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Telehealth Use in Rural Healthcare Models and Innovations

These stories feature model programs and successful rural projects that can serve as a source of ideas and provide lessons others have learned. Some of the projects or programs may no longer be active. Read about the criteria and evidence-base for programs included.

Evidence-Based Examples

Project ENABLE (Educate, Nurture, Advise, Before Life Ends)
Updated/reviewed September 2018
  • Need: To enhance palliative care access to rural patients with advanced cancer or heart failure and their family caregivers.
  • Intervention: Project ENABLE consists of: 1) an initial in-person palliative care consultation with a specialty-trained provider and 2) a semi-structured series of weekly, phone-delivered, nurse-led coaching sessions designed to help patients and their caregivers enhance their problem-solving, symptom management, and coping skills.
  • Results: Patients and caregivers report lower rates of depression and burden along with higher quality of life.
ANGELS: Antenatal & Neonatal Guidelines, Education and Learning System
Updated/reviewed August 2018
  • Need: Arkansas had high rates of low birthweight babies, and women in rural areas had difficulty accessing specialty obstetric care.
  • Intervention: The University of Arkansas for Medical Sciences created the ANGELS telemedicine program to increase access to care for pregnant women in an effort to improve outcomes for high-risk pregnancies.
  • Results: ANGELS has increased access to care and reduced infant mortality for rural Arkansas women through a variety of programs and has been recognized by various organizations as a model program.
Telepsychology-Service Delivery for Depressed Elderly Veterans
Updated/reviewed December 2017
  • Need: To provide evidence-based psychotherapy for depression in elderly veterans who are unable to seek mental health treatment due to distance or stigma.
  • Intervention: Telepsychology-Service Delivery for Depressed Elderly Veterans compared providing behavioral activation therapy via home-based telehealth and the same treatment delivered in a traditional office-based format.
  • Results: A 2015 study and two 2016 studies show that providing treatment via home-based telehealth to elderly veterans in South Carolina resulted in the same improved health outcomes, quality of life, satisfaction with care, and cost of healthcare compared to those receiving face-to-face treatment.
Project ECHO® – Extension for Community Healthcare Outcomes
Updated/reviewed July 2017
  • Need: To increase the capacity for more effective treatment of chronic, complex conditions in rural and underserved communities.
  • Intervention: Through a specially-designed project, remote primary care providers work with academic specialists as a team to manage chronic conditions of rural patients, expanding remote providers’ knowledge base through shared case studies.
  • Results: Patient management and care provided by rural providers through ongoing education and mentoring from Project ECHO® has proved as effective as treatment provided by specialists at a university medical center.

Effective Examples

Avera eCARE
Updated/reviewed September 2018
  • Need: Rural hospitals and healthcare providers have less access to specialty care support.
  • Intervention: A service was created at Avera Health that provides 24-hour virtual access to specialty care physicians, nurses and pharmacists.
  • Results: Rural patients can receive specialty care without leaving their communities, and rural healthcare providers can get needed support in providing quality care to their patients.
Children's Mercy Allergy, Asthma, and Immunology Telemedicine
Updated/reviewed August 2018
  • Need: To increase access to an allergy/asthma/immunology specialist for children in rural Kansas and Missouri.
  • Intervention: Children's Mercy Kansas City offers a telemedicine option for allergy/asthma/immunology visits.
  • Results: In 2018 to date, Children's Mercy has had 320 Asthma/Allergy/Immunology encounters from patients in rural counties. Patients and their families report a 98% satisfaction rate with the telemedicine visits, which a six-month study found to be as effective as in-person visits.
HEALTH-COP Obesity Prevention
Updated/reviewed August 2018
  • Need: Many physicians want to help rural children who are overweight or obese develop healthy lifestyles, and these physicians would benefit from receiving training on specific ways to instruct, motivate, and manage the healthcare of these children.
  • Intervention: A virtual learning network called Healthy Eating Active Living TeleHealth Community of Practice (HEALTH-COP) was created to educate rural physicians and provide peer support.
  • Results: Studies showed an increase in health and wellness topics covered by physicians during children's clinic visits. This likely contributed to healthier eating habits and more active lifestyles that were found when these children were reassessed 3 months later.
Rural Telemental Health (RTMH) Program
Updated/reviewed July 2018
  • Need: To provide high-quality mental healthcare to rural veterans.
  • Intervention: The Rural Telemental Health (RTMH) program, stationed at the Portland VA Medical Center, reaches rural veterans in Idaho, Oregon, and Washington via telehealth.
  • Results: From 2010 to 2013, 1,754 veterans received diagnoses, therapy, medication management, and other mental health services.
University of Vermont Medical Center's Nursing Home Telepsychiatry Service
Updated/reviewed July 2018
  • Need: To improve the health status and access for rural nursing home patients in need of mental health services.
  • Intervention: The University of Vermont Medical Center provides telepsychiatry care and education to nursing homes in communities that face shortages of mental health professionals.
  • Results: These telepsychiatry consultations have eased the burden on nursing home residents by saving travel time, distance, and money it takes to travel to the nearest tertiary facility.
Wyoming Trauma Telehealth Treatment Clinic
Added January 2018
  • Need: To provide psychotherapy to survivors of domestic violence and sexual assault.
  • Intervention: University of Wyoming psychology doctoral students provide psychotherapy via videoconferencing to crisis center clients in two rural locations.
  • Results: Clients, student therapists, and crisis center staff were satisfied with the quality of services, and clients reported reduced symptoms of depression and PTSD.
funded by the Health Resources Services Administration New Mexico Mobile Screening Program for Miners
Updated/reviewed December 2017
  • Need: To increase access to medical screening for miners in New Mexico.
  • Intervention: A mobile screening clinic with telemedicine capability screens miners for respiratory and other conditions.
  • Results: In a recent survey, 92% of miners reported their care as very good, while the other 8% reported it as good. Since 1989, the program has served 6,685 miners.
funded by the Federal Office of Rural Health Policy Madison Outreach and Services through Telehealth (MOST) Network
Updated/reviewed November 2017
  • Need: More mental health and substance abuse prevention and treatment services in rural Texas.
  • Intervention: A network was formed to bring counseling services through telehealth systems and community health workers to Brazos Valley, Texas.
  • Results: The program improved health outcomes, increased general knowledge of the impact of substance abuse, and raised awareness of services among Hispanic residents.

