Technology has made many aspects of life easier for people living in rural and remote areas. Applications that support instant communication and connection along with devices and machines that reduce the reliance on city or urban based facilities are some of the solutions that improve daily living. In healthcare, this has been a great challenge, especially for patients receiving ongoing or complex treatment for chronic issues, who may need to travel long distances for various healthcare services.
Although rural communities often have access to local healthcare facilities, there are many other factors that contribute to how they can access healthcare. Some factors include cost of insurance and specialist services, having reliable transport to and from required services, time to attend appointments and confidence in the quality of services. A coordinated approach to healthcare that incorporates technology such as artificial intelligence is the ideal goal for rural communities.
Geographic barriers
Due to limited infrastructure and retention of quality healthcare professionals in rural communities, residents often have to spend time and money travelling long distances to receive specialised treatment in the cities. It is common for patients in rural communities such as in the South Island of New Zealand, to travel over an hour for a 30-minute appointment – a massive drain in time, energy and resource for the chronically unwell and their families.
This is where an electronic health record (EHR) is crucial to population health management, as it enables healthcare professionals to view a patient’s medical history no matter where they are located. Sharing information electronically means patients can receive more timely and accurate care without travelling for miles to get it. Clinicians are able to view and evaluate previous visits, tests, diagnoses and correspondence between other specialists, allowing for more accurate and personalised care. Where specialist support is required, telehealth systems can make remote consultations and diagnosis easier and more convenient for both patients and clinicians.
A fully comprehensive EHR would be extremely useful for rural patients as it could, in the near future, include digital device data that displays information on a patient’s health issues and can include information about their lifestyle and habits. The global movement towards technology enabled care (TEC) has influenced the growth in digital devices that monitor and record personal health data. These include fitness bands, blood pressure monitors, digestible pills that monitor medication reaction and adherence. Most of these devices transmit data from a patch or sensor to an app on a smart phone. TEC offers benefits to rural communities where healthcare infrastructure is limited, but smart phone ownership is high.
Genomic data could also be added to an EHR to provide a more holistic view of the patient, including certain medications that either agree or disagree with a patient’s genome. Genomic data could help a clinician to know whether a specific type of medicine would work for a patient without having to trial several different treatments. This could save both the clinician’s and patient’s time by removing the need for as many follow up appointments, would reduce the cost of treatment as less medication would be required, and could potentially reduce the risk of allergies and side effects. It could also help to pivot healthcare from being reactive to proactive, giving clinicians the ability to address potential problems long before they become a risk.
Limited resources and infrastructure
Because of a lack of infrastructure and often limited equipment in rural areas, technology could be especially useful to help clinicians with diagnosis and medicine support such as medical image diagnosis. An artificial intelligence company in China have used analytics and deep learning to improve medical diagnosis for rural residents in China. Medical images and reports are analysed through deep learning that then identifies patterns from the data of thousands of patients in the urban hospitals of China.
One of the major stumbling blocks to patient care – medication prescription and dispensation – can also be done remotely. Medication ‘ATMs’ already in use in rural areas in South Africa and India are ensuring that patients are delivered medication they need without reliance on pharmacists, doctors or other hard to find professionals, but in a clinically safe way. In the future, these ‘ATMs’ could have their capabilities enhanced to effectively become an information kiosk and patient portal that could support diagnosis, testing and medication prescription, thereby eliminating pressure on community health centres and hospitals.
Limited Expertise and Training
One of the major challenges facing rural communities is a lack of healthcare expertise – it is hard for communities to gain access to specialised training, hard to attract existing trained medical staff, and harder to retain them for longer periods of time once they are there.
One of the most tried and tested ways to resolve these problems is to bring specialised training to the existing population, which in addition to solving the expertise problem, also ensures that there is adequate career opportunity and growth for the locals. This also allows existing community knowledge and relationships to be leveraged to improve the human touch in medical care.
Virtual reality could be used in rural areas to help health professionals with training and expertise through training simulations using a headset that puts you in a realistic healthcare setting. For example, training in an emergency department (ED) can be very stressful for both patients and medical staff, where there is significant time pressure and patients’ lives are at risk. With virtual reality, a range of scenarios could be developed that allowed a person living in a rural area to gain practical experience without actually being in the emergency room, adding to the pressure on staff and putting patients at jeopardy. Difficult or rare cases could be repeated to gain excellent skills, potentially better experience than in a real ED.
Virtual or tele mentoring groups with other communities and specialists would ensure that training and support is continuous and ongoing, with resources outside the community to draw on should further specialist advice be required.
There are endless possibilities for technology to make a massive improvement to the current model in health, especially the rural health sector. Today, there are obvious challenges such as connectivity and infrastructure holding us back, but these problems are being solved faster every day, and the rural medical landscape in 25 years will be vastly different from today’s.
The purpose of incorporating technology into medicine and healthcare in rural areas is not to replace clinicians, but to enhance healthcare delivery and allow for a much more efficient and accurate diagnosis where specialist knowledge is not always available at the time of care. As long as the healthcare industry continues to put the patient, their family and community at the centre of care, real change and success can be achieved.
