Abstract
Traditional hub-and-spoke rural healthcare delivery models face persistent challenges in providing timely and equitable access to specialty services. Digital technologies serve an increasingly critical role in mitigating access and capacity constraints by extending the virtual reach of tertiary care centers. A modernized hub-and-spoke design utilizes many forms of digital tools with a diverse range of technological interventions. The goal of this narrative review is to provide a framework for understanding the role and supporting evidence of digital technologies in specialized care in rural regions. We break these digital support tools into three functional groups: 1) real-time monitoring applications including artificial intelligence-based analytics and population-level tools, 2) connected solutions including telemedicine and cloud-connected medical devices, and 3) supportive technologies such as augmented image interpretation, decision support and documentation. These technologies collectively expand the capabilities of healthcare providers to treat acutely ill patients outside of tertiary care centers, enable access to services otherwise unavailable in resource-limited settings, and reduce barriers to maximizing the impact of care capabilities in rural communities. By leveraging a spectrum of digital tools that streamline communication and knowledge sharing, healthcare systems can potentially achieve the quadruple aims of improving patient care, value and sustainability, while supporting equitable access and the well-being of the healthcare workforce.