TELEHEALTH NEEDS ASSESSMENT FOR RURAL COMMUNITIES 1
Telehealth Needs Assessment for Rural Communities
Author Note
This author has no known conflict of interest.
TELEHEALTH NEEDS ASSESSMENT FOR RURAL COMMUNITIES 2
TELEHEALTH NEEDS ASSESSMENT FOR RURAL COMMUNITIES 3
Telehealth Needs Assessment for Rural Communities
According to Nelson and Staggers telehealth can be defined broadly as a type of
healthcare that is provided to patients electronically regardless of location. The term is
synonymous with telemedicine, eHealth, or mobile health (2018). The World Health
Organization (WHO) illustrates that telemedicine is “the delivery of health care services, where
distance is a critical factor, by all health care professionals using information and communication
technologies (ICT) for the exchange of valid information for diagnosis, treatment and prevention
of disease and injuries, research, and evaluation, and for the continuing education of health care
providers, all in the interests of advancing the health of individuals and their communities”
(2010, p.10). The advancement of technology has spurred the growth of telehealth and the recent
pandemic has propelled it by acknowledging the vast need for it. Telehealth is a significant part
of healthcare due to its incorporation of health information, assessment, diagnosis, intervention,
consultation, education, and services that are accessible to patients at any time, day or night. This
type of healthcare is not limited by distance, providing remote disease management, triage,
caregiver assistance and provider to provider conferencing (Nelson & Staggers, 2018). As the
daily use of cell phones, tablets and computers have developed and increased so has the ease of
telehealth needs and access. While convenience can be an underlying foundation to the telehealth
world the necessity of it is becoming clear.
Historically, telemedicine, literally meaning “healing at a distance”(World Health
Organization [WHO], 2010, p. 8), was developed in the nineteenth century with the development
of its term in the twentieth century when electrocardiography information was submitted over
telephone wires. Telemedicine was utilized in the 1960s with the military and space programs
(Shirzadfar, 2017). The availability of technology for the universal population has made this
TELEHEALTH NEEDS ASSESSMENT FOR RURAL COMMUNITIES 4
mode of healthcare more accessible and desirable. Organizations that show support with this
mode of healthcare include the American Nurses Association, United States Federal Government
Agencies, American Telemedicine Association, and International Council of Nurses (Nelson &
Staggers, 2018).
Inconsistencies exist in the United States health care systems built on race, education,
age, gender, mental health, socioeconomics, and location. Identifying these disparities and
developing a plan to eliminate and improve the health of all people is a goal of Healthy People
2020. Rural community inhabitants are at an increased risk of poor health due to poverty,
inadequate housing, transportation issues, and absence of insurance. Unfortunately, this
population reports poorer health, increased mental health disorders, chronic diseases, higher
BMI, and limited exercise activity compared with urban areas. While twenty percent of the
population in the United States lives in these rural areas the challenge lies with the number of
providers available in these same communities. Telehealth is the vehicle that assists in advancing
care to rural populations (Lee et al., 2019).
The discoveries as to why rural communities are behind in healthcare are multi-fold.
Frequent process changes, lack of funding and shortage of resources create a deficiency in
maintaining the constant changes and advancements in healthcare. Telehealth can provide the
opportunity to remain relevant because of convenience and immediate access. A survey
conducted in 2018 show that most managed care recipients have access to technology whether
via smartphone, tablet, or computer. The use of these tools has been shown to increase
engagement and management in health care (Carroll, 2018).
Reaching a means of implementation of successful telehealth platform begins with
planning and surveying the needs and barriers. According to the Nelson and Staggers, there are
TELEHEALTH NEEDS ASSESSMENT FOR RURAL COMMUNITIES 5
three stages to successful telehealth implementation. Preimplementation is the decision-making
phase determining what programs and specialties will be offered. An executive team is utilized to
manage goals, budget, and progress. The many steps to this phase will include understanding the
equipment and technology needs, developing policies and procedures, technical support, training,
and testing of the system (2018). Evaluation of technology and broadband infrastructure will also
be key during this phase. Broadband is one of the leading challenges in rural USA (Mishori &
Antono, 2020) and will need to be addressed as to how to bring this equally to rural areas as it is
to urban.