Promising Examples

funded by the Health Resources Services Administration Learning Exchange Reverse Demonstration (LERD) Model
Updated/reviewed July 2018
  • Need: To make it easier for rural nurses to continue their education by decreasing the need to travel.
  • Intervention: An innovative, online health assessment course uses telehealth to allow rural RN-BSN students to demonstrate skills acquisition.
  • Results: Rural participants had similar learning outcomes to those participating in the onsite version of the course, with fewer travel costs, less time away from work, and higher overall satisfaction.
funded by the Federal Office of Rural Health Policy SD eResidential Facilities Healthcare Services Access Project
Updated/reviewed January 2018
  • Need: To bring more local health services to rural, elderly populations in long-term care facilities located in four Midwest states near a tertiary care organization.
  • Intervention: Implementation of telemedicine services to reach patients at their respective sites.
  • Results: The program increased local care evidenced by yearly avoidable provider-determined transfer data: 33%, 50%, 63% program years 1 through 3, respectively.
STAIR (Skills Training in Affective and Interpersonal Regulation)
Updated/reviewed December 2017
  • Need: To increase access to telemental health services for rural women veterans with a history of trauma.
  • Intervention: STAIR (Skills Training in Affective and Interpersonal Regulation) is a 10-week program designed to reduce PTSD and depression symptoms and increase emotional regulation and social functioning in clients.
  • Results: Therapists reported that clients attended more sessions when offered via teleconferencing, and clients reported satisfaction with the program.

