Use of Telehealth to Deliver Services to Rural People and Implications for Public Policy

Research center:
Lead researcher:
Project funded:
September 2012
Project completed:
April 2014
Telehealth is a special type of health information technology that holds considerable promise for enhancing the provision of care in rural communities. Telehealth is defined as the delivery of health care services at a distance, using information and communication technology. Telehealth applications are diverse; this project focuses on the use of telehealth to deliver medical services that support inpatient care. In terms of rural inpatient applications, systematic reviews have found benefits including increased access to services, enhanced quality of care, and avoidance of transfers for patients. However, restricted payment and other policies have reduced its uptake, which in turn has yielded gaps in existing knowledge. Generalizable knowledge of the extent of uptake of telehealth is needed. Likewise, generalizable knowledge of the effect of payment and other policies on telehealth uptake needs exploring.

This project will identify approaches that could aid the spread of this effective delivery approach throughout rural service areas. The specific aims of this project are to:

  1. determine the level and type of uptake of inpatient telehealth services in U.S. hospitals;
  2. compare inpatient telehealth services in urban and rural hospitals and across the rural continuum;
  3. examine organizational characteristics related to intensity and type of inpatient telehealth services;
  4. explore the effect of payment and other policies on telehealth uptake.

The first activity of the proposed project will use three existing national databases (AHA Annual Survey, AHA Information Technology Supplement, and HIMSS Analytics) to address the first three specific aims. During the first year of the project we will analyze these datasets to test the following hypotheses:

  • H1: hospitals with at least one telehealth service are likely to have multiple telehealth services;
  • H2: hospital-based telehealth "hub" functions will be located more often in large urban hospitals while "spoke" functions will be located more often in small rural hospitals; and
  • H3: network affiliations (e.g., owned/managed) will link hub and spoke hospitals; independent hospitals are least likely to use telehealth.


  • Extent of Telehealth Use in Rural and Urban Hospitals
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2014
    This brief provides discussion with statistics on the use of telehealth in rural hospitals and the opportunities telehealth can bring to supporting healthcare in rural communities.
  • Hospital Views of Factors Affecting Telemedicine Use
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2015
    This brief expands upon previous research by examining hospital-based use of telemedicine by determining the type of use by hospitals, whether it be providing services as a hub or receiving services as a spoke, and then identifying factors from the hospitals' perspectives that affect use.
  • Strategic Choice in Developing Telemedicine - Observations From Three Organizations
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2019
    Advances in technology have made it easier to provide telemedicine services, but the actual value of telemedicine programs for health systems providing those services or for patients has not been firmly established. This paper explores organizational motivations of three large health systems for incorporating telemedicine patient care services.