Throughout our 40-year-plus history, the community health centers in North Dakota and South Dakota have had a core mission of protecting access to care for rural and frontier communities. We believe that rural people should have local access to high-quality primary care, behavioral health services, and dental care, and we have fought enormous headwinds to sustain that access, including overcoming barriers to recruiting and retaining staff and dealing with the financial limitations that are inherent to providing care in a low-volume environment.
Now, Rural Health Transformation Program (RHTP) funding is fanning out to rural communities across the country. After struggling to sustain services in a low-resource environment for years, this looks like a welcome opportunity to shore up systems that have become fragile and to invest in innovative ideas coming out of rural communities themselves.
Technology vendors are also fanning out across rural communities with a lot of high-cost ideas for transforming care. While we love technology and all of the ways it can support high quality care and greater efficiency, we will be asking ourselves: Does this technology strengthen or undermine the type of local care we are committed to protecting?
We know, for example, that computer kiosks cannot replace the need for providers in rural communities, and that virtual care works best when connected with hometown providers who can provide continuity of care. Kiosks are fine for a few types of routine services, but when a true medical emergency arises, whether that is pre-term labor or a farm accident, a computer will not be enough. It will also not be enough for those conditions where an in-person assessment is needed or for those – like some elderly individuals – who are uncomfortable with technology or who need a little extra help accessing the care they need. Online-only services and kiosks risk undermining local care when solely used without the support of a primary care provider.
That isn’t to say that we don’t value and need telehealth. We are already using telehealth in ways that strengthen the rural health system. For example, Horizon Health in South Dakota uses telehealth to build connections between rural communities so that when one clinic’s provider is away for time off or continuing education, patients can still visit their hometown clinic location and join a virtual appointment with a Horizon provider based at another site. We also have nurses in rural communities that facilitate connections with specialists so that rural patients can have follow-up visits closer to home. Online patient portals, patient texting apps, and remote patient monitoring can also be amazing tools for building connections to local providers, strengthening that important relationship, so it is there when you need it.
The resources available through RHTP present us with a choice. Will we use this funding to create technology systems that bypass rural providers? Will we believe those who say that local access to care for rural communities will soon become a thing of the past? Or will we use it to support local providers in making the technology advances and building the partnerships they need to sustain local access to care for years to come? Community health centers have already voted with our feet. We love the practice of medicine and dentistry in rural and frontier communities, and we look forward to working with state partners and others to help rural health care get stronger and thrive!
