Telemedicine Expands Access to Healthcare in Rural Areas

Organizations improve rural access to healthcare thanks to telemedicine spikes during the pandemic.

Melissa Delaney is a freelance journalist who specializes in business technology. She is a frequent contributor to the CDW family of technology magazines.

In March 2020, Dr. David Rich planned to use some vacation time to tackle a few projects around the house, but he didn’t get far. Midway through the month, with the coronavirus spreading rapidly throughout the U.S., the federal government declared a national emergency. Within a week, organizations across industries were closing their doors.

“We realized we needed to come up with alternatives,” says Dr. David Rich, chief medical information officer at West Virginia University Health System.

WVU Medicine had a fledgling direct-to-consumer telehealth program offering services to employees and some post-surgical patients. “Due to reimbursement issues, I don’t think we could call them much more than pilots,” says Shannon McAllister, assistant vice president of population health and telemedicine.

But WVU Medicine was able to instantly scale up the telemedicine infrastructure it had recently finished building. “There was no trial and error. We were able to flip the switch and have 95 percent of our providers live in under a month,” she recalls. They went from 25 home-based telemedicine visits in all of 2019 to 50,000 in April 2020 alone.

The quick pivot to telemedicine proved challenging even for large urban hospitals, but it was particularly daunting for those in rural areas, where budgets are often smaller and needs greater due to higher rates of poverty and patients with chronic conditions. Rural hospitals have the added challenge of lower rates of high-speed broadband in their communities, further hampering telemedicine efforts.

But the healthcare organizations that rose to the demand for telemedicine during the pandemic’s outset are now exploring ways to permanently build on that foundation so they can improve healthcare access to areas that need it most.

“As you look across the country at how folks were able to mobilize quickly on this, I think it’s a great example of how technology in healthcare is indeed making a difference,” Rich says.

Telemedicine Gives Rural Hospitals a ‘New Lease on Life’

Telemedicine offers more than just the hope of replacing in-person care; by offering greater access to specialists and easily accessible routine exams, it can also expand care in remote regions.

“Before the pandemic hit, rural hospitals were struggling financially and closing at a greater rate than ever before,” says Neeraj Puro, assistant professor of health administration at Florida Atlantic University. “The adoption of telehealth technology has given a new lease on life to the rural hospital itself.”

Telemedicine’s potential has long been recognized, but obstacles have slowed its growth, including a lack of demand from patients, resistance among clinicians and unwillingness by insurance companies to reimburse many telemedicine services, according to a report last June by Puro and Scott Feyereisen, assistant professor of health administration at FAU. But they believe the expansion of telemedicine throughout the pandemic has helped minimize such obstacles.

Several developments in the past year have sped the adoption of telemedicine. The Coronavirus Aid, Relief, and Economic Security Act addressed infrastructure issues by providing millions of dollars in funding for rural broadband loans and grants, telemedicine services and devices during the pandemic. The Centers for Medicare and Medicaid Services (CMS) has added 144 telehealth services to its coverage, 60 of which it will continue to make available to rural areas after the pandemic.

The adoption of telehealth technology has given a new lease on life to the rural hospital itself.

Neeraj Puro Assistant Professor of Health Administration, Florida Atlantic University

Meanwhile, patient demand for telemedicine has soared in the past year. Due to concerns about COVID-19 exposure, 2 in 3 respondents to a September survey by IDC said they deferred important medical care, including everything from routine care to emergency visits. Telemedicine restored access to care without the risk of exposure, says Lynne Dunbrack, IDC public sector group vice president.

“I call the pandemic our unfortunate opportunity,” says McAllister. “For our providers and our patients, even if it was not the most comfortable thing, it was more comfortable than coming to a clinic in person, and everyone was a little more willing to try it out.”

Patients’ Reception to Telemedicine Will Likely Continue

The benefits of telemedicine have long been clear to Dr. Lisa Finkelstein, a urologist who sees patients in clinics hours away from her home base in Jackson, Wyo., where she serves as medical director of telehealth at St. John’s Health.

Finkelstein spent years trying to give away HIPAA-compliant Zoom licenses and Logitech webcams — available for free through the Wyoming Telehealth Network to any providers in the state who want them — but she had few takers.

