Telemedicine is now a game-changer in rural health care

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BLYTHEVILLE – A few years ago, the only two hospitals left in rural Mississippi County were on the verge of closing.

Over the years, population declines in small Delta towns dotted across the county, such as Blytheville, which once housed a US Air Force base, have made it more difficult for hospitals to recruit doctors, particularly expensive specialists in fields such as cardiology or neurology.

Patients were therefore forced to seek treatment in large cities, such as Memphis or Jonesboro.

Incomes continued to decline.

The future looked bleak.

That all changed in the past year or so, after the two hospitals in the Mississippi County Hospital System adopted a telemedicine system developed by a Little Rock-based startup called Innovator Health.

The technology allows patients to virtually interact with interns and other specialists without having to travel for treatment.

It was a lifeline.

“Now we’re stable,” said Chris Raymer, general manager of the Mississippi County Hospital System, which has a hospital in Blytheville and a smaller critical access hospital down the street in Osceola. “There is money in the bank and there is stability.”

One of the positives of the covid-19 pandemic is the rapid adoption of virtual health solutions in Arkansas and the United States.

As the virus ravaged Arkansas doctors’ offices were forced to close, and hospitals overflowed with people severely affected by the coronavirus, doctors had no choice but to find alternative ways to continue treating the patients.

In many cases, the only way to do this was to use some type of telemedicine, which could range from a phone call, to a video conference, to remote interaction with a doctor via a high definition screen like those used. at the two Mississippi County hospitals. .

The county’s population declined by more than 6,400 people between 2010 and 2020, according to the US Census Bureau.

While these solutions are not new, researchers, doctors and public health experts say their widespread adoption during the pandemic offers new hope for rural communities in places like Mississippi County in the Arkansas Delta. where small hospitals and clinics have been disappearing for decades and where patients sometimes have to travel for hours to get treatment.

These hospitals cannot afford to pay specialists and often do not have enough patients to justify hiring an oncologist, nephrologist or cardiologist, for example.

“It really helps people in underserved rural areas,” said Dr. Bala Simon, chief medical officer for the Arkansas Department of Health. “It was really important to bridge the gap in health care.”

Between 2010 and 2020, 120 hospitals in rural areas of the United States closed their doors, according to a study by The Chartis Group, a healthcare consulting company.

2019 was the worst year with 19 closures, according to the study, recommending that facilities explore ways to offer a “wider range” of services to retain patients and thereby increase the bottom line.

This is exactly what the telemedicine portal created by Innovator Health, called Rounder, has enabled hospitals in Blytheville and Osceola to do, Raymer said.

The Rounder consists of a cart containing a 55-inch high-definition screen that is attached to medical devices, such as a stethoscope, which allows a nurse to examine a patient while a doctor interacts virtually in real time with the patient. patient.

Patients who had to travel to a larger facility for treatment can now see doctors virtually at St. Bernards Medical Center in Jonesboro, which provides internal medicine specialists for telemedicine visits to Mississippi County hospitals .

This means hospitals in Blytheville and Osceola can admit – and retain – more patients, and thus earn more money.

Before getting the telemedicine technology at the end of 2019, Raymer said Great River Medical Center in Blytheville could accommodate six patients every day.

Now, with technology, there are few days when there aren’t at least 25 patients in the rooms.

“By having telemedicine, we can get some of the best doctors who don’t live here,” Raymer said. “We are able to provide high quality medical care at all times and retain more patients.”

“It’s about to change rural health care,” Raymer said.

The major change that has taken place during the telemedicine pandemic is that, with doctors having no choice but to use digital solutions, insurance companies, once reluctant to pay for such services, have agreed to start paying for almost all of them.

It is not known whether the federally approved regulations for Medicare and Medicaid telemedicine coverage will remain in place once the covid-19 health emergency ends.

Arkansas private insurers have also extended telemedicine coverage during the pandemic, and state lawmakers have codified executive orders ensuring that much of this coverage will remain in place after the pandemic.

In Arkansas, covid-19 “likely moved telemedicine football five years in advance where it would have been otherwise,” said David Wroten, executive vice president of the Arkansas Medical Society. “Now you see doctors spending time in their normal day to see patients using telemedicine.”

Simon, who in addition to being the chief medical officer of the health department, works as a physician at the University of Arkansas for medical sciences, said his clinic has seen a substantial increase in telemedicine visits over the course of the last year.

“At the height of the pandemic, 50% of my clinic was done by telemedicine,” said Simon. “There are now more inpatient visits, but still 20% or more are telemedicine.”

“Telemedicine is here to stay,” he said.

In April, UAMS reported that it had made more than 100,000 digital health visits after the covid-19 outbreak last year.

Today, UAMS averages around 2,000 digital health visits per week.

Before the pandemic, only a handful of providers used digital methods for consultations. Since then, 1,090 UAMS providers have used digital visits to meet with patients.

“There was a huge amount of development immediately around the pandemic,” said Dr Joseph Sanford, director of the UAMS Institute for Digital Health and Innovation. “Our options and capabilities, not only on the clinical side but also on the technological infrastructure side, have advanced a lot in a short period of time.”

The UAMS Institute for Digital Health and Innovation works with state hospitals to provide telemedicine solutions that enable patients in smaller facilities with specific conditions, like stroke, to be assessed. remotely by a UAMS specialist.

But there are still limitations, namely high-speed internet access, leading some to question whether telemedicine is something that will be adopted at the individual level to enable patients in rural areas to use the services. home.

“Broadband access is one of the biggest hurdles,” said Dr. Shane Speights, dean of the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University in Jonesboro. “Good broadband infrastructure is essential.”

The institute, in partnership with St. Bernards Medical Center and Innovator Health, has extended telemedicine to rural hospitals in communities like Piggott, Pocahontas and Walnut Ridge.

It is still unclear how common the use of digital health solutions is outside the walls of hospitals.

In urban areas, where Internet connectivity is higher, patients have become more adept at having video conferences, phone calls, and even emailing doctors.

Studies have shown that while the use of telemedicine increased in rural areas during the covid-19 pandemic, the adoption rate was much higher in cities.

Naomi Cottoms, executive director of the nonprofit Tri County Rural Health Network, works daily with people living in the Arkansas Delta who often do not have broadband access, let alone a service. adequate cellular telephony.

Many are also old people and not used to using such technology.

Based in Helena-West Helena, also in the Delta, the Tri County Rural Health Network uses community health workers to help socio-economically disadvantaged people, predominantly from communities of color, access healthcare and other health-related services.

Cottoms said more people are using some form of home telemedicine, but it’s far from widespread.

She said many people without a car still rely on transportation services to get them to their doctor’s appointments in Memphis or Little Rock. “We are doing what we have to do to survive,” Cottoms said.

“We still have areas where there is no Internet access, where there are barriers related to knowing and understanding the use [telemedicine]”Cottoms said.” It’s a great opportunity, but access needs to be improved. “

All of this begs the question of what the limits of telemedicine are in rural Arkansas and whether certain barriers to access are rooted in long-standing systemic inequalities.

“I think we’ve been so oppressed for so long that our hope, our dream, our vision for more has just vanished,” Cottoms said. “Inequalities are so powerful that if we ever overcome them, the world we live in will be amazing.”



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