Telemedicine expands health access to rural Arkansas

Arkansas needs a successful, cost-effective way to reach patients in rural areas. “Telemedicine,” a term coined in the 1970s that means healing at a distance, may be the answer.

About 44 percent of Arkansas is rural and 73 of our 75 counties have been designated either fully or partially medically underserved by the U.S. Department of Health and Human Services. Many rural residents face substantial barriers to accessing health care. While Arkansas Works has helped expand health insurance coverage, that is not the same as health care access. Rural Arkansans’ health care access is limited by high rates of poverty and lack of transportation, low Medicaid reimbursement rates, and a scarcity of specialists and hospitals with specialty services.

Telemedicine can include health care services such as collecting patient history and data, assessment, diagnosis, prescribing medication, treatment, prevention of disease, continuing education, and research and evaluation. Telemedicine uses a two-way, real-time, interactive communication between a patient and a provider at a different location. Telemedicine is supported by audio, video and integrated medical devices.

By offering rural residents and their providers the expertise available at urban health centers, telemedicine helps level the playing field for health care access. In rural and underserved areas, telemedicine is used primarily to link providers with specialists, referral hospitals and remote care centers.

Telemedicine services must meet the same standard of care as health care services provided in person. It cannot be just an email, text or fax message, questionnaire or non-interactive audio. During the 2017 regular session the Arkansas Legislature defined telemedicine, set standards for its appropriate use and addressed insurance coverage of telemedicine services.

Telemedicine is often provided through consultation with the patient’s on-site provider, who is well acquainted with the patient’s needs. It is very effective at enhancing evidence-based medicine and increasing the use of practice guidelines.

Some writers draw a distinction between telemedicine and telehealth.

Telemedicine generally means the provision of remote but direct clinical services. Telehealth usually refers to services such as provider training, meetings and continuing medical education.

The critical need that launched telemedicine in Arkansas was the state’s exceptionally high rates of infant mortality and low birthweight deliveries. More than 10 years ago, as high-risk pregnancies continued to increase, Arkansas Medicaid, the University of Arkansas for Medical Sciences (UAMS) and the Arkansas Medical Society felt that telemedicine could improve obstetrical care.

Their collaboration resulted in the Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS), now a part of UAMS’ Center for Distance Learning. ANGELS offers both high-risk patients and their providers obstetrical and neonatal consultation and education. Evidence-based protocols and checklists, which are available on ANGELS’ website at no cost, 24/7, from any mobile device, have improved quality outcomes. ANGELS delivers quality continuing education at no cost to viewers, through interactive video conferencing and web streaming. It includes interactive training modules, computerized obstetrical mannequin simulation drills and weekly interactive-video teleconferencing with providers.

While telemedicine’s goal is to improve health outcomes, telemedicine and telehealth can also:

• Increase access to health care
• Provide clinical support, patient monitoring and mobile health
• Lower health care costs for providers and patients
• Better manage chronic diseases/conditions
• Reduce travel time and cost
• Reduce number of and length of hospital stays
• Improve the timeliness of treatment
• Strengthen, rather than compete with, on-site health services
• Promote evidence-based best practices and train providers to use them
• Improve professional staffing and access to continuing education

Continuing education is essential for a 21st century medical work force. Several trends are driving telemedicine’s use. The public has become more comfortable with technology. The rapid drop in the cost of communication technology makes it possible for facilities and providers to adopt more efficient ways of providing care.

Emphasis on population health has highlighted the disparity between urban and rural health care access. This disparity has forced health providers and policy makers to work toward more equal access to health care. We can expect to see more telemedicine and telehealth applications in the future.

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Editor’s note: Ray Hanley is president and CEO of AFMC, a company that works healthcare providers and patients to improve quality of care and outcomes. The opinions expressed are those of the author.