Bringing telehealth to rural America has long been heralded as the way to increase healthcare access for millions of people living in remote areas. One early feasibility telehealth study was done in 1977 comparing color television, black and white television and hands-free telephones to deliver healthcare.

As in that early study, technology has always been identified as one of the most significant barriers to expanding healthcare access in rural communities through telemedicine, but that view is shifting as the technology gap between cities and towns narrows.

In a June 2019 study in the Annals of Internal Medicine, Drake and colleagues found that broadband access ranged from 96 percent in urban areas to 82.7 percent in rural areas and 59.9 percent in counties considered to have extreme access to healthcare considerations.

With improved access to broadband added to improved technology for telemedicine, a majority of hospitals are now geared up to begin using telehealth. The 2017 survey of the American Hospital Association Annual Survey IT Supplement revealed that nearly 75 percent of hospitals are currently using or implementing telehealth.

While the technological barriers have been steadily reduced, Struminger and Arora, in a response to Drake in the same issue, noted that while bandwidth and internet speed in many counties may not meet FCC standards, many cloud-based high-definition videoconferencing platforms function fully on modest bandwidth of just 1.5 Mbps; making effective high-definition video telemedicine feasible over smartphones, laptops and tablets.

Drake points out that remaining practical barriers continue to hinder implementation and may be more difficult to overcome. Incentives to encourage rural providers, including reimbursement policies, interstate licensing, interhospital credentialing and scarcity of rural providers remain significant barriers to realizing the goal of expanding rural access to care.

In a 2017 survey by the American Telemedicine Association as reported in HealthTech, an online magazine, 71 percent of respondents cited inadequate coverage and compensation as the most significant barriers to telemedicine. Other hindrances included licensure (53 percent), and resistance to change (50 percent).

Additional barriers identified included lack of uniformity in state policies supporting telehealth with no two states defining, regulating and reimbursing telehealth the same.

In a white paper by the Transatlantic Telehealth Research Network, “Telehealth Innovation: Current Directions and Future Opportunities,” the authors reviewed the current state of telehealth and noted the barriers to telemedicine are no longer technological. They concluded:

“Overall, the lack of a standardized approach at a national level as well as of uniform incentives at an encounter level inhibit the adoption and integration of telehealth into care delivery models and prevents providers from realizing the full benefits,” the authors wrote. “Conflicting state regulations must be reconciled if not harmonized for telehealth to fully reach its potential. In particular, the portability of licensure across U.S. state lines remains a controversial issue that prevents the growth of telehealth services within the U.S.”

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Sources: The Annals of Internal MedicineThe Limitations of Poor Broadband Internet Access for Telemedicine Use in Rural America: An Observational Study” and “Leveraging Telehealth to Improve Health Care Access in Rural America: It Takes More Than Bandwidth”; Transatlantic Telehealth Research Network, “Telehealth Innovation: Current Directions and Future Opportunities