Telehealth is a modern-day solution to health problems both old and new. Though it presents benefits to a variety of patients, rural patients likely experience the richest benefits. As Health Resources & Services Administration (HRSA) notes, it can sometimes be difficult to determine whether an area is urban or rural.1 In fact, the term “rural” is not even defined by the Census Bureau—it is considered to encompass “all population, housing, and territory not included within an urban area.” Essentially, according to this definition, whatever is not urban is considered rural. There are two types of urban areas identified by the Census Bureau: 1) Urbanized Areas (UAs) of 50,000 or more people and 2) Urban Clusters (UCs) of at least 2,500 and less than 50,000 people.1Generally, rural areas are characterized by low population and lack of access to critical resources such as medical care.
Rural individuals face many health disparities compared to urban individuals. Poverty and poor access to healthcare contribute greatly to these disparities. Overall, rural communities are in poorer health than others.2 According to the Centers for Disease Control and Prevention, rural Americans are at higher risk of death from five leading causes: heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke.3 In addition, rural areas have higher rates of preterm births and infant mortality.
Telehealth has helped combat these rural disparities through the following four modalities:4
- Live video, which uses audiovisual telecommunications technology;
- Store-and-forward, which involves transmission of health information such as x-rays and other images through a secure electronic communications system to a healthcare provider;
- Remote patient monitoring, which involves electronic transmission of health data from a patient in one location to a provider in another location; and
- Mobile health (mHealth), which includes healthcare and education supported by mobile devices such as tablets and cell phones.
Although there are some barriers to successfully implementing telehealth, it is generally regarded as a convenient and cost-effective way to provide subspecialty healthcare that is not available locally. This is true in obstetrics and gynecology. In obstetrics, telehealth can be used for both low-risk and high-risk pregnancies, and in gynecology, it is used for both routine and specialty examinations.5-8
Telehealth benefits and considerations
Healthcare in America is becoming too expensive for companies, individuals, and taxpayers. Technology offers the potential to offer increased access to care at a better value. In utilizing telehealth, the overall healthcare system benefits from lower costs, less travel, improved health outcomes, and reduced emergency room utilization.9 Although there are numerous benefits to telehealth, there are also many things to consider when beginning or expanding a telehealth program or clinic, including for obstetrics and/or gynecology (see box below).10
The author reports no potential conflicts of interest with regard to this article.
- Defining Rural Population. Health Resources & Services Administration. January 2017.
- Rural Health. Centers for Disease Control and Prevention. https://www.cdc.gov/ruralhealth/about.html. Published August 2, 2017. Accessed June 19, 2018.
- CDC Newsroom. Centers for Disease Control and Prevention. https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html. Accessed June 19, 2018.
- What is Telehealth? http://www.cchpca.org/what-is-telehealth. Accessed June 19, 2018.
- Tobah YSB, Leblanc A, Branda M, Inselman J, Gostout B, Famuyide A. OB Nest—A Novel Approach to Prenatal Care . Obstet Gynecol. 2016;127. doi:10.1097/01.aog.0000483637.05137.18.
- Morrison J, Bergauer NK, Jacques D, Coleman SK, Stanziano GJ. Telemedicine: cost-effective management of high-risk pregnancy. Advances in pediatrics. https://www.ncbi.nlm.nih.gov/pubmed/11761593. Published November 2001. Accessed June 19, 2018.
- Etherington IJ. Telecolposcopy - a feasibility study in primary care. Advances in pediatrics. https://www.ncbi.nlm.nih.gov/pubmed/12217121. Published 2002. Accessed June 19, 2018.
- Telemedicine for OB/GYN. Chiron Health. https://chironhealth.com/telemedicine/providers/obstetrics-and-gynecology/. Published 2017. Accessed June 19, 2018.
- Vo A, Brooks GB, Farr R, Raimer B. Benefits of Telemedicine in Remote Communities & Use of Mobile and Wireless Platforms in Healthcare.
- UAMS Center for Distance Health. Arkansas eLink: Starting Your Telemedicine Clinic.
- Mooij MJMD, Hodny RL, Oneil DA, et al. OB Nest: Reimagining Low-Risk Prenatal Care. Mayo Clinic Proceedings. 2018;93(4):458-466.
- Barbour KD, Nelson R, Esplin MS, Varner M, Clark EAS. A randomized trial of prenatal care using telemedicine for low-risk pregnancies: patient-related cost and time savings. January 2017. Supplement to January 2017Am J Obstet Gynecol.
- High-Risk Pregnancy. Eunice Kennedy Shriver National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/high-risk. Published 2017. Accessed June 19, 2018.
- Fugate E. Decreasing Preterm Birth Rates | Telehealth. MUSC Health. http://www.muschealth.org/pn/2013/yir-2013/telehealth/preterm-birth-rate.... Published March 20, 2015. Accessed June 19, 2018.
- Thomas T. Maternal Fetal Medicine. MUSC Health. http://www.muschealth.org/telehealth/services/community-based/mfm/index..... Published September 25, 2017. Accessed June 19, 2018.
- South Carolina Urban and Rural Population (1790-2010). South Carolina Statistical Abstract: Population. http://abstract.sc.gov/chapter14/pop30.html. Accessed June 19, 2018.
- Gainer C. Postpartum Mood Disorders Program: MUSC Health Women’s Care. MUSC Health. http://www.muschealth.org/womens/pregnancy/postpartum-mood-disorders/ind.... Published May 7, 2018. Accessed June 19, 2018.
- UAMS Center for Distance Health. ANGELS Program Telemedicine Clinic Policy T-14. June 2016.
- Center for Connected Health Policy. Credentialing and Privileging.
- Arkansas. Search. http://www.cchpca.org/jurisdiction/arkansas?field_area_of_law_tid =101&field_law_type_tid=All&field_status_tid=104. Accessed July 13, 2018.
- Arkansas Loosens Telemedicine Restrictions. Center for Telehealth and eHealth Law RSS. http://ctel.org/2016/09/arkansas-loosens-telemedicine-restrictions/. Accessed July 13, 2018.