Perspectives: Implementing technology in rural communities to support access to mental and behavioral healthcare

May 1, 2023 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today’s Perspectives is from Brian Kenah, Azalea Health’s chief technology officer responsible for engineering, software development initiatives, M&A integrations, and related areas. Azalea Health is a leading US-based provider of cloud-based healthcare solutions and services, including a complete solution of electronic health records (EHR), practice management (PM), revenue cycle management (RCM) billing services, as well as a patient health records portal, and a mobile mHealth application. This article discusses how technology can bridge care gaps that continue to be present in rural areas and enable greater access for individuals.

The COVID-19 pandemic illustrated the health needs facing many communities and nowhere was that more apparent than in rural communities.

Rural areas in the U.S. often have higher rates of mortality and morbidity from the leading causes of death compared to urban areas. A report by the CDC in 2017 found that people living in rural areas had a higher risk of death from heart disease, cancer, stroke, and respiratory disease combined than those living in urban areas. One factor contributing to these disparities is limited access to healthcare services – including behavioral and mental health.

Based on data from the American Psychological Association (APA), there is a shortage of mental health professionals in rural areas of the U.S. According to the APA, about 20% of Americans live in rural areas, but only about 10% of psychologists practice in these areas. Additionally, the APA reports that up to 80% of rural communities do not have a psychologist.

Rural communities may not have the same access to psychologists and other resources such as technology as urban areas, which can limit their ability to support mental and behavioral health. And, while many providers in rural communities cannot hire psychologists and other experts who specialize in mental and behavioral health, residents in these communities still need — and deserve — this type of care. There are efforts underway to address this issue and expand access, specifically with technology tools that can be used in rural communities to support mental and behavioral health issues. Some of these technology tools include the following:

  1. Access to Broadband: One challenge in rural areas is limited broadband internet access, which can make it difficult to access online mental health resources, telemedicine services, and other technology tools. According to the Federal Communications Commission (FCC), nearly one in four rural Americans lack access to broadband internet. Despite these challenges, there are initiatives to expand access to technology tools for mental and behavioral health in rural communities. For example, the FCC has established the Rural Health Care Program, which provides funding to help rural healthcare providers expand their telemedicine services and broadband access.
  2. Telehealth: Telehealth is a service that saw widespread adoption during the pandemic. Telemedicine allows patients in rural areas to access mental health services remotely via videoconferencing. This is especially important where there is a shortage of mental health providers. Investing in telehealth services provides healthcare organizations with an opportunity to revolutionize healthcare delivery. Investing in and expanding the use of telehealth provides an immediate way for providers in smaller communities to tap into larger health systems and their experts. It also strengthens the provider/patient relations by removing proximity as a potential barrier to connecting. Longer term, telehealth allows providers to offer new services and expand existing offerings they wouldn’t otherwise be able to. Telehealth can also help reduce patient wait times and allow providers to serve more patients without necessarily needing to hire additional personnel.
  3. Remote Patient Monitoring/Care: The challenges faced by rural communities in accessing behavioral health services are well documented – long travel times to clinics, limited availability of mental health professionals, and stigma associated with seeking help. Remote patient monitoring (RPM) tools can address many of these barriers and improve the overall quality of care. The use of technology to remotely collect and transmit health data from patients to healthcare providers, such as information on mood, anxiety, sleep patterns, and medication adherence, can help providers identify potential issues before they become acute and intervene accordingly. This can all be done remotely without travel, particularly important in rural communities where access to transportation can be limited. Additionally, remote patient care can increase the frequency of patient-provider interactions, leading to more timely interventions and better outcomes. Remote patient care also has the potential to address the shortage of mental health professionals in rural areas, helping those that are providing services to make better use of their time and resources, ultimately improving access to patient care .
  4. Predictive Analytics: Coupling solutions like telehealth with predictive analytics can enable providers to focus on those with the biggest needs, moving from triage mode to true holistic healthcare management. Rural areas already struggle with a shortage of psychologists, doctors, and nurses, and that shortage won’t stop the flow of patients needing support for mental health issues. Predictive analytics can often help provide support for those individuals with existing and ongoing conditions such as PTSD, phobias, and anxiety disorders.

Overall, technology can help bridge the gap in mental and behavioral health services in rural communities and provide access to virtual care that might not be otherwise available.

Healthcare outcomes shouldn’t be based on a patient’s zip code, but for too long, that’s been the case. Patients in smaller communities deserve the same level of care as their counterparts living in larger communities, and technology enables providers to deliver on that promise.

