What Telehealth Can Do For Rural Communities

A study of public health and healthcare in rural areas undertaken by the European Association of Rural and Isolated Practitioners demonstrated that the healthcare system is faced not only with less provision of doctors, but also with increased workload, lack of resources, as well as insufficient access to continuous professional training and internships. These problems have an impact on the desire of health workers to work in rural conditions.

Due to the fact that in some rural areas the income level is significantly lower than in cities, the level of unemployment or self-employment in agriculture is high. Also, a large segment of the population is formed that does not have health insurance and faces difficulties paying for medical care. The costs of transportation and accommodation associated with receiving medical care further exacerbate financial difficulties.

The Commission on Social Determinants of Health, established by WHO, recommends that governments direct resources to eliminate the inequality between urban and rural health through continuous investment in infrastructure development in rural areas, as well as to combat political factors and processes that contribute to maintaining a low standard of living in rural areas.

Despite the fact that almost half of the world's population lives in rural areas, only 38% of secondary medical personnel and less than 25% of medical personnel are employed outside cities.

Most countries face the difficulty of providing rural areas with the necessary number of medical personnel. Measures aimed at increasing the provision of rural healthcare with qualified medical personnel include training, regulation, financing, as well as developing a telemedicine system for rural hospitals.

The Main Problems of Health Care in Rural Areas

The solution to complex problems in rural healthcare is impossible without a systematic, integrated approach. This approach requires the use of updated, modern methods of organizing patient care in health centers and technologies for its provision.

The problems that rural patients and healthcare providers face are the following:

• Among rural population, there is no general or sanitary culture. From this arises a less healthy lifestyle, a low level of physical activity. All these factors result in super-mortality, with a particularly high proportion of deaths preventable at the current level of quality of care development.
• Deterioration of reproductive health of rural women. The incidence rate and pregnancy complications caused by them are several times higher than similar indicators in the city.
• High infant mortality, as well as undetectable diseases in children and adolescents.
• Deterioration of the health of older adults, meaning an increase in chronic diseases, mortality and a decrease in life expectancy.

At present, modern technological solutions and technical means of healthcare services have been developed, tested and certified. They ensure the pace of stationary substitution necessary to effectively overcome a number of these problems.

Telemedicine

Telemedicine is most often referred to as the provision of medical care using electronic communication between a healthcare professional and a patient in a remote location. The earliest mentions of the use of telemedicine date back to the 1940s.

However, only today the provision of remote medical care is experiencing a sharp increase. This is facilitated by the expansion of access to broadband Internet connections and technological advances in many areas of medicine. Telehealth services allow rural residents to have access to highly specialized medicine, which tends to be found in large health centers located primarily in urban areas.

Remote appointments can be used in three modalities:

• The use of video conferencing in real time for primary care
• The format of data storage and transmission for asynchronous transmission of medical information to healthcare workers
• The form of remote monitoring.

The use of telemedicine services in rural areas increases the effectiveness of specialty care and significantly reduces economic costs. Not to mention its high social significance.

In a study conducted in the USA, the use of the telemedicine approach was evaluated in 354 consecutive patients with chronic conditions in neurology for 2 years. These patients were located in remote rural areas. The results confirmed the success of using the telemedicine approach for monitoring patients with chronic neurological diseases.

The frequency of hospitalizations and the duration of inpatient treatment were reduced by 19% and 25%, respectively.

Using hardware and software, medical professionals can communicate with a patient to obtain information necessary to assess his or her condition, clarify a diagnosis, develop a treatment plan, make recommendations for prevention and treatment of diseases, monitor therapeutic measures, and decide whether to transfer the patient to a specialized department of the healthcare facility or arrange medical evacuation to higher-level institutions.

The Tasks Solved With The Help of Telemedicine Programs

The use of telehealth provides a solution to the tasks of rural health care in the following 4 areas.

#1. Clinical telemedicine

This area includes the organization and provision of consultative and diagnostic assistance from leading federal, regional and foreign medical centers to patients in the region. This assistance is provided at their places of treatment and residence.

