Rural healthcare providers face a host of unique challenges that force physicians, nurses, and hospital administrators to think creatively in order to deliver the highest quality care possible to patients.

Americans living in rural areas can face a myriad of healthcare-related issues—a chronic shortage of doctors, dentists and pharmacists; lack of finances to receive quality health care; a upsurge of hospital closures; and a widening gap in life expectancy. [1][2]

Despite rural communities making up 19 percent of the U.S. population (and facing more health problems than their urban counterparts), less than 11 percent of physicians practice there. [3][4] The ratio of primary care physicians to patients is 13 physicians to every 10,000 people. If we do the math, that means millions of patients may have limited access to quality care and medicine. [5]

Simply put, if a rural-based physician decides to move to an urban city for a more lucrative career, this has the potential to minimize health coverage and care in the community. Hospitals in rural areas often work on thin margins, thwarting their opportunities to entice new physicians.[1]

Left behind
In recent years, rural America has been left behind when it comes to access to cancer care. The National Rural Health Association noted that economic factors, cultural and social differences, educational differences, lack of recognition by legislators, and the sheer isolation of living in remote rural areas all conspire to impede rural Americans in their struggle to lead a normal, healthy life. [5] One recent report from the Centers for Disease Control and Prevention (CDC) found that residents in rural areas display higher incidences of cancer and more cancer-related deaths than their urban counterparts. [6]

As it relates to cancer care and treatment, only six percent of oncology practices in the country cover a rural area—inhibiting access to care among older, sicker, and poorer populations. [7] Adding further setbacks, it’s common that rural cancer centers—which often need technology advancements the most—are not the first choice for technology program pilots. Instead, vendors look to align with large, urban, and renowned cancer centers.

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The efforts being made to democratize access to cancer care aren’t expected to change the system overnight, but with more attention and consideration, rural America is on its way to seeing improvement. One such avenue to accessibility? Mobile technology.

Mobile technology.
Mobile technology is the vessel to bring better healthcare to rural America as it can reach patients across geographic and socioeconomic boundaries. It has the potential to increase access to care and improve health outcomes. Health Information Technology (HIT), including mobile technology, has the potential to empower patients to engage more fully in their own healthcare journey and ensures that care teams have the most up-to-date health information on patients. HIT allows patients the opportunity to proactively engage in the provision of their healthcare by tracking health conditions and accessing provider visit notes, test results and more. The positive effects of HIT on medical outcomes have been proven in the majority of published studies, further demonstrating its value in rural healthcare.[8]

Take for instance the work being done at Tennessee Oncology to spark and inspire patient engagement. As one of the nation’s largest community-based cancer care groups, Tennessee Oncology treats more cancer patients than any other group in the state, reaching approximately 25,000 patients per year. Tennessee is a prime example of the need to democratize access with approximately 22 percent of its residents residing in a rural setting. [9] Noona, an electronic Patient-Reported Outcomes (ePRO) solution, is being deployed at more than 30 Tennessee Oncology centers across Tennessee to manage patient symptoms and capture a holistic view.

Noona was implemented to help elevate the voice of the patient and empower care teams with real-time patient reported data. It can encourage patients to better communicate symptoms and other relevant clinical information to their care team, while eliminating common barriers to adoption—regardless of whether they are three minutes away in the heart of Nashville, or three hours away, tucked between cornfields and poultry farms.

Symptom analysis
Automating symptom analysis is an underutilized yet critical strategy for improving rural cancer care. By providing an intuitive app-based user interface, ePRO platforms enable patients to easily ask questions and communicate symptoms with their care team during treatment, recovery and post-treatment. Smart algorithms can help care teams to identify acute symptoms and prioritize patients in need of immediate care based on patient-reported data.