More good news for telehealth, RPM in FCC approval of $100M Connected Care Pilot Program

August 9, 2018 | by

The Federal Communications Commission (FCC) moved relatively quickly to approve the Connected Care Pilot Program, approving broadband-enabled telehealth and remote patient monitoring services in underserved rural and remote areas. Funding for the program has been pegged at $100 million. The approval was unanimous on the program proposed by FCC commissioner Brendan Carr and Mississippi Sen. Roger Wicker.

CCPP will provide $100 million for subsidies to hospitals or wireless providers running post-discharge remote monitoring programs for low-income and rural Americans. An example is those run by the University of Mississippi Medical Center. The goal is to lower same-cause readmissions and improve patient outcomes. [TTA 13 July] Hearings late last month also were structured to support the program and start to fill out the details for a 2019 start [TTA 1 Aug].

Public comments are now open for a 2019 start to the program (see FCC website–look under Connect2Health which is the umbrella site for this and similar programs). Commissioner Carr had to look no further than the VA to see how Home Telehealth and other remote monitoring programs worked to drive down cost and improve patient outcomes. VA Health’s remote monitoring program cost $1,600 per patient compared to $13,000 for traditional care in one study. The trick is now translating this into an open system.

This is a nice boost to both real-time video and asynchronous remote patient monitoring in market development (and getting paid) in areas of great need. It’s also another Federal signal (so to speak) for 2019, following the proposed Medicare Physician Fee Schedule’s increased payments and broader applicability for both.  mHealthIntelligence, Mobihealthnews, FCC Release Hat tip to reader Paul Costello of Medopad.

Telemedicine reduced hospital readmissions by 40% in rural Virginia: UVA study

June 28, 2017 | by

In last week’s Senate subcommittee hearings on the Federal Communications Commission (FCC)’s Universal Broadband Fund and Rural Healthcare (RHC) program, the University of Virginia’s Center for Telehealth chalked up some substantial results confirming the effectiveness of telemedicine in rural areas. In advocating further funding for an expansion of the program, they presented the following:

  • A 40 percent reduction in 30-day same cause hospital readmissions for patients with heart failure, acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, stroke, and joint replacement
  • It enabled over 65,000 live interactive patient consultations and follow-up visits with high definition video within 60 different clinical subspecialties
  • Their home remote monitoring program included over 3,000 patients and screened more than 2,500 patients with diabetes for retinopathy
  • UVA delivered 100,000 teleradiology consults and provider-to-provider consults supported by the Epic EHR.

The UVA analysis also quantified travel savings in areas where medical and hospital care can be hours away–17 million miles of rural travel including 200,000 miles by high-risk pregnant mothers. For these mothers, NICU hospital days for the infants born to these patients were reduced by 39 percent compared to control patients and patient no-shows by 62 percent.

Karen Rheuban, MD, director and co-founder of the UVA Telehealth Center, recommended that the FCC continue to fund the RHC’s $400 million budget, with the caveat of exploring additional federal revenues should that budget be reduced. She also recommended that Medicaid and Medicare reimbursement for telehealth services be increased, the addition of wireless technologies, and including emergency providers and community paramedics in RHC funding. mHealth Intelligence, Subcommittee information and hearing video (archived webcast)

Broadband and health in USA

August 5, 2016 | by

The Federal Communications Commission (FCC) has been investigating [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/08/C2H-BroadbandMap_Gaps-America.png” thumb_width=”150″ /]the relationship between broadband and health in the US through their Connect2Health Task Force and this week it has released an online tool “Mapping Broadband Health in America”.
It is an interactive map that allows users to visualise, overlay and analyse broadband and health data at the national, state and county levels.

This tool allows easy access to existing health and broadband access data to anyone who wants to look at the possible influence of broadband access on health over a period of time or to identify gaps which may provide opportunities to develop or expand online health services.

The interactive tool allows the user change the broadband availability measure (by say proportion of coverage or download speed for example) and select a health measure such as say obesity rate or preventable hospitalisation days and shows where the selected broadband measure is satisfied, where the selected health measure is satisfied and where both are satisfied. The types of health measures are currently limited but if users find the tool useful and feedback to the FCC there may well be further expansion.

Have a play with the map here.

Telehealth is independent of broadband rollout – Australian DoH

February 5, 2014 | by

We reported in September last year (Telehealth and Broadband in Australia) that the cost of the National Broadband Network in Australia was being debated with telehealth being proposed as a potential[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/02/Parliament-of-australia-logo.jpg” thumb_width=”150″ /] justification. The Australian broadband rollout was very ambitious with fibre to the premises (FTTP), one of the costliest solutions, as the target. The Government has now lowered its sights and does not expect to connect all premises with FTTP.

Recently a series of questions were raised in the Australian Parliament on both the status of telehealth in Australia and the broadband programme and what impact, if any, the latter has on the first.  The written reply from the Australian Department of Health is not unexpected and enlightening. (more…)