Other Project Examples

Intermountain Healthcare Connect Care Pro®
Updated/reviewed October 2018
  • Need: An aging population, shortage of medical providers, and reforms in reimbursement systems were just some of the challenges for rural areas recognized by Intermountain Healthcare.
  • Intervention: In response, they’ve developed an Intermountain TeleHealth Services strategy to provide consultation and emergency medical help electronically for patients and clinicians in both urban and remote areas.
  • Results: Intermountain has installed video and audio conferencing platforms in over 1,200 locations. To date, mortality rates and length of hospital stays have decreased, and patient retention has increased.
Sexual Assault Nurse Exams through the National TeleNursing Center
Updated/reviewed September 2018
  • Need: Clinicians in rural areas are often unprepared to treat sexual assault victims after an assault.
  • Intervention: The National TeleNursing Center (NTC) in Massachusetts uses telemedicine to connect Sexual Assault Nurse Examiners to clinicians in remote areas, offering them guidance through examinations.
  • Results: Clinicians report that the help gives them confidence through the examination process and NTC has assisted in the care of 260 patients.
ADPH Telehealth Program
Updated/reviewed August 2018
  • Need: To increase access to healthcare throughout Alabama.
  • Intervention: The Alabama Department of Public Health (ADPH) has created telehealth communications at county health departments.
  • Results: ADPH telehealth services are currently available in 48 of 66 county health departments.
Arrowhead Telepresence Coalition
Updated/reviewed August 2018
  • Need: Individuals in northeastern Minnesota who experience mental health crises have often taken action in ways that are harmful to themselves or others.
  • Intervention: The Arrowhead Telepresence Coalition connects behavioral health providers to rural patients in traditional and non-traditional medical settings through a telehealth platform.
  • Results: The service is used by 378 registered users in 7 Minnesota counties and 3 tribes.
Telehealth Collaborative Care
Updated/reviewed August 2018
  • Need: To increase access to specialty care for rural veterans with HIV.
  • Intervention: The Telehealth Collaborative Care (TCC) study connects these patients with HIV specialists via telehealth and works to create shared care relationships with primary care teams in rural areas.
  • Results: TCC provides HIV specialty care to 600 rural veterans in Georgia and Texas and has expanded to include Indiana, Ohio, and Mississippi.
TelePrEP
Added August 2018
  • Need: To prevent new cases of HIV in rural Iowa.
  • Intervention: TelePrEP provides preventive care via telehealth and prescription delivery.
  • Results: 90 patients have been enrolled.
funded by the Federal Office of Rural Health Policy Family Advocacy Network
Updated/reviewed July 2018
  • Need: A service to address the high number of child abuse cases reported in Nebraska in the late 1990s.
  • Intervention: The Family Advocacy Network (FAN) was developed to assist in the investigations of child abuse cases. FAN provides forensic interviews, forensic medical examinations, hair follicle testing, case coordination, advocacy, and education to help prevent revictimization.
  • Results: FAN helped over 600 children and 23 adults in 2016, as well as educated hundreds of healthcare and community professionals.
funded by the Health Resources Services Administration University of Mississippi Medical Center's Center for Telehealth
Updated/reviewed July 2018
  • Need: Many rural areas in Mississippi lacked adequate access to specialty healthcare services such as emergency medicine, stroke neurology, pediatric specialists and psychiatrists.
  • Intervention: The University of Mississippi Medical Center created the Center for Telehealth to deliver quality specialty services through telehealth video conferencing and remote monitoring tools to the underserved areas of Mississippi.
  • Results: The program has been successfully implemented throughout many of the state's rural hospitals and has reduced transfers and geographic barriers for patients.
funded by the Federal Office of Rural Health Policy Bridges to Care Transitions-Remote Home Monitoring and Chronic Disease Self-Management
Added June 2018
  • Need: Decrease hospital readmissions and emergency room visits for patients in rural Tidewater, Virginia.
  • Intervention: After inpatient admission or ER visit, identify at-risk patients to offer enrollment in remote monitoring and disease self-management education and coaching, with a special focus on behavioral health wellness.
  • Results: Decreased readmissions and ER visits paired with high patient satisfaction scores.
funded by the Federal Office of Rural Health Policy Catalina Island Telemedicine Center
Updated/reviewed June 2018
  • Need: To access specialty medical services, residents of Santa Catalina Island have to travel 20 miles by boat to southern California. A telemedicine service was needed to connect island residents to the mainland's specialty services.
  • Intervention: The Catalina Island Medical Center created a telemedicine center to give residents quick access to specialty medical care, including diabetic consultations, retinal imaging, and pain management.
  • Results: An analysis of the telemedicine program found that patients had measurable improvements, and that 90% of patients were pleased with the program and will continue to use it.
Tele-ICU for Veterans
Added June 2018
  • Need: To enhance care for patients in critical condition.
  • Intervention: Two VA facilities in Oklahoma and Ohio are connected through audiovisual equipment using smart technology in order for providers to monitor patients and consult with clinical staff at the bedside.
  • Results: From June 2017 to March 2018, there were 5,155 video assessments performed on ICU patients at the Oklahoma facility by tele-ICU staff. This resulted in over 140 hours of patient care time.
funded by the Federal Office of Rural Health Policy Montana Health Network Primary Care Telemedicine
