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Research in the field of rural health care delivery has documented significant need for improved quality-of-care. Dr. L. L. Hicks summed up the research by describing the following characteristics related to rural health care delivery concerns1:

Rural communities have much fewer health care providers per capita than do urban communities.

Rural residents travel much longer distances to obtain health care services.
Rural communities have higher levels of alcoholism, smoking and infant mortality resulting in a greater need for health care services.

These problems are particularly acute for rural mental health provision. Many rural communities have higher levels of child abuse, child neglect, divorce, suicide and youth delinquency, possibly due to the social factors of higher-than-average poverty, unemployment and financial stress 2. Despite large rural mental health needs, very few rural communities have access to mental health services in their area. Over half of the counties in the United States have no psychiatrists, psychologists or social workers3. Due to this shortage, many rural communities must pay high costs for mental health professionals to travel to their local clinics. Common practice is to pay psychiatrists travel expenses to drive from urban centers to outlying rural hospitals, clinics or community centers.

To add to the difficulty in providing adequate mental health services in rural areas, rural residents face a greater stigma against the pursuit of mental health care, as compared to urban residents. This stems in part from the lack of anonymity in rural areas and strong beliefs concerning self-reliance4.

To further complicate the provision of adequate mental health care in rural areas, rural caregivers may face ethical dilemmas due to the lack of qualified rural mental healthcare providers. For example, rural caregivers may be put in the position of providing mental health care without proper training, support or safeguards. They may also have to ration care, provide services outside of their areas of expertise, deal with patients who are unable to comply with recommendations because of access problems, and respond to a host of complaints and issues without the benefit of trained specialists5.

Rural Americans feel the same cost squeeze and have similar concerns about health care quality as their urban counterparts. Healthcare costs have inflated over the last 20 years, far in excess of the consumer price index. According to the Bureau of Labor Statistics, outpatient medical care cost inflated 174% from 1986-2006, far in excess of the consumer price index, which inflated by 84% over the past 20 years. Americans now spend $2.25 trillion/year on healthcare, and inefficiencies and impaired processes abound in the healthcare system.

In order to meet concerns about cost and quality, one of the top priorities of the Bush Administration and the health care industry is to improve the quality of and access to patient information through the adoption of electronic medical records (EMRs). In his last four State of the Union addresses, President Bush specifically referred to the priority of full adoption of EMRs. In 2004 he set 2014 as a goal for full adoption of electronic health records throughout the healthcare system. A few key quotes from the four addresses are listed below:

2004: “By computerizing health records, we can avoid dangerous medical mistakes reduce costs, and improve care.”
2005: “To make our economy stronger and more productive, we must make healthcare more affordable with improved information technology to prevent medical error and needless costs.”
2006: “We will make wider use of electronic records and other health information technology to help control costs and reduce dangerous medical errors.”
2007: “We need to reduce costs and medical errors with better information technology”.

This issue enjoys bipartisan support in the US Congress and among candidates in the current Presidential race. Senator Clinton has stated, “A move toward electronic medical records would help tackle the cost of poor quality, inefficiency and redundancy.” Senator Obama successfully advocated legislation in the Senate to force the Pentagon to work towards an efficient electronic medical records system that will help the nation's troops. Based on this recent history in the political scene, it is anticipated that there will be continuing regulatory pressure for the adoption of EMRs.

IconoPsych Care, LLC, is positioned to address the need for mental health practitioners in rural areas as well as the demand for high quality electronic medical recordkeeping technologies customized for mental health. Through innovative research and development funded in part by their Phase I USDA SBIR grant, IconoPsych determined the technical feasibility and commercial applicability of two web-based solutions that can contribute to rural development. First is an online telepsychiatry “clinic” that creates greater access to mental health care in rural areas through webcam videoconferencing. This product is capable of linking mental health care providers with patients in rural areas while eliminating transportation costs and providing the option for patients to seek mental health treatment from their own homes and avoid the stigma faced in public waiting rooms. The second product is an advanced, efficient electronic medical recordkeeping software customized for mental health providers. Phase I USDA SBIR funds also helped determine that it is technically feasible to integrate both solutions into one product suite to be offered to rural health clinics and private practioners. Phase II USDA SBIR funds will be used to refine the product suite and commercialize this online software suite for utilization by doctors, counselors and patients alike.