on state and federal policies, as well as insurance company-specific policies.

Mobile health, also known as mHealth, refers to the use of mobile phones to deliver healthcare services. Unlike telehealth which includes the use of any technology for medical purposes, mHealth is confined to mobile devices alone.

According to a Pew Research study, 96% of Americans own a cellphone of some kind — 81% owning smartphones, specifically. With such a large amount of the country owning smartphones, mHealth has become very accessible.

With the use of technology comes concerns surrounding privacy and security — telemedicine services are no different. Telemedicine solutions must comply with HIPAA in order to legally operate. This includes patients, all providers, and staff, as well as any software applications used to provide the services. The U.S. Department of Health and Human Services recommends that providers inform patients of the risks associated with third-party telehealth services and direct them towards all available encryption or privacy modes.

For telehealth to work patients must have access to a device, such as a smartphone or tablet, and an internet connection. Residents of rural areas especially must prioritize access to a high-speed, reliable internet connection or a high-speed mobile network. Devices must also feature a built-in microphone, speaker, and ideally, a webcam. These functions enable audio and video conferencing and allow patients to receive regular feedback from providers.

What is considered “rural” can mean different things to different people. The official definition, however, comes from the U.S. Census Bureau. They define “rural” as “what is not urban.” In other words, the Bureau defines individual urban areas and then whatever is left is rural.

Several rural demographics could benefit from telehealth services. These services can benefit the following groups:

• People with disabilities - In the U.S., 17.1% of rural people report having at least one disability. People with disabilities living in rural areas have increased barriers to healthcare if they are unable to drive or find reliable transportation to doctor’s appointments.
• Older adults and those on Medicare - Older adults who live in rural areas may experience increased barriers to healthcare if they’re unable to leave their homes without support.
• Children - Research by Rural Health Information Hub reports that poverty among children in rural areas is 12.2%, slightly higher than those in urban areas. Socioeconomic standing is a significant measure of well-being, especially for children.
• Veterans - With almost a quarter of all U.S. Veterans living in rural areas, telehealth can provide many benefits to this demographic.
• People with substance use disorders, addictions, or mental health conditions - Research by the CDC shows that less densely populated areas have a higher suicide rate than more densely populated areas. The effect of the opioid crisis has also been significant in rural communities. Limited resources and personnel, a lack of mental health services, and the stigma surrounding mental health are only a few of the barriers to treating addiction and mental health conditions in rural areas.
• People with limited proficiency in English - People with limited proficiency in English can find licensed healthcare professionals and engage in video consultations in a language they’re comfortable with via telehealth services.
• Indigenous peoples - According to research by the First Nations Development Institute, 54% of indigenous peoples live in rural areas.
• Island populations - Populations living in island communities are especially limited when it comes to sufficient healthcare services.

The advantages of telehealth for rural populations are vast. Emphasizing healthcare accessibility and availability, telehealth services can improve an individual’s overall physical, social, and mental health, as well as provide disease prevention, detection and treatment of illnesses, and an extension on life expectancy.

The option to have a doctor’s appointment at home can improve the experience and satisfaction of care in myriad ways. Below are a few examples:

• Reduces transportation costs and time - Engaging in audio and video consultations eliminates transportation costs and time, especially for patients who live far away.
• No need to take time off from work - Having the option to do a virtual consultation means doing so on your time. Patients no longer have to take time off from work — reducing transportation time along the way.
• Eliminates child or elder care issues - Not having to leave your home also eliminates the need to hire a sitter for children or elderly adults.
• Increases access to specialists - Telehealth increases access to specialists who may not be located at your closest healthcare facility. Connecting to doctors via the internet means a variety of healthcare specialists are available.
• Less chance of catching a new illness - Not having to enter a hospital or other healthcare facility eliminates the risk of catching a new illness.
• Lowers out-of-pocket costs owing to fewer hospitalizations and less nursing home care for seniors - With fewer hospitalizations and less nursing home care for seniors, out-of-pocket expenses are diminished.
• Support, information, and education without needing to be at a doctor’s physical office - Online medical portals can provide the support, information, and education patients need without them having to be physically present at a doctor’s office.
• Less time in the waiting room - By reducing the need for in-person consultations, patients can spend less time in the waiting room and more time on their day-to-day responsibilities.
• Reduces stress and increases well-being - Hospitals are often associated with stress among patients, despite their intentions of healing. Reducing the need to visit a hospital or other healthcare facilities, thereby reduces stress and increases wellbeing.

Though there are many advantages to telemedicine, like any new practice it has its disadvantages. Rural communities must navigate barriers around health insurance and cost, while healthcare providers must resolve technical problems and acquire the proper equipment to implement telemedicine.

More detailed examples of telemedicine barriers are included below:

• Laws, policies, and industry barriers - Healthcare laws and reimbursement policies may struggle to keep up with changes in telehealthcare, potentially making services cost-prohibitive. Research into your state’s reimbursement policies can help determine if you’re covered.
• Technical training and equipment - Healthcare professionals must restructure IT staff and buy new equipment in order to conduct virtual consultations. Physicians, nurses, and other medical staff must also be trained to use the new equipment. These matters cost time and money — resources potentially not fully available.
• Limitations to physical examinations - Conducting a physical examination over a webcam can be limiting, and altogether not as effective as an in-person consultation. Residents of rural areas may not get the full scope of care they need through virtual appointments alone, and instead must only use telehealth selectively.
• Reduced care continuity - Patients who use on-demand telehealth services may be less likely to seek continued care. In this instance, the doctor-patient experience accounts for a lot when it comes to whether a patient will continue sessions.
• Poor internet connection - A poor internet connection is perhaps one of the biggest barriers to telehealth services — especially for residents of rural areas. Dropped calls, delays, and other interferences can contribute to a reduced quality of care for patients.