#2. Preventive telemedicine, monitoring and management of the epidemic situation

It consists of the organization and conduct of medical examinations of the population, preventive medical examinations of employees of enterprises in remote areas, with the use of telehealth technologies and mobile telemedicine laboratories. In addition to fighting TB, health information is used to combat the Covid-19 pandemic and other socially dangerous diseases.

#3. Application of telehealth programs in disaster medicine

This area is used for providing medical assistance in case of mass injuries as a result of natural and man–made disasters. Additionally, it includes assistance for those who suffered during the liquidation of the emergency consequences.

#4. Distance education, advanced training of medical personnel

The combination of lectures, seminars and practical classes on specific equipment in existing telemedicine centers allows students to fully assimilate the current level of implementation of modern technologies in healthcare practice. A perfect opportunity for your staffing and training.

Teletriage

The Teletriage service was created to facilitate timely medical care. This allows the distribution of patients depending on the assessment of their condition and urgent symptoms.

This service is popular in countries where medical transportation is paid, and teletriage helps to identify its need. But countries with free medical transportation also need a rational and efficient distribution of patients to provide high-quality patient care.

The experience of Australia is particularly interesting in this matter, where a special website has been created with the support of the Australian Government Department of Health and Aged Care in order to improve the medical literacy of the population and provide reliable medical information.

With the help of this website, a remote patient has the opportunity to independently indicate the symptoms of his disease and receive advice on first aid and an immediate recommendation on further necessary actions, such as:

• Call an ambulance
• Visit a specialist doctor on an outpatient basis
• Receive in-person care.

Since an ambulance call is a paid service in Australia, this website and the mobile application developed on its basis have become very popular among the population.

Advantages of Telemedicine for Clinicians

With telemedicine technologies, doctors have a convenient channel for communication with other doctors. Additionally, they have access to patient data from databases to maintain more effective contact with regular patients and track their physical and mental health.

We have outlined the following advantages you should consider:

• Numerous new patients
• Revenue growth
• Increase in reputation and recognition
• Increase of patient engagement
• Drastic reduction in the cost of patient acquisition in comparison with the cost of using medical aggregators
• A novel method of advertising and promotion of clinic services.
  
  

Not Just Internet Access

In order for remote villages and towns to start actively resorting to telemedicine, the Internet alone is not enough. It is essential that people are ready and capable of using its capabilities for treatment.

Telemedicine is connected with the development of the global Internet, through which it is possible to carry out all the tasks that are assigned to telemedicine. However, the lack of guaranteed bandwidth between the participants of the teleconsultation leads to a slowdown in the transmission of visual information and a restriction in the transmission of audio information (up to the practical impossibility of communication and transmission of video fragments due to their large volume). Additionally, the Internet is an open network, and it is therefore illegal to transfer and discuss medical data in an open manner. The introduction of strict information protection is associated with the need to respect the confidentiality of medical (personal, about the patient) information.

As a result, the use of telecommunications in medicine (and the satisfaction of various information needs of specialists and healthcare institutions) has been developing in two main directions: through the open Internet and through closed network business models of telemedicine, or in the form of fragments of existing networks allocated to the time of teleconsultation as "point-to-point" or "point-to-multipoint."

Telemedicine is based on three components: doctor, patient and the exchange of medical data between them

The fewer data provided to the doctor, the fewer opportunities for patient monitoring and treatment. And the patient should not only get access to his electronic health record, but also be able to contact the right doctor from any device (tablet, desktop computer, smartphone).

Healthcare access requires a secure communication channel and a device to receive and transmit data. The secure communication channel includes a certified server that provides for certain encoding of personal video/audio exchange data.

Telemedicine is available to everyone once digital solutions are implemented. Now we use blockchain data protection as a fundamental tool for telemedicine, since it allows us access to the patient's personal information. Information about telemedicine consultations is divided into blocks to maintain protection and reliability.

There is also many log files (files containing system information about actions that occurred on the server) to store all information about consultations. Experts can review and compare the current data with the past, plan future in-person visits, or examine the patient.

Digitalization of healthcare will not be limited to the introduction of EHR and remote consultations. Technologies for working with big data have huge potential, and medical equipment manufacturers are trying to maximize it.