The following is a guest article by Christopher Caggiano, MD, FACP, Solutions Director at Allscripts.
Some 58% of adults in rural areas say access to high-speed internet is a problem for them, including 24% who say the problem is major, according to 2018 data from Pew Research Center. Healthcare providers, who are especially concerned with costs, may also not know which affordable services they can offer patients from afar and how to best use these to actively engage with patients themselves.
Because a single hospital may serve a large and loosely connected area, providers find it difficult to manage resources efficiently among the population. At the same time, patients may lack convenient or affordable access to the care they need. Due to distance from a facility, rural patients may often miss routine appointments or, when they do need immediate care, have few options other than the emergency department (ED). In these communities, alternate forms of access are key to saving resources and ensuring viable patient options.
As a result, providers and patients in rural communities face several unique challenges in giving and receiving healthcare. Recently, one of my emergency department patients was seen at his primary care office and had radiology tests performed at the local critical access hospital. The result would be available later in the day. The patient then went to work. After finishing his evening work shift, he was unable to view his test results via patient portal, as had no internet access from home. The usual public access internet sites, such as the library and local restaraunts, were closed by that time.
Appropriately, the hospital radiology department would not release results over the phone, and the health information management department was closed. The patient was becoming anxious over the possibility of receiving bad news. He then decided that going to the emergency department (ED), the only medical facility open at that time, was the only way to get the results. The patient explained his situation at triage, so we were able to avoid an actual ED visit and charge.
Digital access and telehealth
Many telehealth services entail manageable costs supplemented by public and private payers, though providers and patients may need to identify those services. For example, remote patient monitoring can help allocate and prioritize resources more effectively than not. Remote video visits or artificial intelligence chat functions that act as triage can be effective ways to assess the issue.
While telehealth offerings are growing in both scope and capacity, rural patients may not be positioned to take advantage of them. They may not know these alternatives exist, have the reliable and capable internet access they need to use them or be able to determine what the best solution is for them.
Physical access and transportation
For some care episodes, in-person interaction is essential. In rural settings, patients may have problems getting to routine doctor visits, and simply not go to scheduled appointments, if they do not need immediate care. In urgent care situations, regardless of severity, these patients may have no choice but to use their closest ED.
For example, if an elderly patient has a cough for several days and cannot get to a primary care physician, her symptoms may worsen until she believes she has no other choice but to go to the ED. If a municipal ambulance service is used for this transport,
- Not only is a charge generated, but the ambulance is taken out of emergency service for the community.
- The transport and ED costs escalate even before treatment begins.
If the patient had been transported to the primary care physician’s office for routine care before symptoms worsened, however, much of this expense could have been avoided. As well as increasing the cost of recovery, the treatment also often leads to greater morbidity and mortality risk.
Alternation solutions in rural communities
Alternate forms of access that defray these costs are developing in many rural communities. A mobile ride share service, incorporated into the electronic health record (EHR), can coordinate transportation with patients’ primary care and specialty clinic appointments. Costs are a simple pass-through for the hospital and are far below those seen for ambulance or medical transport services. Patients are more apt to seek primary preventative care when transport is readily available and arranged by the provider.
Solutions like mobile urgent care services are emerging, where nurse practitioners or EMTs are also being dispatched to diagnose and perform simple lab tests so that next steps can be taken accordingly. This way, a cost of perhaps $6,000 for transport to and evaluation and treatment in the ED can be reduced to $600. The savings to the community gained by not taking an ambulance out of emergency service are obvious if not immediately calculable.
Similar steps, and taking advantage of similar solutions, can help rural patients and providers solve the unique challenges they face in access to care. Telemedicine leveraging drones, monitoring the home environment through connected smart home devices, wearable devices, autonomous driving vehicles, and remote personal digital assistants will all play a part in improving the rural patients access to preventative and semi-acute (urgent) care in the future.
About Christopher Caggiano, MD, FACP
Christopher Caggiano, MD, FACP, Solutions Director, Allscripts, is a seasoned emergency physician informatician, dual board certified in emergency medicine and clinical informatics. He specializes in health informatics solutions, hospital and enterprise governance of health informatics, physician leadership, improving clinician adoption of technology, novel technology, workflow analysis, and change management. He has served as CMIO for large (650 bed) enterprises as well as smaller community hospitals. At Allscripts, Dr. Caggiano partners with hospitals and enterprises, collaboratively designing and implementing health information solutions and governance that leverages and aligns technology with workflows and enterprise initiatives.