Rural hospital closures persist throughout the United States. According to the American Hospital Association (AHA), more than 135 rural hospitals closed between 2010 and 2021, with 19 rural hospitals closing in 2020 alone. The Center for Healthcare Quality and Payment Reform estimates that an additional 300 rural hospitals are at risk. These closures (and threatened closures, which themselves may discourage additional financial or other resource investment) typically have ripple effects beyond the hospital walls. In addition to the immediate loss of local healthcare, KFF Health News identified evaporated jobs and negative impacts on restaurants and other small businesses as follow-on impacts of hospital closures in small towns. Moreover, in small communities that already lack access to healthcare specialists, the closure of a hospital can almost instantly eliminate access not only to emergency care but to labs, physical therapy, urgent care and other services.
An oft-repeated aphorism is that silver bullets are rare, but that silver buckshot can be a good way to take aim at problem. Tech innovation, and particularly broadband-enabled technology, can help mitigate at least some aspects of rural hospital closures. To be sure, urgent and emergency care will require hands-on intervention. But telehealth and other broadband-derived services can be a tool to stem at least some impacts of rural hospital closures.
A 2015 study developed an alternative reality (AR)-based virtual activities of daily life (ADL) protocol for post-stroke patients, including cooking and other household tasks. That study cites other investigations that incorporated AR-based games which include lifting and reaching for physical and occupational therapy, focusing on “gait training, balance, table-top activities, strengthening exercises of the upper limb, and ADL training.” The U.S. Veterans Administration explains that AR can also be used for pulmonary rehabilitation that generally involves “long-term, repetitive exercise and behavioral changes.” Benefits of AR and virtual reality (VR) applications extend to physician training: In one study, students who trained with VR simulators demonstrated greater improvement than students training with conventional practices.
Remote patient monitoring (RPM) that relies on broadband connectivity can mitigate other care provider shortages in rural areas (though to be sure, RPM is a valuable tool in metro areas, as well). When coupled with artificial intelligence (AI), RPM devices (including wearable and ambient sensors) can analyze data and create reports for physician review. The combined data sets can help doctors self-identify a diagnosis or produce an AI-generated diagnosis for physician review. On the patient side, AI-powered chat bots can assist patients with non-emergency needs, including identifying symptoms and obtaining medical advice.
While these applications do not fully replace local personal healthcare, they can fill some gaps and enable distant or less-frequently visited healthcare providers to assist patients.
Rural hospital closures implicate non-health-related impacts, including empty real estate. KFF described large, dormant buildings – but also provided examples where creative and collaborative ventures resulted in new life for the buildings and valuable resources for the community. In Somerville, Tenn., a closed rural hospital was repurposed as a satellite campus for a local university. In Carroll County, Tenn., the electrical infrastructure of a shuttered hospital was attractive to an edge AI firm that provides data center capabilities; the firm is reportedly exploring acquisition of other closed rural hospitals.
Real estate repurposing nor AI-assisted telehealth will fully replace access to local healthcare, or the jobs lost when hospitals close. But telehealth (including VR, AR and AI-based applications) is a valuable tool across many healthcare applications and repurposed real estate is an explorable strategy to bring new life to shuttered spaces. No silver bullets, but plenty of silver buckshot.