Telecommunications and Rural Health Communities

Four years ago, the University of New Mexico School of Medicine initiated a rural health community-based education curriculum for interdisciplinary teams of health professional students. The teams comprised students from medicine, nursing, pharmacy, and various allied health sciences, including physical therapy, respiratory therapy, dental hygiene, mental health, and social work.

The students were assigned to a rural community for 2 months to continue studies with community preceptors and tutors. During this time, the students and clinical rural preceptors were equipped with desktop computers and modems and provided with telecommunication linkage so that they could access electronic mail, computer-aided instructional materials, the National Library of Medi-cine (Grateful Med and Lonesome Doc), and other databases through the Internet. At least three outcomes are expected when telecommunications is coupled with interdisciplinary training.

1. Professional isolation of rural settings can be minimized through easy access to literature and networking with colleagues using electronic mail.

2. Better health care can be provided through conferences by computer with other health providers and through accessing updated medical procedures and protocols.

3. Opportunities for recruitment and retention of health care practitioners can be provided when it is recognized that they can grow and develop professionally and, through Grateful Med, keep abreast of what is occurring elsewhere in medicine.

It is too early to measure the effectiveness of the curriculum in achieving the desired outcomes. We have seen favorable changes in students' attitudes toward and perceptions of a rural practice; the tangible evidence is that 25% of the students have accepted positions in rural hospitals or health facilities. With today's communication technology, it is possible to provide the young aspiring health care provider with ongoing professional stimulation, continuing medical education, and instant access to information from library sources, no matter how remote the rural site.

The computer-based technology described above for the Interdisciplinary Rural Health Care Program in New Mexico offers valuable support for health care professionals in remote areas through access to electronic mail, literature searches, bulletin boards, and other information services. Standard communication protocols (TCP/IP) have already been developed and widely accepted, making this technology independent of proprietary vendor-based systems. The accessibility, affordability, and international connectivity of computer-networking systems establish a positive outlook for the future use of these systems. Other approaches to meeting the needs of rural practitioners are being tried. One is the Texas Tech MEDNET program described in some detail in the position paper from the American College of Physicians in this issue [2]. I certainly support the College's Position 4, which urges wider use of telecommunications technology to increase the attractiveness of rural practice.

The distinct advantage of computer networking is that it enables the use of widely available technology and relatively inexpensive equipment for building a unified system. Most offices and many persons currently use personal computers. Through simple modems, standard analog lines, and network nodes, the person can link his or her own desktop to a community of health care professionals.

Video applications are currently emerging as expanded desktop systems, allowing users to see and hear each other using desktop cameras and microphones. Although digital telecommunications are needed to transport this type of application, communication protocols remain consistent with current network applications and thus ensure the interoperability of the system. By establishing an analog network with appropriate protocols now, our rural health care communities, rural health offices, primary care clinics, and emergency medical services will be positioned to take advantage of this emerging technology.

• Copyright ©2004 by the American College of Physicians