Rural patients and providers commonly experience frustration with the lack of specialty services. For patients, this can mean delays in accessing specialty or higher acuity care for both diagnoses and treatments, including in emergency situations like a stroke, or having to travel to distant sites for specialty care. This is reflected in poorer outcomes, including preventable death and readmissions. For providers, this means they have limited access to referrals and second opinions, they have limited exposure to learning opportunities from collaborative work, and might need to care for patients whose needs exceed their own scope of practice. This might also require less sustainable on call schedules, and higher burn-out rates, especially in a pre-existing context of provider shortage. For both providers and patients, what is at stake here is equity: disparities lead to poorer outcomes and experiences.
Telehealth aims at bridging the digital divide by allowing the reorganization of delivery of care into networks of care, with low acuity sites being able to connect with specialty care sites. One such example is Dartmouth-Hitchcock's Connected Care Hub and Spoke model. Small, low-acuity hospitals (the spokes) contract with Dartmouth-Hitchcock (the hub) for a range of services like TeleER, TeleICU, TeleStroke, TelePharmacy or TeleBehavioral Health. When a patient’s needs are beyond the spoke’s scope of practice or acuity level, the hub’s services are accessed either via synchronous video-conferencing or via store-and-forward consultations. This allows optimal diagnosis and treatment plans to be made, and ultimately for the patient to either remain safely at their local hospital or for transfer to Dartmouth-Hitchcock to occur in an integrated way.