telehealth – Looking Forward

Two months ago, in “The Last Big Barrier To A Rural Renaissance: Healthcare”,
I reported on a White House meeting on rural telehealth that I
participated in. On June 1, we had a follow-up conference call.

This is sort of a report on that call, intertwined with my
observations from this call about why it’s hard to get things done in
the Federal government.

First, there was some encouraging news, including these items:

The
White House is starting to fund research on how telehealth improves
medical outcomes, which will be important for future changes.
Because
of changes in Federal law and market conditions, there has been such a
rapid growth of integrated health care systems that, on their own, some
are now reaching out to serve rural areas.
In various ways,
there was agreement that telehealth is now expanding into remote patient
monitoring. This is especially good news for rural residents who may
have to travel miles even to get to a local clinic which is in turn
connected to a major medical center.

This last item also reminded me of Longfellow’s Little Girl:

“There
was a little girl, and she had a little curl right in the middle of her
forehead. When she was good, she was very, very good, and when she
was bad she was horrid”

At the same time the Veterans Health
Administration has had its problems with waiting lists at some
facilities, it is has taken the lead in innovations, like tele-health, to bring health care to veterans at work or at home in small towns, rural areas and other places where it is difficult for the veterans to get to major facilities.

I’d
note that I’ve spent much more time with local and state government,
where with good leadership, things can get done fairly quickly, even
when major innovations are involved. Many of these governments are at
least as efficient, if not more efficient, than most large
corporations. As we’ve heard and seen many times in this election year,
the Federal government is another story.

Here then are some relevant, if not new, observations based on the rural tele-health work:

It’s very hard to get things done even if you’re sitting in the White House.
To
some extent, this is built into the constitution, the system of
government, which divides power and ensures that Federal agencies almost
suffer from a kind of matrix management with multiple parties having a
say about what happens.

And when the Federal government gets
around to doing something it needs to be very careful and thoughtful
about the rules because its impact is so outsized – part of its slowness
is to ensure it doesn’t behave like a bull in a china shop.
There
are millions of Federal employees to contend with, each of whom has
his/her own sense of what their public responsibility calls for. This
can lead to a silo effect where people in different departments don’t
work with each other or even know each other are working on the same
issue. As an example, psychiatrists who are encouraged by one part of
the Federal government to provide face-to-face services through
videoconferencing worry about running afoul of the concerns of the Drug Enforcement Administration about electronic prescriptions of controlled substances.

Having said all this, the White House staff should still be applauded
for continuing to push these innovative tele-healthcare services,
despite the built-in obstacles and the short time they have left.

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I’ve written before about the ways that small towns and rural areas
can take advantage of broadband Internet connections to gain access to
global economic opportunities, educational and cultural resources, even
the virtual equivalents of coffee shops that used to be only available
in big cities.

Perhaps the biggest remaining barrier to a 21st century rural renaissance is access to world class health care.

With
that in mind, President Obama’s Rural Council brought together about
three dozen experts to the White House complex last week to identify
innovative ways of bringing health care to the countryside and to
establish a “community of practice” that will help the Obama
administration and hopefully its successor to address the problem.

The
group included:

Federal officials from various agencies, including Secretary of Agriculture Vilsack
Leading broadband providers and the Rural Broadband Association’s CEO, Shirley Bloomfield, and Joshua Seidemann, Vice President of Policy (who helped organize this meeting)
Exemplary providers of tele-health, and
A
couple of other experts, including myself (in my role as Senior Fellow
of the Intelligent Community Forum and director of its New Connected
Countryside initiative)

This “convening” was led by Doug O’Brien, Senior White House Advisor for Rural Affairs.

It
was noted, although not news to those around the table, that the nearly
60 million Americans who live in rural areas were hit especially hard
by the Great Recession. Their local economies have taken longer to
recover, still not back to pre-recession employment levels.

But the comparisons of rural versus urban health care were most striking. Here are just some highlights:

Rural areas have higher rates of disease and higher mortality rates than urban areas. In 1980, the rural mortality rate was 2% worse than the urban rate and now it’s 13% worse.
While
approximately one in six Americans live in rural areas, only one in ten
physicians practice there. There are even fewer medical specialists per
capita.
Suicide rates are higher and getting worse in rural
areas. Along with a growing drug abuse problem, this is a reflection of a
growing need for mental health services.

None of these
medical problems are helped by the fact that rural residents are poorer
and less likely to have health insurance. Of course, given the lack of
sufficient nearby medical resources, rural residents need to travel
further – often hours further – than their urban counterparts.

In
the Internet age, that last problem should be able to be mostly overcome
with health care delivered remotely. So most of the meeting was
devoted learning about the use and deployment of tele-health care. In
this post, I won’t be able to describe all of them or any one of them in
detail, but here are some that stood out to me:

Using cost-effective solutions, like iPads, Vanderbilt University Medical Center
has established a network of rural tele-health services. This even
includes virtual group sessions for people with drug addictions.

The
US Department of Veterans Affairs has pioneered the use of virtual ICUs
in its rural clinics and facilities. With a fully developed set of
tele-health tools, to the patients and local staff, it’s like having the
expert ICU doctor at the bedside. As a byproduct of these virtual
ICUs, the medical staff at these facilities are also getting an
education in newer and better medical techniques.

Through East Carolina University School of Medicine, there is now a tele-psychiatry network in North Carolina. The relatively low cost of making tele-psychiatry available is helpful, given the increasing need for mental health services.

Obviously,
many rural areas do not yet have the broadband which is necessary to
deliver these services. But there are clearly broadband providers,
especially telecommunications coops, which are up to the task. We heard
about just two of those who had completed gigabit deployments to every
household in their rural areas in Kentucky and North Carolina. One of
those, Peoples Rural Telephone Coop was reported on in a Daily Yonder article last month, “One of the Nation’s Fastest Networks Serves Two of Its Poorest Counties”.

Even
before the recent recession, there were long term trends in rural
America that called out for a different and new economic strategy. In
his closing remarks, Secretary Vilsack noted that, since 1950,
agricultural productivity has increased a hundred fold on 27% less land
and with 22 million fewer farmers. So the challenge today is what
opportunities and quality of life can the remaining families have.

The
people around that table last week and ICF believe that a revived rural
community can be built upon the intelligent and creative use of
technology – and improving access to quality healthcare is just one very
important example.

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Tag: telehealth

White House Rural Telehealth — Continued

The Last Big Barrier To A Rural Renaissance: Healthcare