For the 46M Americans living in rural communities, accessing specialized healthcare can be a daunting task. 148 rural hospitals have closed since 20101, fueling a rural healthcare crisis that makes it hard for patients to access specialized care in their local community. Factors such as taking time off work, finding childcare, making lengthy and potentially risky drives, and incurring hotel expenses just to get to a specialist can add stress to an already nerve-wracking experience. For patients with physical limitations, the act of travel may be near impossible. The unfortunate reality is that some patients may delay or forgo a recommended referral due to these added challenges.
“It’s important to remember that, typically, this is not a choice. Patients in rural communities commonly lack access to providers, hospitals and clinics,” said Dianne Kessler, RNC-OB, Digital Product Manager at GE HealthCare. “Even if a clinic is drivable, the cost of childcare and travel, coupled with lost wages due to time off work, can unfortunately make getting the care they need not possible.”
Building local specialized care teams with tele-ultrasound
One innovation that is bringing specialized healthcare expertise to rural communities is tele-ultrasound.
Tele-ultrasound has been used in various forms for more than twenty years. It is generally defined as “the use of ultrasound with voice and video and an additional instructor, such as an ultrasound-certified physician, who is remotely connected to it.”2 Use cases span focused assessment with sonography for trauma (FAST) exams aboard the International Space Station3 to emergency scans in resource-limited settings.
Collaborative tele-ultrasound is a form of this digital innovation that virtually embeds specialists from anywhere into appointments with local care providers. It works on an ultrasound device to transmit a secure, live feed of the images captured during an exam. Two-way video allows the remote specialist to provide the sonographer, primary care physician, or other local clinician with guidance on the ultrasound exam real-time. The remote provider can advise on image acquisition to ensure a complete and accurate exam and advise on how to maximize insights with the scanner. This technology enables remote specialists to augment the capabilities of local clinical staff to enable the delivery of high-quality care.
Strengthening rural women’s care through tele-ultrasound collaboration
Convenient access to specialized women’s healthcare is particularly limited in rural areas. Remote ultrasound can be applied in these care pathways to bring much-needed expertise into local encounters.
Tele-ultrasound for breast imaging
One workflow for tele-ultrasound is breast imaging. This care scenario is inherently fraught with uneasiness because an ultrasound typically happens as a follow-up to an irregular mammogram. Long wait times for results can add to a patient’s anxiety. With tele-ultrasound, rural imaging clinics can proactively and consistently have a metro-based breast imaging specialist present during these exams. The remote specialist can advise the sonographer on techniques to improve the scan.
“Witnessing this collaboration in real-time can give patients reassurance and confidence that they are receiving a complete exam even though they haven’t left their home clinic,” said Kessler. “They know their local care team is being guided by experts.”
Tele-ultrasound for obstetrics
Obstetrics is another care pathway leveraging tele-ultrasound. As of 2014, more than half of all rural counties in the U.S. were considered maternity care deserts, with no hospital-based obstetric services.4 Women in these communities who are high-risk because of a maternal health problem, an issue with the pregnancy, a fetal birth defect, or other complication, lack local access to specialized care. A recent geographical analysis of maternal fetal medicine (MFM) specialists in the U.S. found that some women must drive three to six hours to see a MFM specialist. This includes patients in the majority of tribal land reservations, Wyoming, North and South Dakota, border cities in Texas, Western Colorado, and the Appalachian regions on the western borders of New England states.5
“As a former labor and delivery nurse, I recall scary situations of pregnant women arriving on our unit in the middle of the night with disease conditions that had progressed undiagnosed due to lack of prenatal care. Sadly, in many of these situations, the bad outcome was preventable. With access to appropriate antepartum care, which could include collaboration and guidance from remote specialists via ultrasound when needed, some problems can be managed by the local care team early for the mom or the fetus, reducing the risk of death or permanent injury,” said Kessler.
Regular ultrasound exams are essential in high-risk pregnancies to monitor fetal growth and evaluate the progression of complications such as placenta previa or placenta accreta. Remote ultrasound can give a high-risk mother in a rural community a virtual lifeline to a MFM or perinatology specialist. This digital solution enables frequent and expert monitoring. Remote perinatologists can guide and support local sonographers who are performing ultrasound exams.
“This experience can give expectant mothers more confidence and peace of mind. They know they have a specialist monitoring their pregnancy, even though they aren’t physically right next to them. This should be available to all women,” said Kessler.
In the case of a suspected fetal heart condition an expectant mother may need to have weekly fetal echocardiography scans to diagnose and monitor structural, functional, and heart rhythm abnormalities prior to delivery. The Colorado Fetal Care Center at Children's Hospital Colorado in Denver, CO, is one of 34 fetal care centers in the U.S.6 It uses tele-ultrasound to provide women in rural communities with expertise and counseling for fetal cardiac diagnoses. Previously, moms were traveling more than 250 miles to seek cardiac care while pregnant. Now, in conjunction with their local care provider, these mothers can consult with a multidisciplinary fetal care team—cardiologists, surgeons, neonatologists, psychologists, genetics experts, radiologists, and anesthesiologists—on an array of complex fetal diagnoses without having to travel to Denver.
Combatting rural healthcare disparities
According to a poll conducted by National Public Radio, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health, 26% of Americans living in rural communities have not been able access healthcare when they needed it in recent years, and a healthcare facility being too far away or difficult to get to was one factor.7 For many rural communities, expanding the physical presence of in-office specialist care is not feasible. In these settings, remote tele-ultrasound can transform existing points of care into hubs for specialized support. This digital solution is helping to address healthcare disparities by enabling patients in underserved areas to access high-quality, expert care without traveling long distances to specialized medical facilities. Patients do not even have to have a device or manage account credentials to have a tele-ultrasound consultation–it is integrated into their local care experience. Tele-ultrasound creates a new pathway toward timely care for patients with incredibly limited options.
Watch this video to see how Digital Expert Connect can expand access to care.
REFERENCES:
1. “Rural Hospital Closures,” Cecil G. Sheps Center for Health Services Research at The University of North Carolina at Chapel Hill, last modified October 2023, https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/.
2. Christopher Uschnig et al., “Tele-ultrasound in the Era of COVID-19: A Practical Guide,” Ultrasound in Medicine & Biology 48, no. 6 (2022): 965-974.
3. Ashot E. Sargsyan et al., “FAST at MACH 20: clinical ultrasound aboard the International Space Station,” The Journal of Trauma 58, no. 1 (2005): 35-9.
4. Martha Hostetter and Sarah Klein, “Restoring Access to Maternity Care in Rural America,” The Commonwealth Fund, last modified September 30, 2021, https://www.commonwealthfund.org/publications/2021/sep/restoring-access-maternity-care-rural-america.
5. Nichole Nidey et al., “Examining geographic access to Maternal-Fetal Medicine care across the United States,” American Journal of Obstetrics and Gynecology, 226, no.1 (2022): S564-S564.
6. Kenneth J. Moise et al., “Current Status of the Workforce and Training at Fetal Therapy Centers in North America,” Fetal Diagnosis and Therapy, 49, no. 7-8 (2022): 333-339.
7. “Poll: Financial insecurity and limited access to health care plague many rural Americans,” Harvard T.H. Chan School of Public Health, last modified 2019, https://www.hsph.harvard.edu/news/hsph-in-the-news/poll-financial-insecurity-and-limited-access-to-health-care-plague-many-rural-americans/.
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