Rural Areas Face Greater Challenges Adapting to Telehealth, New Research Finds

Since the COVID-19 pandemic began, people have accessed health care appointments and services in a virtual format more than ever before. A new study by the University of Maryland School of Public Health found that hospitals in rural areas faced more barriers in adopting these telehealth approaches than those in urban areas. 

Specifically, rural hospitals were least likely to have telehealth systems with patient engagement capabilities, such as viewing health records online and electronically transmitting medical information to a third party. The study, published in the Journal of Rural Health, was co-authored by Health Policy and Management Professor Jie Chen and Ph.D. candidates Aitalohi Amaize and Deanna Barath. Chen directs the Hospital And Public health interdisciPlinarY research (HAPPY) Lab, which is focused on system-level coordination between hospitals, communities and public health agencies with the aim of reducing health disparities, such as those seen in rural communities.

Compared to urban areas, rural areas have a higher percentage of older adults, higher frequency of health disparities, lower patient volume in health care facilities and significantly poorer health care infrastructure, including telehealth adoption and health information technology (HIT) system capabilities.

Telehealth has several benefits, for it can improve health care delivery, quality and costs. Research also suggests that telehealth can expand access to health care by using “remote providers, streamlining treatment, and easing burnout among frontline health care providers.” 

Despite the advantages, the study found that rural hospitals were 6% less likely to adopt any telehealth services compared to metro-area hospitals. 

The primary barrier to telehealth adoption in rural hospitals is the implementation cost. Additional barriers are technological concerns and beliefs that a patient’s needs do not require telehealth services.

Currently, rural areas have rapid rates of COVID-19 cases and deaths, making this a crucial time to understand barriers to implementing “robust and responsive HIT systems,” the research team said in the study.

The pandemic is not only impacting telehealth currently, but it will also transform the landscape of telehealth practice in the long run, according to Chen. 

As more investments are aimed toward forming and strengthening the telehealth capacity in rural areas, including access to broadband networks, the goal of the researchers’ analysis is to provide important baseline evidence on current hospital telehealth use and barriers.

It will be more “important than ever” to understand the concepts of population health in the post-COVID-19 era, the researchers said. Effective and efficient prevention and treatment require integration across systems. 

Data communication among diverse stakeholders, such as primary care and social services, thus becomes extremely critical to promoting care coordination. Ongoing policy initiatives, such as the Accountable Care Organization (ACO) alternative payment model and the ACO Investment Model (AIM), are intended to promote care coordination through financial incentives.

During emergencies, payment measures should be adjusted to reimburse for quality care. By encouraging telehealth, payment models can be framed as not to add an excessive financial burden on health care providers.

The pandemic has spotlighted the critical role of local health departments in advancing population health. Future research should look at how the public health system can lead or facilitate care coordination efforts across multiple sectors to advance health for rural populations and if telehealth systems can play a key role by enabling data communication, exchange and sharing across public health systems.

Meanwhile, payment design policies and financing systems should be evaluated to determine their effectiveness in promoting integrated and interoperable data systems. It will also be important to research the cost‐effectiveness of public health‐driven telehealth capacity‐building efforts, such as those they use for patients with TB and Ebola, Chen said.