In the vast expanses of rural America, access to quality healthcare has long been a challenge. But telehealth can be a digital lifeline for these communities. According to the American Hospital Association, 76% of U.S. hospitals connect with patients through video and other technology. This underscores the growing importance of telehealth for rural areas where medical facilities are often few and far between. 

Let’s explore how this technology is making waves in rural healthcare, its benefits, challenges, and what the future holds.

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Benefits of Telehealth for Rural Residents

Telehealth is changing healthcare delivery, particularly in rural areas where access to medical services can be limited. 

In a survey of 202 adults living in a rural area, 88% of them were open to telehealth. When asked about barriers to show up for doctor appointments or receiving adequate healthcare, they cited several reasons (Kolluri et al., 2022):

• The wait to see the doctor is too long – 32.7%
  
  
• Too expensive – 24.8%
  
  
• Lack of transportation – 22.8%
  
  
• Schedule conflicts – 22.8%
  
  
• Not sick – 15.8%
  
  
• Distrust the quality of healthcare – 13.9%
  
  
• Other – 4.5% (“My insurance isn’t accepted for at least 100 miles.”)

With this data, we can clearly see how telehealth can positively impact rural patients. Here are some specific benefits.

Better access to doctors with reduced travel

For many rural residents, visiting a doctor means traveling long distances, which can be costly and time-consuming. Finding a specialist is also challenging due to limited availability. 

Telehealth bridges this gap by connecting patients with specialists through video visits and online consultations, which eliminates the need for long travel (Butzner & Cuffee, 2021). Patients who receive care from the comfort of their homes save on transportation costs and reduce the need to take time off from work.

Faster access to care in emergencies

Tele-emergency services provide real-time access to emergency medicine physicians, allowing rural healthcare providers to manage emergencies more effectively (Rural Health Information Hub, 2024). This quick access can be crucial in life-threatening situations.

Increased continuity of care for chronic conditions

Chronic disease management is vital for improving patient outcomes. Telehealth enables continuous monitoring and follow-up care, ensuring that patients with chronic conditions receive consistent and timely interventions.

Improved patient engagement and health outcomes

Telehealth encourages patients to take an active role in their healthcare. With tools like remote monitoring and mobile health apps, patients can track their health metrics and communicate with healthcare providers more frequently, leading to better health outcomes.

These benefits highlight how telehealth is making healthcare more accessible and effective for rural patients. However, implementing telehealth in these areas comes with its own set of challenges.

Success Stories: Rural Telehealth in Action

Many rural communities have successfully implemented telehealth programs with success stories to celebrate. Here are a few.

Effective telehealth programs 

Project ECHO®

Programs like Project ECHO® have connected rural healthcare providers with specialists, allowing for better management of complex cases (Rural Health Information Hub, 2024). These kinds of programs show the potential of telehealth to improve healthcare delivery in rural communities.

Hybrid healthcare in the South

East Carolina University (ECU) developed a hybrid healthcare program to improve health outcomes for rural residents in that area. A nurse visits patients at home and connects them virtually with providers at health centers. 

This program allows patients to access various healthcare services, including consultations with pharmacists, while the nurse assesses their needs. The program has proven beneficial, as illustrated by a bed-bound diabetes patient who, after joining, received comprehensive care and reduced hospital visits. 

This hybrid approach combines telehealth with in-person visits to address barriers faced by rural patients, such as long travel distances to healthcare facilities. It also allows the clinical team to collaborative and address patients’ health issues, making them more discoverable and actionable. 

Mobile clinic for substance abuse in the Mid-Atlantic

The University of Maryland (UMD) launched a telehealth program to address the shortage of healthcare providers for opioid use disorder (OUD) in rural areas, particularly after a care center in western Maryland lost its OUD provider. They partnered with health departments and secured funding from the Health Resources and Services Administration (HRSA) to set up mobile clinics equipped with vans and computers. 

These clinics, staffed by a counselor, nurse, and peer recovery specialist, park in central locations to provide care. Telehealth plays a crucial role in expanding access to OUD treatment. This initiative has successfully served hundreds of people, reaching individuals who otherwise might not have access to treatment.

Emergency care access in rural hospitals in the Midwest

In rural areas, residents face higher risks of death from accidents and strokes. Telehealth allows specially trained providers to assist rural hospital staff in delivering prompt emergency care, which is crucial for improving outcomes. 

One such case study comes from Sanford Health, which uses telehealth to improve emergency care access in rural hospitals across South Dakota, North Dakota, and Minnesota. Their program connects 32 rural emergency service locations to specialists through a virtual care hub. This hub allows rural staff to quickly consult with specialists on treating strokes, burns, and other traumas. 

The program’s success relies on technology, including two large monitors that allow specialists to access patient information from multiple sources simultaneously. 