Updated/reviewed May 2018
  • Need: Backup coverage for primary care providers in rural Montana.
  • Intervention: A network of healthcare facilities developed a primary care telemedicine program.
  • Results: While the technology worked for primary care telemedicine and patients were open to the process, primary care telemedicine did not become a long-term solution in this Montana region due to low patient volume and a lack of telemedicine provider availability.
Alabama Partnership for TeleHealth
Updated/reviewed April 2018
  • Need: To increase access to healthcare via telehealth in the rural, underserved areas of Alabama.
  • Intervention: A nonprofit organization that promotes and supports telehealth programs across Alabama.
  • Results: The establishment and support of telehealth networks at multiple sites across Alabama providing clinical telehealth services including behavioral health, stroke/neurology, and cardiology.
funded by the Federal Office of Rural Health Policy Indiana Veterans Behavioral Health Network
Updated/reviewed April 2018
  • Need: To address the lack of mental healthcare options for rural veterans.
  • Intervention: A telebehavioral health hub network was created to connect community mental health centers to the VA Medical Center.
  • Results: To date, 2,071 IVBHN appointments have been made, saving veterans time and money.
funded by the Health Resources Services Administration Teleaudiology: Taking Diagnostics to the Infant
Updated/reviewed April 2018
  • Need: Due to geographic distances between audiology professionals and rural North Dakota infants, more local pediatric audiology services were needed for required testing.
  • Intervention: Hub and spoke management and technical protocols with toolkits to promote teleaudiology services for infants 0 to 6 months of age.
  • Results: Teleaudiology implementations resulted in reduced parental travel times and increased audiology follow-up exams.
Finger Lakes Community Health Telehealth Network
Updated/reviewed December 2017
  • Need: To provide organizations with telehealth infrastructure in order to improve the healthcare access for rural residents.
  • Intervention: New York’s Finger Lakes Telehealth Network (FLTN) provides an open access network to facilitate partnering organizations collaboration.
  • Results: FLTN provides connectivity using telehealth technology services to more than 20 partnering organizations, including FQHCs, specialists, hospitals, and other provider groups, allowing for a collaborative sharing of services, as well as cost savings to providers.
Lutheran Social Services of North Dakota Abound Counseling
Updated/reviewed December 2017
  • Need: To provide mental health services to rural residents in North Dakota.
  • Intervention: Lutheran Social Services of North Dakota provides telehealth counseling through its offices and communities' Lutheran churches.
  • Results: In the first year of practice, Abound Counseling has brought greater access to quality mental healthcare for young children.
SCDMH Emergency Department Telepsychiatry Consultation Program
Added December 2017
  • Need: The shortage of mental health professionals in rural South Carolina resulted in an influx of patients admitted to emergency departments who were in need of psychiatric care.
  • Intervention: South Carolina Department of Mental Health partnered with the Duke Endowment to create the SCDMH Emergency Department Telepsychiatry Consultation Program. Rural emergency departments can now reach a psychiatrist to assess a patient via telehealth.
  • Results: The program has improved access, affordability, and provided quality care for rural providers and patients with mental illness.
Capitol Dental Care's Virtual Dental Homes
Added November 2017
  • Need: Dentists in Polk County, Oregon who accepted Oregon Health Plan were booked out for months, causing patients with dental needs to have to wait for an appointment or travel to an adjoining county for dental care.
  • Intervention: Capitol Dental Care began a Virtual Dental Home teledentistry model to bring preventive dental care to 3 elementary schools and several Head Start programs.
  • Results: Through this program, over 700 students have received dental care in their schools.
funded by the Health Resources Services Administration Medical Advocacy & Outreach's Telehealth Services
Updated/reviewed November 2017
  • Need: Rural Alabama residents with HIV/AIDS face stigma, poverty, and transportation barriers, limiting their access to expert HIV/AIDS healthcare.
  • Intervention: Medical Advocacy & Outreach utilizes telemedicine to remove these barriers and offers cost-effective care to rural patients living with HIV/AIDS.
  • Results: This telehealth network has expanded to reach rural patients in 12 Alabama counties. Patients are staying engaged due to its convenience and cost-effective nature.
TeleTEAM Care for Diabetes Program
Updated/reviewed October 2017
  • Need: The rate of diabetes and diabetes mortality in North Carolina is higher than in many other states, but is even higher in the eastern part of the state.
  • Intervention: TeleTEAM provides integrated care for patients with diabetes during regular primary care visits, using telehealth to connect them with off-site behavioral therapists, dietitians, clinical pharmacists, and a medical diabetologist.
  • Results: Patients who have received care from TeleTEAM providers have shown decreases in blood sugar, as well as in weight, depression, and diabetes-related distress.
funded by the Health Resources Services Administration Health-e-Schools
Updated/reviewed August 2017
  • Need: Rural school children lack proper healthcare resources within the school setting.
  • Intervention: Health-e-Schools provides health services to students via teleconferencing using video conferencing and special equipment.
  • Results: Health-e-Schools increases access to primary healthcare, increases attendance in the classroom, and decreases the amount of time that parents or guardians must take off of work to bring their child to health-related appointments.

Last Updated: 10/4/2018