Michael Morris | Senior Editor-iTelemedicine
September 24, 2015
Rural telemedicine in the United States is receiving great attention, with considerable effort being applied to changing laws and reimbursement policies. Rural telemedicine is consistently moving forward thanks to diminishing legal barriers in the United States. Efforts like the American Telemedicine Association (ATA) National Telehealth Lobby Day are vital in raising awareness at the congressional level. Still, many hurdles must be overcome to achieve wide-scale deployment of services in rural regions.
Developing nations also encounter many of the same challenges as the United States; however those countries also face a number of challenges unique to their circumstances. In this article iTelemedicine examines the current state, existing obstacles, and future opportunities for rural telemedicine in the United States and in Sub-Saharan Africa.
Challenges in Rural America
One company making strides in rural access to telemedicine is SkyMD, a specialty-specific telemedicine platform for medical practices. Founder and CEO Eric Price told iTelemedicine that despite some wins, there are still three major hurdles rural telemedicine must face:
- Insurance Coverage: “There have been great advances in coverage for video chat telemedicine over the past few months,” Price said. “However coverage for asynchronous communication, which is a more cost-effective method of treatment for many conditions, is still not broadly available.”
- State-specific license fees for physicians: These required fees can make it difficult and prohibitively expensive for doctors to treat patients across state lines. Physicians currently shell out a total of $300 million to be licensed in multiple states, according to the ATA.
- Adoption at the local level: Telemedicine is being slowly introduced in rural environments, but it is still a very nascent concept and there is a lot of work to be done to build awareness among both doctors and patients.
Oftentimes, patients living in outlying areas have long drives to the nearest medical facility and simply choose to not travel rather than get much-needed treatment. “At best, this drives up healthcare costs unnecessarily, and at worst it can lead to potentially fatal complications for the patient down the road.” Price said.
Opportunities in Rural America
Ned Thurman, CEO of Telehealth Solutions identifies key growth areas: “Stroke (neurology) consults were one of the first telemedicine programs provided to rural healthcare and it changed the ability to deliver specialty care to patients unable to reach urban facilities. However, rural telemedicine is still in the early stages of growth with expansion into pediatrics, pulmonology, and behavioral health on the rise.”
Thurman sees opportunity in utilizing government grants to reduce the initial “cost of ownership” as well as taking advantage of the new and lower cost wave of Telemedicine As A Service (TaaS) products. In this way many rural facilities can begin offering additional clinical lines of service as well as accessing specialist consults that were previously unavailable.
The challenges to delivering rural healthcare in the United States are considerable. However they perhaps pale in comparison to healthcare delivery in developing nations such as the Sub-Saharan African region.
One company focusing on telemedicine in rural Africa is Med1 Healthcare of McLean, Virginia. Yaya Mbaoua, Med1’s VP of Sales and Business Development, believes telemedicine technology is the best way to provide both basic medical services and specialist resources in the remote areas of Africa.
“More than 50 percent of the population in African countries lives in remote regions,” Mbaoua explained. “Conversely, most physicians in Africa only practice in bigger cities that have good infrastructure and a more concentrated patient-base.” This leaves a massive gap in medical care, considering the average doctor-to-patient ratio in Africa is one doctor to about one million inhabitants.
Most telemedicine programs in African countries have been largely experimental and academic in nature, consisting of pilot programs and some remote medical training. “By-and-large, it’s very hard to find telemedicine services deployed at scale and used in real-life clinical situations in areas where it’s most needed. That’s where the promise of telemedicine becomes very acute.” according to Mbaoua. Large-scale adoption, from government policy and budgeting to training for sustainability at the practice level, is what Med1 is working toward.
Mbaoua identified 3 primary factors inhibiting wide-scale deployment in Sub-Saharan Africa:
- Education: “Many of the long-serving medical professionals and decision-makers aren’t very computer literate,” Mbaoua said. “That becomes an obstacle to adoption of the technology.”
- Limited budgets: Telemedicine could have an incredible impact in many African countries. However, government priorities often lie within defense, education, and general healthcare. “Some countries have even suspended telemedicine initiatives based on financial constraints and political will,” Mbaoua added. “There has to be emphasis at the top.”
- Political Will: Med1 works with the ministries of health in African countries to raise awareness and the level of priority for telemedicine. South Africa and Ethiopia have already taken substantial steps to adopt telemedicine. Likewise, Cameroon has been very pro-active in setting policies in preparation for telemedicine systems.
Ebola Effected Regions
Perhaps some of the more challenging, yet sharply needed environments for telemedicine have been in Ebola-stricken countries. Ebola became an issue primarily because of the lack of infrastructure for early detection of the disease.
“Clearly if you have a telemedicine system in use for primary care, the same system can be utilized for early detection of possible epidemics,” Mbaoua commented. He believes that had there been an effective telemedicine system with real-time data access, in any of these Ebola effected countries, it would have been possible to early-detect incidents, implement quarantine, or take other steps to inhibit spread before it became a major issue.
Technologies Making A Difference
Let’s take a look at recent developments in technology and how they impact the quality of healthcare in rural regions. SkyMD’s Eric Price believes increased growth in smartphone penetration is making a big difference.
“With smartphones, patients can exchange information with their doctor securely on the go,” Price said. “In addition, with advances in camera phone quality over the past few years, doctors can diagnose many conditions virtually from a camera phone image with accuracy that’s comparable to a face-to-face encounter.”
For similar reasons, Yaya Mbaoua agrees. “The fact that most people in Africa, even in remote areas, have access to a cellphone is significant,” he said. “As this technology becomes more sophisticated and bandwidth increases, mobile phones will become the way that services will reach the most remote regions.”
As demand for healthcare services escalate due to the Affordable Care act, Eric Price believes there will be a critical physician shortage in rural areas. “Telemedicine will be increasingly necessary to bridge the gap,” he predicted. “The models that succeed will be those that develop creative ways to build awareness and that make the experience as simple and intuitive as possible for both doctors and patients.”
Telehealth Solution’s Ned Thurman believes that the future of telehealth lies with systems that enable the provider and patient to communicate wherever, whenever, and however they choose, with security. For this transformation to happen telehealth needs to leverage three concepts:
- Mobility – Enabling healthcare transactions to take place between provider and patient regardless of location or distance.
- Simplicity– Technology that is easy to use for both providers and patients.
- Convergence– Converging and enabling communication across all mediums regardless of platform or brand. Both patient and provider can personalize and customize the experience.
For developing nations, telemedicine is a long-awaited solution to an extreme need. Yaya Mbaoua projects that telemedicine will rapidly evolve to become the norm – even mainstream – for medical systems in Africa. “It will become the defacto delivery method for services not only in Africa, but in all developing nations and in the rural United States itself,” Mbaoua said.