JMIR Publications

ABSTRACT

Background:

This article explores factors that influence the implementation and use of telehealth in critical access hospitals.

Objective:

To understand factors that influenced telehealth uptake and use in a set of frontier Critical Access Hospitals in the US.

Methods:

This work was conducted as part of a larger evaluation of a Centers for Medicare & Medicaid Services–funded demonstration program to expand cost-based reimbursement for services for Medicare beneficiaries for frontier critical access hospitals. Our sample was eight critical access hospitals in Montana, Nevada, and North Dakota that implemented the telehealth aspect of that demonstration. We reviewed applications and progress reports for the demonstration program and conducted in-person site visits. We used a semi-structured discussion guide to facilitate conversations with clinical, administrative, and information technology staff. Using NVivo, we coded notes from the interviews, then analyzed the themes.

Results:

Several factors influenced telehealth implementation and use in critical access hospitals, including making changes to workflow and infrastructure as well as practitioner acceptance and availability. Technical assistance and support for implementation were also factors participants cited as supportive.

Conclusions:

Frontier critical access hospitals may adopt telehealth to overcome challenges such as distance from specialty practitioners and workforce challenges. Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality. However, the ability of telehealth to improve outcomes is limited by factors such as workflow and infrastructure changes, practitioner acceptance and availability, and financing. Clinical Trial: NA