Canada's Internet expansion efforts show the way for improving care in rural US communities

Since 2010 there have been approximately 80 rural hospitals nationwide that have closed due to a myriad of financial, economic and changing demographic influences. This trend has rapidly increased recently despite implementation of the Affordable Care Act (ACA), known as Obamacare; which was designed in part to help rural hospitals continue to operate. But, according to the National Rural Health, a 50 percent increase in unpaid patient debt associated with the enactment of the ACA has caused further strain among already vulnerable hospitals, especially in states that decided not to expand Medicaid.  

As of today, according to the Chartis Center for Rural Health, another 673 hospitals are in danger of also being forced to close their doors in the near future. Despite any boost provided by recent expansion of Medicaid under the Affordable Care Act, the access to convenient quality healthcare by Americans living in rural areas is becoming a scarce commodity. Without addressing this rapidly escalating problem, up to 60 million Americans living in geographically rural areas are at risk for not having access to quality healthcare within 60 miles of their homes.

Could trends in turning to technology and the “Internet of Things” (IOT) in Canada be a viable answer to this vexing problem? The Canadian federal government is investing up to $500 million CAD to bring high-speed, broadband Internet access to 300 rural and remote communities by 2021. Navdeep Bains, Innovation Minister, says “the [Connect to Innovate] program is the modern equivalent of building roads or railway spurs to remote locations, providing Internet access to schools, hospitals and First Nation band offices.”

In conjunction with this effort, the Society of Rural Physicians of Canada launched a strategy aimed at improving rural health by leveraging the internet. Known as the Rural Road Map for Action, it includes four major directions aimed at ensuring the 33 million Canadians living outside urban centers have equal access to high quality health care. The strategy proposed using enhanced internet connectivity to strengthen remote access to a network of specialists and other care providers, helping rural doctors offer the best care for patients and communities, despite geographical challenges.  

Dr. Trina Larsen Soles, co-chair of the taskforce, says the plan is vital because recruiting and retaining family physicians in rural areas through financial incentives alone is not enough. “Family medicine residents who are educated in rural training sites, immerse themselves in the communities and who see themselves supported by peers, specialists, health-care providers and evolving distance technologies are more likely to choose rural and stay rural,” she says.

At the recently held Arizona Telehealth Telemedicine Service Provider Showcase, various State healthcare systems and service providers shared how they were beginning to emulate the Canadian model and augmenting the loss of hospitals in rural areas with clinic-based care supported by access to clinical specialists via telehealth solutions. Using Federal and State grants, the various entities have begun to install adequate bandwidth and purchase technology solutions to develop robust telehealth programs. 

One such example is a rural health system located in the southeast corner of Arizona which serves a population of approximately 100,000.  Several years ago, the 100-year-old hospital serving the community closed, leaving the inhabitants in the surrounding 2,500 square miles without access to adequate healthcare.  Through various grants, healthcare system leadership built a freestanding clinic and increased bandwidth access from 6MB to over 100MB and has been able to establish a successful telemedicine program they believe has been instrumental in returning a higher acuity level of healthcare services.

The health authority also indicated that this past year they have been able to save their Emergency Department approximately $600,000 through telemetry service accessible through internet based technology.  Additionally, by having access to specialty care via telemedicine equipment, the health authority indicated that they also saved the State’s health budget approximately $1.2 million by averting the need to transport 27 patients who previously would have been transported to an urban hospital.    

Following the lead of the Canadian Health System, it is becoming increasingly clear that telemedicine helps: counterbalance disparities between urban and rural medical environments; deliver better care to rural patients; and lower care delivery costs on several levels. The overall value of telemedicine, as an effective healthcare delivery tool, is directly correlated to the quality of service of the internet connectivity and the reliability of telemedicine solutions to provide real-time two-way audiovisual telepresence. 

Dr. Ivar Mendez and his team from the Saskatoon Health Region of the Canadian Province of Saskatchewan have evaluated several telemedicine solutions over the past several years and are currently evaluating Hodei Technology’s HCview GEMINI medical telepresence solutions.  Initial reports indicate they are convinced that point-of-care diagnosis and treatment using solutions like HCview GEMINI  will be transformative in the delivery of health care.  

“We see this as part of a comprehensive program that will allow us to resolve most medical issues remotely,” Mendez said. “That is the future. Medical care will change from a model where people go to a central location for care to a model where the care will go to where the patient is.”  Additional evaluation of HCview GEMINI is occurring in other provinces within Canada to help address disparities in access to care in rural areas.     

Guy Mascaro, President and CEO of Hodei Technology 

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