Pandemic Forces Rural Hospitals to Turn to Telemedicine

Not enough doctors to go around

Key Takeaways

  • Rural hospitals are increasingly turning to telemedicine to help diagnose and monitor patients during the coronavirus pandemic.
  • Telemedicine, in which medical personnel remotely monitor patients, is a way to get more help to short-staffed hospitals and clinics.
  • Munson Healthcare, a rural hospital system in northern Michigan, has turned to telehealth to address its patients’ needs during the Michigan stay-at-home order.
Dr. Maurice Cates, Orthopedic Surgeon, conducts a live Orthopedic consultation remotely by video with a patient (Ronald Jeffries) at Kaiser Permanente's Capitol Hill Medical Center
Brooks Kraft LLC / Corbis / Getty Images

As the coronavirus pandemic pushes some parts of the US medical system towards the brink of collapse, rural hospitals are increasingly turning to telemedicine to help diagnose and monitor patients. 

Hospital systems around the country are under strain from the ballooning number of COVID-19 cases. The staggering caseload means medical staff is stretched thin. In rural areas with few resources, the pandemic is creating more strain. Telemedicine, in which medical staff remotely monitor patients via video link and other technologies, is a way to get more help.

"Across the country, we are seeing virtual visits deployed across all service lines to reach patients directly from home as much as possible," Mitchell Fong, director of telehealth services at OnlineDoctor.com, said in an email interview. "In rural communities, in particular, we have seen an influx of inpatient and monitoring services see a spike in utilization to help support the staffing challenges."

ICUs Need Help

Both regular hospital staff and intensive care units have been getting virtual telemedicine support in rural communities during the pandemic and assisting in preventing staff isolation and burnout, Fong said. 

"Remote patient monitoring has been effective in assisting rural and urban communities in monitoring patients and maintaining safe isolation procedures in the patient homes," he added." In particularly hard-hit communities with strict visitor policies, telemedicine is also being used to facilitate family interaction with the patients."

The need for telehealth is growing during the pandemic, experts say. Most severe COVID cases involve sepsis—a potentially deadly infection that is a leading cause of death in hospitals, Dr. John Vozenilek said in an email interview. Emergency departments are seeing more patients with sepsis, and some patients will avoid rural departments fearing they won’t get the same care as in a larger hospital. 

"One critical care physician can monitor several hospitals without traveling and intervene over the wire."

"The data shows over and again that where a person lives is a social determinant of health and that living in a rural community and lack of access due to rurality is a differentiator for health outcomes," Vozenilek said. 

"Distance and barriers in logistics can be overcome in remarkable ways through telehealth," he continued. "Putting the top expertise in play when it is needed, even if remotely, has a dramatic effect on outcomes. In many cases, telehealth expands the available resources to a team operating in rural environments, not just in terms of higher levels of expertise, but also as additional eyes and ears on a situation."

Experiment Connects Doctors and Patients

Vozenilek is part of a team researching the use of a live-stream video-enabled camera on a telehealth cart at two rural emergency departments in Galesburg and Pontiac, Illinois to connect with an electronic intensive care unit in Peoria, Illinois. The monitoring includes cameras on the cart; patient vitals, as seen on in-room monitors; conversations between the emergency department staff and ICU nurses via telephone; or a combination of the three.

William Bond, MD, an emergency department physician and director of research at Jump Simulation, said in a news release that the study looked at expanded use of remote monitoring for rural emergency departments, which typically have small staffs and easily can be overwhelmed by an influx of severely ill patients.

With sepsis patients, in particular, Bond said the research introduced remote monitoring earlier "to better connect patients in the ER to caregivers in the telehealth realm, who would eventually be overseeing their care in the intensive care unit at those sites." He added, "It helps make that transition earlier, and helps to create a layer of back-up and extra monitoring to make sure we’re meeting all the sepsis care goals."

Dr. Maurice Cates, Orthopedic Surgeon, conducts a live Orthopedic consultation remotely by video with a patient
Brooks Kraft LLC / Corbis / Getty Images

Other rural areas are boosting telemedicine during the pandemic. Munson Healthcare, a rural hospital system in northern Michigan, has turned to telehealth to address its patients’ needs during the Michigan stay-at-home order. It has 530 providers providing telehealth options to patients, even though none were using telehealth before the pandemic.

"Telehealth and virtual visits provide a new level of access to healthcare in our rural setting," Matt Wille, president and CEO of Munson Medical Center, told a local news outlet. "There is a need for behavioral health services and management of chronic illnesses, like diabetes, and we’ve seen telehealth make a big impact in these areas. During the pandemic, 92% of behavioral health services (were) conducted virtually; 78% for endocrinology and metabolism."

Rural Areas Lack Doctors

Caring for patients virtually became increasingly more important even before the pandemic. It’s becoming essential in rural areas in particular because 80% of the rural US is considered a "healthcare desert," and medically underserved. 

"This discrepancy holds true throughout the developed and developing world," Sarah Johnson, a nurse and health ambassador at FamilyAssets, said in an email interview. "Many counties in the US, for instance, have no general surgeons or advanced diagnostic equipment."

Telemedicine allows specialists to bring their expertise into remote areas. "One critical care physician can monitor several hospitals without traveling and intervene over the wire," said Vozenilek. "The final mile of that solution has to be receptive and responsive, well-trained, hands-on providers who can be at the patient’s bedside for whatever is physically necessary."

However, while the field of telemedicine is booming, it may never replace actual doctors and nurses. Certain physical and chronic illnesses simply require in-person diagnosis and maintenance. 

"For those providing telemedicine services, the digital infrastructure can be costly to set up and maintain," explained Johnson. "However, for non-emergency and routine care, telemedicine will continue to be an important alternative for people living prohibitively far from mainstream healthcare."

Virtual visits by medical staff are helping ease the burden on rural hospitals during the pandemic. Ultimately, though, the US needs to address chronic inequalities in its healthcare system. Everyone deserves to be treated by a real doctor rather than by video.

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