Map

Appendix D: DHA Thematic Analysis Results Template

Student Name:

Findings presented as brief phrases aligned with DOI/TAM constructs and four problem areas: interoperability, user training, data security, regulatory compliance.

Author(s) and date	Findings with Initial Codes	Code List for Theme Development
Abdul Rahim & Alshahrani (2023)	patient privacy safeguards; informed consent protocols; data encryption standards	Data security; Regulatory compliance; Ethical implementation
American Hospital Association (2026)	urban-rural utilization gap; policy extension support; equity-focused deployment	Practice gap evidence; Policy alignment; Health equity focus
Amundson et al. (2023)	hybrid care model flexibility; medication reconciliation via telehealth; workflow adaptation needs	Perceived usefulness (TAM); Workflow compatibility; Implementation strategy
Anawade et al. (2024)	geographic barrier reduction; cost containment potential; security protocol integration	Perceived usefulness (TAM); Data security; Implementation strategy
Benjamin et al. (2024)	rural infrastructure deficits; technology access limitations; application-level challenges	Infrastructure readiness; Perceived complexity (TAM); Rural context specificity
Chen et al. (2024)	perceived usefulness drives adoption; ease of use affects training uptake; intention-behavior link	Perceived usefulness (TAM); Perceived ease of use (TAM); User training need
Chen et al. (2021)	rural hospital resource constraints; staff readiness variability; leadership support critical	Organizational adoption (DOI); Resource limitations; User training need
Fields (2020)	interstate licensure complexity; malpractice liability concerns; HIPAA adherence requirements	Regulatory navigation; Legal barrier; Data security
Gurupur & Miao (2022)	broadband connectivity gaps; clinician training deficits; reimbursement uncertainty	Infrastructure readiness; User training; Reimbursement barrier
Hadian et al. (2024)	interoperability fragmentation; staff competency gaps; infrastructure investment needs	Interoperability challenge; User training; Infrastructure readiness
HealthIT.gov (2026)	FHIR standard adoption progress; secure exchange protocols; ongoing integration work	Interoperability standards; Data security; Regulatory compliance
Liu et al. (2025)	digital divide exacerbates access gaps; affordability barriers persist; infrastructure interventions needed	Digital divide; Affordability barrier; Infrastructure investment
Novikova et al. (2024)	early adopter clinician traits; specialty-specific diffusion patterns; communication channel influence	Adopter categories (DOI); Perceived attributes (DOI); Communication channels (DOI)
Otto et al. (2023)	organizational readiness assessment; phased rollout strategy; stakeholder engagement critical	Organizational adoption (DOI); Implementation strategy; Communication channels (DOI)
Padmavathy (2021)	cloud architecture scalability; encryption for data protection; system efficiency gains	Interoperability enabler; Data security; Perceived usefulness (TAM)
Perez et al. (2025)	AI tool integration potential; digital literacy prerequisite; rural infrastructure dependency	Technology acceptance (TAM); User training; Infrastructure readiness
Potter et al. (2016)	perceived cost savings; specialist access improvement; workflow disruption concerns	Perceived usefulness (TAM); Perceived complexity (TAM); Workflow compatibility
Rural Health Information Hub (2024)	broadband access limitations; provider shortage impact; patient digital literacy barriers	Infrastructure readiness; User training; Digital divide
Totten et al. (2024)	provider-to-provider consult efficacy; interoperable platform necessity; communication protocol clarity	Interoperability; Communication channels (DOI); Implementation strategy
Zhou et al. (2024)	urban-rural outcome divergence; adoption consequence variation; context-specific implementation needs	Rural context specificity; Perceived attributes (DOI); Implementation strategy

References

AbdulRahim, S., & Alshahrani, S. (2023). Ethical considerations in telemedicine and remote healthcare.  Saudi Journal of Nursing and Health Care,  6(7), 241–246. https://saudijournals.com/articles/9326/

American Hospital Association. (2026, March 10). 5 key telehealth insights. https://www.aha.org/aha-center-health-innovation-market-scan/2026-03-10-5-key-telehealth-insights

Amundson, C., Marupuru, S., Kliethermes, M. A., Axon, D. R., Warholak, T. L., Turgeon, J., & Bingham, J. M. (2023). Comprehensive medication management services provided via telehealth or hybrid models: A scoping review.  Journal of the American College of Clinical Pharmacy,  6(1), 53–72. https://collections.uhsp.edu/pharm-practice_pubs/348/

Anawade, P. A., Sharma, D., & Gahane, S. (2024). A comprehensive review on exploring the impact of telemedicine on healthcare accessibility. Cureus, 16(3), e55996. https://doi.org/10.7759/cureus.55996

