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. 
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.  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. 
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.
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.  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. 
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.  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.
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 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.
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.  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.
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.  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.
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.  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.
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