Rural Telemedicine: Lessons from Alaska for Developing Regions

Abstract

Alaska shares many characteristics with other rural and remote regions of the Asia-Pacific, including a small population spread over a large area, lack of roads linking villages to hospitals, a significant indigenous population, and a shortage of doctors in rural areas. Communication with village health aides was originally by high frequency (HF) radio. Satellites brought reliable voice communication in the 1970s. Alaska has now introduced the first permanent upgrade to the voice satellite system, known as the Alaska Federal Health Care Access Network (AFHCAN). This satellite-based system is now the world's most extensive telemedicine network, linking 248 sites, including 158 village health centers. This paper examines the approach used to design the network, and includes preliminary findings on utilization of the network and associated cost-savings. It also discusses the U.S. Universal Service Fund subsidy for rural health care facilities. It concludes with lessons learned that could be applicable for other remote and isolated areas and developing regions.

Patient and provider perspectives on using telemedicine for chronic disease management among Native Hawaiian and Alaska Native people

“…The high turnover of providers in rural areas and the lack of specialty care services throughout remote rural health care delivery areas have led to a growing interest in telemedicine-supplemented health systems. For rural Native populations in Hawai'i and Alaska, the issue of physician shortages and geographic separation is particularly problematic (3). In Alaska, 23 of 27 of its boroughs and census areas are federally designated as medically underserved areas or populations (4).…”

“…Thus, the potential of telemedicine to address these health care disparities is being evaluated as a means to improve access and quality of care for communities in Alaska and Hawai'i (3). …”

Ethical Disparities: Challenges Encountered by Multidisciplinary Providers in Fulfilling Ethical Standards in the Care of Rural and Minority People

“…Ethnic minority people are more likely to be uninsured for health care (over 25% uninsured) 6 . Moreover, geography and climate are relevant considerations outside of metropolitan settings, as many remote areas of the United States have no road or transportation system and/or are not accessible except by plane in certain seasons 30 . In addition, the actual use of existing services by rural and ethnic minority people is shaped by attitudes toward illness (eg, stoicism, stigma) and by issues pertaining to cultural sensitivity and competence (eg, views of illness, trust in technology and/or allopathic care, availability of translators) 31 .…”

Climate change and eHealth: a promising strategy for health sector mitigation and adaptation

“…Use of the satellite-based Alaska Federal Health Care Access Network (AFHCAN) is an example of successful health care provision in resource poor and remote areas. AFHCAN provides care among the Alaskan indigenous populations (45). Many and powerful forces are thus in motion that will guide the development of eHealth from regional, national and global perspectives.…”