However, with the aid of telehealth, citizens living in rural or remote areas of the country can receive quality health care. Someday telehealth may solve the geographic challenges that many rural citizens face in accessing quality health care.           
                                                                                                                
Telehealth is the use of telecommunications to provide health information, clinical care, health professions education, consumer health education, public health and administrative services at a distance.

Telehealth is administered in various forms. For instance, a physician can conduct a comprehensive examination of his patience through an interactive video. Laboratory results, x-rays and other kinds of clinical tests can be stored and sent to another practitioner for review at a later time. Individuals can monitor their own health by a touch of a phone or answering a few questions from a survey administered from a computer. 

Although rural residents comprise approximately one quarter of the U.S. population, they do not have the same level of access to basic primary health care services that is available to other Americans. Rural healthcare delivery is complicated by significant challenges such as poverty, inadequate transportation, large distances, an aging population base and rural economic decline. 

To promote the use of telehealth, the U.S. Department of Health and Human Services established the Office for Advancement of Telehealth. Since 1998, the Office has awarded more than $180 million under the Rural Telemedicine Grant Program.

The purpose of the program is to expand access to, coordinate, restrain the cost of and improve the quality of essential health care services, including preventative and emergency services, through the development of integrated health care delivery systems or networks in rural areas. The Office administers grants to public nonprofit organizations, universities, and health care providers.            

Telehealth Examples
Thirty states have developed telehealth systems to increase patients? access to specialists through video-imaging and real-time collaboration.  This technology also brings continuing medical education and training to isolated rural providers.

In addition, telemedicine links rural hospitals, primary care clinics, medical schools and individual providers can offer rural patients immediate interpretations of medical information, laboratory and radiological test results. Through telehealth, unnecessary patient travel to remote care facilities can be avoided.

Examples of some of the 30 states that are implementing telehealth from a distance are:
* Marshfield Clinic Research Foundation will use a Universal Service Fund grant to expand its Telehealth Network in Wisconsin. The Telehealth Network currently operates from 17 sites. The grant will allow the network to add an additional 10 provider sites.  The locations, such as rural schools and prisons, are connected to Marshfield Clinic and its regional centers through high-speed data lines. Through a live video, doctors are able to do a virtual examination.

* The State of Georgia has one of the largest telemedicine systems. Started in 1987, the network now involves sixty sites, including rural community hospitals, an ambulatory center, a public health facility, and correctional institutions. Along with interactive patient consultation, the system enables rural physicians to accrue continuing medical education. A future goal of the project is to examine patients with chronic illness via interactive cable television in their homes. The project is also developing a ?glove? that employs virtual-reality interface technology, giving specialists the ability to reach out and ?touch? their patients.

* ?Rural? has a different connotation in Alaska than most people are familiar with due to the lack of a connected road system to the majority of remote villages scattered across vast expanses. Travel to more than 200 rural communities can only be done by a small plan or boat if weather conditions are cooperative. Often people are flown to the nearest hospital for medical treatments. The Alaska Federal Health Care Access Network is a telehealth initiative designed to improve access to health care through the development of a sustainable telehealth network using telemedicine technologies.

The use of telehealth can help bridge the geographical distances between healthcare providers in cities and underserved rural patients, bringing advanced diagnostic methods and treatment to areas that currently have little access.

As with all new approaches, some significant legal, interstate governance, and insurance reimbursement issues must be addressed.  In addition, the issue of patient confidentiality has come to the forefront.  With the electronic dissemination of medical records and test results required to facilitate effective telehealth procedures, some states are considering the development of model privacy statutes to ensure that patient information is protected. 

For more information about the NLC Linking Rural Communities to Communication Opportunities Project, best practices that you would like to share or for ideas about how you may contribute to the network, contact Deborah George-Feres, manager, local government services at (202) 626-3129, or email george-feres@nlc.org, or LaStar Matthews, staff associate at 202-626-3177, or email matthews@nlc.org.