Evaluating Telehealth Adoption and Related Barriers Among Hospitals Located in Rural and Urban Areas

PURPOSE: To assess telehealth adoption among hospitals located in rural and urban areas, and identify barriers related to enhanced telehealth capabilities in the areas of patient engagement and health information exchange (HIE) capacity with external providers and community partners. METHODS: We used the 2018 American Hospital Association (AHA) Annual Survey and IT Supplement Survey. We applied state fixed effects multivariate analyses and Oaxaca decomposition to estimate the variation of outcomes of interest by hospital geographies. FINDINGS: Our research showed substantial differences in telehealth adoption among hospitals located in rural, micropolitan, and metropolitan areas, where adoption rates increase with urbanicity. Rural hospitals were least likely to have telehealth systems with patient engagement capabilities such as the ability to view their health information online and electronically transmit medical information to a third party. They were also the least likely to report that clinical information was available electronically from outside providers. Our model explained 65% of the rural/urban difference in telehealth adoption, 55% of the number of telehealth services adopted, and 43%‐49% of the rural/urban difference in telehealth barriers. CONCLUSION: Findings demonstrated significant barriers to telehealth use among hospitals located in rural and urban areas. For rural hospitals, barriers include lack of HIE capacity among health care providers in the community, and lack of patient engagement capability.