Dear Editor,

Alabama has made great strides when it comes to addressing health disparities. As just one example, it was recently reported that Birmingham, Alabama, ranked second in the country for the having least health disparity when comparing those with the lowest incomes to those with the highest. However, we are far from disparity free. Death rates from cardiovascular, oncologic, and diabetes are still significantly higher for rural Alabamians than those living in urban areas.
Access to healthcare likely plays a large role in some of these rural and urban health disparities. Economics may hinder access to healthcare in rural Alabama. Eight of Alabama’s rural counties are among the 250 poorest in the country, and the uninsured population in rural Alabama is higher than that of urban areas. Geography also plays a role in limiting access to care in rural areas. Rural areas have fewer physicians than urban areas, with only two of Alabama’s 54 rural counties not being classified as a primary care shortage area. Thus, those in rural areas must commute great distances to receive care at significant expense and time.
How can we continue the progress Alabama has made towards eliminating health disparities? One possibility is with the use of telehealth.
Telehealth, a broad term loosely defined as providing healthcare through electronic means such as interactive videoconferencing, would provide unprecedented access to care in rural areas by eliminating the geographic divide. It holds the promise of improving quality of care by increasing the ability to remotely monitor a myriad of data such that interventions can be done to prevent poor outcomes rather than reacting once they have already occurred.
Telehealth may improve quality of life for those with chronic and rare diseases, because instead of spending time driving to and from appointments and enduring long wait times in waiting rooms, these patients can be contributing at work or enjoying their time at home with family.
Although Alabama has been slower than our neighbors Mississippi and Georgia to adopt telemedicine, we are now in a position to learn from their successes, adapt sustainable programs to our unique needs, and become leaders in our own right in telehealth. Great strides towards this have already occurred in the past year, including the establishment of a telehealth network within the Alabama Department of Public Health, which has succeeded in providing the backbone for numerous telemedicine programs like Medical Aids Outreach, Mental Health, and the delivery of home dialysis care via telemedicine. In fact, the ADPH has established telehealth clinics in 14 county health departments already, with plans to have 25 sites — more than one-third of the state — with telehealth clinics by the end of the year. This is great progress.
Further, in December 2015, Blue Cross Blue Shield of Alabama began a pilot program reimbursing telemedicine visits for six subspecialties. Most recently, the University of Alabama at Birmingham hired Bart Kelly as the Director of Telemedicine, showing its commitment to this mode of healthcare delivery.
We must not stop here. The momentum that has been generated around telehealth must be followed by the development of sustainable telehealth programs, research to guide the most economic and effective implementation of these programs, and training of the next generation of physicians. Barriers still exist to widespread adoption of telehealth, but they can, must, and will be overcome given the healthcare needs of our state.
About UAB
Known for its innovative and interdisciplinary approach to education at both the graduate and undergraduate levels, the University of Alabama at Birmingham is an internationally renowned research university and academic medical center and the state of Alabama’s largest employer, with some 23,000 employees and an economic impact exceeding $5 billion annually on the state. The five pillars of UAB’s mission deliver knowledge that will change your world: the education of students, who are exposed to multidisciplinary learning and a new world of diversity; research, the creation of new knowledge; patient care, the outcome of ‘bench-to-bedside’ translational knowledge; service to the community at home and around the globe, from free clinics in local neighborhoods to the transformational experience of the arts; and the economic development of Birmingham and Alabama. Learn more at www.uab.edu.

Eric Wallace, M.D., 

a nephrologist and assistant
professor of medicine 

University of Alabama at Birmingham School of Medicine