Impact on local healthcare providers and clinics 

Telehealth allows rural clinics to offer a broader range of services, reducing the need for patient transfers and hospital bypasses. There can be caveats to this, but telehealth can improve the viability of rural healthcare facilities and helped retain healthcare providers in these areas. 

Economic benefits for rural communities 

Implementing telehealth can lead to economic benefits such as reduced patient transportation costs, increased local pharmacy revenues, and decreased hospital staffing costs.

These success stories illustrate the transformative impact telehealth can have on rural healthcare, providing a model for future initiatives.

While telehealth often leads to positive outcomes, its implementation in rural areas is not without obstacles.

Challenges in Implementing Rural Telehealth

Despite its advantages, telehealth implementation in rural areas faces several hurdles. Understanding these challenges is crucial for developing effective solutions.

Telehealth access for people experiencing homelessness

Federally Qualified Health Centers (FQHCs) serve vulnerable, unhoused, and underinsured people in the U.S. 

During the COVID-19 pandemic, FQHCs set up telehealth in shelters and community organizations, used vans for mobile telehealth services, and gave smartphones and tablets to shelters to connect unhoused patients with primary care doctors and specialists. 

However, challenges remain, like unreliable phone and internet service. Post-pandemic, many unhoused patients still rely on phone visits instead of video visits (Azar et al, 2024).

Limited broadband internet access

Reliable internet is essential for telehealth services. Unfortunately, many rural areas lack the necessary broadband infrastructure, which can hinder the delivery of telehealth services.

Technology literacy and adoption among older populations

Older adults may struggle with using new technologies, which can limit their ability to benefit from telehealth services. Providing education and support is necessary to increase technology adoption among this demographic (Gurupur & Miao, 2022).

Regulatory and licensing inconsistencies

Telehealth often involves providing services across state lines, since technology allows for worldwide connections. This can lead to regulatory and licensing challenges. The requirements vary by state, which complicates the process for healthcare providers (Gurupur & Miao, 2022).

Reimbursement and insurance coverage complexities

Insurance coverage for telehealth also varies, as some providers don’t reimburse certain types of care. For example, each state has different rules and regulations about the types of services that can be reimbursed by Medicaid. This inconsistency discourages some healthcare providers from offering telehealth services.

Privacy and security concerns in digital health platforms 

Protecting patient data is a top priority in telehealth. Ensuring that digital health platforms comply with privacy regulations like HIPAA is essential to maintain patient trust.

Language barriers

In a study by UC Davis in Sacramento with The University of Queensland in Brisbane, providers had mixed experiences with interpreter services during telehealth visits. Some found it challenging to use interpreters effectively through their clinic’s telehealth platform. In some cases, non-English speaking patients were asked to come to the clinic in person instead of using telehealth. One provider mentioned relying on family members for translation, but this wasn’t always possible (Azar et al, 2024). 

On the other hand, many providers said they could meet the needs of non-English speaking patients using available interpreter services. Some clinics had smooth workflows for integrating interpreters into telehealth visits, while others were still working on finding good solutions to this issue (Azar et al, 2024).

Addressing these challenges requires collaboration between policymakers, healthcare providers, and technology companies. By overcoming these obstacles, telehealth can become a more integral part of rural healthcare.

The Future of Telehealth in Rural Healthcare

Lin et al (2018) found that health centers located in rural areas were associated with a 10-percentage-point increase in the probability of telehealth use, and 12.2 percentage points more likely to use telehealth for mental health care, compared to those in urban areas. 

Several years later, technology continues to improve, and telehealth plays an even more important role in providing healthcare to people in rural communities. Here are some trends and developments to watch.

Emerging technologies enhancing telehealth capabilities 

Innovations like wearable devices and artificial intelligence (AI) are expanding the possibilities of telehealth. These technologies provide more comprehensive monitoring and personalized care.

Policy changes and initiatives regarding rural telehealth 

Governments and organizations recognize the importance of telehealth in rural areas. However, telehealth in those communities can negatively impact their local healthcare access, and several federal waivers are set to expire soon. 

Rural vs. urban healthcare systems

A study by the University of Tennesee at Knoxville found that rural hospitals often lose patients to urban hospitals offering telehealth services. This shift results in financial strain for rural hospitals, affecting their investment choices and capital structure. As a result, some rural hospitals may have to cut back on staff, including doctors and nurses, or even close down intensive care units. And in extreme cases, this can lead to bankruptcy. 

These financial challenges arise because rural hospitals lose revenue when patients opt for telehealth services from urban providers. This situation is worsened because rural hospitals typically face higher financial risks. 

Policymakers and patients should consider these long-term financial impacts when using telehealth services, as they can have unintended negative consequences for rural healthcare providers. Initiatives aimed at expanding broadband access and simplifying regulatory processes are crucial for the continued growth of telehealth.

