Sound healthcare requires reliable networks that include primary physicians and specialists. However, rural America tends to lack these networks. Medical providers serving rural populations often work alone, sometimes without even basic resources like a hospital, medical support staff, and some medications. As a result, clinicians can’t always deliver appropriate care, resulting in illness and death rates increase that disproportionate to the rest of the country.  

This gap in rural care isn’t a new phenomenon, but it has become more evident as COVID-19 ravaged populations far from urban centers. Many rural communities lack critical resources, such as a single physician, hospital, or sufficient local infrastructure to handle the pandemic. Rural healthcare systems are essential to the communities they serve and technology can bridge gaps, enabling providers to deliver more care even with very limited resources. 

Bridging the Gaps in Healthcare 

While a large community of rural physicians and advanced practice providers exists in the U.S., a significant gap remains in the number of primary care physicians per capita and a much larger gap in the number of medical subspecialists like dermatologists, oncologists, gastroenterologist, and rheumatologists per capita relative to urban areas. In fact, for every 100,000 patients in urban areas there are about 53.3 primary physicians. In rural areas the number is 39.8. Many rural hospitals have closed, and many more are struggling to stay open.  

National Rural Health Snapshot  Rural  Urban 
Percentage of population  19.3 percent  80.7 percent 
Number of physicians per 10,000 people  13.1  31.2 
Number of specialists per 100,000 people  30  263 
Population aged 65 and older  18 percent  12 percent 
Adults who describe health status as fair/poor  19.5 percent  15.6 percent 
Adolescents who smoke  11 percent  5 percent 
Source: Health Resources and Services Administration and Rural Health Information Hub 


Healthcare leaders must answer a basic question when it comes to closing the rural healthcare gap: How do you build a healthcare system without hospitals and without a network of subspecialists?  For rural patients living with serious chronic conditions, like rheumatoid arthritis or interstitial lung disease, the nearest subspecialist may be many hours away from their homes, which is too far for most patients to travel. As a result, it may take longer to get a diagnosis and, once diagnosed, rural patients may struggle to find an accessible physician with expertise in managing their disease. 

Technology Can Connect Rural Populations to Care 

One key tool to bridge that rural care gap is the use of technology. For example, telehealth could fill key gaps in care in obstetrics and gynecology, particularly in rural areas. Less than half of rural women live within a 30-minute drive of obstetric care facility. While not a perfect solution, technology can serve an important role in facilitating efficient and effective healthcare delivery in rural areas. For example, in an idealized rural rheumatology care network, physicians may see patients from 10 or 20 counties—only be possible if the right technology is in place. Technology can be used to achieve the following specific goals: 

  • Enabling doctors to see more patients efficiently and safely. 
  • Increasing patient satisfaction with their care. 
  • Building patient trust in the clinic and quality of care delivered.  
  • Increasing efficiency by allowing the safe supervision of a network of primary care physicians and advanced practice providers, who are also seeing rheumatology patients. 
  • Conducting research programs and clinical trials on par with academic settings. 

    “Technology is a powerful tool that has the potential to reach patients who might otherwise not essential pre- and post-delivery care,” said OB-GYN Rameet Singh, MD, MPH. “In rural New Mexico, our patients want telehealth as part of their ob-gyn care. We are working on improving access by connecting patients to digital care and services and alleviating barriers like driving long distances to the clinic, transportation issues, inflexible work schedules, and childcare challenges for expecting and new mothers.” 

    Alleviating the Strain on Rural Care Teams 

    Through customized patient messaging pathways, subspecialists can keep patients on track with medications and care. Automating these patient workflows can eliminate labor-intensive and inefficient outreach processes. Providers can automatically enroll patients in a messaging pathway as part of their visit protocol.  

    A patient may come to the clinic for an eye condition and receive a prescription for treatment. In an ideal workflow, a clinician soon checks in with the patient to ensure they’re taking the medication, see if they have any questions or side effects, and set a follow-up appointment. However, in an understaffed rural clinic, some or all these steps may unintentionally fall through the cracks. In such cases, patient engagement communication technology can automate each step in the workflow, thereby empowering patients to actively participate in their care. These workflows give staff more time to help patients needing more clinical attention.  

    In addition, using specific workflows lets patients refill medications for up to a year in advance, making it more convenient and more likely they will adhere to their treatment plan. The patient engagement communication technology monitors their care, ensures they keep their scheduled checkups, and alerts the clinic if they miss any appointments. As long as the data is regularly available (e.g., labs or confirmation of medication adherence), stable patients can see their providers less often. 

    Another advantage of using this digital patient engagement technology in a rural setting is the ability to send images via text message. For example, a patient may have a rash. Rather than having to drive two hours each way for an office appointment, they can simply text photos. This is much more accessible for rural patients, who often have unreliable broadband. With texting, patients can quickly send messages, and physicians can respond. Platforms designed specifically for this purpose are more reliable than those that rely on a downloaded app or video conferencing technology. 

    Give Rural Communities Access to Comprehensive Care With Digital Tools 

    Digital patient engagement can help close care gaps for patients in rural communities and help generate personalized communication workflows based on patient preferences, response to treatment, and social determinants of health—keeping rural communities connected to care in a convenient and safe way. 

    To learn more how Twistle by Health Catalyst can help power your patient engagement strategy, contact us today!