Benjamin, I., Idoko, J., Alakwe, J., Ugwu, O., Ochanya-Idoko, F., & Ayoola, V. (2024). The role of telemedicine in rural America: Overcoming electrical and technological barriers to improve health outcomes. International Journal of Science and Research Archive, 12(2), 188-205. https://ijsra.net/content/role-telemedicine-rural-america-overcoming-electrical-and-technological-barriers-improve

Chen, B., Chang, Y., Wang, B., Zou, J., & Tu, S. (2024). Technology acceptance model perspective on the intention to participate in medical talents training in China. Heliyon, 10(4), e26206. https://doi.org/10.1016/j.heliyon.2024.e26206

Chen, J., Amaize, A., & Barath, D. (2021). Evaluating telehealth adoption and related barriers among hospitals located in rural and urban areas.  The Journal of Rural Health,  37(4), 801–811. https://doi.org/10.1111/jrh.12511

Fields, B. G. (2020). Regulatory, legal, and ethical considerations of telemedicine.  Sleep Medicine Clinics,  15(3), 409–418. https://pubmed.ncbi.nlm.nih.gov/32762973/

Gurupur, V., & Miao, Z. (2022). A brief analysis of challenges in implementing telehealth in a rural setting. mHealth, 8, 17. https://doi.org/10.21037/mhealth-21-38 Alternative link: https://mhealth.amegroups.org/article/view/86195/html

Hadian, M., Jelodar, Z. K., Khanbebin, M. J., Atafimanesh, P., Asiabar, A. S., & Dehagani, S. M. H. (2024). Challenges of implementing telemedicine technology: A systematized review. International Journal of Preventive Medicine, 15, 8. https://doi.org/10.4103/ijpvm.ijpvm_48_23

HealthIT.gov. (2026). Progress on interoperability and ongoing improvements. https://healthit.gov/wp-content/uploads/2025/09/2026AnnualMeeting_Progress-on-Interoperability-and-Ongoing-Improvements.pdf

Liu, L., Onega, T., Moen, E. L., Tosteson, A. N. A., Smith, R. E., Wang, Q., Cowan, L., & Wang, F. (2025). Digital divides in telehealth accessibility for cancer care in the United States. NPJ Digital Medicine, 8(1), 534. https://doi.org/10.1038/s41746-025-01931-5

Novikova, Z., Singer, S. J., & Milstein, A. (2024). Innovation diffusion across 13 specialties and associated clinician characteristics. Advances in Health Care Management, 22, 97-115. https://doi.org/10.1108/S1474-823120240000022005

Otto, L., Schlieter, H., Harst, L., Whitehouse, D., & Maeder, A. (2023). The telemedicine community readiness model—successful telemedicine implementation and scaleup.  Frontiers in Digital Health,  5, 1057347. https://doi.org/10.3389/fdgth.2023.1057347

Padmavathy, R. (2021). Cloudbased telemedicine for enhanced scalability, security, and efficiency in healthcare.  International Journal,  6(4), 1–18. https://papers.ssrn.com/sol3/Delivery.cfm/5482766.pdf?abstractid=5482766&mirid=1

Perez, K., Wisniewski, D., Ari, A., Lee, K., Lieneck, C., & Ramamonjiarivelo, Z. (2025). Investigation into application of AI and telemedicine in rural communities: A systematic literature review.  Healthcare,  13(3), Article 324. https://doi.org/10.3390/healthcare13030324

Potter, A. J., Ward, M. M., Natafgi, N. M. P. H., Ullrich, F., MacKinney, A. C., Bell, A. L., & Mueller, K. J. (2016). Perceptions of the benefits of telemedicine in rural communities.  Perspectives in Health Information Management,  13, 1–13. https://journal.ahima.org/Portals/0/archives/AHIMA%20files/Perceptions%20of%20the%20Benefits%20of%20Telemedicine%20in%20Rural%20Communities.pdf

Rural Health Information Hub. (2024). Barriers to telehealth in rural areas. https://www.ruralhealthinfo.org/toolkits/telehealth/1/barriers

Totten, A. M., Womack, D. M., Griffin, J. C., McDonagh, M. S., DavisO’Reilly, C., Blazina, I., … Elder, N. (2024). Telehealthguided providertoprovider communication to improve rural health: A systematic review.  Journal of Telemedicine and Telecare,  30(8), 1209–1229. https://doi.org/10.1177/1357633X221139892

Zhou, M., Li, X., & Burtch, G. (2024). Healthcare across boundaries: Urbanrural differences in the consequences of telehealth adoption.  Information Systems Research,  35(3), 1092–1113. https://doi.org/10.1287/isre.2023.1237