Jun 02 2022
Patient-Centered Care

What Are Medical Deserts, and How Can Technology Alleviate Them?

Medical deserts create a shortage of care in both rural and urban areas due to geographical and economic causes, but AI-infused health IT tools and telehealth can help.

People across the United States face difficulties in accessing healthcare services. Areas without access to hospitals, primary care physicians, pharmacies and other healthcare providers are called medical deserts, and every state has at least one desert county that fits this description, according to Tori Marsh, director of research at GoodRx, a consumer-focused digital healthcare platform.

In a recent white paper, the company revealed that more than 80 percent of U.S. counties lack proper access to health services. States such as North Dakota and Alaska have large medical deserts, Marsh says. However, medical deserts are not limited to rural areas. Populations in urban areas also lack the means to get proper care due to their economic conditions.

“Just because you live in a very populated city doesn’t necessarily mean you have the infrastructure needed,” Marsh says. “It might mean that you have fewer hospital beds; it might mean that there are not enough providers for your community.”

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Dr. Onisis Stefas, vice president and chief pharmacy officer at Northwell Health, a New York–based health system, notes that just a few years ago a medical desert would be defined by the number of brick-and-mortar hospitals, doctor’s offices and pharmacies found there. Now it can mean a lack of access to internet connectivity or care, including telemedicine, telepharmacies, smart devices or computers, Stefas says.

“I think it’s more of a broader definition of not just the number of physical resources, but what other types of care can you access within that community,” Stefas says.

How Sanford Health Reduces Friction in Medical Deserts

Headquartered in Sioux Falls, S.D., Sanford Health serves more than 1 million patients across 250,000 square miles. Geographic distance and transportation issues as well as provider shortages can make it difficult to access care, says Erica DeBoer, the health system’s chief nursing officer.

Jared Antczak, Sanford Health’s chief digital officer, notes that in addition to a lack of broadband internet or cellular connectivity, device access and digital literacy are all social determinants of health and can contribute to medical deserts.

“All of these things create friction, and friction creates barriers to engagement,” Antczak explains. He says the goal is to create a “simple, intuitive and seamless” digital experience in healthcare, like streaming services such as Netflix do in entertainment and Uber in transportation. Sanford Health uses the Epic MyChart patient portal to send secure messages to patients to keep them connected with their providers. Sanford Health, the largest rural health system in the U.S., has also set up mobile clinics for patients who otherwise would have to travel four to six hours to receive pulmonary care.

EXPLORE: How virtual care expands patient access and engagement in pediatrics.

Virtual care is a key part of Sanford Health’s strategy to reach patients in remote areas. The health system has deployed TytoCare home exam kits so patients can receive remote care for conditions such as earaches or sore throats. They can also receive prescriptions for antibiotics through TytoCare visits with doctors, DeBoer says. Sanford also sends trucks equipped with mobile mammography and other diagnostic imaging capabilities to patients in medical deserts.

In 2021, the health system launched a $350 million initiative to build a virtual care center to reach patients in rural and underserved communities across the Midwest, including North Dakota, South Dakota and Minnesota. As part of the virtual care initiative, Sanford plans to set up small, two-room clinics in farming communities with populations of 2,000 or less. These rural satellite clinics will be staffed by nurses to help patients who may not have access to broadband to log in to a telemedicine visit, DeBoer says.  Remote access for patient monitoring, primary and specialist care, mental health services and additional advanced resources will be available 24/7 at these sites.

Meanwhile, Sanford Health is developing machine learning algorithms, embedded in the electronic medical record, to identify health concerns and intervene earlier to improve outcomes, says Antczak; for example, such screenings might prompt clinicians to recommend earlier preventive care if patients are at high risk for a condition such as diabetes or breast cancer.

Alleviating Medical Deserts Using Chatbots and Telemedicine

Northwell Health has developed an app that uses artificial intelligence to coordinate Black maternal health in particular ZIP codes that need it. Stefas says a chatbot asks mothers questions such as whether they are taking their aspirin if they have preeclampsia, a complication during pregnancy that causes high blood pressure, among other symptoms.

“Based on their responses, an algorithm can directly link them to our emergency department on demand, where they can meet with an ED doc virtually for further assessment,” Stefas says. “Or it will route them to the provider that would make sense based on their responses.”

Dr. Onisis Stefas
Based on their responses, an algorithm can directly link them to our emergency department on demand, where they can meet with an ED doc virtually for further assessment.”

Dr. Onisis Stefas Vice President and Chief Pharmacy Officer, Northwell Health

The chatbot app also follows up with new mothers to set them up with lactation consultants if they are struggling with breastfeeding.

“The whole idea is really to improve Black maternal health and support the care of the mothers and the babies,” Stefas says. “So, the pharmacy plays a role in supporting the medication needs within that scenario, because we’ve seen that low-income areas have poor birth outcomes and poor maternal outcomes.”

Remote Patient Monitoring, Predictive Analytics Reach Medical Deserts

Remote patient monitoring of heart rate, blood pressure and glucose numbers is important to provide early intervention for patients in medical deserts who may not seek care as often, Stefas says. Medical professionals can also use predictive modeling to examine the social determinants of a geographic area and get food, shelter and medicine to patients in need, he adds.

Along with using technology such as predictive analytics, remote monitoring and telemedicine, the healthcare industry can address medical deserts by understanding a community’s needs and building trust and credibility within that population, Stefas says.

RELATED: Learn how to integrate remote patient monitoring data to improve health outcomes.

“Technology becomes an enabler of a lot of those things, particularly around curating the data, predictive analytics, all of those,” he says. “But you can’t just come in with the technology. You need to build those relationships and leverage that technology as a tool to better assess the population in terms of where you’re going to be spending those limited resources to get the largest outcome or impact.”

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