Federal waiver expirations

At the end of 2024, six federal waivers and provisions will end  unless the U.S. government takes further action:

• Site Waivers: Temporary Medicare changes, including geographic and site flexibilities, are set to expire, which affects FQHCs and Rural Health Clinics (RHCs).
  
  
• In-Person Follow-Ups for Mental Telehealth: A waiver that removes the need for an in-person visit within six months of an initial telemental health visit is expiring.
  

• HSA Safe Harbor: Laws that allow high-deductible health plans to cover telehealth services without affecting health savings accounts is ending.
  

• Controlled Substance Prescribing: The temporary Drug Enforcement Administration (DEA) guidelines that allow telehealth providers to prescribe controlled substances without an in-person visit are set to expire.
  

• Provider Privacy: Medicare telehealth providers currently have privacy regarding their location on claim forms, but this may change.
  

• Acute Hospital Care at Home: A waiver that allows remote patient monitoring by eliminating the need for 24/7 on-site nursing is expiring.

Integration with other healthcare services and systems

Telehealth is becoming more integrated with traditional healthcare services, offering a seamless experience for patients. This integration can improve care coordination and ensure that telehealth complements in-person care effectively.

Potential for addressing healthcare disparities

Telehealth has the potential to reduce healthcare disparities by providing equitable access to care for underserved populations. By making healthcare more accessible, telehealth can help address some of the systemic issues contributing to health disparities.

Conclusion

Quality healthcare should be equitable and available for everyone, regardless of their zip code. Telehealth can be a powerful tool to address the healthcare needs of rural communities. By breaking down geographical barriers, it’s bringing quality care to those who need it most. 

As technology advances and policies adapt, there are many opportunities for telehealth to further improve rural healthcare. By continuing to innovate and address existing challenges, telehealth can become a cornerstone of rural healthcare delivery.

Whether you’re a patient, provider, or policymaker, embracing telehealth could be the key to ensuring that everyone, regardless of location, has access to the care they deserve. The future of rural healthcare is here, and it’s digital. Are you ready to connect?

References

Azar, R., Chan, R., Sarkisian, M., Burns, R. D., Marcin, J. P. , Gotthardt, C. De Guzman, K. R., Rosenthal, J. L., & Haynes, S. C. (2024). Adapting telehealth to address health equity: Perspectives of primary care providers across the United States. Journal of Telemedicine and Telecare; 1-7. doi:10.1177/1357633X241238780

Butzner, M., & Cuffee, Y. (2021). Telehealth Interventions and Outcomes Across Rural Communities in the United States: Narrative Review. Journal of Medical Internet Research; 23(8). doi.org/10.2196/29575

Expanding access to emergency care in rural hospitals. (2024). Health Resources and Services Administration (HRSA). Retrieved from https://telehealth.hhs.gov/community-stories/expanding-access-emergency-care-rural-hospitals

Gurupur, V. P., & Miao, Z. (2022). A brief analysis of challenges in implementing telehealth in a rural setting. MHealth; 8. doi.org/10.21037/mhealth-21-38

Home-based, hybrid health care in rural communities. (2024). Health Resources and Services Administration (HRSA). Retrieved from https://telehealth.hhs.gov/community-stories/home-based-hybrid-health-care-rural-communities

Kolluri, S., Stead, T. S., Mangal, R. K., Littell, J., & Ganti, L. (2022). Telehealth in Response to the Rural Health Disparity. Health Psychology Research; 10(3). doi.org/10.52965/001c.37445

Lin, C. C., Dievler, A. , Robbins, C., Sripipatana, A., Quinn, M. & Nair, S. (2018). Telehealth in Health Centers: Key Adoption Factors, Barriers, and Opportunities. Retrieved from 

https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05125

Mobile clinics for substance use disorder. (2024). Health Resources and Services Administration (HRSA). Retrieved from https://telehealth.hhs.gov/community-stories/mobile-clinics-substance-use-disorder

Stewart, H. (2024). Telehealth trends in 2024: Converging challenges on the virtual care frontier. CHG Healthcare. Retrieved from https://chghealthcare.com/blog/telehealth-trends

Telehealth and Health Information Technology in Rural Healthcare. (2024). Rural Health Information Hub. Retrieved from https://www.ruralhealthinfo.org/topics/telehealth-health-it

Telemedicine usage can have unexpected impact on rural communities’ access to local care. (2024). News Medical. Retrieved from https://www.news-medical.net/news/20240801/Telemedicine-usage-can-have-unexpected-impact-on-rural-communities-access-to-local-care.aspx

The Key Benefits of Telehealth in Rural Areas. (n.d.). Health Recovery Solutions. Retrieved from https://www.healthrecoverysolutions.com/blog/the-key-benefits-of-telehealth-in-rural-areas