A quarter of rural adults have used telehealth including mobile solutions in the past few years and report high satisfaction and convenience. Such solutions are proving critical for rural communities with financial and transportation barriers. [10] The Journal of Clinical Oncology conducted a randomized controlled trial and found that the use of ePRO solutions like Noona can result in 20 percent fewer ER visits, 10 percent fewer hospitalizations, and a 20 to 25 percent improved survival rate. However, numerous changes will need to take place in the healthcare industry for ePRO solutions to bring comprehensive benefits to rural America.[11]

Rural healthcare is a top issue among voters in 2020 and, as telehealth grows, lawmakers and payers will continue to hear the call for benefit options for rural communities. [12] Using these solutions has the potential to not only improve patient outcomes, but boost bottom lines for rural hospitals. With the right ePRO platforms and legislative strategies, the sun will shine bright in rural America.

[1] Slabach B. Fixing the medical staff shortage problem in rural areas. The Becker’s Hospital Review. June 20, 2018. [Article]
[2] Bannow T. Local government, Rennova tussle over shuttered Tenn. hospital’s fate Modren. July 08, 2019 [Article]
[3] One in Five Americans Live in Rural Areas. What is Rural America. United States Census Bureau. August 9, 2017. Online. Last accesses August 1, 2019.
[4] Talley RC, Chwalisz K, Buckwalter KC. (Eds.) Rural Caregiving in the United States|Research, Practice, Policy. Springer.
[5] About Rural Health Care. National Rural Health Association. Online. Last accessed August 1, 2019.
[6] Do rural populations experience greater worry and fatalism about cancer?. Mayo Clinic. ScienceDaily. March 7 2019. Online Last accessed August 1, 2019.
[7] The State of Cancer Care in America, 2017: A Report by the American Society of Clinical Oncology. American Society of Clinical Oncology (ASCO) Online. Last accessed August 1, 2019.
[8] Kruse CS, Beane A. Health Information Technology Continues to Show Positive Effect on Medical Outcomes: Systematic Review. J Med Internet Res. 2018 Feb 5;20(2):e41. doi: 10.2196/jmir.8793. [Pubmed][Article]
[9] Rural Health Information Hub. Tennessee. Online. Last Accessed August 1, 2019.
[10] Waddill K. 22% of Those With Rural Healthcare Lack Telehealth Coverage | Telehealth offers solutions for rural healthcare, but payers are inconsistent about covering telehealth services.HealthPayerIntelligence. Online. Last accessed. August 1, 2019
[11]Basch E, Deal AM, Kris MG, Scher HI, Hudis CA, Sabbatini P, Rogak L, et al. Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial.J Clin Oncol. 2016 Feb 20;34(6):557-65. doi: 10.1200/JCO.2015.63.0830. Epub 2015 Dec 7. [Pubmed][Article]
[12] Rappleye E. Rural healthcare a top issue among voters for 2020.  June 12th, 2019. Online. Last accessed August 1, 2019.

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Jani Ahonala is the global head of life science solutions at Varian, where he spearheads the strategy for Noona, the company’s smart cloud-based mobile service designed to capture patient-reported outcomes (PROs) in oncology. Ahonala focuses on Varian’s global go-to-market strategies for Noona in addition to business development, brand management, thought leadership, partnership, and stakeholder integration. His vision is to set a new standard for PROs in oncology, revolutionizing cancer care through novel digital technologies that can help democratize access for all. The goal is to have one million Noona patient users by 2021. Ahonala has worked in the field of cancer treatment throughout his career, 15 years of which involved experience as an entrepreneur, healthcare management consultant, and researcher. He had the opportunity to observe first-hand how much anticipatory symptoms monitoring can improve patients’ quality of life, all while positively impacting healthcare costs. His current role at Varian is at the intersection of technology, design and medical expertise, as he guides the team to work with the world’s leading cancer researchers and foremost clinics, including Stanford University. Ahonala has an exceptional track-record in computational design and digitization of healthcare services. His early research on customer-centered cancer care inspired him to found Kaufmann Agency, the leading healthcare design consultancy in the Nordics. As managing director of Kaufmann, Ahonala helped hospitals and Big Pharma adopt design-led business models to thrive in an increasingly complex and global healthcare environment. Ahonala has also been a consistent public speaker at key industry events over the last decade. He holds a master’s degree in economic sciences from the University of Vaasa.