Ensuring Access to Care in Rural Areas: The Role of Communication Technology

Telecommunication and other forms of information technology, in concert with the National Information Infrastructure, are poised to make revolutionary changes in the delivery of healthcare and other human services in this country over the next decade. These technologies hold particular importance for rural and remote areas, where the delivery of health and human services, provision of educational programs, and dissemination of information are compromised by such factors as low population density, distance, rough terrain, and provider shortages. Since the 198os, rural areas have experienced deteriorating economic opportunities and resources, financial pressures, personnel shortages, and difficulties in attracting and retaining healthcare and other service providers. Today, rural communities have less than half the physician coverage available in urban areas, and numerous rural health facilities have closed (Witherspoon et al., 1992; U.S. Congress Office of Technology Assessment, I99o). Such inadequacies in the healthcare system undermine the viability of other human services, adversely affect the economic development potential of rural communities, and, most important, place people at undue risk for inadequate healthcare, unnecessary disability, and even death. Rural elders are among those most affected by the inadequacies in health and human services in rural America. It is not unusual for people 65 years and older to constitute zo percent or more of the population of small towns and rural counties (U.S. Bureau of the Census, i99o). These elders have more chronic health impairments, more medical conditions, and more functional limitations than their urban counterparts (Econometrics, I98I; U.S. Congress, Office of Technology Assessment, I99o; Coward and Dwyer, I99I). Moreover, because rural elders are more likely to be poor, they are less financially able to gain access to distant healthcare resources, and so for them local health services are especially important. Poor access to healthcare affects not only the old and the frail, and not only local residents. A serious illness, workrelated injuries, or injuries from an auto accident may strike anyone living inor traveling through-a rural area. Appropriate and timely care can mean the difference between life and death. Telecommunication and other forms of information technology offer new and exciting possibilities for the improvement and, indeed, the survival of rural healthcare, but they may not be without problems. This article discusses the major forces pushing telecommunications and other information technology to the forefront in the delivery of health and other human services, the ways that these technologies are providing better access to care and information; the possibilities these technologies hold for the future; and what all of this means for the most important element in the equation, the consumer. INTERACTIVE TELEVIDEO (ITV) AND THE INTERNET The healthcare industry has lagged behind others in exploiting the power of communications technologies, but this situation is changing. The applications of computer-based information systems and interactive televideo (rIv) technologies to rural healthcare are rapidly expanding. Today, information travels around the world in a matter of seconds or minutes via a global, cooperative collection of interconnected computer networks called the Internet. This network, along with the World Wide Web, is radically changing the way people get information and increasing by astronomical proportions the types and amounts of information available. We also have available today the technology to provide real-time, interactive full-motion video, often accompanied by medical instrumentation, which can simultaneously link patients and healthcare practitioners who are hundreds of miles apart. Common scenarios include the following: (I) a primary care physician seeking consultation on care of a patient from a medical specialist in a distant location; (z) a nurse or physical therapist consulting with a physician or other type of health provider; and (3) a patient consulting with a healthcare provider. …