The next step is the implementation phase. Once the equipment is fine-tuned to serve the
appropriate population, a simulated telehealth conference can take place to better understand
where corrections or additions need to be made. During this time the provider can gain
understanding of how the health assessment is conducted, using the varied telehealth tools,
uploading information for the patient to utilize, and correctly input patient encounter for billing
purposes (Nelson & Staggers, 2018). Working out the kinks is vital during this time of practice
and allows the providers to become more comfortable in their role.
The final stage is the postimplementation phase. Effectiveness of training, equipment,
application, technology, and outcomes can be evaluated during this time. Quality assurance and
improvements are included during this phase. Each of these phases must be utilized in order for a
successful trajectory into the telehealth field (Nelson & Staggers, 2018).
Other challenges to implementing telehealth is the licensure of providers and the
credentialing of health systems. Licensing and credentialing are controlled by the state level.
Compact nursing licenses does make this process easier because they can work across state lines
with the same nursing license. Providers must recognize the laws that regulate their practice
TELEHEALTH NEEDS ASSESSMENT FOR RURAL COMMUNITIES 6
rights and comply accordingly established by where the patient is located. As with the ever-
changing world of technology so the advancement of licensure is changing with regard to
telehealth and streamlining the process of requirements (Nelson & Staggers, 2018). Currently,
regulation of telehealth comes from Centers for Medicare and Medicaid Services (CMS), the
Affordable Care Act, and the Joint Commission.
As with any type of business, reimbursement is an important part of success. Telehealth is
viewed as a cost-effective means of the healthcare industry (Seto et al., 2019). Reimbursement is
dependent of the payor (insurance versus government funded) and the state of residency.
Medicare’s allowance of telehealth in rural America began in 2012 due to the shortage of
providers and developed sites according to the Health Professional Shortage Area (HPSA) or in
the counties outside of a Metropolitan Statistical Area (MSA) (Nelson & Staggers, 2018). Also,
due to the pandemic CMS loosened many of their restrictions and allowed home and community-
based services to be provided via telehealth regardless of patient’s physical location (Jonk et al.,
2020). It is hopeful that the success of telehealth during the pandemic will continue to allow its
growth.
Health informatics integrates health, computer, and informational sciences with a purpose
of communicating data, information, and knowledge to ensure healthcare for everyone, equally.
Informatics is interdisciplinary specialty utilizing information technology and focuses on
supporting healthcare providers to communicate with their patients, providing information and
education to bring about their best standard of health (Nelson & Staggers, 2018). Health
informatics does not solely place the learning on the patients or consumers but also within the
healthcare team. The team must learn how to use the technology and how to effectively
communicate with patients. It is vital that the team converses in a way the patient can
TELEHEALTH NEEDS ASSESSMENT FOR RURAL COMMUNITIES 7
comprehend the needed information. Diversity of individuals equates into diversity of
communication and learning which can prove to be difficult for the unprepared healthcare team.
Understanding the different ways of learning will help in planning and implementation and is
instrumental in making telehealth a successful part of health care (Nelson & Staggers, 2018).
As technology has evolved the nursing role has grown too. As frontline nurses are with
the patients the majority of their admission and become acutely aware of their mode of learning
and development of their plan of care. Nurses should be utilized to provide vital information for
assistance in the formation of telehealth programs. Nurses have a foundation of using
technology-based equipment such as monitoring devices, electronic health records, and utilizing
iPads for educational purposes. With their expertise nurses not only enhance the telehealth
environment but also contribute to the health of the patients.
All people have the right to quality, accessible and affordable healthcare. Nurses
intuitively advocate for their patients and their communities. Matthew 7:12 declares that “in
everything, do to others what you would have them do to you” (NIV). Reducing the gap for
communities who do not have quality healthcare is paramount in providing for all individuals
beyond their socioeconomic status or their place of residence. Christian nurses are called to be
Christlike, to serve those around us and treat them with care and compassion. It is essential for
nurses to know that the need is great in the rural communities and have a responsibility to
promote the answer to that need.
Implementing telehealth in rural communities may appear challenging and initially costly
but as the population learn and understand the convenience of this type of healthcare the long-
term benefits will outweigh the initial hardship felt by the facility and health care team. Making
TELEHEALTH NEEDS ASSESSMENT FOR RURAL COMMUNITIES 8
telehealth a priority in rural communities will provide quality of care with accessibility, ease of
use, continuous education, and cost effectiveness for all involved.
TELEHEALTH NEEDS ASSESSMENT FOR RURAL COMMUNITIES 9
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