Patients, too, had little interest in telehealth. Many travel to cities in Colorado or Utah for healthcare. “It’s almost accepted that, ‘I just have to drive three hours to see my specialist,’” says Finkelstein. “It’s a mindset that we were trying to break.”

Finkelstein convinced a few clinics to offer telemedicine services, but the numbers remained small.

“Then the virus hit, and everybody called me,” says Finkelstein. “Before it was, ‘Talk to the hand,’ Now it’s, ‘How do you do this?’ ‘How do you set this up?’”

In February, there were 35 telemedicine patients at St. John’s Health. By April, that figure jumped to 2,169. It fell to 875 in August but climbed again to 1,127 in November as COVID-19 cases rose, according to Finkelstein.

25 Million

The number of Medicare beneficiaries who used telemedicine services between mid-March and mid-October

Source: Centers for Medicare and Medicaid Services

Hospitals around the nation have seen similar spikes and dips as virus cases have fluctuated, but many will likely wind up with larger telemedicine programs than they had before the pandemic hit.

“I think it’s going to be pretty hard to retrench, because once the genie’s out of the bottle, so to speak, it’s only going to grow,” says FAU’s Feyereisen. “If nothing else, people have options.”

How to Expand Telemedicine Offerings for Remote Facilities

That was WVU Medicine’s goal in 2018, when it started its telemedicine program — to provide options. But it had limitations.

Before the pandemic, CMS reimbursed telemedicine only in healthcare shortage areas, and WVU Medicine’s hospitals were close enough to cities in neighboring states that they didn’t qualify.

WVU Medicine, however, wanted to offer specialty consults to its remote facilities — such as a 20-bed critical-access hospital in Keyser, W. Va., more than two hours from Pittsburgh and Washington, D.C. — so it began exploring alternative ways to subsidize the cost of telemedicine. “We were keeping people from going to the emergency department and saving that cost there,” says McAllister.

The health system chose a telemedicine platform integrated with its Epic electronic medical record system, so patients can initiate visits through their MyChart accounts. Physicians could use an iPad Pro device, or their desktop computer equipped with either a webcam or a monitor with an integrated camera; or they could use a cart. In fall 2019, WVU Medicine created two standardized telemedicine carts.

The first cart has a 12.9-inch iPad Pro with an optional Jabra Speak 510 speakerphone and mount. The second is a Capsa M38e powered cart and Lenovo ThinkCentre M920 PC equipped with a Jabra Speak 510 or 710 speakerphone and a Logitech PTZ Pro 2 camera and mount, Lenovo ThinkVision 24-inch monitor or Microsoft LifeCam. The carts also have digital otoscopes, dermatoscopes and stethoscopes.

The effect of the pandemic on rural healthcare organizations will continue to evolve, but for WVU Medicine, the plan is to maintain telemedicine as a valuable practice. “We’re hopeful for the future that we’ll not have to pull a lot of this back,” McAllister says.

Reaching Out

In the years that Dr. Lisa Finkelstein built the telehealth program at St. John’s Health in Wyoming, she worked on signing up originating sites — clinics where patients could see nurses or physician assistants and connect virtually with specialists. When the pandemic hit, St. John’s Health began offering both home- and clinic-based telemedicine. But rural health care providers face challenges with both. For example, home telemedicine visits often are hampered by a lack of broadband coverage in rural areas. To improve access to care, WVU Medicine established regional clinic hubs throughout the state that provide virtual access to specialists. The organization also provides telemedicine access through local fire departments and schools, and when all else fails, providers speak with patients on the telephone, says Shannon McAllister of WVU Medicine. During the pandemic, St. John’s Health launched a curbside telehealth program. Patients could drive up to clinics, where nurses would hand them Apple iPad devices with Zoom videoconferencing software so they could meet with physicians. Another challenge in telemedicine adoption is its clinical limitations. “You can’t get certain vital signs. You can’t look in the patient’s ear,” says Dr. David Rich of WVU Medicine. “But for many of the things that we do in medicine, we’re still able to provide care.”

Getty Images/Wouter Jansen